title: What happens to the posterior compartment and bowel symptoms after sacrocolpopexy? evaluation of 5-year outcomes from E-CARE.
abstract: OBJECTIVE
  The objective of this study was to describe posterior prolapse (pPOP) and obstructed defecation (OD) symptoms 5 years after open abdominal sacrocolpopexy (ASC).
  
  
  METHODS
  We grouped the extended colpopexy and urinary reduction efforts trial participants with baseline and 5-year outcomes into 3 groups using baseline posterior Pelvic Organ Prolapse Quantification (POP-Q) points and concomitant posterior repair (PR) (no PR, Ap <0; no PR, Ap ≥0; and +PR). Posterior colporrhaphy, perineorrhaphy, or sacrocolpoperineopexy were included as PR, which was performed at surgeon's discretion. Outcomes were dichotomized into presence/absence of pPOP (Ap ≥0) and OD symptoms (≥2 on 1 or more questions about digital assistance, excessive straining, or incomplete evacuation). Composite failure was defined by both pPOP and OD symptoms or pPOP reoperation.
  
  
  RESULTS
  Ninety participants completed baseline and 5-year outcomes or were retreated with mean follow-up of 7.1 ± 1.0 years. Of those with no PR (Ap <0), 2 women (2/36; 9%) developed new pPOP with OD symptoms; 1 underwent subsequent PR. Nearly all (23/24; 96%) with no PR (Ap ≥0) demonstrated sustained resolution of pPOP, and none underwent PR. Fourteen percent (4/29) of +PR underwent repeat PR within 5 years, and 12% had recurrent pPOP. Regardless of PR, OD symptoms improved in all groups after ASC, although OD symptoms were still present in 17% to 19% at 5 years.
  
  
  CONCLUSIONS
  Symptomatic pPOP is common 5 years after ASC regardless of concomitant PR. Obstructed defecation symptoms may improve after ASC regardless of PR. Recurrent pPOP and/or reoperation was highest among those who received concomitant PR at ASC. Further studies identifying criteria for concomitant PR at the time of ASC are warranted.
authors.affiliation: From the *Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; †Department of Reproductive Medicine, UC San Diego Health Systems, San Diego, CA; ‡RTI International, Research Triangle Park, NC; §Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL; ∥Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; ¶Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; #Obstetrics, Gynecology, & Women's Health Institute, Cleveland Clinic, Cleveland, OH; **Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada; ††Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; ‡‡Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; §§Department of Biostatistics, University of Michigan, Ann Arbor, MI; and ∥∥The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors.forename: Cara L
authors.initials: CL
authors.lastname: Grimes
authors.forename: Emily S
authors.initials: ES
authors.lastname: Lukacz
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.forename: Lauren Klein
authors.initials: LK
authors.lastname: Warren
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cundiff
authors.forename: Paul
authors.initials: P
authors.lastname: Fine
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Visco
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Susan
authors.initials: S
authors.lastname: Meikle
mesh_terms: D000368:Aged; D003127:Colposcopy / Q000379:methods; D003672:Defecation / Q000502:physiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012086:Reoperation; D012445:Sacrococcygeal Region / Q000601:surgery; D016896:Treatment Outcome