Pelvic organ prolapse in a cohort of women treated for stress urinary incontinence

• Published in: American journal of obstetrics and gynecology Vol. 211; no. 5; pp. 550.e1 - 550.e5
• Main Authors: Norton, Peggy, MD, Brubaker, Linda, MD, Nager, Charles W., MD, Lemack, Gary E., MD, Zyczynski, Halina M., MD, Sirls, Larry, MD, Rickey, Leslie, MD, Stoddard, Anne, PhD, Varner, R. Edward, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: asymptomatic cystocele; Asymptomatic Diseases; Cohort Studies; Cystocele - complications; Cystocele - physiopathology; Cystocele - surgery; Disease Progression; Female; Humans; Longitudinal Studies; midurethral sling; Obstetrics and Gynecology; Pelvic Organ Prolapse - complications; Pelvic Organ Prolapse - physiopathology; Pelvic Organ Prolapse - surgery; Severity of Illness Index; stress urinary incontinence; Suburethral Slings; Urinary Incontinence, Stress - complications; Urinary Incontinence, Stress - surgery; urogynecology; Uterine Prolapse - complications; Uterine Prolapse - physiopathology; Uterine Prolapse - surgery; Vagina - surgery; stress urinary incontinence; asymptomatic cystocele; midurethral sling; urogynecology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.07.053

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 up 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 midurethral sling (TOMUS) and E-TOMUS, and measured these same parameters annually for 5-7 years after the index surgery. Additional information about subsequent treatment for POP was also recorded. Results In all, 597 women were randomized to 1 of 2 midurethral sling procedures in the TOMUS; concomitant vaginal procedures for POP were allowed at the surgeon’s discretion. Stage 2 POP was present at baseline in 291 subjects (49%). Symptoms of POP were reported in 67 (25%). Of the asymptomatic women, 34 of 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 of 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.