Who has a more successful outcome from her bladder lift surgery? Is it the woman who is undergoing it for the first time, or is it the woman who is undergoing it for the second time? Reason would dictate that if a woman needs a corrective surgery for the second time because the first failed, the likelihood of success the second time would be lower. In addition, are there underlying risk factors that lead to bladder drop (cystocele) in the first place that may lead to recurrent bladder drop no matter how many times the surgery is done? If this is the case, is there anything that can be done to prevent or at least reduce recurrence rates to lower repeated surgeries?
To demonstrate this dilemma, a recent paper from Cleveland Clinic-Florida was published looking at the success rates of cystocele repair in women undergoing it for the first time, vs. those undergoing it for the second time. The “in-between-the lines” question to be asked from reading this research is how to try to prevent women from having a recurrence after their first surgery so there is potentially no subsequent surgery.
The results from the study are a bit depressing. After one year, the group of women undergoing surgery for the second time (group I) and the group of women undergoing surgery for the first time (group II), had the following success rates at one year:
Group I: 18/23 or 78.2 percent (“second timers”)
Group II: 17/21 or 81 percent (“first timers”)
You may say to yourself, these groups are nearly the same, without significant difference. That’s good, right? The real story here is why are 20 percent of women developing recurrence in either group just one year after reconstructive bladder surgery?
Now let’s evaluate their results at two years:
Group I (“second timers”) 9/21 (2 lost to follow up) or 42.8 percent
Group II (“first timers”) 15/21 or 71.4 percent
What are we to make of these worsening results?
These results are actually in line and consistent with published data about how bladder surgery commonly fails within the first one to four years post-operatively. In fact, failure rates are actually between 40-70 percent.