Concomitant Anterior Repair, Preoperative Prolapse Severity, and Anatomic Prolapse Outcomes after Vaginal Apical Procedures

Charles W. Nager, Cara L. Grimes, Tracy L. Nolen, Clifford Y Wai, Linda Brubaker, Peter C. Jeppson, Tracey S. Wilson, Anthony G. Visco, Matthew D. Barber, Gary Sutkin, Peggy Norton, Charles R. Rardin, Lily Arya, Dennis Wallace, Susan F. Meikle

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

The aim of the study was to compare anterior and overall prolapse prevalence at 1 year in surgical participants with or without concomitant anterior repair (AR) at the time of sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (ULS). Methods This is a secondary analysis of two surgical trials; concomitant AR was performed at surgeon's discretion. Anterior anatomic success was defined as pelvic organ prolapse quantification of prolapse point Ba ≤0 and overall success was defined as pelvic organ prolapse quantification points Ba, Bp, and C ≤0 at 12 months. Results Sixty-three percent (441/701) of the participants underwent concomitant AR and were older, more often postmenopausal, had previous hysterectomy, and had higher-stage anterior, but not apical prolapse. Anterior anatomic success was marginally but statistically better in the combined group (SSLF and ULS) with concomitant AR (82% vs 80%, P = 0.03). In subanalyses, the improvement in anatomic support with AR was observed only in the SSLF subgroup (81% vs 73%, P = 0.02) and mostly in the SSLF subgroup with higher preoperative stage (74% vs 57%, P = 0.02). Anterior repair did not improve success rates in participants with lower-stage prolapse or undergoing ULS. Overall success rates were similar to anterior anatomic success rates. Participants with higher-stage preoperative anterior prolapse had significantly lower success rates. Conclusions In the absence of clinical trial data, this analysis suggests an AR should be considered for women with higher-stage prolapse undergoing an SSLF. Preoperative prolapse severity is a strong predictor of poor anatomic outcomes with native tissue vaginal apical surgeries.

Original languageEnglish (US)
Pages (from-to)49-55
Number of pages7
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • anterior repair
  • pelvic organ prolapse
  • sacrospinous ligament fixation
  • surgery
  • surgical trial
  • uterosacral ligament suspension

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology
  • Urology

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    Nager, C. W., Grimes, C. L., Nolen, T. L., Wai, C. Y., Brubaker, L., Jeppson, P. C., Wilson, T. S., Visco, A. G., Barber, M. D., Sutkin, G., Norton, P., Rardin, C. R., Arya, L., Wallace, D., & Meikle, S. F. (2019). Concomitant Anterior Repair, Preoperative Prolapse Severity, and Anatomic Prolapse Outcomes after Vaginal Apical Procedures. Female Pelvic Medicine and Reconstructive Surgery, 25(1), 49-55. https://doi.org/10.1097/SPV.0000000000000526