Medline ® Abstracts for References 5-7
of 'Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth'
Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL
Obstet Gynecol. 1997;89(4):501.
OBJECTIVE: To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics.
METHODS: Our retrospective cohort study included all patients undergoing surgical treatment for prolapse and incontinence during 1995; all were members of Kaiser Permanente Northwest, which included 149,554 women age 20 or older. A standardized data-collection form was used to review all inpatient and outpatient charts of the 395 women identified. Variables examined included age, ethnicity, height, weight, vaginal parity, smoking history, medical history, and surgical history, including the preoperative evaluation, procedure performed, and details of all prior procedures. Analysis included calculation of age-specific and cumulative incidences and determination of the number of primary operations compared with repeat operations performed for prolapse or incontinence.
RESULTS: The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair.
CONCLUSION: Pelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. Our results warrant further epidemiologic research in order to determine the etiology, natural history, and long-term treatment outcomes of these conditions.
Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, USA.
Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery.
Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M
Obstet Gynecol. 2014 Jun;123(6):1201-6.
OBJECTIVE: To estimate the lifetime risk of stress urinary incontinence (SUI) surgery, pelvic organ prolapse (POP) surgery, or both using current, population-based surgical rates from 2007 to 2011.
METHODS: We used a 2007-2011 U.S. claims and encounters database. We included women aged 18-89 years and estimated age-specific incidence rates and cumulative incidence (lifetime risk) of SUI surgery, POP surgery, and either incontinence or prolapse surgery with 95% confidence intervals (CIs). We estimated lifetime risk until the age of 80 years to be consistent with prior studies.
RESULTS: From 2007 to 2011, we evaluated 10,177,480 adult women who were followed for 24,979,447 person-years. Among these women, we identified 65,397 incident, or first, SUI and 57,755 incident prolapse surgeries. Overall, we found that the lifetime risk of any primary surgery for SUI or POP was 20.0% (95% CI 19.9-20.2) by the age of 80 years. Separately, the cumulative risk for SUI surgery was 13.6% (95% CI 13.5-13.7) and that for POP surgery was 12.6% (95% CI 12.4-2.7). For age-specific annual risk, SUI demonstrated a bimodal peak at age 46 years and then again at age 70-71 years with annual risks of 3.8 and 3.9 per 1,000 women, respectively. For POP, the risk increased progressively until ages 71 and 73 years when the annual risk was 4.3 per 1,000 women.
CONCLUSION: Based on a U.S. claims and encounters database, the estimated lifetime risk of surgery for either SUI or POP in women is 20.0% by the age of 80 years.
LEVEL OF EVIDENCE: III.
Department of Obstetrics and Gynecology, the Center for Women's Health Research, and the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence.
Denman MA, Gregory WT, Boyles SH, Smith V, Edwards SR, Clark AL
Am J Obstet Gynecol. 2008;198(5):555.e1.
OBJECTIVE: This study measured the 10-year risk of reoperation for surgically treated pelvic organ prolapse and urinary incontinence (POPUI) in a community population.
STUDY DESIGN: We conducted a prospective cohort analysis of 374 women who were>20 years old and who underwent surgery for POPUI in 1995.
RESULTS: The 10-year reoperation rate was 17% by Kaplan Meier analysis. Previous POPUI surgery at the time of index surgery conferred a hazard ratio of 1.9 (95% CI, 1.1-3.2; P = .018). The abdominal approach was protective against reoperation compared with the vaginal approach (hazard ratio, 0.37; 95% CI, 0.17-0.83; P = .02) With the use of Cox regression, no association was observed for age, vaginal parity, previous hysterectomy, body mass index, prolapse severity, ethnicity, chronic lung disease, smoking, estrogen status, surgical indication, or anatomic compartment.
CONCLUSION: A reoperation rate of 17% is unacceptably high and likely represents an underestimate of the true rate. Most of the factors that influence reoperation have not yet been identified.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.