Effect Of Age On Outcomes Of Transvagnial Native Tissue Repairs For Apical Vaginal Prolapse

There is a paucity of data regarding the differential impact of aging on surgical outcomes in women undergoing vaginal repair for prolapse. The primary aim was to compare subjective treatment success in older versus younger women at least 3 years post transvaginal native tissue repair for apical vaginal prolapse. Post-operative symptom severity, quality of life (QOL), overall symptomatic improvement, surgical complications, and retreatment were also examined. Women undergoing primary transvaginal native tissue repair for apical vaginal prolapse (either uterosacral ligament suspension or sacrospinous ligament fixation) between 2011 and 2013 were eligible for this retrospective cohort study. Baseline demographics including symptom severity and QOL questionnaires were obtained by chart review. Subjects were mailed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I). Patients were categorized as “younger” (age <70) or “older” (age ≥70). Primary outcome was treatment success defined as “no” to “do you usually have a bulge or something falling out that you can see or feel in your vaginal area” from the POPDI subscale of the PFDI-20. Of 641 eligible patients, 327 returned questionnaires. Overall response rate was 51% (49% and 56% for younger and older groups, respectively, p = 0.13). Median follow-up time was 58 months for each group (Interquartile range [IQR] 18 for younger and IQR 14 for older). Median age was 61 (IQR = 11) for younger and 74 (IQR = 5) for older subjects. No difference in concomitant procedures (hysterectomy, anterior and/or posterior colporrhaphy) were noted between groups (all p > 0.05). Treatment success was noted in 76% of younger versus 84% older women (p = 0.11). Post-operative PFDI-20 and PFIQ-7 total and subscale scores were similar between groups (Table, p > 0.05 for all). Median PGI-I was 2 (IQR = 2) for each group (p = 0.48). Retreatment rate was 10.1% for younger and 7.8% for older women (p = 0.52). A composite success, defined as having absence of bulge symptoms and no retreatment, was noted in 69.9% of younger and 81.1% of older subjects (p = 0.04). Surgical complication rates were 13% for younger and 9% for older women (p = 0.30), including cystotomy during midurethral sling (67% of total complications). Older and younger women had similar subjective success rates at least 3 years post transvaginal native tissue repair for apical vaginal prolapse. Using a composite success outcome, older women had significantly higher success rates. Postoperatively, both groups reported similar symptom severity and condition-related QOL. Older women did not experience increased complications or retreatment for prolapse. This information may be helpful in counseling regarding surgical expectations and decision making.