* Abdominal sacrocolpopexy relieves symptoms of pelvic organ prolapse but is variably effective long-term.

Data on long-term follow-up of women who've undergone abdominal sacrocolpopexy for pelvic organ prolapse are scant, as are data on women who've undergone urethropexy at the same time for incontinence-a common adverse effect of sacrocolpopexy. A recent study of 302 women who had completed two years of follow-up in an earlier multicenter randomized trial further followed 157 of those women for seven years.

At year 7, rates of anatomic prolapse failure (defined according to reoperation, placement of a pessary, or failure according to predefined measurements) in the urethropexy group and the group not undergoing urethropexy were 27% and 22%, respectively; rates of symptomatic failure (a positive response to one or more items on the Pelvic Organ Prolapse Distress Inventory, reoperation, or placement of a pessary) were 29% and 24%, respectively. Approximately half of the women who experienced either type of failure were not treated again: 16 of 31 with anatomic failure were asymptomatic and not retreated; 27 of 49 with symptomatic prolapse weren't retreated.

The probability of experiencing stress urinary incontinence was slightly lower in the urethropexy group than in those who hadn't undergone the additional procedure (62% versus 77%). Generally, stress urinary incontinence occurred in the urethropexy group later than in the no-urethropexy group (at 131 months, compared with 40).

By the end of the seven-year follow-up, 23 women had experienced mesh erosion (occurring with all types of mesh) and four had suture erosion. Overall, at least 36 women at year 7 had received additional related surgery: 11 for prolapse, 14 for incontinence, and 1 for mesh-related complications.

The authors noted three major findings: abdominal sacrocolpopexy is somewhat effective, with two-year cure rates ranging from 19% to 97% (according to the definition of success) but with the procedure generally providing symptom relief; prophylactic urethropexy doesn't provide a clinically significant benefit; and synthetic mesh erosion is common. They recommend that women with pelvic organ prolapse be provided with counseling concerning the benefits and drawbacks of surgical treatment and be made aware of the symptoms of mesh erosion after surgery.

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