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Pelvic Organ Prolapse Recurrence and Patient-Centered Outcomes Following Minimally Invasive Abdominal Uterosacral Ligament and Mesh-Augmented Sacrohysteropexy

Davidson, Emily R. W. MD; Casas-Puig, Viviana MD; Paraiso, Marie Fidela R. MD; Ridgeway, Beri MD; Ferrando, Cecile A. MD, MPH

Female Pelvic Medicine & Reconstructive Surgery: March 6, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000710
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Objectives The objective of this study was to compare outcomes after minimally invasive uterosacral ligament hysteropexy (USLH) and mesh-augmented sacrohysteropexy (MSH) for women with uterovaginal prolapse including prolapse recurrence and long-term patient satisfaction.

Methods This was a retrospective cohort study with a cross-sectional survey component. The medical record was queried for perioperative data for patients undergoing USLH and MSH between 2004 and 2016. Pelvic organ prolapse (POP) recurrence was defined as bulge symptoms and/or retreatment with a pessary or surgery. A cross-sectional survey assessed for adverse events and used validated questionnaires to assess symptoms and improvement.

Results Ninety-seven patients met the inclusion criteria: 42 MSH and 55 USLH. Mean age was 48 ± 14 years. Patients undergoing MSH were older, had more advanced POP, and were less likely to undergo concurrent procedures. There were no differences in perioperative complications between groups; 22.7% (n = 22) of patients experienced POP recurrence with 8.3% (n = 8) undergoing repeat surgery. After controlling for preoperative differences, there was no difference in POP recurrence between groups. The incidence of sacrohysteropexy mesh exposure was 7% (n = 3). Sixty-one percent (n = 59) of patients completed the survey; median follow-up time was 104 (46–164) months. Forty-one percent of respondents reported bothersome pelvic floor symptoms. Bulge symptoms were more common after MSH (41% vs 10%, P = 0.006). Ninety-three percent of all patients reported improvement after surgery, which was not different between groups.

Conclusions One in 5 patients experienced POP recurrence with fewer than 10% undergoing repeat surgery for recurrence. There does not seem to be a significant difference in the incidence of recurrence between MSH and USLH.

From the Center for Urogynecology and Reconstructive Pelvic Surgery; Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH.

Correspondence: Emily R. W. Davidson, MD, 9500 Euclid Ave, A81, Cleveland, OH 44195. E-mail: emilyrwdavidson@me.com.

The findings contained in this article were presented as an oral poster at the 2018 annual meeting for the American Urogynecologic Society in Chicago, IL, on October 9 to 13, 2018.

M.F.R.P. has an unrestricted research grant from Coloplast, Inc, and from Caldera, Inc, and receives royalties as an UpToDate author. B.R. is a consultant for Coloplast, Inc, and has provided legal testimony for Ethicon. C.A.F. has an unrestricted research grant from Coloplast, Inc, and from Caldera. Inc, and receives royalties as an UpToDate author. The other authors have declared they have no conflicts of interest.

Author contributions: E.R.W.D.: study design, data collection, analysis, manuscript preparation; V.C.-P.: study design, data collection, manuscript preparation; M.F.R.P.: manuscript preparation; B.R.: manuscript preparation; C.A.F.: study design, analysis, manuscript preparation.

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