TY - JOUR
T1 - Surgical outcomes after apical repair for vault compared with uterovaginal prolapse
AU - Rogers, Rebecca G.
AU - Nolen, Tracy L.
AU - Weidner, Alison C.
AU - Richter, Holly E.
AU - Eric Jelovsek, J.
AU - Shepherd, Jonathan P.
AU - Harvie, Heidi S.
AU - Brubaker, Linda
AU - Menefee, Shawn A.
AU - Myers, Deborah
AU - Hsu, Yvonne
AU - Schaffer, Joseph I.
AU - Wallace, Dennis
AU - Meikle, Susan F.
N1 - Funding Information:
Dr. Rogers has received royalties from UptoDate. Dr. Richter has received a research grant from and been a consultant for Pelvalon. She has also received royalties from UptoDate. Dr. Brubaker has received editorial revenue from UptoDate. Dr. Menefee has received royalties from UptoDate. Dr. Schaffer has received royalties from McGraw Hill, research funds from Boston Scientific, and has been a speaker for Astellas. The remaining authors did not report any potential conflicts of interest.
Funding Information:
Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (2U01HD41249, 2U10 HD41250, 2U10 HD41261, 2U10 HD41267, 1U10 HD54136, 1U10 HD54214, 1U10 HD54215, 1U10 HD54241, U10 HD069013, U10 HD069025, U10 HD069010, U10 HD069010, and U01 HD069031) and the National Institutes of Health Office of Research on Women’s Health.
Publisher Copyright:
© 2018 by American College of Obstetricians and Gynecologists.
PY - 2018
Y1 - 2018
N2 - OBJECTIVE: To retrospectively compare surgical success and complications between vaginal vault prolapse compared with uterovaginal prolapse in women who underwent apical prolapse repair for stage II-IV prolapse. METHODS: Women in one of three Pelvic Floor Disorders Network prolapse surgical trials were included. Absence of bothersome bulge symptoms, no prolapse beyond the hymen, and no subsequent prolapse treatment defined success and was our primary outcome. Secondary outcomes included comparison of quality-oflife measures, anatomic changes, and adverse events. Pelvic organ prolapse quantification (POP-Q) and quality-of-life measures were administered at baseline and 1-2 years postoperatively. Comparisons were controlled for study site, age, body mass index, baseline POP-Q, apical and anterior or posterior repair performed, and prior prolapse repair. Outcomes measured at multiple time points were analyzed using longitudinal models to assess whether differences existed across study follow-up. RESULTS: Four hundred twenty-one women underwent vault prolapse, and 601 underwent uterovaginal prolapse apical repair. The vault prolapse group was older, more likely to be white, and to have prior urinary incontinence or prolapse repair, stage IV prolapse, and more prolapse bother on a validated scale (all P#.034). The vault prolapse group was more likely to undergo sacrocolpopexy (228/421 [54%] vs 93/601 [15%]); the uterovaginal prolapse group was more likely to undergo vaginal repair (508/601 [85%] vs 193/421 [46%] P,.001). There were no differences in success (odds ratio [OR] 0.76 for vault prolapse vs uterovaginal prolapse, 95% CI 0.51-1.15, P5.20), changes in Pelvic Organ Prolapse Distress Inventory scores (279.4 vs 279.8, P5.89), postoperative POPQ point C measurements (27.0 vs 27.1 cm, P5.41), or serious adverse events (86/421 [20%] vs 90/601 [15%], P5.86) between groups. Among women who underwent a vaginal approach for repair of vault prolapse (n5193) or uterovaginal prolapse (n5508), there were no differences in success rates (OR 0.67, 95% CI 0.43-1.04, P5.09) at 1-2 years postoperatively. CONCLUSION: Surgical success of stage II-IV vault prolapse and uterovaginal prolapse apical repair was similar whether performed vaginally or abdominally at 1-2 years postoperatively.
AB - OBJECTIVE: To retrospectively compare surgical success and complications between vaginal vault prolapse compared with uterovaginal prolapse in women who underwent apical prolapse repair for stage II-IV prolapse. METHODS: Women in one of three Pelvic Floor Disorders Network prolapse surgical trials were included. Absence of bothersome bulge symptoms, no prolapse beyond the hymen, and no subsequent prolapse treatment defined success and was our primary outcome. Secondary outcomes included comparison of quality-oflife measures, anatomic changes, and adverse events. Pelvic organ prolapse quantification (POP-Q) and quality-of-life measures were administered at baseline and 1-2 years postoperatively. Comparisons were controlled for study site, age, body mass index, baseline POP-Q, apical and anterior or posterior repair performed, and prior prolapse repair. Outcomes measured at multiple time points were analyzed using longitudinal models to assess whether differences existed across study follow-up. RESULTS: Four hundred twenty-one women underwent vault prolapse, and 601 underwent uterovaginal prolapse apical repair. The vault prolapse group was older, more likely to be white, and to have prior urinary incontinence or prolapse repair, stage IV prolapse, and more prolapse bother on a validated scale (all P#.034). The vault prolapse group was more likely to undergo sacrocolpopexy (228/421 [54%] vs 93/601 [15%]); the uterovaginal prolapse group was more likely to undergo vaginal repair (508/601 [85%] vs 193/421 [46%] P,.001). There were no differences in success (odds ratio [OR] 0.76 for vault prolapse vs uterovaginal prolapse, 95% CI 0.51-1.15, P5.20), changes in Pelvic Organ Prolapse Distress Inventory scores (279.4 vs 279.8, P5.89), postoperative POPQ point C measurements (27.0 vs 27.1 cm, P5.41), or serious adverse events (86/421 [20%] vs 90/601 [15%], P5.86) between groups. Among women who underwent a vaginal approach for repair of vault prolapse (n5193) or uterovaginal prolapse (n5508), there were no differences in success rates (OR 0.67, 95% CI 0.43-1.04, P5.09) at 1-2 years postoperatively. CONCLUSION: Surgical success of stage II-IV vault prolapse and uterovaginal prolapse apical repair was similar whether performed vaginally or abdominally at 1-2 years postoperatively.
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U2 - 10.1097/AOG.0000000000002492
DO - 10.1097/AOG.0000000000002492
M3 - Article
C2 - 29420409
AN - SCOPUS:85047747457
VL - 131
SP - 475
EP - 483
JO - Obstetrics and Gynecology
JF - Obstetrics and Gynecology
SN - 0029-7844
IS - 3
ER -