Objectives: This study aimed to evaluate and compare 1-year anatomic and functional outcomes in patients undergoing transvaginal versus transabdominal repair of pelvic organ prolapse (POP) with synthetic mesh reinforcement.
Methods: We conducted a retrospective, matched cohort study of patients undergoing robotic-assisted laparoscopic sacrocolpopexy (RALSC) and vaginal extraperitoneal colpopexy (VEC) with synthetic mesh from December 2008 to March 2011. We compared the preoperative to postoperative changes in anatomic, quality of life, and functional outcomes between groups after 1 year of follow-up. One-year surgical satisfaction was also assessed.
Results: Thirty-eight RALSC patients met the inclusion criteria and were matched by age and month of surgery to 38 VEC patients. Of those, 31 RALSC and 30 VEC patients (80%) had complete 1-year data. Preoperative to postoperative outcomes were similar in both groups with similar improvement seen in anatomic Pelvic Organ Prolapse Quantification measures as well as functional questionnaire scores. Both groups demonstrated high surgical satisfaction. Symptom distress inventory scales revealed 84% and 90% resolution of symptomatic “bulge” in RALSC and VEC patients, respectively (P = 0.74). The RALSC group had a significantly greater operative time by approximately 96 minutes and greater use of general anesthesia (P = <0.001). No difference was noted in blood loss, hospital days, or return to normal voiding between groups.
Conclusions: Transabdominal and transvaginal techniques of colpopexy using synthetic mesh implants for POP have been shown in this retrospective cohort study to improve quality of life and anatomic measures with similar outcomes. Robotic-assisted laparoscopic sacrocolpopexy results in a greater use of general anesthesia and longer operative time.
At one year, the transvaginal and transabdominal placement of mesh for pelvic organ prolapse repair have comparable anatomic and functional outcomes.
From the *Obstetrics and Gynecology, Abington Memorial Hospital, Abington; †Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales; and ‡Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA.
Reprints: Lisa H. Jambusaria, MD, Vanderbilt University Medical Center, Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, B-1100 Medical Center North, Nashville, TN 37232. E-mail: lisa.h.jambusaria@Vanderbilt.edu.
Lisa H. Jambusaria has no disclosures. Miles Murphy has been with Ethicon Women’s Health & Urology (consultant, expert witness), American Medical Systems (consultant/research funding), Boston Scientific (consultant), and Coloplast (consultant). Vincent R. Lucente has been an Allergan speaker, American Medical Systems consultant, Bard research consultant, Ethicon grant consultant, Kimberly-Clark consultant, Watson speaker, Coloplast consultant, and Medtronic’s consultant.
Presented at the American Urogynecologic Society 33rd Annual Scientific Meeting, October 3-6, 2012, Chicago, IL.