Reoperation for pelvic organ prolapse within 10 years of primary surgery for prolapse

Gotthart, Philipp T.; Aigmueller, Thomas; Lang, P.; Ralph, G.; Bjelic‐Radisic, Vesna; Tamussino, Karl

doi:10.1007/s00192-012-1736-9

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…Studies with longer term follow-up indicate that anatomic outcomes for mesh and non-mesh apical procedures are similar [16][17][18][19]. In fact, the results from one of the most rigorous and respected RCTs concerning SC show that the rate of recurrent prolapse symptoms is similar to rates often quoted for traditional native tissue repairs and the mesh complication rate is similar to that seen with vaginal mesh procedures [19].…”

mentioning

confidence: 78%

Systematic reviews of apical prolapse surgery: are we being misled down a dangerous path?

Moen¹,

Gebhart

Tamussino

2015

Int Urogynecol J

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BI was told I had the best procedure for my condition. Is it true I could have had vaginal surgery without mesh?^This question was posed by the 43-year-old woman now facing the need for adhesiolysis and trachelectomy due to pelvic pain and cyclic bleeding two years after undergoing laparoscopic supracervical hysterectomy and mesh sacrocervicopexy for stage 3 uterine prolapse (Fig. 1).The claim of superiority of sacrocolpopexy (SC) over other pelvic organ prolapse (POP) procedures was initiated by the results of three randomized controlled trials (RCTs) involving a total of 287 patients comparing abdominal SC (ASC) and sacrospinous ligament fixation (SSLF) published in 1996, 1998 and 2004 [1-3]. These studies reported superior anatomic outcomes with ASC when compared with SSLF, but also showed higher short-term morbidity with ASC. The claim of superiority of ASC over SSLF was further reinforced with the publication of the first Cochrane systematic review of surgery for POP published in 2004, which summarized the findings of the three previously mentioned studies stating Babdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse and less dyspareunia, but the trend towards a lower reoperation rate for prolapse following abdominal sacrocolpopexy was not statistically significant^ [4]. Since these initial RCTs comparing ASC with SSLF, several systematic reviews have shown the same findings of superior anatomic outcomes associated with ASC compared with SSLF [4][5][6][7][8][9][10][11]. These reviews reinforce the perception that there is a large body of evidence supporting ASC as the best option for treating POP.Laparoscopic SC (LSC) and robot-assisted SC have been developed to reduce the short-term morbidity associated with ASC [12,13]. Many surgeons consider these less invasive approaches to SC (and variations such as sacrocervicopexy) equivalent to ASC in terms of anatomic outcome leading them to claim that LSC and robotic SC approaches are now the best options for treating POP. The most recent Cochrane review published in 2013 concludes Bsacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinous colpopexy, uterosacral colpopexy and transvaginal mesh^implying that all forms of SC are superior to all other surgical options for treating apical prolapse [9].A close look at the current literature, however, reveals that there are actually very few level 1 studies from which to derive such a bold conclusion concerning SC compared with other options for treating POP. Only two studies comparing SC with other procedures have been added to the Cochrane review over the past decade and both of these are controversial. One is a trial comparing LSC with total vaginal mesh (TVM) that showed superiority of LSC compared to TVM [14]. The study is controversial because the reported success rate for TVM was significantly lower than the rate achieved by other authors and because of this low rate, LSC was reported as superior. The...

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confidence: 78%

Systematic reviews of apical prolapse surgery: are we being misled down a dangerous path?

Moen¹,

Gebhart

Tamussino

2015

Int Urogynecol J

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“…The benefits of ASC have to be weighed against the risks associated with synthetic mesh erosion, longer operating time, and longer recovery time. Although overall re‐operation rates for traditional anterior colporrhapy are variable, reported as 1–20.2%, they appear to significantly improve when concomitant apical suspension procedure is performed at time of prolapse surgery . A study of 2,756 female medicare beneficiaries who underwent anterior colporrhapy, posterior colporrhapy, or both with or without apical suspension, showed that cumulative re‐operation rates were highest among women who had isolated anterior repair (20.2%) and significantly exceeded re‐operation rates among women who had a concomitant apical support procedure (11.6%, P < 0.01) .…”

