Ureteral Compromise in Laparoscopic Versus Vaginal Uterosacral Ligament Suspension

Barbier, Heather M.; Smith, Margo; Eto, C.U.; Welgoss, J.; Pechmann, Walter von; Horbach, Nicolette S.; Gruber, Daniel

doi:10.1097/spv.0000000000000202

Cited by 22 publications

(10 citation statements)

References 8 publications

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“…This shortened length of admission was notable because 87% of patients underwent hysterectomy; however, 38% were discharged on postoperative day 0 and 60% were discharged on postoperative day 1. In addition, there was no ureteral injury or compromise in the L-USLS cohort, which is consistent with prior studies that report a 0% rate of ureteral compromise [6,[10][11][12]. The low rate of ureteral injury is postulated to be due to the laparoscopic approach allowing visualization of the ureter course to avoid ureter injury or kinking.…”

Section: Discussionsupporting

confidence: 88%

“…The laparoscopic approach to USLS (L-USLS) is gaining more widespread use because it allows full visualization of the uterosacral ligament, allowing suspension at a higher point along the uterosacral ligament. Studies comparing L-USLS to V-USLS showed a lower risk of ureteral compromise compared to V-USLS [4][5][6]. In addition, Turner et al found no significant difference in prolapse recurrence between L-USLS and V-USLS [7].…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic uterosacral ligament suspension versus sacrospinous ligament fixation for apical prolapse: perioperative outcomes

et al. 2021

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Background Pelvic organ prolapse can be repaired vaginally or laparoscopically. Studies comparing vaginal repair with sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (V-USLS) have found no difference in functional or adverse outcomes. Laparoscopic USLS (L-USLS) is becoming a popular treatment for pelvic organ prolapse because it has a low rate of ureteral compromise. To date, no studies have compared perioperative outcomes between L-USLS and SSLF. The objective of this study is to compare the rates of perioperative complications between these two methods. Methods This was a retrospective chart review of 243 consecutive patients who underwent L-USLS or SSLF at one institution between March 2017 and August 2019 for apical pelvic organ prolapse. Descriptive data was analyzed as appropriate with Student’s t tests and chi-square. Univariable logistic regression analysis was performed to assess predictors of perioperative complications. Results Preoperative Pelvic Organ Prolapse Quantification Stage (POP-Q) was similar between the two cohorts (p = 0.23). After adjusting for confounding factors, L-USLS was associated with a longer operative time (118 vs 142 min, p < 0.01) and shorter length of hospitalization (0.68 vs 1.06 days, p < 0.01). The estimated blood loss between the procedures was not statistically significant after adjusting for confounding factors. There was no difference in perioperative complication rates between L-USLS and SSLF (5% vs 7%, p = 0.55). No clinical risk factors were significantly associated with perioperative complications. Conclusion We did not find a difference in complications between L-USLS and SSLF.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Laparoscopic uterosacral ligament suspension versus sacrospinous ligament fixation for apical prolapse: perioperative outcomes

et al. 2021

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“…In addition, there was no ureteral injury or compromise in the L-USLS cohort, which is consistent with prior studies that report a 0% rate of ureteral compromise. 6,[10][11][12] The low rate of ureteral injury is postulated to be due to the laparoscopic approach allowing visualization of the ureter course to avoid ureter injury or kinking. This is a potential advantage over V-USLS as it has been associated with a 3-8% incidence of ureteral compromise.…”

Section: Discussionmentioning

confidence: 99%

“…Studies comparing L-USLS to V-USLS showed a lower risk of ureteral compromise compared to V-USLS. [4][5][6] In addition, Turner et al found no signi cant difference in prolapse recurrence between L-USLS and V-USLS. 7 To date, there are no studies comparing perioperative complications and surgical outcomes between L-USLS and SSLF to guide patient counseling.…”

Section: Introductionmentioning

confidence: 98%

Laparoscopic Uterosacral Ligament Suspension versus Sacrospinous Ligament Fixation for Apical Prolapse: Perioperative Outcomes

