i read an article in the Lancet today, December 2016 (given to me by a consultant ) suggesting 80% women having vaginal wall surgery in the UK have a recurrence of symptoms within 2 years. in other words the vast majority of women, 8 out of 10, are no better off. (traditional and mesh repairs)
last week i saw a surgeon who said 8/10 operations are successful....how can both these figures be true when they contradict each other, totally?
Having already had failed prolapse surgery i feel pessimistic. i don't know whether it's worth trying again, especially with such confusing odds or just learn to live with the discomfort. i fear the possibility of being left with pain. Can anyone suggest why such different odds are offered?
I've had quite a quick scan of the article as it's quite late so apologies if I haven't explained my reading of it well. It is open access for anyone interested in having a look themselves.
The study looked at women (about 1400) that had anterior or posterior repairs with synthetic mesh/biological graft vs. standard native tissue repairs. The problems that the women had ranged in severity; women with urinary incontinence to multi-compartment pelvic organ prolapse. They used pelvic organ symptom and quality of life questionnaires in their anaylsis.
They followed up the women in the first 2 years after their surgery and found that there wasn't any benefit to using mesh (synthetic nor biological) compared to a repair without. This was contrary to a cochrane study from 2016.
In the quality of life questionaire which is from 0 (no impact) - 10 (great deal) there was a reduction from 6.6 (average) to 2.2 two years after surgery. The 80% refers to women that have the recurrence of at least one prolapse symptoms after surgery which is then classed as symptomatic prolapse - I don't know what the scale of POP-SS scoring severity is; i.e. what an average of 4.9 might look like in terms of types and level of symptoms (I'm sure that Matron most certainly does).
I am having a different procedure - my consultant has said that I'll be having a ventral mesh rectopexy alongside repairs of the rectocele and blocking off of my enterocele, but he has said to me that even in the 70% success rate of the operaton, he still expects there to be some symptoms as the operation is to improve my quality of life rather than solve the issue completely, which doesn't go against the types of findings of this review.
I can understand why you would feel pessimistic and it's a lot to think about when you've already had a failed repair. This study also looked at women that hadn't had surgery before. I think it's so important to know that whilst we might have similiar problems, the types of symptoms these problems cause and the impact upon our lives can range quite a lot - particularly when using questionnaires that are of course subjective.
Very soon all consultant surgeons will have to publish their success and more importantly their failure rates but Clementine is absolutely correct when she says it depends on the surgeon. There are other pieces of research which would not agree with these findings. I always say do your homework before your referral, there's usually information online re most consultants these days, the research they do and years of experience. All urogynaecologists now must have undertaken extra training after they reach consultant level so I look to where they did that training because there are centres if excellence in Leeds, Huddersfield among others. Urogynaecologists who are registered to use mesh (I'm not saying you have to have mesh) are considered to be the better more experienced consultants according to the Royal College of Gynaecologists/Urogynaecologists. I don't agree with the 80% failure rate and last night I Emailed 3 urogynaecologists I know and they definitely don't agree either.
Hi Matron - in the paper they said 80% of women had a "symptomatic prolapse" two years after surgery which was defined as a pop-ss score of more than 0, I presume this would be different to how failure would be defined in your practice?
I have had hysterectomy with anterior repair then 3 years later had anterior repaired again due to fail along with posterior repair.
I think that many different factors come into play with regard to success or fail of repair.
Personally, I have had a different experience with both recovery; but based on my personnel experience I feel that we do not get enough time to recuperate properly and information on discharge does not impress strongly enough that pelvic floor repair is major surgery and as such we need to rest completely for the first few weeks then take it very slowly and gradually build activity back up over the next few months. They also need to strongly impress the need to always be careful not to put any down pressure on the pelvic floor which includes the length of time we spend on our feet as well as no heavy lifting which can also mean lighter loads. We have to find our own capabilities.
I think the 80% includes those whof may still have symptoms or partial mild reprolapse but not full collapse of repair.
I have found it difficult protecting my repair at work and strongly believe that if I had been retired I would have been able to be more protective of repair able to determine what I can and can't do.
Recovery is really about learning about what we can do without doing damage to the repair. I do believe though that many younger women may have much better recovery rates as their ligaments and tissues will still be subject to higher hormone levels and be much stronger.
