80% failure rates for vaginal wall surgery?
Posted , 11 users are following.
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?
1 like, 36 replies
Jan999 Rosabee
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Rosabee Jan999
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Clementine55 Rosabee
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Doesn't it depend on the surgeon?
edith- Rosabee
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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.
Rosabee edith-
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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.
edith- Rosabee
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You're very welcome, Rosabee.
I think that sounds like a very considered decision. It's certainly not a linear process that we go through when managing chronic conditions. I have definitely experienced an ebb and flow of acceptance and upset. I wish you the very best along that process to better wellbeing.
Jan999 Rosabee
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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.
edith- Jan999
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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?
Jan999 edith-
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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.
edith- Jan999
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I'm a med writer and this wasn't the clearest to follow at all - I had to take notes!
Jan999 edith-
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Must admit I sometimes struggle to get my head round some of these articles, I put it down to age! One reason why I'm retiring for good in June.
edith- Jan999
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Rosabee Jan999
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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.
Kegel8Stephanie Jan999
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Hi Matron and All,
I think measuring surgical outcomes will be beneficial for us all, I don't want to scape goat, but rather use this as an opportunity to shine a light on excellent surgical results, and also have these surgeons stress the importance of self care following their procedures, to boost their outcomes.
Of course, there could be an argument in there that says at what point is a woman monitored? Six months, 1 year? 2 years post-surgery?
My sadness for all this pelvic treatment, including physiotherapy is that women are not given a yearly check-up. We have pap tests, mammograms etc, so why not monitor our pelvic floor strength, we can all get lazy/complacent/forgetful - and an annual check could help to keep us focussed and improve surgical outcomes.
I'd better step down now from my soap box! Have a great weekend everyone.
mary13511 Kegel8Stephanie
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Jan999 Kegel8Stephanie
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It's good to have someone on their soapbox Stephanie and I agree with you. Pelvic floor is neglected in the NHS there are some centres of excellence then there are urogynaecology Departments that are dreadfully underfunded and are only able to give a 2nd class service. At the moment all ladies in my local NHS Trust are monitored for 2 years following prolapse repair surgery but that's it after that they are discharged. Success rates vary across the country (the U.K.) and as I said in a previous post all consultants will have to publish their success and failure rates soon but they can be misinterpreted so we'll see. Urogynaecology isn't life threatening like heart disease so it gets left behind unless you have strong urogynaecologists pushing CEO's for more funding and resources, I know just how well a Centre of Excellence can benefit women. This week we've heard that NHS Trusts wil no longer have to adhere to the 18 week waiting times, this is not good news for urogynaecology sadly all I can advise that any woman waiting longer than 18 weeks to ring the consultants secretary/waiting list department and pester them on a weekly basis.
Doolou1966 Jan999
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Hello everyone. I totally agree with your comments on this situation. I also feel the recovery information given to us ladies post op is inadequate for the although not life threatening condition, it has a huge impact on our quality of life. I had a hysterectomy in January 2016, and basically abandoned post op. No follow up appointment, and after just having slight anterior and larger posterior repair 4 weeks ago, with laparascopic surgery for adhesions and some endo spots again, I am here once again with no follow up. Have just got a prescription for my HRT but no information about when I can start it, or the topical oestrogen I have used for over a year trying to help the symptoms. I had to go privately to be taken seriously and to get to see my previous surgeon, and then put onto the NHS waiting list which was a 6 month wait. I read somewhere that there are supposed to be new guidelines for recovery being published, and not before time in my opinion. It can make you feel very low and scared that you will end up as you were before if you don't play by the rules, but without more specific information, how do you know? Whinge over. It would be great if we could make a difference. Wishing everyone a successful recovery, even if we are guessing.
Ellie1943 Doolou1966
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Hi Doolou1966. If you go to the top of this page, click on Genitourinary Prolapse and follow the links pinned sites ther'e lots of post op info to read. Your own GP should be able to advise on when to take medication or use the cream. I doubt if you can use the cream until your healed a bit more but try your Doc's surgery the nurse, may be able to help. Best wishes, x
Doolou1966 Ellie1943
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Hi Pollyanna UK. Thank you for the information, I'll have a look again. I had a telephone appointment yesterday which was already scheduled with the menopause clinic, and they are going to contact the surgeons secretary for a start date, and also ask about a follow up appointment. Thanks again x