Anterior vaginal wall surgery in elderly patients: outcomes and assessment

To evaluate the efficacy, safety, and impact on quality of life of anterior vaginal surgery in the elderly. Incontinence in the elderly is a devastating medical and social condition accounting for 50% of admissions to nursing homes; the incidence of anterior vaginal wall prolapse also increases in the elderly. Most patients are treated conservatively, because of a reluctance to offer surgical treatment to this age group owing to the perceived increased risk of complications and decreased rate of treatment success.

We prospectively evaluated all consecutive elderly patients who underwent anterior vaginal wall surgery between November 1999 and May 2003. The surgical outcomes were determined by the symptom, bother, and quality-of-life questionnaires answered by the patients. The physicians were unaware of the patients' responses.

A total of 209 patients were available for analysis. The mean age was 70 years (range 65 to 88) and the mean follow-up 15.3 months. All items in the symptom and bother questionnaires showed significant improvement. Significant improvement was also demonstrated in quality of life and pad use (P <0.005). No significant perioperative complications occurred. Only patients older than 71 years of age did not experience an improvement in the symptom scores for urge incontinence. Nevertheless, as for all other patients, older patients experienced improvement in stress urinary incontinence (SUI) symptoms, the bother scores of SUI and urge incontinence, and quality of life.

Surgical treatment of anterior vaginal wall prolapse and SUI in the elderly is effective and safe and significantly improves the quality of life of these patients.