Trial Outcomes & Findings for Outcomes Following Vaginal Prolapse Repair and Mid Urethral Sling Trial (NCT NCT00460434)

NCT ID: NCT00460434

Last Updated: 2018-05-30

Results Overview

Defined as a positive cough stress test, bothersome incontinence symptoms, or treatment for urinary incontinence, and urinary incontinence (stress, urge, or mixed), regardless of whether interim treatment for incontinence had been provided.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

337 participants

Primary outcome timeframe

3 months post-surgery

Results posted on

2018-05-30

Participant Flow

All women presenting to the participating PFDN clinical centers with the complaint of prolapse, as defined by the inclusion criteria, will be screened for the subjective complaint of SUI using items on the PFDI. Eligible individuals will be offered RCT participation.

Participants consisted of women who were being considered for an apical and/or anterior vaginal prolapse repair via a vaginal approach without subjective complaints of SUI. They must have had vaginal bulge symptoms (defined as positive responses to the PFDI), and anterior vaginal prolapse with point Aa at -1cm or greater (determined by POP-Q).

Participant milestones

Participant milestones
Measure
Midurethral Sling
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Overall Study
STARTED
165
172
Overall Study
3 Months
163
171
Overall Study
12 Months
162
165
Overall Study
COMPLETED
162
165
Overall Study
NOT COMPLETED
3
7

Reasons for withdrawal

Reasons for withdrawal
Measure
Midurethral Sling
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Overall Study
Lost to Follow-up
3
7

Baseline Characteristics

Self-reported question, population is those who provided a response.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Midurethral Sling
n=165 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=172 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Total
n=337 Participants
Total of all reporting groups
Age, Continuous
63.4 years
STANDARD_DEVIATION 10.8 • n=165 Participants
62.2 years
STANDARD_DEVIATION 10.2 • n=172 Participants
62.8 years
STANDARD_DEVIATION 10.5 • n=337 Participants
Sex: Female, Male
Female
165 Participants
n=165 Participants
172 Participants
n=172 Participants
337 Participants
n=337 Participants
Sex: Female, Male
Male
0 Participants
n=165 Participants
0 Participants
n=172 Participants
0 Participants
n=337 Participants
Race/Ethnicity, Customized
White
143 Participants
n=165 Participants
143 Participants
n=172 Participants
286 Participants
n=337 Participants
Race/Ethnicity, Customized
Black
10 Participants
n=165 Participants
14 Participants
n=172 Participants
24 Participants
n=337 Participants
Race/Ethnicity, Customized
Asian
3 Participants
n=165 Participants
2 Participants
n=172 Participants
5 Participants
n=337 Participants
Race/Ethnicity, Customized
Other
9 Participants
n=165 Participants
13 Participants
n=172 Participants
22 Participants
n=337 Participants
Race/Ethnicity, Customized
Hispanic
21 Participants
n=165 Participants
27 Participants
n=172 Participants
48 Participants
n=337 Participants
Race/Ethnicity, Customized
Not Hispanic
144 Participants
n=165 Participants
145 Participants
n=172 Participants
289 Participants
n=337 Participants
Annual Income <$30,000
31 Participants
n=64 Participants • Self-reported question, population is those who provided a response.
27 Participants
n=65 Participants • Self-reported question, population is those who provided a response.
58 Participants
n=129 Participants • Self-reported question, population is those who provided a response.
Married
121 Participants
n=163 Participants • Self-reported question, population is those who provided a response.
101 Participants
n=161 Participants • Self-reported question, population is those who provided a response.
222 Participants
n=324 Participants • Self-reported question, population is those who provided a response.
Body Mass Index
27.8 Kg/m^2
STANDARD_DEVIATION 4.9 • n=165 Participants
28.1 Kg/m^2
STANDARD_DEVIATION 5.5 • n=172 Participants
28.0 Kg/m^2
STANDARD_DEVIATION 5.2 • n=337 Participants
Pelvic Organ Prolapse Quantification
2
45 Participants
n=165 Participants
48 Participants
n=172 Participants
93 Participants
n=337 Participants
Pelvic Organ Prolapse Quantification
3
107 Participants
n=165 Participants
106 Participants
n=172 Participants
213 Participants
n=337 Participants
Pelvic Organ Prolapse Quantification
4
13 Participants
n=165 Participants
18 Participants
n=172 Participants
31 Participants
n=337 Participants
Positive Cough Stress Test
54 Participants
n=165 Participants
57 Participants
n=172 Participants
111 Participants
n=337 Participants
Anterior Vaginal - Prolapse Repair
Anterior Repair Only
20 Participants
n=165 Participants
17 Participants
n=172 Participants
37 Participants
n=337 Participants
Anterior Vaginal - Prolapse Repair
Apical Suspension Only
32 Participants
n=165 Participants
42 Participants
n=172 Participants
74 Participants
n=337 Participants
Anterior Vaginal - Prolapse Repair
Both Anterior Repair and Apical Suspension
101 Participants
n=165 Participants
100 Participants
n=172 Participants
201 Participants
n=337 Participants
Anterior Vaginal - Prolapse Repair
Colpocleisis
11 Participants
n=165 Participants
13 Participants
n=172 Participants
24 Participants
n=337 Participants
Posterior Vaginal - Prolapse Repair
74 Participants
n=165 Participants
80 Participants
n=172 Participants
154 Participants
n=337 Participants
Previous Hysterectomy
62 Participants
n=165 Participants
66 Participants
n=172 Participants
128 Participants
n=337 Participants
Concomitant Hysterectomy
82 Participants
n=165 Participants
83 Participants
n=172 Participants
165 Participants
n=337 Participants

