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 part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, 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 a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.