OBJECTIVE: The aim of our study was to observe pelvic organ prolapse (POP) over time, treated and untreated, in a group of highly characterized women being followed subjectively and objectively over 5-7 years following continence surgery.
STUDY DESIGN: We measured baseline prolapse symptoms and anatomic prolapse in subjects enrolled in the Trial of Mid Urethral slings (TOMUS) and E-TOMUS trials, and measured these same parameters annually for five to seven years after the index surgery. Additional information about subsequent treatment for POP was also recorded.
RESULTS: 597 women were randomized to one of two mid-urethral sling procedures in the TOMUS trial; concomitant vaginal procedures for POP were allowed at the surgeon's discretion. Stage 2 POP was present at baseline in 291 of subjects (49%). Symptoms of POP were reported in 67 (25%). Of the asymptomatic women, 34/223 (15%) underwent a concomitant POP repair at the time of index sling surgery. Anatomic progression of prolapse in women with asymptomatic, unoperated stage 2 POP over the next 72 months was infrequent and occurred in only 3/189 subjects (2%); none underwent surgery for POP. Most symptomatic women [47/67 (70%)] underwent a concomitant repair for POP at the index sling surgery. Three of the 47 women who had undergone concomitant repair for symptomatic stage 2 POP underwent repeat POP surgery (2 at 36 months and 1 at 48 months.)
CONCLUSION: For patient populations similar to the TOMUS and E-TOMUS populations, surgeons may counsel women with asymptomatic stage 2 POP that their prolapse is unlikely to require surgery in the next 5-7 years.
Written by:
Norton P, Brubaker L, Nager CW, Lemack GE, Zyczynski HM, Sirls L, Rickey L, Stoddard A, Varner RE. Are you the author?
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City; Department of Obstetrics and Gynecology, Loyola Stritch School of Medicine, Chicago; Department of Obstetrics and Gynecology, University of California at San Diego School of Medicine, La Jolla; Department of Urology, University of Texas Southwestern School of Medicine, Dallas; Department of Obstetrics and Gynecology, University of Pittsburgh; Department of Urology, Wm Beaumont School of Medicine, Royal Oak Michigan; Department of Urology, Yale School of Medicine, New Haven, CT; New England Research Institute, Boston, MA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham.
Reference: Am J Obstet Gynecol. 2014 Jul 31. pii: S0002-9378(14)00802-3.
doi: 10.1016/j.ajog.2014.07.053
PubMed Abstract
PMID: 25088865
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