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Surgical Outcomes After Apical Repair for Vault Compared With Uterovaginal Prolapse

Rogers, Rebecca, G., MD; Nolen, Tracy, L., DrPh; Weidner, Alison, C., MD; Richter, Holly, E., PhD, MD; Jelovsek, J., Eric, MD, MMEd; Shepherd, Jonathan, P., MD, MSc; Harvie, Heidi, S., MD; Brubaker, Linda, MD, MS; Menefee, Shawn, A., MD; Myers, Deborah, MD; Hsu, Yvonne, MD; Schaffer, Joseph, I., MD; Wallace, Dennis, PhD; Meikle, Susan, F., MD, MSPHfor the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network

doi: 10.1097/AOG.0000000000002492
Contents: Female Pelvic Reconstruction: Original Research

OBJECTIVE: To retrospectively compare surgical success and complications between vaginal vault prolapse compared with uterovaginal prolapse in women who underwent apical prolapse repair for stage II–IV prolapse.

METHODS: Women in one of three Pelvic Floor Disorders Network prolapse surgical trials were included. Absence of bothersome bulge symptoms, no prolapse beyond the hymen, and no subsequent prolapse treatment defined success and was our primary outcome. Secondary outcomes included comparison of quality-of-life measures, anatomic changes, and adverse events. Pelvic organ prolapse quantification (POP-Q) and quality-of-life measures were administered at baseline and 1–2 years postoperatively. Comparisons were controlled for study site, age, body mass index, baseline POP-Q, apical and anterior or posterior repair performed, and prior prolapse repair. Outcomes measured at multiple time points were analyzed using longitudinal models to assess whether differences existed across study follow-up.

RESULTS: Four hundred twenty-one women underwent vault prolapse, and 601 underwent uterovaginal prolapse apical repair. The vault prolapse group was older, more likely to be white, and to have prior urinary incontinence or prolapse repair, stage IV prolapse, and more prolapse bother on a validated scale (all P≤.034). The vault prolapse group was more likely to undergo sacrocolpopexy (228/421 [54%] vs 93/601 [15%]); the uterovaginal prolapse group was more likely to undergo vaginal repair (508/601 [85%] vs 193/421 [46%] P<.001). There were no differences in success (odds ratio [OR] 0.76 for vault prolapse vs uterovaginal prolapse, 95% CI 0.51–1.15, P=.20), changes in Pelvic Organ Prolapse Distress Inventory scores (−79.4 vs −79.8, P=.89), postoperative POP-Q point C measurements (−7.0 vs −7.1 cm, P=.41), or serious adverse events (86/421 [20%] vs 90/601 [15%], P=.86) between groups. Among women who underwent a vaginal approach for repair of vault prolapse (n=193) or uterovaginal prolapse (n=508), there were no differences in success rates (OR 0.67, 95% CI 0.43–1.04, P=.09) at 1–2 years postoperatively.

CONCLUSION: Surgical success of stage II–IV vault prolapse and uterovaginal prolapse apical repair was similar whether performed vaginally or abdominally at 1–2 years postoperatively.

Anatomic and functional outcomes are similar after repair of the vaginal vault and uterovaginal apical prolapse 1–2 years postoperatively.

Departments of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, Duke University, Durham, North Carolina, University of Alabama at Birmingham, Birmingham, Alabama, University of Pennsylvania, Philadelphia, Pennsylvania, University of California, San Diego, and Kaiser Permanente, San Diego, California, Brown University, Providence, Rhode Island, University of Utah, Salt Lake City, Utah, and University of Texas, Southwestern, Dallas, Texas; the Department of Women's Health, Dell Medical School, University of Texas, Austin, Austin, Texas; RTI International, Research Triangle Park, North Carolina; Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Departments of Obstetrics & Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; and Northwest Texas Physician Group, Amarillo, Texas.

Corresponding author: Rebecca G. Rogers, MD, Department of Women's Health, Dell Medical School, University of Texas, 1301 W 38th Street, Suite 705, Austin, TX 78705; email:

Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (2U01HD41249, 2U10 HD41250, 2U10 HD41261, 2U10 HD41267, 1U10 HD54136, 1U10 HD54214, 1U10 HD54215, 1U10 HD54241, U10 HD069013, U10 HD069025, U10 HD069010, U10 HD069010, and U01 HD069031) and the National Institutes of Health Office of Research on Women's Health.

Financial Disclosure Dr. Rogers has received royalties from UptoDate. Dr. Richter has received a research grant from and been a consultant for Pelvalon. She has also received royalties from UptoDate. Dr. Brubaker has received editorial revenue from UptoDate. Dr. Menefee has received royalties from UptoDate. Dr. Schaffer has received royalties from McGraw Hill, research funds from Boston Scientific, and has been a speaker for Astellas. The remaining authors did not report any potential conflicts of interest.

Presented at the annual meeting of the Society of Gynecologic Surgeons 2014, November 18, 2014, Orlando, Florida.

For a list of acknowledgments pertaining to this study, see Appendix 1, available online at

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.