title: Pelvic organ prolapse in a cohort of women treated for stress urinary incontinence.
abstract: OBJECTIVE
  The aim of our study was to observe pelvic organ prolapse (POP) over time, treated and untreated, in a group of highly characterized women being followed up subjectively and objectively over 5-7 years following continence surgery.
  
  
  METHODS
  We measured baseline prolapse symptoms and anatomic prolapse in subjects enrolled in the trial of midurethral sling (TOMUS) and E-TOMUS, and measured these same parameters annually for 5-7 years after the index surgery. Additional information about subsequent treatment for POP was also recorded.
  
  
  RESULTS
  In all, 597 women were randomized to 1 of 2 midurethral sling procedures in the TOMUS; concomitant vaginal procedures for POP were allowed at the surgeon's discretion. Stage 2 POP was present at baseline in 291 subjects (49%). Symptoms of POP were reported in 67 (25%). Of the asymptomatic women, 34 of 223 (15%) underwent a concomitant POP repair at the time of index sling surgery. Anatomic progression of prolapse in women with asymptomatic, unoperated stage 2 POP over the next 72 months was infrequent and occurred in only 3 of 189 subjects (2%); none underwent surgery for POP. Most symptomatic women (47/67 [70%]) underwent a concomitant repair for POP at the index sling surgery. Three of the 47 women who had undergone concomitant repair for symptomatic stage 2 POP underwent repeat POP surgery (2 at 36 months and 1 at 48 months.)
  
  
  CONCLUSIONS
  For patient populations similar to the TOMUS and E-TOMUS populations, surgeons may counsel women with asymptomatic stage 2 POP that their prolapse is unlikely to require surgery in the next 5-7 years.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: Peggy.Norton@hsc.utah.edu.
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.affiliation: Department of Obstetrics and Gynecology, Loyola Stritch School of Medicine, Chicago, IL.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.affiliation: Department of Obstetrics and Gynecology, University of California at San Diego School of Medicine, La Jolla, CA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Nager
authors.affiliation: Department of Urology, University of Texas Southwestern School of Medicine, Dallas, TX.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.affiliation: Department of Urology, William Beaumont School of Medicine, Royal Oak, MI.
authors.forename: Larry
authors.initials: L
authors.lastname: Sirls
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, CT.
authors.forename: Leslie
authors.initials: L
authors.lastname: Rickey
authors.affiliation: New England Research Institute, Boston, MA.
authors.forename: Anne
authors.initials: A
authors.lastname: Stoddard
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: R Edward
authors.initials: RE
authors.lastname: Varner
mesh_terms: D058070:Asymptomatic Diseases; D015331:Cohort Studies; D052858:Cystocele / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D012720:Severity of Illness Index; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D014596:Uterine Prolapse / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D014621:Vagina / Q000601:surgery
keywords: asymptomatic cystocele; midurethral sling; stress urinary incontinence; urogynecology
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