You Don’t Want to be 90 and Having it Done”: Advice from Older Women after Prolapse Surgery

Objectives: The risk of pelvic organ prolapse (POP) increases with age. Despite the perioperative risks associated with age, older women with POP are increasingly offered and may choose surgical management. We aimed to explore the concerns and needs of older urogynecologic patients preparing for surgery and to describe how they would advise others considering POP surgery.

Methods: We conducted semi-structured telephone interviews of women aged ≥60 years who had previously undergone POP surgery at a large academic medical center between 2018-2019. Interviews were audio-recorded and transcribed verbatim. We performed content and thematic analyses focused on participant reflections on their pre-operative concerns, how they prepared for surgery, and their advice for others considering surgical POP management. All transcripts were coded independently using an open, iterative approach by 2 coders. Demographic variables were also collected on the patients for descriptive analysis.

Results: Interviews from 10 women were analyzed. Participant age ranged from 71-78 years of age, and interviews were conducted 1.7-2.3 years after their prolapse surgery. Five patients underwent obliterative vaginal surgery, 3 underwent vaginal or laparoscopic uterosacral ligament suspension, and 2 underwent rectocele repair.

With regards to preoperative considerations, preliminary concepts included the following: 1) importance of patient education since understanding their own anatomy and the surgical procedure allowed patients to feel prepared for surgery; 2) need for careful preparation of the home recovery environment to account for postoperative restrictions; 3) challenges of arranging for caregiver assistance for those without reliable support nearby; 4) history of prior non-urogynecologic surgeries being a comfort in better understanding postoperative expectations, risks, and restrictions and in dispelling fears of surgery. Patients also highlighted the importance of not putting off surgery if one is experiencing bothersome POP, especially when considering older age as a potential factor in surgical risk and recovery challenges. Surgery made “everything better” for many, but several interviewees expressed frustration with persistence or development of other pelvic floor disorders postoperatively (e.g. incontinence). Choosing a “good doctor” who instilled a sense of confidence and safety was one of the top recommendations expressed by patients.

Conclusions: Our study highlights unique preoperative considerations for older women undergoing POP surgery, including the importance and challenges of recovery environment and caregiver preparation. Knowledge of the older patient surgical experience may influence others with bothersome POP to further consider, accept, and better prepare for POP surgery.