Procedure for Female Incontinence May Have Downside
In 7-year study, failure rate for pelvic organ prolapse surgery gradually increased
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.
In an accompanying editorial, Dr. Cheryl Iglesia wrote that, as with face lifts or hernia surgery, "operations for pelvic organ prolapse also may be vulnerable to the normal wear and tear of aging and activities of daily living. Although imperfect, surgery for pelvic organ prolapse is generally safe and effective, and relief of bulge symptoms is associated with high patient satisfaction."
Iglesia is an associate professor of obstetrics and gynecology and urology at Georgetown University School of Medicine, and the director of urogynecology at MedStar Washington Hospital Center in Washington, D.C.
Her advice to women experiencing pelvic organ prolapse? "Go to a surgeon who you can have a legitimate conversation with about treatment options. Talk about what happens if you don't do anything. Talk about nonsurgical options. Talk about the different types of surgeries and their risks. Look for someone with a high experience rate with more than one procedure. Don't go to a one-trick pony," she said. "Find out if mesh will be used, and if you'll have an anti-incontinence operation done at the same time."