PROLAPSE SURGERY IMPROVES BOWEL FUNCTION EVEN WHEN NO POSTERIOR REPAIR IS DONE

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INTRODUCTION

To evaluate the effect of different surgical procedures on bowel function in women with pelvic organ prolapse (POP).

METHODS

Adult women enrolled in a prospective POP database between 2008 and 2014 were reviewed. Baseline (BL) data and outcomes at one year after enrollment (1yr) were collected including the Colorectal-Anal Distress Inventory-8 (CRADI). Patients were grouped by having surgery (SGY) within the first year or no surgery (N-SGY) and compared. Sub-analyses of the SGY group were then performed by surgical approach (vaginal (Va) or abdominal (Ab)), with or without concurrent hysterectomy (HYS vs N-HYS), placement of mesh (mesh vs N-mesh), and concurrent posterior repair (POS vs N-POS). Data were analyzed with descriptive statistics, Chi-square tests, Fisher’s exact tests, paired t-tests, and Wilcoxon rank sum tests.

RESULTS

Of 274 prolapse patients, there were 230 in the SGY group and 44 in the N-SGY group. No significant differences in age, race or marital status was found between the SGY and N-SGY groups. 24.8% (57/230) of total surgery patients underwent a concurrent posterior repair (POS); all were done vaginally. For the SGY vs. N-SGY groups, CRADI scores were similar at BL and at 1yr, with intragroup comparisons showing a significant decrease in CRADI for SGY but not N-SGY (p < 0.0001 and p = 1.00). When comparing the Va vs. Ab approach and mesh vs. N-mesh, there were no differences in BL nor 1yr CRADI scores. When comparing HYS to N-HYS, BL CRADI was significantly lower for HYS but there was no difference at 1yr. (see Table) 40.1% (57/142) of the vaginal group had a concurrent rectocele repair (POS). When comparing POS to N-POS, BL CRADI was higher but CRADI at 1yr was not different. All surgical treatment groups had statistically significant CRADI improvement within group, from BL to 1yr, including those without posterior repair.

CONCLUSION

Women who underwent surgical repair for prolapse had significantly improved CRADI scores regardless of abdominal or vaginal approach, with or without concurrent posterior repair, hysterectomy or mesh use.

Funding: Ministrelli Program for Urology Research and Education