PRIMARY outcome

Timeframe: 3 months post-surgery

Defined as a positive cough stress test, bothersome incontinence symptoms, or treatment for urinary incontinence, and urinary incontinence (stress, urge, or mixed), regardless of whether interim treatment for incontinence had been provided.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=165 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=172 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Number of Participants With Treatment Failure Defined as Subsequent Treatment for Urinary Incontinence, Signs or Symptoms of Bothersome Urinary Incontinence
39 Participants
85 Participants

PRIMARY outcome

Timeframe: 12 months post-surgery

Defined as a positive cough stress test or report of bothersome incontinence symptoms.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=165 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=172 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Prevalence of Bothersome Urinary Incontinence at 12 Months Following Index Surgery
45 Participants
74 Participants

SECONDARY outcome

Timeframe: Baseline, 3 months, and 12 Months post-surgery

Population: Women who completed the Medical Outcomes Study 36-Item Short Form Health Survey at baseline and 3 and 12 months after the index surgery.

This survey is a generic health-related quality of life measure. Scores have normalized values with a mean of 50 and a standard deviation of 10, with higher scores indicating better health status. Results measure the average change in scores from baseline to follow-up.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=156 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=154 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Medical Outcomes Study 36-Item Short Form Health Survey
3 Months - Mental Component
1.5 units on a scale
Standard Deviation 9.25
0.6 units on a scale
Standard Deviation 8.44
Medical Outcomes Study 36-Item Short Form Health Survey
3 Months - Physical Component
2.1 units on a scale
Standard Deviation 8.21
1.5 units on a scale
Standard Deviation 7.52
Medical Outcomes Study 36-Item Short Form Health Survey
12 Months - Mental Component
1.9 units on a scale
Standard Deviation 8.4
2.0 units on a scale
Standard Deviation 8.94
Medical Outcomes Study 36-Item Short Form Health Survey
12 Months - Physical Component
3.1 units on a scale
Standard Deviation 9.23
2.3 units on a scale
Standard Deviation 7.51

SECONDARY outcome

Timeframe: 3 and 12 Months Post-surgery

Population: Women who came in for 3 and 12 month post-op office visits and completed a cough stress test.

A leakage of urine with coughing or straining in either the supine or standing position with the bladder filled through a urethral catheter to 300 ml.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=158 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=157 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Positive Cough Stress Test
3 Months
10 Participants
54 Participants
Positive Cough Stress Test
12 Months
5 Participants
31 Participants

SECONDARY outcome

Timeframe: 3 and 12 Months Post-surgery

Population: Women who completed questions in the Pelvic Floor Distress Inventory regarding leakage 3 and 12 months after their index surgery.

Symptoms that were at least moderately bothersome to the participant (as measured by a response of "moderately" or "quite a bit" to any of the four items on the Pelvic Floor Distress Inventory regarding leakage).

