Pelvic reconstructive surgery in octogenarians: Are we pushing the limits too far?

M. Raschid Hoda, Mohammad N, Paolo Fornara
Clinic for Urology and Kidney Transplantation Center
University Medical School of Halle/Wittenberg, Germany


Purpose:
Although the use of transobturator mesh implants for pelvic organ prolapse repair has been shown to be safe and effective, little data exist on their efficacy and appreciation in elderly women. This report describes our experience with pelvic reconstructive surgery in women with ages around or above 80 years.

Material and Methods
Prospective non-randomised study including 73 female patients aged >75 years with pelvic organ prolapse with or without stress urinary incontinence. Transvaginal anterior or posterior wall repair using transobturator mesh implants and concomitant transobturator sling procedure (25 Patients) were performed. Intra- and postoperative outcome data, POP-Q measurements, PAD-count, and quality of life measurements were recorded prospectively. Patients were followed for up to 12 months.

Results:
Mean age at surgery was 82.8±3.1 years. A total of 10 anterior repairs, 4 posterior repairs and 8 posterior and anterior repairs were performed using transobturator mesh implants. Concomitant synthetic mid-urethral transobturator sling procedure was performed in 18 women (82%). Mean operating time was 47.2±22.3 minutes, and the mean hospitalization period was 5.9±1.6 days. There were no systemic complications related to anaesthesia or surgery. Two patients (9.1%) required intraoperative bladder suturing due to iatrogenic bladder lesion. There were no rectal injuries, no bleeding necessitating transfusion, voiding dysfunction or erosions of synthetic implants. Pelvic floor testing at 24 months postoperatively showed 15% of the patients presenting with stage II vaginal wall prolapse. Further, quality of life parameters, as measured by SF-36 questionnaire, were improved compared to baseline values.

Conclusions:

Results of our study demonstrate that pelvic reconstructive surgery using mesh implants is feasible for management of pelvic organ prolapse in patients around 80 years of age and results in improvement of quality of life. However, special caution should be paid to risks and benefits of such surgery in this patient population.

 
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