Female Pelvic Surgery No Sure Thing

Lifted pelvic organs can collapse again years down the line

(RxWiki News) Gravity and bodily wear-and-tear have their effects. In some women who are growing older or who have given birth, those effects eventually may cause the pelvic organs to prolapse.

Surgery to reposition these organs is often done along with a separate operation to relieve urinary incontinence – the loss of bladder control that can be triggered by dislocated pelvic organs.

Both operations may be temporary fixes for many women, according to a new study.

As the United States’ increasingly aging women are projected to seek more and more of such surgeries, future medical innovations aimed at repairing what is known as pelvic organ prolapse should be analyzed beforehand to measure their prospects of long-range success, the researchers concluded.

"Ask your gynecologist about pelvic surgery."

In a prolapsed pelvis, the vaginal walls bulge or slip out of their normal place, sometimes shifting or putting pressure on the bladder.

Ingrid Nyaard, MD, a University of Utah gynecologist and surgeon, led the study of hundreds of women who had one or both of the operations.

The first surgery involves inserting mesh under the pelvis to support and restore it to its original position. In the second surgery, the bladder is lifted and stitched back into place to lessen urinary incontinence.

The researchers followed 215 women for several years following surgery. Of that group, 104 women had undergone surgery consisting only of inserting mesh to lift collapsed pelvic organs. The remaining 111 women were given the mesh inserts, then had the bladder restored to its original position.

After seven years of being monitored, 27 percent of the women who had both procedures showed physical signs that their pelvic organs had returned to their pre-surgical prolapsed position, the researchers found.

Of the group that had only the supportive mesh inserted, 22 percent of women experienced physical signs that the benefits of surgery were reversing themselves.

Also during those seven years, problems with incontinence returned for 62 percent of women who had both surgeries, and 72 percent of women who only had mesh inserted.

Even so, said Tristi Muir, MD, a University of Texas Medical Branch gynecologist and reconstructive surgeon, women whose prolapse surgeries are not a total fix rarely return to where they were before the operation.

"As surgeon[s], we are challenged to restore the fallen structures in anatomy and function and provide durability of the repair while the woman continues to live life," said Dr. Muir, a Galveston-based physician and professor. "Understanding the long-term durability and complications is vital to appropriate counseling of women when they are considering surgery. This information is also critical in allowing us to continue to improve our procedures.

"Fortunately," she continued, "while recurrence or prolapse or incontinence may occur with time, it is frequently not as severe as it was prior to surgery and many women do not require another surgery."

The researchers wrote that they expect research on mesh to be ongoing and that new and better devices – mesh and non-mesh – to repair prolapsed pelvises will be developed. Those new tools should undergo at least five years worth of medical trials to measure their effectiveness before they are used on female patients, researchers said.

"We found that complications related to synthetic mesh continue to occur over time,” the authors wrote.

More than a quarter-million women in the United States—up to almost 20 percent of those who are affected by the disorder—have surgery to correct pelvic prolapse each year, the researchers said.

The researchers added that 21 surgeons at seven different locations had patients in the study. The study did not take into account how different operating room techniques and levels of surgical skill affected the long-term outcomes of the surgery.

Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women’s Health, the study was published online on May 13 in the Journal of the American Medical Association.

Ten of the 13 researchers reported no financial gain or investments that might influence the study’s design or outcomes. Three researchers reported being consultants to, receiving grants from or sitting on the advisory boards of several pharmaceutical companies, including mesh-makers that are being sued by patients claiming they were harmed by surgical mesh.

Reviewed by: 
Review Date: 
May 8, 2013