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A Comparison of Sacrospinous Hysteropexy Augmented With Polypropylene Mesh Versus Human Dermis at 12-Month Follow-up

An Ambidirectional Study

Seitz, Miriam, MD*; Jirschele, Kelly, DO; Tran, Alexis, DO; Iyer, Shilpa, MD, MPH§; Gafni-Kane, Adam, MD; Tomezsko, Janet, MD; Botros, Sylvia M., MD, MSci; Sand, Peter K., MD

Female Pelvic Medicine & Reconstructive Surgery: October 17, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000640
Original Article: PDF Only
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Background Suture-based hysteropexy is performed for pelvic organ prolapse with varying results. Graft augmentation may improve outcomes.

Objective The aim of this study was to determine whether vaginal hysteropexy with mesh reduces recurrence at 1-year postoperative examination compared with hysteropexy with allograft.

Methods Data were collected for patients who underwent vaginal hysteropexy with either mesh “Uphold” (referred to as “mesh”) or a cadaveric allograft “Axis or Repliform” (referred to as “dermal”). The primary outcome was anatomic success defined as no prolapse Pelvic Organ Prolapse Quantification System stage II or less at 12 months postoperative. The secondary outcomes were recurrence to the hymen and a composite score (any positive response to the 20-item Pelvic Floor Distress Inventory question 3 and cervix ≥ −1/2 total vaginal length at rest or as reference point 3 cm proximal to or above the hymenal ring anteriorly [Ba] ≥0) measured at 12 months.

Results Two hundred seventy-four patients returned for their 1-year postoperative examination: 93.5% of the mesh group (231/247 subjects) and 95.5% of the dermal group (43/45 subjects). The mesh group had fewer recurrences to or beyond Pelvic Organ Prolapse Quantification System stage II (mesh 18% vs dermal 29%, P = 0.03), to the hymen (2.6% vs 9.3%, P = 0.007), or based on composite score (19 vs 33%, P = 0.007). Questionnaire data improved more in the mesh group (P < 0.0001). The exposure rate was 5.75% (13/247) in the mesh group. Reoperation rate was greater in the dermal group (mesh 4.3%vs dermal 7.3%, P = 02).

Conclusions Hysteropexy augmented with mesh reduced the recurrence at 1 year compared with hysteropexy with allograft. Fewer patients in the mesh group felt a bulge at 1 year (4.5% vs 20.9%, P < 0.0001). These findings need to be weighed against the mesh exposure rate of 5.75%.

From the *Division of Urogynecology, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI;

Pelvic Medicine and Urogynecology Center, Rush Copley Medical Center, Aurora, IL;

Division of Urogynecology, Department of Obstetrics and Gynecology, Albany Medical College, Albany, NY;

§Division of Urogynecology, Department of Obstetrics and Gynecology, University of Chicago, Chicago; and

Center for Pelvic Health, NorthShore University Health Systems/The University of Chicago, Skokie, IL; and

Division of Urogynecology, Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX.

Correspondence: Miriam Seitz, MD, Female Pelvic Medicine and Reconstructive Surgery, University Health Specialists at Pali Momi, 98-1005 Moanalua Road, Suite 3010, Aiea, HI 96701. E-mail: mseitz@hawaii.edu.

The authors have declared they have no conflicts of interest.

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