AMA Publishing Group: Obstetrics/Gynecology Topic Collection

Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse Outcomes for Pelvic Organ Prolapse

Nygaard I, Brubaker L, Zyczynski HM, et al. — Wed, 15 May 2013 00:00:00 GMT

Importance

More than 225 000 surgeries are performed annually in the United States for pelvic organ prolapse (POP). Abdominal sacrocolpopexy is considered the most durable POP surgery, but little is known about safety and long-term effectiveness.

Objectives

To describe anatomic and symptomatic outcomes up to 7 years after abdominal sacrocolpopexy, and to determine whether these are affected by concomitant anti-incontinence surgery (Burch urethropexy).

Design, Setting, and Participants

Long-term follow-up of the randomized, masked 2-year Colpopexy and Urinary Reduction Efforts (CARE) trial of women with stress continence who underwent abdominal sacrocolpopexy between 2002 and 2005 for symptomatic POP and also received either concomitant Burch urethropexy or no urethropexy. Ninety-two percent (215/233) of eligible 2-year CARE trial completers were enrolled in the extended CARE study; and 181 (84%) and 126 (59%) completed 5 and 7 years of follow-up, respectively. The median follow-up was 7 years.

Main Outcomes and Measures

Symptomatic POP failure requiring retreatment or self-reported bulge; or anatomic POP failure requiring retreatment or Pelvic Organ Prolapse Quantification evaluation demonstrating descent of the vaginal apex below the upper third of the vagina, or anterior or posterior vaginal wall prolapse beyond the hymen. Stress urinary incontinence (SUI) with more than 1 symptom or interval treatment; or overall UI score of 3 or greater on the Incontinence Severity Index.

Results

By year 7, the estimated probabilities of treatment failure (POP, SUI, UI) from parametric survival modeling for the urethropexy group and the no urethropexy group, respectively, were 0.27 and 0.22 for anatomic POP (treatment difference of 0.050; 95% CI, 0.161 to 0.271), 0.29 and 0.24 for symptomatic POP (treatment difference of 0.049; 95% CI, 0.060 to 0.162), 0.48 and 0.34 for composite POP (treatment difference of 0.134; 95% CI, 0.096 to 0.322), 0.62 and 0.77 for SUI (treatment difference of 0.153; 95% CI, 0.268 to 0.030), and 0.75 and 0.81 for overall UI (treatment difference of 0.064; 95% CI, 0.161 to 0.032). Mesh erosion probability at 7 years (estimated by the Kaplan-Meier method) was 10.5% (95% CI, 6.8% to 16.1%).

Conclusions and Relevance

During 7 years of follow-up, abdominal sacrocolpopexy failure rates increased in both groups. Urethropexy prevented SUI longer than no urethropexy. Abdominal sacrocolpopexy effectiveness should be balanced with long-term risks of mesh or suture erosion.

Trial Registration

clinicaltrials.gov Identifier: NCT00099372

The Role of Medicaid and Medicare in Women's Health Care

Wed, 15 May 2013 00:00:00 GMT

This month's Visualizing Health Policy provides information about the role of Medicaid and Medicare in women's health care: the proportion of US women who are covered by Medicaid and Medicare; how women comprise the majority of those covered by the Medicaid and Medicare programs and the majority of those receiving long-term services and supports (such as home health care); how women on Medicaid are poorer and sicker than women with private coverage; how Medicaid is a primary payer for women's reproductive health services; and how women on Medicare spend more than their male counterparts on medical care and also have higher rates of health problems and social challenges. For a complete view, select the PDF available in the upper-right article toolbar.

Contraceptives and the Law A View From a Catholic Medical Institution Contraceptives and the Law

Zimmer EA, Welie JM, Rendell MS. — Wed, 15 May 2013 00:00:00 GMT

Contraception Is a Fundamental Primary Care Service Contraception Is Fundamental in Primary Care

Gossett DR, Kiley JW, Hammond C. — Wed, 15 May 2013 00:00:00 GMT

One in 5 Teens Giving Birth Already Has a Child

Wed, 15 May 2013 00:00:00 GMT

Teen births have decreased in the last 20 years, but a new statistic demonstrates the need for more counseling about preventing pregnancy: nearly 20% of teens giving birth already have at least 1 child.