Eight-Year Functional Outcomes In Pelvic Organ Prolapse Repair Using Mesh In The Elderly
Dr Sophie Plagakis (1), Dr Chasta Bascu (1), A Prof Vincent Tse (1,2)
(1) Concord Repatriation General Hospital, Sydney, Australia, 2Macquarie University Hospital, Sydney, Australia
There is limited information in the literature on the outcomes of pelvic organ prolapse (POP) surgery in the elderly female population. We took the opportunity to analyse the outcomes of a group of women over 70 years old who underwent a prolapse repair procedure, with and without mesh, from 2003 to 2012. We used a mostly prospectively collected cohort of patients and report on their quality of life outcomes.
Elderly POP patients were identified from the public and private patients of a single surgeon operated on from 2003 to 2010. These patients were stratified into mesh and non-mesh repairs. An initial cohort were identified and analysed prospectively, with additional patients later recruited and added to the analysis retrospectively. All patients were investigated initially with urodynamics, cystoscopy and POP-Q staging. Their quality of life outcomes were assessed using the Pelvic Floor Distress Inventory Short Form 20 (PFDI-SF20) and Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-SF7) at 6 and 12 months and at least one additional time point, the longest being 13 years post operatively. Each has a urinary, bowel and sexual function domain.
Thirty one patients aged 70 or over who had surgery for recurrent POP utilising mesh were recruited. Mean age at time of surgery was 74.9 years (range 70-88). Mean follow-up was 60 months for our initial data set, and for those contacted most recently the average follow up achieved was 140 months. 11 (35%) had abdominal sacrocolpopexy, and 18 (58%) had cystocele repair with a transobturator mesh system of which 12 (38%) had concomitant sacrospinous colpopexy. 5 (16%) had concomitant posterior colporrhaphy. Three (11%) required further surgery for recurrent prolapse. Four underwent a mid-urethral sling insertion for stress urinary incontinence after their POP surgery. One had a small mesh extrusion requiring topical oestrogen treatment. No other patients had mesh complications. One patient underwent cystectomy subsequently for bladder cancer, diagnosed some years after her POP surgery. Both questionnaires demonstrated improvement in all domains to 5 years follow up. 15 patients were followed up more than 8 years postoperatively. Of those 15, 12 reported they were “very much” or “much better” on their PGI-I score. They also reported no issues in the PFIQ-7 questionnaire.
Our series illustrates that POP surgery in the elderly is a safe and effective procedure which should be offered to those who are fit, in lieu of conservative options such as pessaries and continence aids. In this particular cohort, there have been minimal complications related to the use of mesh. POP repair can offer good quality of life improvements in this group of women with minimal risk of complication.