SCOTTSDALE, AZ USA (UroToday.com) - In his keynote speech, Dr. John DeLancey highlighted the need to improve outcomes in pelvic organ prolapse (POP) based upon data demonstrating that there are more surgeries performed in the United States each year for POP than for prostate cancer. Yet, prostate cancer gets most of the attention. As both native tissue and mesh repairs have ~20% failure rates and have associated complications, there is a strong need to transition away from “new random operations” to a “who needs what surgery” mentality. Dr. DeLancey feels that a limiting factor for improving outcomes is that we do not truly understand what specific defects result in POP. Data from his institution’s 3D MRI studies have been used to create pelvic floor prolapse models to assess which fascial defects are most related to specific forms of POP.
He reviewed data from University of Michigan where they studied age and parity matched groups of women. The MRI revealed that 15% of women without POP had major levator damage (>50% levator injury) as compared to 55% of women with POP (odds ratio 7.3). Additionally, they reviewed vaginal measurements and angles under stress load. Their data showed that vaginal width did not appear to be a risk factor for POP, but vaginal length contributed 28% to anterior POP. When looking at the “golden triangle,” apical attachment defects were a cause of anterior POP in 78%, paravaginal in 82%, and levator hiatus size in 62% of cases.
Dr. DeLancey feels that 3D modeling to assess POP is the first step toward truly understanding POP and thus allowing for personalized treatment with hopefully higher success rates.
Presented by John O.L. DeLancey, MD at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
University of Michigan Health System, Ann Arbor, MI USA
Reported for UroToday by Drew Freilich, MD. Dr. Freilich is a graduate of the University of Massachusetts Medical School and completed his urology residency at New York Medical College/Westchester Medical Center. He is currently a fellow in Female Urology, Neurourology and Reconstructive Urology at Medical University of South Carolina. He has authored more than 40 peer-reviewed articles, monographs, abstracts, and book chapters and abstracts. Dr. Freilich is a member of the American Urological Association and the Society for Urodynamics and Female Urology.