Tuesday, May 14, 2013

Surgery for Common Condition May Not Be Effective for Women over Long Term

JAMA study evaluates durability of surgery for pelvic-organ prolapse

MAYWOOD, Ill.  – The initial success rates of the most durable surgery for a common condition in women declines over the long term, according to data published today in the Journal of the American Medical Association.

The procedure, abdominal sacrocolpopexy, is used to manage pelvic-organ prolapse, a widespread but little-known condition that occurs when the vaginal wall protrudes outside of the vaginal opening.

More than 225,000 surgeries are performed annually in the United States for pelvic-organ prolapse. The cost for these procedures is more than $1 billion per year, yet little until now has been known about its long-term effectiveness.

The goal of this study was to compare the long-term anatomic and symptomatic success rates in women undergoing abdominal sacrocolpopexy up to seven years following the procedure and whether these factors were affected by an associated surgery to prevent incontinence, a common side effect of prolapse procedures.

The study found that anatomic support failure rates increased over time and mesh erosion, a complication of this surgery, occurred in 10.5 percent of patients by seven years. The study also revealed that adding a procedure to prevent incontinence following surgery decreased but did not completely eliminate subsequent urinary incontinence.

Most women (95 percent) in the study did not seek retreatment for prolapse once they experienced loss of vaginal support in the seven years following an abdominal sacrocolpopexy. Authors reported that women may have found the initial treatment adequate, because abdominal sacrocolpopexy generally provides relief of pelvic-organ prolapse symptoms, such as pelvic pressure or a bulge, despite progressive loss of anatomic support.

“While these findings highlight the reality of the condition treated by this procedure, abdominal sacrocolpopexy may still be a good option for some women. Physicians also can use this information to better counsel patients based on individual needs,” said Linda Brubaker, MD, MS, study investigator and dean, Loyola University Chicago Stritch School of Medicine. “Fortunately, this procedure is now available with the minimally invasive approach. We also have vaginal reconstructive procedures that may be good alternatives for patients who do not choose to undergo a traditional abdominal sacrocolpopexy."

Other study authors included: Ingrid Nygaard, MD, University of Utah School of Medicine; Halina Zyczynski, MD, University of Pittsburgh; Geoffrey Cundiff, MD, University of British Columbia; Holly Richter, MD, University of Alabama; Lauren Klein Warren, MS, and Marie Gantz, PhD, RTI International; Paul Fine, MD, Baylor College of Medicine; Shawn Menefee, MD, Kaiser Permanente; Beri Ridgeway, MD, Cleveland Clinic; Anthony Visco, MD, Duke University; Min Zhang, PhD, University of Michigan; and Susan Meikle, MD, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.