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=160 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=165 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Symptoms of Incontinence
3 Months
15 Participants
41 Participants
Symptoms of Incontinence
12 Months
18 Participants
30 Participants

SECONDARY outcome

Timeframe: 3 months post-surgery

Population: Women who reported whether or not they needed treatment for any urinary incontinence.

The need for treatment for any urinary incontinence, including surgery, medication, pessary for incontinence, supervised pelvic-muscle exercises, timed voiding and fluid management, periurethral injection, botulinum toxin injection, neuromodulation, or other treatment for incontinence.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=164 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=172 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Treatment for Incontinence
11 Participants
13 Participants

SECONDARY outcome

Timeframe: Baseline, 3 months, and 12 months post-surgery

Population: Women who completed the PFDI UDI survey at baseline and 3 and 12 months after the index surgery.

PFDI is a symptom inventory for pelvic floor disorders. Scores ranges from 0 to 300, with higher scores indicating more symptoms. Results measure the average change in scores from baseline to follow-up.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=160 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=155 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Pelvic Floor Distress Inventory (PFDI) Urinary Distress Inventory (UDI)
3 Months
-44.9 units on a scale
Standard Deviation 48.24
-34.4 units on a scale
Standard Deviation 44.92
Pelvic Floor Distress Inventory (PFDI) Urinary Distress Inventory (UDI)
12 Months
-43.1 units on a scale
Standard Deviation 44.25
-39.3 units on a scale
Standard Deviation 40.93

SECONDARY outcome

Timeframe: Baseline, 3 months, and 12 months post-surgery

Population: Women who completed the UDI obstructive symptom subscale survey at baseline and 3 and 12 months after the index surgery.

Scores on the UDI subscales range from 0 to 100, with higher score indicating more symptoms. Results measure the average change in scores from baseline to follow-up.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=160 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=158 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Urinary Distress Inventory (UDI) Obstructive Symptom Subscale
3 Months
-27.3 units on a scale
Standard Deviation 22.69
-28.0 units on a scale
Standard Deviation 20.81
Urinary Distress Inventory (UDI) Obstructive Symptom Subscale
12 Months
-26.4 units on a scale
Standard Deviation 22.69
-27.1 units on a scale
Standard Deviation 21.39

SECONDARY outcome

Timeframe: Baseline, 3 months, and 12 months post-surgery

Population: Women who completed the UDI irritative symptom subscale survey at baseline and 3 months after the index surgery.

Scores on the UDI subscales range from 0 to 100, with higher score indicating more symptoms. Results measure the average change in scores from baseline to follow-up.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=160 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=158 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Urinary Distress Inventory (UDI) Irritative Symptom Subscale
3 Months
-12.5 units on a scale
Standard Deviation 18.83
-10.5 units on a scale
Standard Deviation 17.06
Urinary Distress Inventory (UDI) Irritative Symptom Subscale
12 Months
-10.9 units on a scale
Standard Deviation 17.15
-11.6 units on a scale
Standard Deviation 15.87

SECONDARY outcome

Timeframe: Baseline, 3 months, and 12 months post-surgery

Population: Women who completed the UDI stress subscale survey at baseline and 3 and 12 months after the index surgery.

Scores on the UDI subscales range from 0 to 100, with higher score indicating more symptoms. Results measure the average change in scores from baseline to follow-up.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=160 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=155 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Urinary Distress Inventory (UDI) Stress Subscale
3 Months
-5.1 units on a scale
Standard Deviation 16.29
4.2 units on a scale
Standard Deviation 20.42
Urinary Distress Inventory (UDI) Stress Subscale
12 Months
-5.7 units on a scale
Standard Deviation 14.62
-0.5 units on a scale
Standard Deviation 16.89

SECONDARY outcome

Timeframe: Baseline, 3 months, and 12 months post-surgery

Population: Women who completed the Incontinence Severity Index survey at baseline and 3 and 12 months after the index surgery.

Scores on the Incontinence Severity Index range from 1 to 12, with higher scores indicating greater severity. Results measure average change in scores from baseline.

