Prolapse repair in the elderly patient: contemporary trends and 30-day perioperative complications

Drain, Alice; Escobar, Christina; Pape, Dominique Malacarne

doi:10.1007/s00192-020-04365-7

Cited by 10 publications

(13 citation statements)

References 20 publications

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“…This finding is consistent with rates in other studies analyzing complications after colpocleisis 14 . Older age, postmenopausal status, and increased comorbidities in women undergoing colpocleisis combined with the large percentage of women requiring temporary catheterization after colpocleisis likely accounts for the high number of postoperative UTIs seen in this population 12–15 . Because this population is at higher risk of ascending infection and/or sepsis from a UTI, factors minimizing that risk should be considered 16 …”

Section: Discussionsupporting

confidence: 87%

“…14 Older age, postmenopausal status, and increased comorbidities in women undergoing colpocleisis combined with the large percentage of women requiring temporary catheterization after colpocleisis likely accounts for the high number of postoperative UTIs seen in this population. [12][13][14][15] Because this population is at higher risk of ascending infection and/or sepsis from a UTI, factors minimizing that risk should be considered. 16 The most notable finding in this study was the difference in length of catheterization between the TUC and SPC groups, 7 versus 11 days, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Colpocleisis is a highly successful obliterative surgical treatment for prolapse reserved for women no longer interested in vaginal intercourse. These women are often elderly or medically frail 12,13 . After this procedure, approximately half of patients will require temporary catheterization 4,5 .…”

mentioning

confidence: 99%

“…These women are often elderly or medically frail. 12,13 After this procedure, approximately half of patients will require temporary catheterization. 4,5 Because many women undergoing this procedure would have difficulty performing CIC due to medical comorbidities and challenges with dexterity, options for catheter management are typically limited to either TUC or planned placement of an SPC at the time of surgery.…”

mentioning

confidence: 99%

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Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

DiCarlo-Meacham

Dengler

Welch

et al. 2022

Female Pelvic Med Reconstr Surg

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ObjectivesTransient postoperative urinary retention occurs in approximately half of women after colpocleisis; however, the optimal strategy for postoperative catheter management is unclear. This study compared length of catheterization and postoperative complications after colpocleisis between planned suprapubic catheter placement and transurethral catheterization.MethodsThis is a retrospective cohort study including all women undergoing colpocleisis from January 2015 to December 2019 in a large female pelvic medicine and reconstructive surgery practice. Women undergoing planned placement of a suprapubic catheter intraoperatively during colpocleisis and women who were discharged with a transurethral catheter after failing an active voiding trial postoperatively after colpocleisis were included. Women with surgical complications requiring prolonged catheterization and those needing catheterization before surgery were excluded. Length of catheterization and postoperative complications were compared between groups.ResultsTwo hundred fifty-eight women underwent colpocleisis during the study time frame and 170 were eligible for analysis: with 78 in the planned suprapubic catheter group and 92 in the transurethral catheter group. Length of catheterization with suprapubic catheter placement was significantly longer than transurethral catheter placement with median catheter days of 11 (95% confidence interval [CI], 10–14) versus 7 (95% CI, 6–7), which persisted after adjustment (HR, 2.61, 95% CI, 1.85–3.68, P < 0.001). No significant differences were found in overall complications or urinary tract infections.ConclusionsSuprapubic catheter placement at the time of colpocleisis is associated with increased length of catheterization postoperatively compared with transurethral catheter for management of postoperative urinary retention. These data can aid surgeons in preoperative counseling and shared decision making with patients.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

DiCarlo-Meacham

Dengler

Welch

et al. 2022

Female Pelvic Med Reconstr Surg

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“…After the analysis of a retrospective cohort of 12,731 patients undergoing POP surgery, of which 5.3% underwent colpocleisis, it is described how for POP surgery, age is strongly associated with the type of procedure, and fragility with the postoperative complications [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Pessary with perineal suture for treatment of pelvic organ prolapse: description and benefit of the technique

