Prolapse and Incontinence Surgery in Older Women

Abstract

Purpose-Pelvic floor disorders including urinary incontinence, pelvic organ prolapse and fecal incontinence are common problems encountered by the older woman. With the increasing population of older American women, urologists and gynecologists can expect to provide evaluation and treatment of these conditions with increasing frequency. These conditions are amenable to both medical and surgical therapies.Materials and Methods-Contemporary published articles (year 2003 to present) that included older women undergoing urogynecologic surgical procedures were included in this review. Current data on morbidity, mortality and/or surgical outcomes are presented along with evidencebased pre, intra and post-operative surgical management strategies.Results-The older woman can expect similar operative risks as well as subjective and objective anatomic and quality-of-life outcomes as that of younger women undergoing pelvic floor surgery. Conclusion-The decision for surgical intervention for the treatment of pelvic floor disorders should not be based on chronologic age alone. Prior to selection of a specific surgical procedure, all existing pelvic floor defects should be evaluated. Further research is required to understand the impact that surgery for pelvic floor disorders has on anatomic, physiologic, and functional outcomes in older women.

Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

“…POP is a common condition with an estimated incidence of up to 40% of women and shows a growing prevalence in Western countries due to increased life expectancy [14]. 30% of women aged 50 -89 years require a consultation for pelvic floor dysfunction and the life-time risk of surgical repair is estimated at 11%, with almost one-third of the patients requiring repeat surgery.…”

Obstructive Uropathy by Total Uterine Prolapse Leading to End-Stage Renal Disease

“…Its prevalence is 37% in the general population, but increases to 64.8% in older women. 11 The association of POP and hydronephrosis differs across studies. Costantini et al 12 reported that the prevalence of hydronephrosis was 5% in patients with POP who were candidates for surgery, and bilateral in 3.1% versus unilateral in 1.9%.…”

Preoperative evaluation of deep venous thrombosis in patients with pelvic organ prolapse

“…All women aged 60 years and above undergoing pelvic floor surgery are classified as high-risk patients for thromboembolic complications owing to their age and other factors involved in undergoing major surgery. 2 Although pelvic floor surgeries seem to have low risk, postoperative DVT might occur more frequently than expected. In addition, patients with preoperative DVT are at high risk of postoperative DVT or pulmonary thromboembolism (PTE).…”

“…1 Likewise, the demand for POP care has been increasing in recent years. 2 Surgical procedures for POP include vaginal hysterectomy, colporrhaphy, the Le Fort operation, and tension-free vaginal mesh insertion, among others. These procedures are thought to be less invasive and safe, and therefore, the morbidity of these procedures is considered low.…”