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Ureteral Compromise in Laparoscopic Versus Vaginal Uterosacral Ligament Suspension: A Retrospective Cohort

Barbier, Heather M. MD, MPH*; Smith, Margo Z. MD*; Eto, Chidimma U. MD; Welgoss, Jeffrey A. MD; Von Pechmann, Walter MD; Horbach, Nicolette MD; Gruber, Daniel D. MS, MD*

Female Pelvic Medicine & Reconstructive Surgery: November/December 2015 - Volume 21 - Issue 6 - p 363–368
doi: 10.1097/SPV.0000000000000202
Original Articles

Objectives The aim of this study was to evaluate if ureteral compromise is significantly different between laparoscopic and vaginal uterosacral ligament suspension (USLS).

Methods This is a retrospective cohort study comparing all women who underwent laparoscopic and vaginal USLSs at 2 institutions (part of a single training program with procedures performed by 11 fellowship-trained Female Pelvic Medicine and Reconstructive Surgery gynecologic surgeons) between January 2008 and June 2013.

Results A total of 208 patients in the study underwent a USLS, 148 in the laparoscopic group and 60 in the vaginal group. At baseline, there were statistically significant differences between the groups in mean age (50.4 vs 55.3 years, P = 0.008), parity (2.44 vs 2.77, P = 0.040), and prior hysterectomy (3.4% vs 11.7% in the laparoscopic and vaginal groups, respectively; P = 0.042).

There were no ureteral compromises in the laparoscopic group and 6 in the vaginal group (0.0% vs 10.0%, respectively; P < 0.001). In an analysis evaluating only those ureteral compromises requiring stent placement, the higher rate of ureteral compromise in the vaginal group persisted despite exclusion of those cases requiring only suture removal and replacement (0.0% vs 5.0% in the laparoscopic and vaginal groups, respectively; P = 0.023).

There was a lower median blood loss in the laparoscopic group (137.5 vs 200.0 mL, respectively; P = 0.002) as well as a lower rate of readmission (0.7% vs 6.7%, respectively; P = 0.025). There were no other significant differences in postoperative complications between the 2 groups.

Conclusions We found a lower rate of ureteral compromise in the laparoscopic approach to USLS compared with the traditional vaginal approach.

Ureteral compromise is lower in the laparoscopic approach to uterosacral ligament suspension compared to the vaginal approach.

From the *Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD; †Department of Obstetrics and Gynecology, George Washington University, Washington, DC; and ‡Inova Fairfax Hospital, Annandale, VA.

Reprints: Heather M. Barbier, MD, MPH, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bldg 9, 2nd Floor, Bethesda, MD 20889. E-mail: hbarbier@mac.com.

The authors have declared they have no conflicts of interest.

All authors have no relevant disclosures. The views expressed in this manuscript are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Air Force, Department of Defense, or the US Government.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.