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What Happens to the Posterior Compartment and Bowel Symptoms After Sacrocolpopexy? Evaluation of 5-Year Outcomes From E-CARE

Grimes, Cara L. MD, MAS*; Lukacz, Emily S. MD, MAS; Gantz, Marie G. PhD; Warren, Lauren Klein MS; Brubaker, Linda MD§; Zyczynski, Halina M. MD; Richter, Holly E. PhD, MD; Jelovsek, J. Eric MD, MMEd#; Cundiff, Geoffrey MD**; Fine, Paul MD††; Visco, Anthony G. MD‡‡; Zhang, Min PhD§§; Meikle, Susan MD, MSPH∥∥For the NICHD Pelvic Floor Disorders Network

Female Pelvic Medicine & Reconstructive Surgery: September/October 2014 - Volume 20 - Issue 5 - p 261–266
doi: 10.1097/SPV.0000000000000085
Original Articles

Objectives The objective of this study was to describe posterior prolapse (pPOP) and obstructed defecation (OD) symptoms 5 years after open abdominal sacrocolpopexy (ASC).

Methods We grouped the extended colpopexy and urinary reduction efforts trial participants with baseline and 5-year outcomes into 3 groups using baseline posterior Pelvic Organ Prolapse Quantification (POP-Q) points and concomitant posterior repair (PR) (no PR, Ap <0; no PR, Ap ≥0; and +PR). Posterior colporrhaphy, perineorrhaphy, or sacrocolpoperineopexy were included as PR, which was performed at surgeon’s discretion. Outcomes were dichotomized into presence/absence of pPOP (Ap ≥0) and OD symptoms (≥2 on 1 or more questions about digital assistance, excessive straining, or incomplete evacuation). Composite failure was defined by both pPOP and OD symptoms or pPOP reoperation.

Results Ninety participants completed baseline and 5-year outcomes or were retreated with mean follow-up of 7.1 ± 1.0 years. Of those with no PR (Ap <0), 2 women (2/36; 9%) developed new pPOP with OD symptoms; 1 underwent subsequent PR. Nearly all (23/24; 96%) with no PR (Ap ≥0) demonstrated sustained resolution of pPOP, and none underwent PR. Fourteen percent (4/29) of +PR underwent repeat PR within 5 years, and 12% had recurrent pPOP. Regardless of PR, OD symptoms improved in all groups after ASC, although OD symptoms were still present in 17% to 19% at 5 years.

Conclusions Symptomatic pPOP is common 5 years after ASC regardless of concomitant PR. Obstructed defecation symptoms may improve after ASC regardless of PR. Recurrent pPOP and/or reoperation was highest among those who received concomitant PR at ASC. Further studies identifying criteria for concomitant PR at the time of ASC are warranted.

Regardless of concomitant posterior repair, 5 years after sacrocolpopexy symptomatic posterior compartment prolapse is common and symptoms of obstructed defecation may improve.

From the *Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; †Department of Reproductive Medicine, UC San Diego Health Systems, San Diego, CA; ‡RTI International, Research Triangle Park, NC; §Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL; ∥Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; ¶Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; #Obstetrics, Gynecology, & Women’s Health Institute, Cleveland Clinic, Cleveland, OH; **Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada; ††Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; ‡‡Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; §§Department of Biostatistics, University of Michigan, Ann Arbor, MI; and ∥∥The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

Reprints: Emily S. Lukacz, MD, MAS, Department of Reproductive Medicine, UC San Diego Health Systems, San Diego, CA, 9350 Campus Point Dr, #0974, La Jolla, CA 92037-1300. E-mail:

Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Research on Women’s Health at the National Institutes of Health (U01 HD41249, U10 HD41250, U10 HD41261, U10 HD41267, U10 HD54136, U10 HD54214, U10 HD54215, U10 HD54241, U10 HD054136, U10 HD054215, U10 HD041261, U10 HD041267, U10 HD069006, U10 HD054214, U10 HD041250, U01 HD069031).

Dr Lukacz is a researcher at Boston Scientific, a consultant at the Renew Medical, consultant at the American Medical Systems, and a consultant and research support at Pfizer. Dr Zyczynski is a consultant at the Johnson & Johnson Inc. Dr Richter is a consultant at IDEO, GlaxoSmithKline, Uromedica, and Xenodyne and was awarded with grants from Astellas, Warner Chilcott, Pfizer, University of California/Pfizer, Pelvalon, and National Institute of Diabetes and Digestion and Kidney Diseases. Other authors have no conflicts of interest to declare.

© 2014 by Lippincott Williams & Wilkins