Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse | Health Care Safety | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.  Obstet Gynecol. 1997;89(4):501-5069083302PubMedGoogle ScholarCrossref
Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse.  Obstet Gynecol. 2010;116(5):1096-110020966694PubMedGoogle ScholarCrossref
Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM. Surgical management of pelvic organ prolapse in women.  Cochrane Database Syst Rev. 2010;(4):CD00401420393938PubMedGoogle Scholar
Visco AG, Advincula AP. Robotic gynecologic surgery.  Obstet Gynecol. 2008;112(6):1369-138419037049PubMedGoogle ScholarCrossref
Nygaard IE, McCreery R, Brubaker L,  et al; Pelvic Floor Disorders Network.  Abdominal sacrocolpopexy: a comprehensive review.  Obstet Gynecol. 2004;104(4):805-82315458906PubMedGoogle ScholarCrossref
Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse surgery in the United States.  Obstet Gynecol. 2001;98(4):646-65111576582PubMedGoogle ScholarCrossref
Brown JS, Waetjen LE, Subak LL, Thom DH, van den Eeden S, Vittinghoff E. Pelvic organ prolapse surgery in the United States, 1997.  Am J Obstet Gynecol. 2002;186(4):712-71611967496PubMedGoogle ScholarCrossref
Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997.  Am J Obstet Gynecol. 2003;188(1):108-11512548203PubMedGoogle ScholarCrossref
Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050.  Am J Obstet Gynecol. 2011;205(3):230, e1-e521600549PubMedGoogle ScholarCrossref
Brubaker L, Cundiff GW, Fine P,  et al; Pelvic Floor Disorders Network.  Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence.  N Engl J Med. 2006;354(15):1557-156616611949PubMedGoogle ScholarCrossref
Brubaker L, Nygaard I, Richter HE,  et al; Pelvic Floor Disorders Network.  Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence.  Obstet Gynecol. 2008;112(1):49-5518591307PubMedGoogle ScholarCrossref
Brubaker L, Cundiff G, Fine P,  et al; Pelvic Floor Disorders Network.  A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods.  Control Clin Trials. 2003;24(5):629-64214500059PubMedGoogle ScholarCrossref
Bump RC, Mattiasson A, Bø K,  et al.  The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.  Am J Obstet Gynecol. 1996;175(1):10-178694033PubMedGoogle ScholarCrossref
Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders.  Am J Obstet Gynecol. 2001;185(6):1388-139511744914PubMedGoogle ScholarCrossref
Sandvik H, Espuna M, Hunskaar S. Validity of the incontinence severity index: comparison with pad-weighing tests.  Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(5):520-52416547687PubMedGoogle ScholarCrossref
Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women.  Obstet Gynecol. 2005;106(4):759-76616199633PubMedGoogle ScholarCrossref
Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Prediction model and prognostic index to estimate clinically relevant pelvic organ prolapse in a general female population.  Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1013-102119444367PubMedGoogle ScholarCrossref
Gutman RE, Ford DE, Quiroz LH, Shippey SH, Handa VL. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms?  Am J Obstet Gynecol. 2008;199(6):683, e1-e718828990PubMedGoogle ScholarCrossref
Cundiff GW, Varner E, Visco AG,  et al; Pelvic Floor Disorders Network.  Risk factors for mesh/suture erosion following sacral colpopexy.  Am J Obstet Gynecol. 2008;199(6):688, e1-e518976976PubMedGoogle ScholarCrossref
Barber MD, Brubaker L, Nygaard I,  et al; Pelvic Floor Disorders Network.  Defining success after surgery for pelvic organ prolapse.  Obstet Gynecol. 2009;114(3):600-60919701041PubMedGoogle ScholarCrossref
Neumann UP, Langrehr JM, Kaisers U, Lang M, Schmitz V, Neuhaus P. Simultaneous splenectomy increases risk for opportunistic pneumonia in patients after liver transplantation.  Transpl Int. 2002;15(5):226-23212012043PubMedGoogle Scholar
Yoshizumi T, Taketomi A, Soejima Y,  et al.  The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft.  Transpl Int. 2008;21(9):833-84218482177PubMedGoogle ScholarCrossref
Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M. Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8-year followup.  J Urol. 2011;185(6):2236-224021497843PubMedGoogle ScholarCrossref
Tate SB, Blackwell L, Lorenz DJ, Steptoe MM, Culligan PJ. Randomized trial of fascia lata and polypropylene mesh for abdominal sacrocolpopexy: 5-year follow-up.  Int Urogynecol J. 2011;22(2):137-14320798922PubMedGoogle ScholarCrossref
Siddiqui NY, Geller EJ, Visco AG. Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy.  Am J Obstet Gynecol. 2012;206(5):435, e1-e522397900PubMedGoogle ScholarCrossref
Original Contribution
May 15, 2013

Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse

Author Affiliations

Author Affiliations: University of Utah School of Medicine, Salt Lake City (Dr Nygaard); Loyola University, Chicago, Illinois (Dr Brubaker); University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Zyczynski); University of British Columbia, Vancouver, Canada (Dr Cundiff); University of Alabama, Birmingham (Dr Richter); RTI International, Research Triangle Park, North Carolina (Dr Gantz and Ms Warren); Baylor College of Medicine, Houston, Texas (Dr Fine); Kaiser Permanente, San Diego, California (Dr Menefee); Cleveland Clinic, Cleveland, Ohio (Dr Ridgeway); Duke University, Durham, North Carolina (Dr Visco); University of Michigan, Ann Arbor (Dr Zhang); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Dr Meikle).

JAMA. 2013;309(19):2016-2024. doi:10.1001/jama.2013.4919

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