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Obstetric Risk Factors and Pelvic Floor Symptoms Associated with Stage II

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Obstetric Risk Factors and Pelvic Floor Symptoms Associated with Stage II ORAL PRESENTATION 01 for patient populations similar to the populations in this multicenter trial, surgeons may counsel women with asymptomatic stage 2 POP that their prolapse is unlikely to require surgery in the next 5-7 years. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Pelvic Organ Prolapse in a Cohort of Women Treated for Stress Urinary Incontinence Peggy Norton: Nothing to disclose Norton P,1 Brubaker L,2 Nager C,3 Stoddard A,4 Sirls L,5 Lemack G,6 Linda Brubaker: Nothing to disclose Zyczynski H,7 Rickey L,8 Varner RE.9 1OB/GYN, University of Utah, Salt Charles Nager: Nothing to disclose Lake City, Utah; 2OB/GYN, Loyola, Chicago, Illinois; 3OB/GYN, Anne Stoddard: Nothing to disclose University of California San Diego, San Diego, California; 4New England Larry Sirls: Nothing to disclose Research Institute, Boston, Massachusetts; 5Urology, William Beaumont Gary Lemack: Nothing to disclose Medical School, Royal Oak, Michigan; 6Urology, University of Texas Halina Zyczynski: Nothing to disclose Leslie Rickey: Pfizer, investigator, research support Southwest, Dallas, Texas; 7OB/GYN, University of Pittsburgh School of Robert E. Varner: Nothing to disclose Medicine, Pittsburgh, Pennsylvania; 8Urology, Yale University School of Medicine, New Haven, Connecticut; 9OB/GYN, University of Alabama at Birmingham Medical Center, Birmingham, Alabama ORAL PRESENTATION 02 Objectives: 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 subjectively and objectively over 5-7 years following continence surgery. Obstetric Risk Factors and Pelvic Floor Symptoms Associated with Materials and methods: We measured baseline prolapse symptoms (pelvic Stage II Posterior Vaginal Prolapse 1 2 3 4 1 floor distress inventory, any POP response of ‘‘somewhat,’’‘‘moderately,’’or Wilbur MB, McDermott K, Blomquist J, Handa V. Department of ‘‘quite a bit’’) and anatomic prolapse (POPQ performed by blinded Gynecology & Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland; observers) in subjects enrolled in a large multicenter trial of incontinence 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public surgery, and measured these same parameters annually for 5 to 7 years Health, Baltimore, Maryland; 3Department of Gynecology, Greater after the index surgery. Additional information was collected annually Baltimore Medical Center, Towson, Maryland; 4Department of about subsequent treatment for POP. This analysis focuses on stage 2 Gynecology & Obstetrics, Johns Hopkins Bayview Medical Center, prolapse (within 1 cm of the hymenal ring), as there is more uncertainty Baltimore, Maryland as to whether these patients should undergo prolapse surgery. All participating sites obtained institutional review board approval for this Objectives: The goals of this study are (1) to investigate the association randomized trial. between posterior vaginal prolapse and obstetrical history and (2) to Results: Five hundred ninety-seven women were randomized to one of two compare symptoms of pelvic floor disorders between women with mid-urethral sling procedures in the index trial; concomitant vaginal posterior vaginal prolapse, anterior vaginal prolapse, and no prolapse. procedures for POP were allowed at the surgeon’s discretion. Stage 2 Materials and methods: This is a secondary analysis from the Mothers’ POP was present at baseline in 291 of subjects (49%); of these, 246 Outcomes after Delivery study. Women were enrolled 5 to 10 years after (85%) involved the anterior wall and 174 (60%) were limited to the first delivery and followed annually. At each research visit, women were anterior wall. Symptoms of POP were reported in 67 (25%) while 223 asked about symptoms associated with prolapse, anal incontinence, and (75%) were asymptomatic. Of the asymptomatic women, 34/223 (15%) defecation using the Epidemiology of Prolapse and Incontinence underwent a concomitant POP repair at the time of index sling surgery; Questionnaire and the short form of the Colorectal-Anal Impact most (189/223 [85%]) did not. Prolapse progression in women with Questionnaire. Data regarding deliveries were assessed with review of asymptomatic, unoperated stage 2 POP over the next 72 months was hospital records. Pelvic examinations were performed annually using the infrequent and occurred in only 3 of 189 subjects (2%); none underwent Pelvic Organ Prolapse Quantification system. We defined posterior surgery for POP. Most symptomatic women (47/67 [70%]) underwent a prolapse as stage II or greater posterior support (Ap R -1). Women concomitant repair for POP at the index sling surgery, and 20 (30%) did with posterior prolapse were