|Combined Surgery Reduces Incontinence In Women
with Pelvic Organ Prolapse
By performing two surgical procedures during the same operation,
researchers in a National Institutes of Health (NIH) network reduced
by half the incidence of urinary incontinence in women with a condition
known as pelvic organ prolapse.
Ordinarily, a single surgery is performed to correct pelvic organ
prolapse, and a second surgery is performed only if incontinence
“This is an important advance in treatment for a large number
of women,” said Duane Alexander, M.D., Director of NIH’s National
Institute of Child Health and Human Development. “More than 200,000
women have prolapse surgery every year, and these research findings
could prevent incontinence in many of them.”
These findings, reported by NICHD’s Pelvic Floor Disorders Research
Network, appear in the April 13 issue of the New England Journal
The first author of the study was Linda Brubaker, M.D., of Loyola
University Medical Center, in Maywood, Ill.
Pelvic organ prolapse occurs when the pelvic muscles and connective
tissue within the pelvic cavity weaken or are injured, explained
the NICHD author and program officer of the study, Anne Weber,
M.D., of the Institute’s Contraception and Reproductive Health
Branch. The tissue ordinarily supports the vagina and holds it
in place within the pelvis. Without normal support, however, the
uterus, bladder, and bowel press down on the vagina, causing it
to invert and, in some women, these organs eventually protrude
through the vaginal opening.
With advanced pelvic organ prolapse, the vaginal protrusion may
cause a kinking of the urethra, blocking the flow of urine and
preventing the bladder from emptying completely (called partial
retention). This retention, in turn, may lead to frequent or persistent
urinary tract infections. In other cases, depending on the individual,
pelvic organ prolapse may occur along with stress incontinence — urine
leakage from the bladder during a cough or a sneeze.
To treat pelvic organ prolapse, gynecologists may recommend that
patients have a surgical procedure known as sacrocolpopexy, Dr.
Weber added. In this procedure, surgical mesh and sutures are used
to anchor the vagina to the sacrum.
However, after sacrocolpopexy, many women experience incontinence,
which makes them candidates for a second surgical procedure, the
Burch colposuspension. With Burch colposuspension, Dr. Weber said,
additional sutures are sewn through the wall of the vagina and
anchored to ligaments inside the pelvic cavity, near the pubic
The Network investigators undertook the current study to determine
if proactively performing the Burch colposuspension at the same
time as sacrocolpopexy might prove effective at preventing incontinence
in women with prolapse who did not have symptoms of stress incontinence
For their study, with the women’s consent, the researchers randomly
assigned women who were undergoing sacrocolpopexy to receive either
Burch colposuspension or no additional surgery. Of 322 women, 157
received Burch colposuspension and sacrocolpopexy, and 165 received
Three months after their surgery, the women were evaluated according
to standardized criteria for urinary stress incontinence. These
criteria measured incontinence that occurred in response to such
activities as coughing, sneezing, laughing, physical exercise,
lifting, or bending over. Of the Burch group, 23.8 percent met
one or more criteria for stress incontinence. In comparison, of
the group that underwent sacrocolpopexy alone, 44.1 percent met
one or more criteria for stress incontinence.
The women also responded to a questionnaire asking whether they
were bothered by their symptoms of incontinence. The questionnaire
was designed to distinguish between minor leakage and incontinence
severe enough to be considered a bother by the women. Three months
after the surgery, 24.5 percent of the women in the control group
reported bothersome symptoms of incontinence, compared to 6.1 percent
of women in the Burch colposuspension group.
“In women without stress incontinence who are undergoing abdominal
sacrocolpopexy for prolapse, Burch colposuspension significantly
reduced postoperative symptoms of stress incontinence without increasing
other urinary tract symptoms,” the study authors wrote.
In addition to the NICHD, other member institutions of the Pelvic
Floor Disorders Research Network that participated in this study
were the Loyola University Medical Center in Maywood, Illinois;
the Johns Hopkins University in Baltimore; Baylor College of Medicine
in Houston, Texas; the University of Iowa in Iowa City; the University
of Alabama at Birmingham; the University of North Carolina at Chapel
Hill; the University of Pittsburgh; and the University of Michigan,
The NICHD sponsors research on development, before and after birth;
maternal, child, and family health; reproductive biology and population
issues; and medical rehabilitation. For more information, visit http://www.nichd.nih.gov/.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit http://www.nih.gov.