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Open sacrocolpopexy and vaginal apical repair: retrospective comparison of success and serious complications

Authors
  • Rogers, Rebecca G.1, 2
  • Nolen, Tracy L.3
  • Weidner, Alison C.4
  • Richter, Holly E.5
  • Jelovsek, J. Eric6
  • Shepherd, Jonathan P.7
  • Harvie, Heidi S.8
  • Brubaker, Linda9
  • Menefee, Shawn A.10
  • Myers, Deborah11
  • Hsu, Yvonne12
  • Schaffer, Joseph I.13
  • Wallace, Dennis3
  • Meikle, Susan F.14
  • 1 University of Texas, Department of Women’s Health, Dell Medical School, 1301 W 38th Street, Suite 705, Austin, TX, 78756, USA , Austin (United States)
  • 2 University of New Mexico Health Sciences Center, Department of Obstetrics and Gynecology, Albuquerque, New Mexico, USA , Albuquerque (United States)
  • 3 RTI International, Research Triangle Park, NC, USA , Research Triangle Park (United States)
  • 4 Duke University, Department of Obstetrics and Gynecology, Durham, NC, USA , Durham (United States)
  • 5 University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, AL, USA , Birmingham (United States)
  • 6 Cleveland Clinic, Obstetrics, Gynecology & Women’s Health Institute, Cleveland, OH, USA , Cleveland (United States)
  • 7 University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, USA , Pittsburgh (United States)
  • 8 University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA, USA , Philadelphia (United States)
  • 9 Stritch School of Medicine, Department of Obstetrics and Gynecology, Maywood, IL, USA , Maywood (United States)
  • 10 Kaiser Permanente, Department of Obstetrics and Gynecology, San Diego, CA, USA , San Diego (United States)
  • 11 Brown University, Department of Obstetrics and Gynecology, Providence, RI, USA , Providence (United States)
  • 12 University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, UT, USA , Salt Lake City (United States)
  • 13 Department of Obstetrics and Gynecology, University of Texas, Southwestern, Dallas, TX, USA , Dallas (United States)
  • 14 Northwest Texas Physician Group, Amarillo, TX, USA , Amarillo (United States)
Type
Published Article
Journal
International Urogynecology Journal
Publisher
Springer London
Publication Date
May 25, 2018
Volume
29
Issue
8
Pages
1101–1110
Identifiers
DOI: 10.1007/s00192-018-3666-7
Source
Springer Nature
Keywords
License
Yellow

Abstract

Introduction and hypothesisWe compared treatment success and adverse events between women undergoing open abdominal sacrocolpopexy (ASC) vs vaginal repair (VAR) using data from women enrolled in one of three multicenter trials. We hypothesized that ASC would result in better outcomes than VAR.MethodsParticipants underwent apical repair of stage 2–4 prolapse. Vaginal repair included uterosacral, sacrospinous, and iliococcygeal suspensions; sacrocolpopexies were via laparotomy. Success was defined as no bothersome bulge symptoms, no prolapse beyond the hymen, and no retreatment up to 24 months. Adverse events were collected at multiple time points. Outcomes were analyzed using longitudinal mixed-effects models to obtain valid outcome estimates at specific visit times, accounting for data missing at random. Comparisons were controlled for center, age, body mass index (BMI), initial Pelvic Organ Prolapse Quantification (POP-Q) stage, baseline scores, prior prolapse repair, and concurrent repairs.ResultsOf women who met inclusion criteria (1022 of 1159 eligibile), 701 underwent vaginal repair. The ASC group (n = 321) was older, more likely white, had prior prolapse repairs, and stage 4 prolapse (all p < 0.05). While POP-Q measurements and symptoms improved in both groups, treatment success was higher in the ASC group [odds ratio (OR) 6.00, 95% confidence interval (CI) 3.45–10.44). The groups did not differ significantly in most questionnaire responses at 12 months and overall improvement in bowel and bladder function. By 24 months, fewer patients had undergone retreatment (2% ASC vs 5% VAR); serious adverse events did not differ significantly through 6 weeks (13% vs 5%, OR 2.0, 95% CI 0.9–4.7), and 12 months (26% vs 13%, OR 1.6, 95% CI 0.9–2.9), respectively.ConclusionsOpen sacrocolpopexy resulted in more successful prolapse treatment at 2 years.

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