SUFU 2018: Effect of Age on Outcomes Of Transvaginal Native Tissue Repairs for Apical Vaginal Prolapse

Austin, TX ( Dr. Lindsay Martin Kissane and colleagues presented a retrospective study of post-operative symptom severity, quality of life (QoL), overall symptomatic improvement, surgical complications, and retreatment in older compared to younger female patients (<70 years old). They used mailed and validated questionnaires to 641 patients with comparable response rate ( younger= 49% vs older= 56%). 

Subjects were mailed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I). Patients were categorized as “younger” (age<70) or “older” (age≥70). Primary outcome was treatment success defined as “no” to “do you usually have a bulge or something falling out that you can see or feel in your vaginal area” from the PFDI-20. Surgical procedures are mainly apical uterosacral suspension and majority had vaginal hysterectomy. 95% of each group stayed one day in the hospital.

No difference in concomitant procedures were noted between groups (all p>0.05). Treatment success was noted in 76% of younger versus 84% older women (p= 0.11). Post-operative PFDI-20 and PFIQ-7 total and subscale scores, and PGI-I were similar between groups (table, all p>0.05). A composite success, defined as having absence of bulge symptoms and no retreatment, was noted in 69.9% of younger and 81.1% of older subjects (p=0.04). Retreatment rate and surgical complications were similar between groups (table, both p>0.05). Clinical strength is due to minimum 3 years follow up.

They concluded that older and younger women had similar subjective success rates at least 3 years post transvaginal native tissue prolapse repair. Using a composite success outcome, older women had significantly higher success rates. Postoperatively, both groups reported similar symptom severity and condition-related QoL. This information may be helpful in counseling regarding surgical expectations and decision making.

Presenter by: Lindsay Martin Kissane, MD

Authors: Lindsay Kissane MD¹, Isuzu Meyer MD¹, Kimberly Martin PhD², Jubilee Tan MD¹, Kathryn Miller MD³ and Holly Richter MD¹

Author Information:
1. University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, Birmingham, AL
2. University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL
3. University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, AL

Written by: Gamal Ghoniem, MD, FACS, FPMRS, Professor and Vice Chair of Urology, University of California, Irvine, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas