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Uterosacral Ligament Suspension Versus Robotic Sacrocolpopexy for Treatment of Apical Pelvic Organ Prolapse

Smith, Benjamin C., MD*; Crisp, Catrina C., MD, MSc*; Kleeman, Steven D., MD*; Yook, Eunsun, MS; Pauls, Rachel N., MD*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2019 - Volume 25 - Issue 2 - p 93–98
doi: 10.1097/SPV.0000000000000704
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Objective The aim of the study was to compare long-term outcomes of uterosacral ligament suspension (USLS) versus robotic sacrocolpopexy (RSC) in patients with pelvic organ prolapse.

Methods This was an institutional review board–approved retrospective cohort study. Women 3 to 7 years after USLS or RSC were contacted for enrollment. Participants were asked to complete validated questionnaires and physical examinations. The primary outcomes were no symptoms of bulge or retreatment for prolapse (subjective) and POP-Q examination demonstrating prolapse above or equal to −1 (objective). For the subjective outcome, a noninferiority calculation with 10% noninferiority margin deemed 91 subjects in each group were required.

Results We identified the following 770 eligible subjects: 205 were contacted, 19 declined, 186 subjects agreed to participate, and 2 were excluded. There were 92 subjects per group in the analysis for the primary subjective outcome, and 84% underwent examinations for the objective outcome. Baseline characteristics were overall similar; however, previous prolapse surgery was more common in the RSC group (P < 0.001). Subjective success was achieved in 83 subjects in the USLS group and 78 subjects in the RSC group (90.2% vs 84.4%, respectively, P = 0.265 [95% confidence interval = −0.036 to 1.000]). Objective success was noted in 93.2% and 91.3% of the USLS and RSC groups, respectively (P = 0.869). Postoperative complication rates were low and did not differ between groups. Mesh complications were noted in 6.6% of the RSC group. One subject in the USLS group reported pain related to surgery.

Conclusion Uterosacral ligament suspension was noninferior to RSC at 3- to 7-year postsurgery for subjective symptoms and similar for objective outcomes. Both approaches showed high success rates and strong patient satisfaction.

From the *Division of Urogynecology and Pelvic Reconstructive Surgery, TriHealth, Good Samaritan Hospital; and

TriHealth Hatton Research Institute, Cincinnati, OH.

Correspondence: Benjamin C. Smith, MD, TriHealth Good Samaritan Hospital, 3219 Clifton Ave, Medical Office Bldg Suite 100, Cincinnati, OH 45220. E-mail:

This study was supported by an education grant from the TriHealth Medical Education Research Fund.

This study was registered with the National Clinical Trials Registry: NCT02741830.

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