Gabra

Winget

Torabi

et al. 2021

Preprint

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Background: Pelvic organ prolapse can be repaired vaginally or laparoscopically. Studies comparing vaginal repair with sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (V-USLS) have found no difference in functional or adverse outcomes. Laparoscopic USLS (L-USLS) is becoming a popular treatment for pelvic organ prolapse because it has a low rate of ureteral compromise. To date, no studies have compared perioperative outcomes between L-USLS and SSLF. The objective of this study is to compare the rates of perioperative complications (intraoperative and postoperative complications) between these two methods.Methods: This was a retrospective chart review of 243 consecutive patients who underwent L-USLS or SSLF at one institution between 3/2017 and 8/2019 for apical pelvic organ prolapse. Descriptive data was analyzed as appropriate with student t-tests and Chi Square. Univariable Logistic Regression analysis was performed to assess predictors of perioperative complications.Results: Preoperative Pelvic Organ Prolapse Quantification Stage (POP-Q) was similar between the two cohorts (p=0.23). After adjusting for confounding factors, L-USLS was associated with a longer operative time (118 vs 142 min, p <0.01) and shorter length of hospitalization (0.68 vs 1.06 days, p <0.01). The estimated blood loss between the procedures was not statistically significant after adjusting for confounding factors. There was no difference in perioperative complication rates between L-USLS and SSLF (5% vs 7%, p = 0.55). No clinical risk factors were significantly associated with perioperative complications.Conclusion: We did not find a difference in complications between L-USLS and SSLF.

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“…Ureteral obstruction in vaginal USL varies from 1-11%, which can be minimized by suturing deep in the intermediate third of the uterosacral ligament or performing the procedure abdominally where the ureter can be more easily freed and visualized [15][16][17][18]. There has been shown to be minimal ureter obstruction with laparoscopic USL [19]. Nerve injuries can occur as the visceral fibers of the inferior hypogastric plexus in the S2-3 dermatome have been shown to be associated with USL and rarely require suture removal [20].…”

Section: Prolapsementioning

confidence: 99%

Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries

Eddib¹,

Eddib²,

Fan³

2020

JSO

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Background: Many women diagnosed with a gynecologic malignancy may have coinciding urogynecologic complaints, such as pelvic organ prolapse (POP) and/or urinary incontinence, with approximately 35% reporting moderate to severe symptoms. Recent National Surgical Quality Improvement Program (NSQIP) database inquiries of gynecologic cancer cases found only 2.3-2.4% of women undergoing interventional surgery for gynecologic malignancy also had a procedure for pelvic organ prolapse urinary incontinence (POPUI), and those combination cases did not show significant increase in postoperative risks. The purpose of our study is to review our cases of gynecologic cancer that underwent concomitant urogynecologic procedures and compare their perioperative outcomes to gynecologic cancer cases without concomitant urogynecologic procedures. Methods: A retrospective cohort study conducted at a teaching hospital included 29 gynecologic oncology patients who underwent robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Controls underwent standard staging procedure and were compared to women with concomitant pelvic floor dysfunction that underwent additional laparoscopic uterosacral ligament suspension for apical suspension and a sling for stress urinary incontinence (SUI). The primary outcome was operative time, defined as documented total operative time and robot console time. Secondary outcomes include delta hemoglobin, hospital length of stay, readmission rate, total pain medication, urinary retention and discharge with foley. Results: The combined case group had longer total procedure time duration (301 minutes versus 210 minutes, p-value < 0.0001), with comparable mean console time (178 minutes versus 160 minutes; p = 0.1456). Blood loss estimated by mean percent difference of Hgb showed moderate conditional dependence on surgical case (22.2% cases versus 14.9% controls, p-value 0.04). Combined cases resulted in 76.9% of subjects discharged with a foley catheter compared to none in controls (p-value < 0.0001). Otherwise, there was no difference in the other perioperative outcomes between the two groups. Conclusion: With appropriate counseling and clinical judgement, combined urogynecologic and gynecologic oncologic surgeries can be performed to improve a patient’s quality of life (QOL) with minimal increase in perioperative morbidity.

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Ureteral Compromise in Laparoscopic Versus Vaginal Uterosacral Ligament Suspension

Abstract: We found a lower rate of ureteral compromise in the laparoscopic approach to USLS compared with the traditional vaginal approach.

Cited by 22 publications

References 8 publications

Laparoscopic uterosacral ligament suspension versus sacrospinous ligament fixation for apical prolapse: perioperative outcomes

Laparoscopic uterosacral ligament suspension versus sacrospinous ligament fixation for apical prolapse: perioperative outcomes

Laparoscopic Uterosacral Ligament Suspension versus Sacrospinous Ligament Fixation for Apical Prolapse: Perioperative Outcomes

Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries

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