Outcome measures

Outcome measures
Measure
Midurethral Sling
n=157 Participants
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=156 Participants
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Incontinence Severity Index
3 Months
-0.9 units on a scale
Standard Deviation 3.01
0.6 units on a scale
Standard Deviation 3.26
Incontinence Severity Index
12 Months
-0.9 units on a scale
Standard Deviation 2.7
0.1 units on a scale
Standard Deviation 2.7

Adverse Events

Midurethral Sling

Serious events: 28 serious events
Other events: 92 other events
Deaths: 0 deaths

Sham Incision

Serious events: 20 serious events
Other events: 63 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Midurethral Sling
n=165 participants at risk
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=172 participants at risk
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Cardiac disorders
Arrhythmia
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Cardiac disorders
Congestive heart failure
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Investigations
Pulse decreased
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Investigations
Abnormal electrocardiogram
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Hypoxia
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Hypotension
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Nervous system disorders
Dizziness
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
General disorders
Chest Pain
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Metabolism and nutrition disorders
Fluid Overload
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Respiratory, thoracic and mediastinal disorders
Shortness of breath
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Infections and infestations
Urinary Tract Infection
1.2%
2/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Metabolism and nutrition disorders
Dehydration
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Gastrointestinal disorders
Diarrhea
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Surgical and medical procedures
Prolapse repair
3.6%
6/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Infections and infestations
Appendicitis
1.2%
2/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Gastrointestinal disorders
Colitis ischaemic
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Gastrointestinal disorders
Nausea
0.61%
1/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Gastrointestinal disorders
Vomiting
0.61%
1/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Infections and infestations
Diverticulitis
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Gastrointestinal disorders
Small intestinal obstruction
0.61%
1/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Gastrointestinal disorders
Rectal prolapse
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Surgical and medical procedures
Rectocele repair
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Haematoma
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Post procedural haemorrhage
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Anaemia postoperative
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Endocrine disorders
Goitre
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Surgical and medical procedures
Hip arthroplasty
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Lower limb fracture
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Surgical and medical procedures
Knee arthroplasty
0.61%
1/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Musculoskeletal and connective tissue disorders
Osteoarthritis
0.00%
0/165 • 12 months after index surgery
1.2%
2/172 • 12 months after index surgery
Musculoskeletal and connective tissue disorders
Lumbar spinal stenosis
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Colon cancer
0.00%
0/165 • 12 months after index surgery
1.2%
2/172 • 12 months after index surgery
Investigations
Mammogram abnormal
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Pain postoperative
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Musculoskeletal and connective tissue disorders
Intervertebral disc protrusion
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Musculoskeletal and connective tissue disorders
Pain in extremity
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Nervous system disorders
Transient ischaemic attack
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Respiratory, thoracic and mediastinal disorders
Pneumothorax
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Renal and urinary disorders
Nephrolithiasis
0.61%
1/165 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Renal and urinary disorders
Pyelonephritis
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Infections and infestations
Abscess
0.00%
0/165 • 12 months after index surgery
1.2%
2/172 • 12 months after index surgery
Reproductive system and breast disorders
Pelvic pain
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Renal and urinary disorders
Pollakiuria
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery
Injury, poisoning and procedural complications
Vaginal haemorrhage postoperative
0.61%
1/165 • 12 months after index surgery
1.2%
2/172 • 12 months after index surgery
Infections and infestations
Vaginal abscess
0.00%
0/165 • 12 months after index surgery
0.58%
1/172 • 12 months after index surgery

Other adverse events

Other adverse events
Measure
Midurethral Sling
n=165 participants at risk
Women in this arm received a concomitant tension-free vaginal tape (TVT) procedure.
Sham Incision
n=172 participants at risk
Women in this arm received two one-centimeter suprapubic incisions, comparable to those received in the intervention group.
Injury, poisoning and procedural complications
Bladder perforation
6.7%
11/164 • 12 months after index surgery
0.00%
0/172 • 12 months after index surgery
Infections and infestations
Urinary tract infection
31.0%
49/158 • 12 months after index surgery
18.3%
30/164 • 12 months after index surgery
Renal and urinary disorders
Bladder retention at hospital discharge
42.6%
69/162 • 12 months after index surgery
30.0%
51/170 • 12 months after index surgery
Renal and urinary disorders
Bladder retention at 2 weeks
5.5%
9/163 • 12 months after index surgery
0.59%
1/169 • 12 months after index surgery

Additional Information

Marie Gantz

RTI International

Phone: 919-597-5110

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place