2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Abstract

OBJECTIVE-Recurrent pelvic organ prolapse (POP) has been attributed to many factors, one of which is lack of vaginal apical support. To assess the role of vaginal apical support and POP, we analyzed a national dataset to compare long-term reoperation rates after prolapse surgery performed with and without apical support. METHODS-PublicUse File data on a 5% random national sample of female Medicare beneficiaries was obtained from the Centers for Medicare and Medicaid Services. Women with POP who underwent surgery during 1999 were identified by relevant International Classification of Diseases, 9 th revision, Clinical Modification and Current Procedural Terminology, 4 th edition codes. Individual patients were followed through 2009. Prolapse repair was categorized as anterior, posterior, or anterior-posterior with or without a concomitant apical suspension procedure. The primary outcome was the rate of retreatment for POP. 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery that year. There were 2,756 women who underwent an anterior colporrhapy, posterior colporrhaphy, or both with or without apical suspension. After 10 years, cumulative reoperation rates were highest among women who had an isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%, p < 0.01). RESULTS-InCONCLUSION-Ten years after surgery for POP, the reoperation rate was significantly reduced when a concomitant apical suspension procedure was performed.

A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation

“…1,2 In two-thirds of these post-hysterectomy prolapses, there is multi-compartment prolapse present 3 and it is now established that vault support significantly improves the results of both anterior and posterior wall reconstructive surgery, in terms of longevity of repair, reducing reoperation rates at 10 years from 20% to 11%. 4 Vault support can be achieved either via abdominal or vaginal techniques.…”

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

“…Instead of covering the presumed defects, the importance of apical support in the pathophysiology of pelvic organ prolapse is gaining increased recognition [5]. Rather than being considered an isolated defect, anterior vaginal wall prolapse (cystocele) is often considered a consequence of an undiagnosed apical defect (level I deficiency).…”

“…Rather than being considered an isolated defect, anterior vaginal wall prolapse (cystocele) is often considered a consequence of an undiagnosed apical defect (level I deficiency). Thus, native tissue repair or covering the anterior vaginal tissue defect with mesh without addressing the apical defect may contribute to the unfavorable recurrence rates often described after transvaginal surgery [5]. In line with this reasoning, a biomaterialaugmented surgical intervention to address level I and II deficiencies of the anterior compartment should ideally address both the tissue defect and the lack of support, while at the same time minimizing the intraoperative dissection and postoperative biomaterial load.…”

Recurrent pelvic organ prolapse: a case report

“…15 The success rate of apical fixation procedures is 82-92%. Increasingly, women wish to avoid hysterectomy, because of delay in childbearing and the belief that the uterus is important for sexual satisfaction.…”