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Procedure for Female Incontinence May Have Downside

In 7-year study, failure rate for pelvic organ prolapse surgery gradually increased

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Results of the study are published in the May 15 issue of the Journal of the American Medical Association.

Each year, as many as 225,000 American women have surgery for pelvic organ prolapse, the study authors noted. However, very little long-term follow-up data is available on the success of these procedures, Brubaker said. Most studies only follow women for two years.

The current study included seven years of follow-up. Abdominal sacrocolpopexy isn't the only procedure available for pelvic organ prolapse, but it is commonly used. And, in more recent years, the surgery is being done laparoscopically, so it's less invasive.

The mesh used during the procedure has evolved over time as well. Brubaker said that some of the types of mesh used at the start of this study are no longer in use due to possible complications. The U.S. Food and Drug Administration recently cautioned surgeons about the potential for complications from using surgical mesh for pelvic organ prolapse, and suggested that surgeons use alternatives, such as stitching wherever possible. The agency said that mesh didn't appear to provide any greater benefit to the alternatives.

But, Brubaker and her colleagues recruited patients for their study long before the FDA advisory, so many had repairs that included mesh. The study included 215 women. Of these, 104 had pelvic organ prolapse surgery, along with an additional procedure to stop urinary incontinence. The remaining 111 women just had abdominal sacrocolpopexy.

No matter what the procedure, the failure rate gradually increased each year following surgery. For example, the probability of surgical failure where a patient was experiencing symptoms again in women who had the dual procedure was 14 percent at two years, 21 percent at four years and 29 percent at seven years, according to the study.

Women who had the dual procedure were less likely to have urinary incontinence than women who just had pelvic organ prolapse surgery.

Brubaker said there are other surgical techniques available now that don't involve mesh. However, the different surgeries haven't been studied in head-to-head trials, so it's difficult to know which might be best. There are also nonsurgical options. And, Brubaker said that if a woman is overweight, losing even a small amount of weight can help relieve some symptoms.

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