Transvaginal surgery in the octogenarian using cadaveric fascia for pelvic prolapse and stress incontinence: Minimal one-year results compared to younger patients

Objectives. To evaluate prospectively our transvaginal surgery experience in octogenarian women and compare the results with those in younger patients. As our population has aged, the treatment of incontinence and prolapse in women older than 80 years, known as octogenarians, has become a significant clinical issue. Methods. To date, our prospective database includes 455 women who have undergone transvaginal sling surgery using nonfrozen cadaveric fascia lata with or without concurrent prolapse repair. Of these, 51 (11%) were at least 80 years old at surgery. Complete follow-up was defined as pelvic examination findings, validated questionnaire responses (incontinence and quality of life), and SEAPI (Stress, Emptying, Anatomy, Protection, and Instability) score. The outcomes analysis was focused on the 31 octogenarian women with a minimum of I year of complete follow-up and compared their data with the data of 234 younger women with an identical minimal follow-up time. Results. The mean octogenarian age was 83 years (maximal age 93). The mean octogenarian questionnaire and examination follow-up was administered at 21.4 months and 17.5 months, respectively. Of the 31 octogenarians, 17 (55%) reported continence improvement of greater than 70%, and 28 (90%) had no symptomatic recurrent prolapse. Compared with younger patients, no statistically significant difference in outcome parameters was identified. The rates of persistent urgency and urgency in dissatisfied patients were greater in octogenarian women, but did not reach statistical significance. Statistically significant improvement in the octogenarian quality-of-life measures was demonstrated. No perioperative complications occurred. Conclusions. Transvaginal incontinence and/or prolapse surgery may be safely performed in octogenarian women, with resultant improvement in quality-of-life measures. Although outcomes after transvaginal surgery were comparable between octogenarian and younger women, persistent urgency may predict dissatisfaction in the octogenarian population. (C) 2004 Elsevier Inc.