Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study)

Abstract

Background Abdominal and laparoscopic sacro-colpopexy (LSC) is considered the standard surgical option for the management of a symptomatic apical pelvic organ prolapse (POP). Women who have their uterus, and for whom an LSC is indicated, can have a laparoscopic sacro-hysteropexy (LSH), a laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH + LSC) or a total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH + LSC). The main aim of this study was to compare clinical and patient reported outcomes of uterine sparing versus concomitant hysterectomy LSC procedures. Methods A retrospective analysis of clinical, imaging and patient reported outcomes at baseline, 3 and 12 months after LSH versus either LSCH + LSC or TLH + LSC between January 2015 and January 2019 in a tertiary referral urogynecology center in Pilsen, the Czech Republic. Results In total, 294 women were included in this analysis (LSH n = 43, LSCH + LSC n = 208 and TLH + LSC n = 43). There were no differences in the incidence of perioperative injuries and complications. There were no statistically significant differences between the concomitant hysterectomy and the uterine sparing groups in any of the operative, clinical or patient reported outcomes except for a significantly lower anterior compartment failure rate (p = 0.017) and higher optimal mesh placement rate at 12 months in women who had concomitant hysterectomy procedures (p = 0.006). Conclusion LSH seems to be associated with higher incidence of anterior compartment failures and suboptimal mesh placement based on postoperative imaging techniques compared to LSC with concomitant hysterectomy.

Rate of Mesh Erosion After Sacrocolpopexy With Concurrent Supracervical Compared With Total Hysterectomy

“…Twelve studies reported treatment outcomes in 319 women (including women with a history of hysterectomy) with mesh erosion, and 77% (247/ 319) required re-operation for a mesh-related complication. 7,8,10,11,13,[15][16][17]27,28 Seven studies reported patientlevel data on those women with mesh erosion treated with conservative measures (n528), with 17 (61%) treated with expectant management, six (21%) treated with vaginal estrogen, and five (19%) treated with excision of mesh in the office. 8,10,11,15,16,27,28 In studies that reported mesh erosion, most did not stratify the level of complication associated with mesh erosion based on published classification systems.…”

“…Some studies have shown a lower rate of mesh erosion when supracervical hysterectomy was performed compared with total hysterectomy, whereas others have noted no difference. [7][8][9][10][11][12][13][14][15][16][17][18][19] Expert consensus opinions have been conflicting, with a few stating that total hysterectomy concurrently performed with abdominal sacrocolpopexy should be avoided, whereas others indicate that further evaluation is necessary. 20,21 Yet, recent trends in the United States show almost equal proportions of concomitant supracervical hysterectomy compared with total hysterectomy being performed at the time of abdominal sacrocolpopexy.…”

“…Excluding this study, treatment outcomes in 97 women (including women with a history of prior hysterectomy) with mesh erosion noted that 54% (52/97) required re-operation for a mesh related complication. 7,8,10,11,13,15,16,27,28 This study has several strengths, including a prospectively disclosed protocol, a comprehensive search scheme with no limitations of language that included populaces from varied parts of the world, and study of contemporary surgical practices for abdominal sacrocolpopexy. Limitations of our study should be noted.…”

Medium-Term Risk of Recurrent Pelvic Organ Prolapse within 2-Year Follow-Up after Laparoscopic Sacrocolpopexy

“…The percentage of cases with surgical failure in the anterior compartment was also higher in the subgroup with UP (10.7%) than in concomitant SCH (4.0%) in the present study. Our results with regard to anterior compartment failures were similar to those of Gagyor et al .,[ 22 ] who reported rates of 21.1% in cases undergoing UP and 8.8% in those undergoing SCH at 1 year postoperatively. Surgical failure in the posterior compartment was also more common in the UP subgroup (7.1%) than the SCH subgroup (2.3%) in our cohort, in contrast to the results of Gagyor et al .…”

“…Surgical failure in the posterior compartment was also more common in the UP subgroup (7.1%) than the SCH subgroup (2.3%) in our cohort, in contrast to the results of Gagyor et al . [ 22 ] who reported posterior compartment failure rates of 0% in the UP group and 15.8% in the SCH group. Our UP subgroup showed no cases of apical compartment failure too, which only occurred in the SCH subgroup (1.7%).…”