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The role of conventional pelvic floor reconstructive surgeries in obstructed defecation symptoms change: CARE and OPTIMAL trials sub-analysis of 2-year follow-up data

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A Commentary to this article was published on 15 February 2020

Abstract

Introduction and hypothesis

The current study was aimed at addressing two questions: first, is any conventional vaginal prolapse repair effective in curing obstructed defecation symptoms, and second, is there evidence to suggest that a sacrocolpopexy will increase the risk of worsening or new-onset obstructed defecation symptoms?

Methods

This is a sub-analysis of two major clinical trials performed by the Pelvic Floor Disorders Network: the Colpopexy and Urinary Reduction Efforts (CARE) trial and the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial. Two-year follow-up data were included. Demographics, pelvic organ prolapse quantification examination, and symptoms were compared between first, two surgical arms in the OPTIMAL study and second, CARE and OPTIMAL datasets using Chi-squared test for categorical variables and Student’s t test or Mann–Whitney U test for continuous variables.

Results

A total of 353 subjects form the OPTIMAL study and 279 subjects from the CARE study met the inclusion criteria. Regardless of trial, obstructed defecation symptoms were present in more than half of the patients at the initial visit before the surgical intervention, and interestingly, about one third of the patients were symptomatic at the 24-month follow-up in all surgical groups.

Conclusion

The conventional vaginal prolapse surgeries, with or without posterior vaginal wall repair, improved obstructed defecation symptoms by 50%, but about 35% of patients were suffering from at least one of the aspects of obstructed defecation at the 24-month follow-up. It is also important to note that about a quarter of the patients experienced persisting or worsening of their obstructed defecation symptoms in the absence of anatomical failure.

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Authors and Affiliations

  1. Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA

    Ghazaleh Rostaminia & Roger P. Goldberg

  2. Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA

    Steven Abramowitch

  3. NorthShore University HealthSystem Research Institute, Evanston, IL, USA

    Cecilia Chang

  4. University of Chicago Pritzker School of Medicine, Chicago, USA

    Roger P. Goldberg

Authors
  1. Ghazaleh Rostaminia
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  2. Steven Abramowitch
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  3. Cecilia Chang
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  4. Roger P. Goldberg
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Correspondence to Ghazaleh Rostaminia.

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Rostaminia, G., Abramowitch, S., Chang, C. et al. The role of conventional pelvic floor reconstructive surgeries in obstructed defecation symptoms change: CARE and OPTIMAL trials sub-analysis of 2-year follow-up data. Int Urogynecol J 31, 1325–1334 (2020). https://doi.org/10.1007/s00192-019-04190-7

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  • DOI: https://doi.org/10.1007/s00192-019-04190-7

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