Febles

De-Miguel-Manso

García-García

et al. 2022

Arch Gynecol Obstet

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Introduction and hypothesis Vaginal pessaries are used as a conservative treatment for POP in women who do not want or are not candidates for surgery, or as a preliminary step to surgery. Our goals are: evaluate the evolution of patients with advanced POP and repeated expulsion of the pessary, who underwent perineal suture to try to maintain the device. Describe the epidemiological characteristics of patients treated with pessaries in our environment, with or without perineal closure. Methods Observational, descriptive and prospective study (October 2016-March 2021) that includes 352 women with advanced-stage POP treated with a pessary, of which 55, after repeated expulsion of the pessary, were treated with a pessary and perineal suture. Results After pessary insertion associated with perineal closure, 26 patients (47.2%) expelled the pessary and underwent surgery, and 29 (52.8%) kept the device, avoiding surgery. Regarding the women who required perineal suture: The mean age was higher than in the group of patients who did not need this intervention (75.3 vs. 68.3 years), 94.5% had POP ≥ grade III and 100% had a perineal width > 2.5 cm. Conclusions Treatment with pessary and perineal closure avoids surgery in women with advanced age and repeated expulsion. Although age should not be an independent factor that limits surgical treatment or the type of intervention, it would be useful to have scales to quantify the frailty of patients, being able to standardize perineal closure in elderly and/or frail women, and in those who do not want or have contraindications for surgery.

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Complications of obliterative versus reconstructive vaginal surgery for pelvic organ prolapse in octogenarians: A retrospective cohort study

Coleman,

Bonasia,

Pascali

et al. 2024

Neurourology and Urodynamics

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AimsWomen of advanced age may choose between restorative or obliterative surgery for surgical management of pelvic organ prolapse. Obliterative surgery is traditionally reserved for a subset of older women with more severe medical comorbidities, since obliterative approaches are generally considered to be less morbid and older individuals have higher rates of perioperative complications than younger cohorts. This study compared perioperative complications amongst octogenarians undergoing obliterative versus reconstructive approaches. This data will help to inform perioperative counselling as previous studies have not been powered to evaluate complications in this population.MethodsThe National Surgical Quality Improvement Program database was used to identify patients that had Pelvic organ prolapse surgery between 2012 and 2021, aged 80 years or older. Single‐compartment procedures, vaginal mesh procedures, and oncologic surgery were excluded. The primary outcome was any complication within the first 30 days excluding urinary tract infection (UTI). UTI, readmission, and severe complications were secondary outcomes.ResultsOf the 4149 patients identified, 2514 (60.6%) underwent reconstructive surgery and 1635 (39.4%) underwent obliterative surgery. Patients undergoing reconstructive surgery were more likely to have an American Society of Anesthesiologists (ASA) class of 1 or 2 (46.1% vs. 31.3%, p = 0.002) and were less likely to be on antihypertensive medication (72.0% vs. 75.8%, p = 0.006). Further, there was an increased length of stay (1.47 ± 1.84 vs. 1.03 ± 1.31 days, p < 0.001) in hospital for reconstructive surgery which was more often performed as an inpatient (45.7% vs. 37.9%, p < 0.001). There was no difference in the primary outcome: any complication excluding UTIs. However, UTI was more common in the reconstructive group (aOR 0.48; 95% confidence interval 0.34−0.0). The rate of serious complications (Clavien‐Dindo Class IV) was low overall and not different between reconstructive and obliterative approaches (1.3% vs. 1.0%, respectively).ConclusionsBoth vaginal reconstructive and obliterative approaches have low complication rates in octogenarians, with only UTI rate being different between cohorts. When choosing surgical approach, we suggest a case‐based, patient center discussion on the anatomic outcomes, durability and patient satisfaction.

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Prolapse repair in the elderly patient: contemporary trends and 30-day perioperative complications

Cited by 10 publications

References 20 publications

Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

Pessary with perineal suture for treatment of pelvic organ prolapse: description and benefit of the technique

Complications of obliterative versus reconstructive vaginal surgery for pelvic organ prolapse in octogenarians: A retrospective cohort study

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