eCARE Trial.

By 7 years after abdominal sacrocolpopexy, anatomic and symptomatic POP failures accumulate, but few pts undergo repeat POP surgery. Adding a Burch reduces long term de novo SUI.

Question

Among stress continent pts who underwent open abdominal sacrocolpopexy for POP, how do 7 year POP, UI, and mesh outcomes compare with vs without concomitant Burch?

DESIGN

• Population: N=215, mean age ~62yo, mostly stage III POP, 74% post-hysterectomy, from the original CARE cohort with median 7 year follow up.

• Intervention: Open abdominal sacrocolpopexy + Burch.

• Comparison: Open abdominal sacrocolpopexy alone.

Outcomes

POP Outcomes (Abd SCP + Burch vs Abd SCP alone)
Symptomatic = bulge symptoms or retreatment
Anatomic = apex below upper third of vagina or Ba/Bp > 0 or retreatment

• Symptomatic POP failure: 29% vs 24% (p = 0.38)

• Anatomic POP failure: 27% vs 22% (p = 0.64)

• Composite POP failure: 48% vs 34% (p = 0.15)

• Apex involved among anatomic failures: 11 cases

• About half of anatomic failures had no bulge symptoms and did not seek retreatment.

SUI / UI Outcomes (Abd SCP + Burch vs Abd SCP alone)

• *SUI prevention failure: 62% vs 77% (p = 0.01)

• Overall UI (ISI ≥3): 75% vs 81% (p = 0.19)

• *Median time to SUI failure: 131 months vs 40 months (p < 0.05)

• Any pelvic floor reoperation: 36/215 (11 POP, 14 SUI, 11 mesh)

Mesh / Suture Complications

• Mesh erosion probability: 10.5% at 6.2 years (p no sig diff bw groups)

• Total mesh erosions: 23 (15 OR excision, 4 topical estrogen, 4 asymptomatic)

• All suture erosions treated with office excision.

Quiz

1. Why can POP repair unmask occult SUI?
A) Decreases bladder compliance
B) Restores urethral axis, removing kinking that had provided resistance
C) Causes intrinsic sphincter deficiency
D) Lengthens urethra

2. What drives mesh erosion after Abdominal SCP?
A) Autoimmune attack on polypropylene
B) Chronic foreign body reaction with impaired neovascularization
C) Type I hypersensitivity necrosis
D) Defect in sacral periosteum collagen