Long-Term Patient Satisfaction With Michigan Four-Wall Sacrospinous Ligament Suspension for Prolapse

Larson, Kindra; Smith, Tovia M.; Berger, Mitchell B.; Abernethy, Melinda G.; Mead, Susan Fields; Fenner, Dee E.; DeLancey, John O.L.; Morgan, Daniel M.

doi:10.1097/aog.0b013e3182a7f0d5

Cited by 43 publications

(20 citation statements)

References 17 publications

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“…These observations provide a biomechanical explanation for why the hymen has emerged as an appropriate level both for defining symptomatic prolapse and for assessing surgical cure [24]. It is also consistent with the observation that women's dissatisfaction with surgical results increases once the vaginal wall is below the hymen, but not when it is at or above the hymen [25]. …”

Section: Discussionsupporting

confidence: 68%

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

et al. 2014

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Introduction and hypothesis In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or perineal body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation. Methods Fifty women were selected to represent a full spectrum of AVW support. Each underwent supine, dynamic MR imaging. Most dependent bladder location and apical location were measured relative to the average normal position on the mid-sagittal plane using the Pelvic Inclination Correction System . The length of the exposed AVW and the hiatus diameter were measured as well. The relationship between exposed AVW and most dependent bladder location, apical location, and hiatus diameter were examined. Results A bilinear relationship has been observed between exposed vaginal wall length and most dependent bladder location (R2=0.91, P<0.001). When the bladder descents up to the inflection point (about 4.4 cm away from its normal position), there is little change in the exposed AVW length. With further descent, the exposed vaginal wall length increases significantly, with a 2 cm increase in exposed AVW length for every additional 1 cm of drop bladder location. A similar but weaker bilinear relationship exists between exposed AVW and apical location. Exposed vaginal wall length is also highly correlated with hiatus diameter (R2=0.85, P<0.001). Conclusion A bilinear relationship exists between exposed vaginal wall length and most dependent bladder location and apical location. It is when the bladder descent is beyond the inflection point that exposed vaginal wall length increases significantly.

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Section: Discussionsupporting

confidence: 68%

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

et al. 2014

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“…Other studies have commented upon the overall high objective and/or subjective success of uterosacral ligament suspension and/or McCall or modified McCall culdoplasty (20) and/or other restorative native tissue repairs, such as sacrospinous ligament suspension (21). In a systematic review of uterosacral ligament suspension, Margulies et al (22) described a pooled success rate (based on a definition of anatomic prolapse stage or grade <2 of 81.2% to 94.4% in all compartments, similar to our success rate at 5 years but with a different median follow-up length of 25 months.…”

Section: Discussionmentioning

confidence: 99%

Symptom Relief and Retreatment After Vaginal, Open, or Robotic Surgery for Apical Vaginal Prolapse

Anand¹,

Weaver²,

Fruth³

et al. 2017

Female Pelvic Med Reconstr Surg

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Objectives To determine the degree of symptom relief and survival free of retreatment after Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse. Methods We retrospectively studied patients who had undergone surgery for posthysterectomy apical vaginal prolapse from January 1, 2000, through June 30, 2012, at our institution. Baseline characteristics and perioperative outcomes were abstracted from electronic health records. Cross-sectional data for current pelvic floor symptoms were collected by using validated questionnaires. Survival free of retreatment was estimated with the Kaplan-Meier method. To account for selection bias, adjusted analyses using inverse probability weighting (IPW) were performed to compare outcomes for MMC vs ASC, MMC vs RSC, and ASC vs RSC. Results Of 512 patients, 337 completed at least a validated or abbreviated questionnaire. Among MMC, ASC, and RSC groups, overall PFDI-20, PFIQ-7, and PISQ-12 summary scores were not statistically significant. There was no significant difference in 5-year survival free of retreatment for MMC (94.0%) vs RSC (95.5%) and ASC (94.8%) vs RSC (92.1%). However, patients who had MMC were more likely to have retreatment than patients who had ASC during the first 10 years (10-year survival free of retreatment: 81.1% vs 95.4%; hazard ratio, 3.68 [95% CI, 1.51–8.98]); the 10-year data were not available for RSC comparisons, given the later initiation of RSC. Conclusions Symptom relief was comparable after MMC, ASC, and RSC. Among all groups, most patients were free of retreatment for prolapse at 5 years. Between MMC and ASC groups, survival free of retreatment (%) within 10 years was still favorable, but ASC had greater durability, particularly after accounting for selection bias.

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“…25 Similar to this study, several recent publications offer stronger evidence for improvement in quality of life: Larson et al reported high satisfaction rates eight years after sacrospinous ligament suspension, even in those women with pelvic floor defects at the hymenal ring after surgery. 26 Ulrich and colleagues reported that improvements in vaginal and sexual function depended on the type of repair, with patients undergoing levator plication reporting less benefit compared to women undergoing posterior prolapse repairs without levator plication 27 . Our study adds a large sample of highly characterized patients reporting improvement using standardized validated questionnaires.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life and Sexual Function 2 Years After Vaginal Surgery for Prolapse: Correction

2017

Obstetrics &Amp; Gynecology

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Objective-To longitudinally assess the effect of native tissue vaginal apical prolapse repair with anti-incontinence surgery on quality of life, sexual function, and body image between uterosacral and sacrospinous suspensions.Methods-A planned secondary analysis was performed on 374 women enrolled in a randomized trial of the two types of native tissue repair for apical prolapse. Condition-specific and HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript generic quality of life, sexual function, overall and de novo dyspareunia, and body image were assessed using validated instruments at baseline, 6, 12, and 24 months postoperatively, and changes from baseline were assessed and compared between surgical groups. General linear mixed models were used for comparisons and clinically significant differences were assessed using minimum important differences.Results-Of the women randomized, 82% had outcomes available at 2 years. Overall, clinically and statistically significant improvements in generic and condition-specific quality of life and sexual function were observed after surgery. Dyspareunia rates decreased from 25% to 16% by 24 months, with only 3% of all women undergoing treatment. De novo dyspareunia occurred in 5% and 10% by 12 and 24 months, respectively. Body image scores also significantly improved from baseline. There were no clinically meaningful or statistically significant differences between groups for any of these outcomes (all p>0.05).Conclusion-Native tissue vaginal prolapse surgery results in statistically and clinically significant improvements in quality of life, sexual function, and body image at 24 months with no significant differences between uterosacral and sacrospinous suspensions. One in 10 women experience de novo dyspareunia but few requested treatment.

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Long-Term Patient Satisfaction With Michigan Four-Wall Sacrospinous Ligament Suspension for Prolapse

Cited by 43 publications

References 17 publications

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

Symptom Relief and Retreatment After Vaginal, Open, or Robotic Surgery for Apical Vaginal Prolapse

Quality of Life and Sexual Function 2 Years After Vaginal Surgery for Prolapse: Correction

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