Advertisement

Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study

Published:September 02, 2016DOI:https://doi.org/10.1016/j.ajog.2016.08.035

      Background

      There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy.

      Objective

      We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy.

      Study Design

      This multicenter, prospective parallel cohort study compared laparoscopic sacral hysteropexy to vaginal mesh hysteropexy at 8 institutions. We included women ages 35–80 years who desired uterine conservation, were done with childbearing, and were undergoing 1 of the above procedures for stage 2–4 symptomatic anterior/apical uterovaginal prolapse (anterior descent at or beyond the hymen [Aa or Ba ≥ 0] and apical descent at or below the midvagina [C ≥ –TVL/2]). We excluded women with cervical elongation, prior mesh prolapse repair, cervical dysplasia, chronic pelvic pain, uterine abnormalities, and abnormal bleeding. Cure was defined as no prolapse beyond the hymen and cervix above midvagina (anatomic), no vaginal bulge sensation (symptomatic), and no reoperations. Pelvic Organ Prolapse Quantification examination and validated questionnaires were collected at baseline and 12 months including the Pelvic Floor Distress Inventory Short Form, Female Sexual Function Index, and Patient Global Impression of Improvement. In all, 72 subjects/group were required to detect 94% vs 75% cure (80% power, 15% dropout). Intention-to-treat analysis was used with logistic regression adjusting for baseline differences.

      Results

      We performed 74 laparoscopic sacral hysteropexy and 76 vaginal mesh hysteropexy procedures from July 2011 through May 2014. Laparoscopic patients were younger (P < .001), had lower parity (P = .006), were more likely premenopausal (P = .008), and had more severe prolapse (P = .02). Laparoscopic procedure (174 vs 64 minutes, P < .0001) and total operating time (239 vs 112 minutes, P < .0001) were longer. There were no differences in blood loss, complications, and hospital stay. One-year outcomes for the available 83% laparoscopic and 80% vaginal hysteropexy patients revealed no differences in anatomic (77% vs 80%; adjusted odds ratio, 0.48; P = .20), symptomatic (90% vs 95%; adjusted odds ratio, 0.40; P = .22), or composite (72% vs 74%; adjusted odds ratio, 0.58; P = .27) cure. Mesh exposures occurred in 2.7% laparoscopic vs 6.6% vaginal hysteropexy (P = .44). A total of 95% of each group were very much better or much better. Pelvic floor symptom and sexual function scores improved for both groups with no difference between groups.

      Conclusion

      Laparoscopic sacral hysteropexy and vaginal mesh hysteropexy had similar 1-year cure rates and high satisfaction.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Frick A.C.
        • Walters M.D.
        • Larkin K.S.
        • Barber M.D.
        Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse.
        Am J Obstet Gynecol. 2010; 202: 507.e1-507.e4
        • Gutman R.
        • Maher C.
        Uterine-preserving POP surgery.
        Int Urogynecol J. 2013; 24: 1803-1813
        • Dietz V.
        • van der Vaart C.H.
        • van der Graaf Y.
        • Heintz P.
        • Schraffordt Koops S.E.
        One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study.
        Int Urogynecol J. 2010; 21: 209-216
        • Roovers J.P.
        • van der Vaart C.H.
        • van der Bom J.G.
        • van Leeuwen J.H.
        • Scholten P.C.
        • Heintz A.P.
        A randomized controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function.
        BJOG. 2004; 111: 50-56
        • Vu M.K.
        • Letko J.
        • Jirschele K.
        • et al.
        Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes.
        Int Urogynecol J. 2012; 23: 1753-1761
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Popcock S.J.
        • Gotzsche P.C.
        • Vandenbroucke J.P.
        • STROBE Initiative
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Barber M.D.
        • Walters M.D.
        • Bump R.C.
        Development of short forms for two condition-specific quality of life questionnaires (PFDI-20 and PFIQ 7).
        Am J Obstet Gynecol. 2005; 193: 103-113
        • Bump R.C.
        • Mattiasson A.
        • Bo K.
        • et al.
        The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.
        Am J Obstet Gynecol. 1996; 175: 10-17
        • Rosen R.
        • Brown C.
        • Heiman J.
        • et al.
        The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.
        J Sex Marital Ther. 2000; 26: 191-208
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Clavien P.A.
        • Barkun J.
        • de Oliveiria M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Srikrishna S.
        • Robinson D.
        • Cardozo L.
        Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse.
        Int Urogynecol J. 2010; 21: 523-528
        • McCarthy M.
        • Chang C.H.
        • Pickard A.S.
        • et al.
        Visual analog scales for assessing surgical pain.
        J Am Coll Surg. 2005; 201: 245-252
        • Barber M.D.
        • Janz N.
        • Kenton K.
        • et al.
        Validation of the surgical pain scales in women undergoing pelvic reconstructive surgery.
        Female Pelvic Med Reconstr Surg. 2012; 18: 198-204
        • McCarthy M.
        • Jonasson O.
        • Chang C.H.
        • et al.
        Assessment of patient functional status after surgery.
        J Am Coll Surg. 2005; 201: 171-178
        • Barber M.D.
        • Kenton K.
        • Janz N.K.
        • et al.
        Validation of the activities assessment scale in women undergoing pelvic reconstructive surgery.
        Female Pelvic Med Reconstr Surg. 2012; 18: 205-210
        • Jirschele K.
        • Seitz M.
        • Zhou Y.
        • Rosenblatt P.
        • Culligan P.
        • Sand P.
        A multicenter, prospective trial to evaluate mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse.
        Int Urogynecol J. 2015; 26: 743-748
        • Letouzey V.
        • Ulrich D.
        • Balenbois E.
        • Cornille A.
        • de Tayrac R.
        • Fatton B.
        Utero-vaginal suspension using bilateral vaginal anterior sacrospinous fixation with mesh: intermediate results of a cohort study.
        Int Urogynecol J. 2015; 26: 1803-1807
        • Price N.
        • Slack A.
        • Jackson S.R.
        Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse.
        BJOG. 2010; 117: 62-68
        • Rosenblatt P.L.
        • Chelmow D.
        • Ferzandi T.R.
        Laparoscopic sacrocervicopexy for the treatment of uterine prolapse: a retrospective case series report.
        J Minim Invasive Gynecol. 2008; 15: 268-272
        • Pan K.
        • Cao L.
        • Ryan N.A.
        • Wang Y.
        • Xu H.
        Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse.
        Int Urogynecol J. 2016; 27: 93-101
        • Rahmanou P.
        • Price N.
        • Jackson S.R.
        Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study.
        Int Urogynecol J. 2015; 26: 1687-1694