Abstract
Introduction In the treatment of prolapse and incontinence, the choice of surgical procedure often
depends not only on the clinical findings but also on the age of the patient. Uncertainty
exists at present regarding the effect of patient age on treatment outcomes for both
vaginal and laparoscopic procedures. The aim of this study is therefore to compare
both the anatomical outcome after prolapse surgery and the functional outcome after
incontinence surgery in the context of the treatment of stress urinary incontinence
in older and younger patients.
Patients/Methods This is a retrospective single-centre study conducted at a university site. Over
the study period, a total of 407 women underwent surgery, 278 of whom were < 70 and
129 ≥ 70 years of age. They were assigned to one of three treatment groups (prolapse
surgery, incontinence surgery or a combination of both types of surgery) and were
then subjected to statistical analysis after assessment of the anatomical and functional
outcome after 3 – 6 months.
Results The most common form of prolapse among the 407 evaluated patients was in the anterior
and middle compartment, with a higher degree of severity being diagnosed in the older
patients. Grade 4 prolapse according to the Baden–Walker system was thus present in
the anterior compartment in 15.6 vs. 28.8% (p = 0.033) and in the middle compartment
in 5.7 vs. 23.7% (p < 0.001) of cases. Younger women underwent vaginal mesh implantation
less frequently and laparoscopic sacropexy more frequently for this overall. The proportion
of cases of combined prolapse and incontinence surgery was the same in both groups.
Overall, high success rates were observed in both younger and older patients following
prolapse and incontinence surgery. These rates were 93.5 vs. 84.8% (p = 0.204) after
prolapse surgery and 92.8 vs. 84.2% (p = 0.261) after incontinence surgery. A significant
disadvantage for the older patients was the persistence of stress urinary incontinence
after prolapse surgery alone (19.6 vs. 50%, p = 0.030) and the rate of occult (de
novo) stress urinary incontinence (7.4 vs. 20%, p = 0.030).
Conclusion Our data show that both pelvic organ prolapse and stress urinary incontinence can
be treated with surgery with good results in women aged ≥ 70 years. It was thus possible
to show for the first time in a large patient population that older women should not
be denied appropriate surgery but can be offered the same range of surgical options
as younger patients.
Key words
prolapse surgery - incontinence surgery - urogynaecological surgery - pelvic organ
prolapse - older patient
