Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup

Rebecca S. Lavelle, Alana L. Christie, Feras Alhalabi, Philippe E. Zimmern

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse. Materials and Methods: We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. Results: A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4%, isolated apical 10.7%, isolated posterior 8.3% and multiple compartments 19%. Surgery for recurrent prolapse included anterior compartment 3.3% at 1.4 ± 1.0 years, apical 9.9% at 2.8 ± 3.0 years, posterior compartment 5.8% at 2.0 ± 1.0 years and multiple compartments 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and a 5.7% rate of 30-day complications (all Clavien I). Conclusions: Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33% of patients required secondary prolapse compartment procedures from 0.6 to 13 years later, highlighting the importance of long-term followup.

Original languageEnglish (US)
JournalJournal of Urology
DOIs
StateAccepted/In press - 2016

Fingerprint

Prolapse
Suspensions
Pelvic Organ Prolapse
Recurrence
Fecal Incontinence
Stress Urinary Incontinence
Research Ethics Committees
Intraoperative Complications
Hysterectomy
Reoperation
Physical Examination
Quality of Life
Outcome Assessment (Health Care)
Databases
Morbidity
Equipment and Supplies

Keywords

  • Pelvic organ prolapse
  • Reconstructive surgical procedures
  • Recurrence

ASJC Scopus subject areas

  • Urology

Cite this

Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup. / Lavelle, Rebecca S.; Christie, Alana L.; Alhalabi, Feras; Zimmern, Philippe E.

In: Journal of Urology, 2016.

Research output: Contribution to journalArticle

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title = "Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup",
abstract = "Purpose: We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse. Materials and Methods: We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. Results: A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4{\%}, isolated apical 10.7{\%}, isolated posterior 8.3{\%} and multiple compartments 19{\%}. Surgery for recurrent prolapse included anterior compartment 3.3{\%} at 1.4 ± 1.0 years, apical 9.9{\%} at 2.8 ± 3.0 years, posterior compartment 5.8{\%} at 2.0 ± 1.0 years and multiple compartments 17.4{\%} at 3.2 ± 3.3 years. There was a 1.6{\%} rate of intraoperative complications and a 5.7{\%} rate of 30-day complications (all Clavien I). Conclusions: Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33{\%} of patients required secondary prolapse compartment procedures from 0.6 to 13 years later, highlighting the importance of long-term followup.",
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N2 - Purpose: We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse. Materials and Methods: We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. Results: A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4%, isolated apical 10.7%, isolated posterior 8.3% and multiple compartments 19%. Surgery for recurrent prolapse included anterior compartment 3.3% at 1.4 ± 1.0 years, apical 9.9% at 2.8 ± 3.0 years, posterior compartment 5.8% at 2.0 ± 1.0 years and multiple compartments 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and a 5.7% rate of 30-day complications (all Clavien I). Conclusions: Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33% of patients required secondary prolapse compartment procedures from 0.6 to 13 years later, highlighting the importance of long-term followup.

AB - Purpose: We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse. Materials and Methods: We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. Results: A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4%, isolated apical 10.7%, isolated posterior 8.3% and multiple compartments 19%. Surgery for recurrent prolapse included anterior compartment 3.3% at 1.4 ± 1.0 years, apical 9.9% at 2.8 ± 3.0 years, posterior compartment 5.8% at 2.0 ± 1.0 years and multiple compartments 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and a 5.7% rate of 30-day complications (all Clavien I). Conclusions: Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33% of patients required secondary prolapse compartment procedures from 0.6 to 13 years later, highlighting the importance of long-term followup.

KW - Pelvic organ prolapse

KW - Reconstructive surgical procedures

KW - Recurrence

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