compared with two groups: women with not. Three of the 47 women who had undergone concomitant repair for anterior prolapse but no posterior prolapse (Ap \ -1 and Aa R -1) and symptomatic stage 2 POP underwent repeat POP surgery (two at 36 women with no prolapse (Ap \ -1, Aa \ -1, C \ -1). The obstetric months and one at 48 months). exposures were compared between groups. Bowel symptoms were Conclusion: In this cohort of well characterized women undergoing compared at initial visit and subsequent visits. Using logistic regression continence surgery, we found that unoperated stage 2 POP was and baseline data, the odds of having certain bowel symptoms were unlikely to progress over the ensuing 5-7 years and very unlikely to predicted for the posterior prolapse group and the group without go on to surgery. Similarly, treated stage 2 POP was unlikely to prolapse using anterior prolapse as the reference group. Generalized require additional surgery over time. This is in contrast to the advice estimating equations and longitudinal data were used to investigate often given to repair all prolapse defects at the time of surgery, and to bowel symptoms across all visits. studies using national databases (Anger et al 2008) to project that a Results: A total of 1497 women completed 3840 person-visits. At the significant number of women undergoing surgery for continence will baseline visit, 85 women had stage II posterior prolapse and none had require additional POP surgery within 12 months. We conclude that stage III or IV posterior prolapse. Compared to women with no prolapse, 1553-4650/$ - see front matter Ó 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jmig.2013.12.007 S2 Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S24 women with posterior or anterior prolapse were significantly more likely to 0.13% in 2003. Vaginal procedures have risen steadily over this period have had at least one vaginal delivery (p \ 0.001), to have delivered an from 51% in 1996 to 67% in 2010. Transvaginal mesh repair rapidly infant weighing greater than 4000 g vaginally (p \ 0.001), and to have increased from non-existent prior to 2005 to 26.5% of all procedures in experienced an anal sphincter laceration (p = 0.030). Women with 2010. The proportion of mesh procedures among all vaginal procedures posterior prolapse were also significantly more likely to have had an steadily increased 39.49% in 2010. operative delivery (p \ 0.001). At enrollment, women with posterior Conclusion: MarketScan database collects information on CPT procedure prolapse were more likely than the other two groups to report codes and thereby allows categorization of apical prolapse repairs to more incontinence of gas (p = 0.011), sensation of a bulge (p \ 0.001), and precise categories such as vaginal and abdominal and laparoscopic unlike splinting for bowel movements (p = 0.003). There was no difference other national databases. This degree of precision is not available in other between women with anterior or posterior prolapse with respect to national datasets such as National Inpatient Sample. Overall number of incontinence of stool or difficult bowel movements, although both groups reported procedures for apical prolapse repairs increased from 1996 to were more likely than women with no prolapse to report these symptoms. 2010 among women 18-65 years of age with commercial insurance. Up Incorporating all person-visits in the generalized estimating models until 2003, abdominal and vaginal procedures for apical prolapse repair resulted similar trends. were about equally popular. Proportion of abdominal sacrocolpopexy Conclusion: Obstetric risk factors are similar for anterior and posterior procedures dramatically dropped from about 49% in 1996 to 12% in vaginal prolapse. However, women with posterior prolapse are more 2010. This corresponded to an increase in proportion of procedures likely to report incontinence of gas, bulge symptoms, and splinting to performed via vaginal route particularly transvaginal mesh repair, and complete a bowel movement. Our results suggest that women with stage laparoscopic sacrocolpopexy. II posterior prolapse may be experiencing more symptoms than DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: previously appreciated. Vani Dandolu: Nothing to disclose DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Shobhana Talukdar: Nothing to disclose MaryAnn B. Wilbur: Nothing to disclose Sneha Sura: Nothing to disclose Kelly McDermott: Nothing to disclose Joan Blomquist: Nothing to disclose Victoria Handa: Nothing to disclose ORAL PRESENTATION 04 ORAL PRESENTATION 03 Effect of a Decision Aid on Decision Making for the Treatment of Pelvic Organ Prolapse Brazell HD,1 Greene J,2 O’Sullivan DM.3 1Obstetrics and Gynecology, Trend in Apical Prolapse Repairs in Commercially Insured Women
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