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Comment & Response
September 11, 2013

Surgery for Pelvic Organ Prolapse

Author Affiliations
  • 1Department of Surgery, Jikei University of School of Medicine, Tokyo, Japan
JAMA. 2013;310(10):1073. doi:10.1001/jama.2013.238041

To the Editor At the completion of 7 years of follow-up after abdominal sacrocolpopexy performed as part of a randomized trial (Colpopexy and Urinary Reduction Efforts [CARE]),1 Dr Nygaard and colleagues2 concluded that abdominal sacrocolpopexy was less effective than desired as a standard criterion procedure for pelvic organ prolapse (POP) because of high rates of anatomic failure (22%-27%), symptomatic failure (24%-29%), and mesh erosion through the vaginal wall (10.5%). However, a Cochrane review published in 2013 concluded that for upper vaginal prolapse, abdominal sacrocolpopexy has superior outcomes compared with a variety of vaginal procedures, including sacrospinous colpopexy, uterosacral colpopexy, and transvaginal mesh.3 The CARE trial was designed to investigate the efficacy of the addition of a colposuspension to protect against postoperative urinary incontinence after sacrocolpopexy, but not to assess the long-term outcomes of sacrocolpopexy.

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