May 3, 2006

BIRMINGHAM, Ala. - The addition of four simple sutures during an abdominal surgery to correct vaginal prolapse can significantly reduce the risk of post-operative stress incontinence – a common side-effect of the surgery performed on nearly 200,000 women a year – even in women without stress incontinence symptoms prior to surgery, according to a recent New England Journal of Medicine study.

Ordinarily, surgery may be performed to correct pelvic organ prolapse, and another procedure may be performed if a patient primarily complains of incontinence or if subsequent incontinence develops. Incontinence can develop in nearly one third of those patients who have the first surgery, “a fact that points to the need for improved preoperative evaluation and treatment of pelvic-floor disorders,” said UAB urogynecologist Holly E. Richter, Ph.D., M.D., one of the study’s authors and a specialist in pelvic floor disorders.

“Once rarely discussed or recognized, pelvic organ prolapse has now become a priority in women’s health,” Richter said.

Pelvic organ prolapse occurs when the muscles and tissues that hold the pelvic organs in place become stretched or weakened. When this occurs, the organs can move from their natural positions and press or bulge into the vagina. Prolapse is most commonly associated with pregnancy and vaginal delivery, but also can be related to anything that causes increased pressure in the abdomen, such as obesity, chronic coughs and constipation. Age also is a primary factor, which is why surgery for prolapse is on the rise, Richter said.

With advanced pelvic organ prolapse, vaginal protrusion may cause a kinking of the urethra, blocking the flow of urine and preventing the bladder from emptying completely. Stress incontinence – or urine leakage from the bladder during stress or pressure such as from a cough or sneeze – frequently occurs along with prolapse, but can also result following surgery because the urethra is no longer kinked and masking the symptoms of incontinence.

Researchers found that in women without primary complaints of urine leakage undergoing surgery through the lower abdomen to correct prolapse, the addition of a procedure called Burch colposuspension significantly reduced postoperative symptoms of stress incontinence without increasing other lower urinary tract symptoms.

Members of the National Institute of Child Health and Human Development’s (NICHD) Pelvic Floor Disorders Network at seven clinical sites across the country, including UAB, enrolled 322 women who did not report symptoms of stress incontinence and who were scheduled to undergo abdominal surgery to treat prolapse. The women were randomly assigned to a concurrent, preventative Burch colposuspension for incontinence or to no Burch colposuspension. They were evaluated at three months after surgery for signs of stress incontinence. Nearly one quarter of the women in the control group reported bothersome symptoms of stress incontinence, compared with only 6.1 percent of those who received the prophylactic surgery for incontinence.

The study was originally designed to enroll 480 women, but following an interim analysis, the data and safety monitoring board of the Pelvic Floor Disorders Network recommended stopping enrollment and publishing data immediately due to the significant reduction of symptoms of those in the research group.

In addition to UAB and the NICHD, other member institutions of the Pelvic Floor Disorders Research Network that participated in the study were Loyola University Medical Center in Maywood, Illinois, Johns Hopkins University in Baltimore; Baylor College of Medicine in Houston, University of Iowa in Iowa City; University of North Carolina at Chapel Hill; University of Pittsburgh; and University of Michigan; Ann Arbor.