Section: Discussionmentioning

confidence: 99%

“…Although overall re-operation rates for traditional anterior colporrhapy are variable, reported as 1-20.2%, they appear to significantly improve when concomitant apical suspension procedure is performed at time of prolapse surgery. 6,[17][18][19] A study of 2,756 female medicare beneficiaries who underwent anterior colporrhapy, posterior colporrhapy, or both with or without apical suspension, showed that cumulative re-operation rates were highest among women who had isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%, P < 0.01). 18 Again, the implicit conclusion is that persistent prolapse represents an unreinforced compartment due to failure to diagnose and treat apical support defects rather than true prolapse recurrence.…”

Section: Discussionmentioning

confidence: 99%

Prolapse repair with and without apical resuspension—Practice patterns among certifying American urologists

Liu

Nettey

et al. 2015

Neurourology and Urodynamics

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“…Estimates of prolapse recurrence vary widely due to differences in study design and length of follow-up ranging from 2.3% 5,7 to 29.2% 8 . Moreover, differential findings from three RCTs resulted in discordant conclusions with respect to the best apical surgery 2–4 .…”

Section: Introductionmentioning

confidence: 99%

Readmission and Prolapse Recurrence After Abdominal and Vaginal Apical Suspensions in Older Women

Sanses

Hanley

Zhang

et al. 2016

Obstetrics &Amp; Gynecology

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Objective Our objective was to evaluate 30-day readmission, 12-month prolapse recurrence, and complications after apical surgeries in older women. Methods A retrospective cohort study was conducted using 2002–2011 Medicare data in women ≥65 years who underwent abdominal sacrocolpopexy with synthetic mesh, or vaginal uterosacral, or sacrospinous colpopexy with 12-months follow-up. Vaginal mesh procedures were excluded. The primary outcome was 30-day inpatient readmission. Secondary outcomes were complications and prolapse recurrence, defined as either reoperation or pessary insertion. We used Pearson Chi-square, Fisher’s tests and ANOVAs to examine difference between surgical treatment groups. Odds Ratio (OR) utilizing Charlson Comorbidity Index, age, race, and procedure type were calculated to assess the differences in the outcomes probability. Results Out of 3015 women, 863 underwent abdominal sacrocolpopexy, 510 – uterosacral, and 1642 – sacrospinous ligament suspensions. The 30-day readmission was 7.4% (95% Confidence Interval (CI) 5.7–9.2%), OR= 2.4 (95% CI 1.7–3.5, p<0.01) after abdominal sacrocolpopexy, 4.5% (95% CI 2.7–6.3%), OR=1.3 (95% CI 0.8–2.1, p=0.3) after uterosacral compared to 3.5% (95% CI 2.6–4.4% p<0.01) after sacrospinous ligament suspensions. Prolapse recurrence did not differ between the groups 8.2% (95% CI 6.4–10.1%), 10.6% (95% CI 7.9–13.3%), and 9.9%, (95 CI 8.4–11.3%, p=0.3), respectively. Women had 30-day gastrointestinal complications 6.1% (95% CI 4.5–7.7%), 1.2% (95% CI 0.2–2.1%), and 1.1% (95% CI 0.6–1.6%, p<0.01); surgical site infections 5.9% (95% CI 4.3–7.5%), 3.1% (95% 1.6–4.7%) and 3.7% (95% CI 2.8–4.6%, p=0.01); genitourinary complications 10.9% (95% CI 8.8–13%), 17.7% (95% CI 14.3–21%), and 13.6% (95% CI 12–15.3%, p<0.01); and medical complications 7.4% (95% CI 5.7–9.2%), 7.8% (95% CI 5.5–10.2%), and 4.4% (95% CI 3.4–5.4%, p<0.01); (all after abdominal sacrocolpopexy, uterosacral, and sacrospinous ligament suspensions, respectively). Conclusions Vaginal apical suspensions compared to abdominal sacrocolpopexy with synthetic mesh are associated with lower rates of postoperative 30-day readmissions without increase in prolapse recurrence among older women.

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Reoperation for pelvic organ prolapse within 10 years of primary surgery for prolapse

Abstract: The reoperation rate for prolapse after primary vaginal hysterectomy and colporrhaphy appears to be modest in this series of patients.

Cited by 16 publications

References 18 publications

Systematic reviews of apical prolapse surgery: are we being misled down a dangerous path?

Systematic reviews of apical prolapse surgery: are we being misled down a dangerous path?

Prolapse repair with and without apical resuspension—Practice patterns among certifying American urologists

Readmission and Prolapse Recurrence After Abdominal and Vaginal Apical Suspensions in Older Women

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