Combined Surgery Reduces Incontinence In Women with Pelvic Organ Prolapse

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Pelvic organ prolapse

By performing two surgical procedures during the same operation, researchers in a National Institutes of Health (NIH) network reduced by half the incidence of urinary incontinence in women with a condition known as pelvic organ prolapse.

Ordinarily, a single surgery is performed to correct pelvic organ prolapse, and a second surgery is performed only if incontinence develops.

"This is an important advance in treatment for a large number of women," said Duane Alexander, M.D., Director of NIH's National Institute of Child Health and Human Development. "More than 200,000 women have prolapse surgery every year, and these research findings could prevent incontinence in many of them."

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These findings, reported by NICHD's Pelvic Floor Disorders Research Network, appear in the April 13 issue of the New England Journal of Medicine.

The first author of the study was Linda Brubaker, M.D., of Loyola University Medical Center, in Maywood, Ill.

Pelvic organ prolapse occurs when the pelvic muscles and connective tissue within the pelvic cavity weaken or are injured, explained the NICHD author and program officer of the study, Anne Weber, M.D., of the Institute's Contraception and Reproductive Health Branch. The tissue ordinarily supports the vagina and holds it in place within the pelvis. Without normal support, however, the uterus, bladder, and bowel press down on the vagina, causing it to invert and, in some women, these organs eventually protrude through the vaginal opening.

With advanced pelvic organ prolapse, the vaginal protrusion may cause a kinking of the urethra, blocking the flow of urine and preventing the bladder from emptying completely (called partial retention). This retention, in turn, may lead to frequent or persistent urinary tract infections. In other cases, depending on the individual, pelvic organ prolapse may occur along with stress incontinence

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