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

Abstract

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.

Evaluation and Management of Pelvic Organ Prolapse

“…Our institutional experience with this approach found a 94% re-treatmentefree survival at 5 years and 81% at 10 years. 25 Similar re-treatment rates (6% with a mean 6.5-year follow-up) have been identified in a retrospective populationbased study. 26 Obliterative Surgery (Colpocleisis).…”

Robotic versus Vaginal Surgery for Treatment of Pelvic Organ Prolapse: A Comprehensive Review

“…No articles were added by searching the reference lists. Therefore, 10 studies met the inclusion criteria and were added to the review [17,[25][26][27][28][29][30][31][32][33]. All included studies were prospective and retrospective studies published from 2013 to 2021 and described a total of 1424 patients.…”

“…Our table includes authors, year of publi-cation, research design, study sample, type of intervention, population age, patient characteristics, degree of prolapse, and hospital variables (Table 1, Ref. [17,[25][26][27][28][29][30][31][32][33]).…”

“…Overall, the literature considered women with many different baseline characteristics, thus preventing a quantitative synthesis of results. In particular, most papers reported statistically significant differences at baseline in the characteristics of patients undergoing robotic and vaginal surgery; in 9 papers [17,[25][26][27][29][30][31][32][33] it was unclear whether the statistical analysis accounted for these differences, thus eliminating potential bias.…”

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

“…One case series reported on 30 RSC patients after 3 years and reported a 13% rate of repeat surgery (33). In a retrospective study of over 100 RSC patients, retreatment rates were 8% at 5 years, with no difference in symptom relief (27).…”