I think the biggest message I would want to send to all the women who use/visit/comment on this forum is the aspect of 'self care'. I cannot stress highly enough that this term 'self care' as used in the NHS guidelines, MUST extend beyond the operation. Women are reprolpasing out of ignorance, thinking the procedure has 'fixed' the problem. As one Physio said the other day. 'If you keep doing what you've always done, then the same thing will happen again'. So, if you do not modify how you do things with your body, the weakness (prolapse) will reoccur, (correct your posture, watch your weight, lift carefully, dont smoke, low impact exercise, avoid constipation etc, do pelvic floor muscle exercises)
Sadly so many women are not taught how to live following surgery. Figures can be interpreted in all manner of ways, either way these figures ARE SHOCKING. There is an epidemic of women with prolpase. A recent report from Brazil concluded ALL women aged 50 showed signs of POP. We don't check for prolpase.
The pivital fact is that YOU have to put the effort in too and surgery should never be undertaken lightly.Good luck Rosabee, you are clearly doing your research. Please remember no surgery strengthens a weak pelvic floor!!
I still have some of my symptoms post-op but they are much much milder than they were pre-op and the surgery was absolutely worth it for me. Even though there are symptoms, I am better off.
I consider the op successful as everything is much better so I am in your surgeons 8 out of 10. I still have some symptoms so I am in the papers 8 out of 10. Does that help?
I need to read the paper edith. Anything like this is usually passed down to me but I haven't seen this, but yes you are absolutely correct that would be different. Thanks for mentioning it......I was confused.
Hi Steph, I totally agree with you. I was not given any info on what I could or could not do after my first surgery, hysterectomy and anterior repair in 1984! Consequently, I went back to doing heavy work in nursing and residential homes and in a dept store once. All very heavy on the pelvic floor. In 2002 I had another prolapse, posterior, rectocele repair, still no info! I'm now due to go in for a SSF for vag vault prolapse and another posterior repair. So, 33 years of prolapse. I'm now retired so hoping I'll have more success as a lady of leisure, (so to speak! lol) Ladies, do take care and listen to Steph and Matron, they know from their own experience too as well as professionally. TAKE CARE!
Thank you Edith for explaining so clearly the content of the study. I have a clearer understanding now of the issues involved.
The question I have to ask myself is whether I am better off learning to accept and manage the symptoms I have, given that it's likely I will still have some prolapse symptoms and a restricted lifestyle even if I have surgery. Also the two procedures on offer from different surgeons are so different: traditional anterior repair, possible ssf and perineal repair or an anterior graft using biomesh. If I can't decide I will wait until I can't bear it any longer. Whilst I can, I think I am better off just managing my symptoms. I am not in physical pain. My quality of life is largely determined by how well I feel I can accept my situation. I need to get some peace and stop looking for a perfect solution as there clearly isn't one.
Thank you, Matron. It will be very helpful to be able to know how successful surgeons are, although when two highly respected consultant surgeons are offering different solutions it's hard to choose.
I am sure I would be in my previous surgeon's "success" cohort as the hysterectomy was successful ( my uterus removed without complication) and a sacrocolpopexy put in, which is still attached, albeit not holding up my vagina very well and creating a space for by bladder to fall through the anterior wall. So although the initial surgery was "successful" my new prolapse symptoms are as bad as ever.
Thank you Phyl. Yes I agree with everything you have written. I think swimming a mile and taking up canoeing 11 weeks after a hysterectomy and sacrocolpopexy was probably not an "achievement " as I felt at the time but a mistake. I was told to rest for 6 weeks and take it easy for another 6. Then I could resume my previous activity except badminton, 6 months. I never made it back to badminton. I also think straining with constipation is a major contributor. Unfortunately my tissue and ligaments are not in good shape either. Like you I have a job which involves standing, carrying and lifting, lots of stairs, so it's a constant strain on the pelvic floor. I can't see myself going for more surgery.
Thanks Steph. I haven't been very successful with pelvic floor exercises. Apparently I have 2/5 strength? One reason I can't retain any pessary. I also think that because of this factor any repair is less likely to succeed and if I don't strain I can't empty my bowel. I can't sit forward as physio demonstrated as i can't get it round the bulge.
Thanks DorryC. One thing I have learned from all the very helpful comments is that we are all different. I think at the moment I feel I know what I am living with and coping with. I have been told it can't get any worse. I am not ready to take a risk with surgery that may not work and could leave me with pain (SSF)