Differences in recurrent prolapse at 1 year after total vs supracervical hysterectomy and robotic sacrocolpopexy

Myers, Erinn M.; Siff, Lauren N.; Osmundsen, Blake; Geller, Elizabeth J.; Matthews, Catherine A.

doi:10.1007/s00192-014-2551-2

Cited by 44 publications

(36 citation statements)

References 18 publications

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“…The benefits of supracervical hysterectomy may reduce the risk of mesh erosion, thus avoiding cautery-induced thermal injury to the vagina [61]. Warner et al [57] observed a 4.9% mesh exposure rate for the total hysterectomy group, but no mesh exposures were seen in the supracervical hysterectomy group (p=0.03).…”

Section: Surgery For Apical Vaginal Prolapsementioning

confidence: 99%

“…A retrospective study demonstrated that supracervical hysterectomy with sacrocolpopexy was 2.8 times more likely to result in recurrent prolapse than total hysterectomy with sacrocolpopexy, when recurrent prolapse was defined as prolapse greater than or equal to stage 2. This study did not have sufficient power to detect differences in rates of mesh exposure, with 7.5% in the total hysterectomy with sacrocolpopexy group vs. 2.3% in the supracervical hysterectomy with sacrocolpopexy group (p=0.35) [61].…”

Section: Surgery For Apical Vaginal Prolapsementioning

confidence: 99%

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Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes

Lee

2019

Investig Clin Urol

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There are a variety of surgical management strategies to help surgeons repair pelvic organ prolapse (POP). Surgical treatment for POP includes native tissue repair, augmentation with mesh, and minimally invasive surgeries. Currently, laparoscopic or robotic techniques for POP repair are increasing in popularity and continuing to evolve. The aim of this review is to present an up-to-date review of surgical techniques used for POP repair and to discuss ways to optimize surgical outcomes.

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Section: Surgery For Apical Vaginal Prolapsementioning

confidence: 99%

Section: Surgery For Apical Vaginal Prolapsementioning

confidence: 99%

Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes

Lee

2019

Investig Clin Urol

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“…Myers et al [ 15 ] showed that women who underwent subtotal hysterectomy versus a total hysterectomy during RASC were more likely to have a recurrent prolapse (stage ≥2 of any compartment) after 1 year. No statistically bothersome symptoms were detected.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study

et al. 2021

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Introduction and hypothesis Surgery for pelvic organ prolapse (POP) has high recurrence rates. Long-term anatomical and patient-reported outcomes after pelvic floor repair are therefore required. Methods This prospective observational cohort study was conducted in a teaching hospital with tertiary referral function for patients with POP. Patients with symptomatic vaginal vault or uterine prolapse (simplified POP Quantification [sPOPQ] stage ≥2), who underwent robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS), were included. Follow-up visits with sPOPQ evaluations were planned 4 years after surgery. Patients received pre- and postoperative questionnaires reporting symptoms of vaginal bulge, Urogenital Distress Inventory (UDI-6), and Pelvic Floor Impact Questionnaire (PFIQ-7). Primary outcome was patient self-reported symptoms. Secondary outcome was anatomical cure (sPOPQ stage 1) for all vaginal compartments. Results Seventy-seven patients were included. Sixty-one patients (79%) were evaluated after 50 months (physical examination n = 51). Symptoms of bulge (95% vs 15% p ˂ 0.0005), median UDI-6 scores (26.7 vs 22.2, p = 0.048), median PFIQ-7 scores (60.0 vs 0, p = 0.008), and median sPOPQ stages in all landmarks improved significantly from the pre- to the postoperative visit. Thirty patients (59%) were completely recurrence free and 96% of patients had no apical recurrence. Most recurrences were asymptomatic cystoceles (20%). There was one surgical re-intervention for recurrent prolapse (1.6%). Conclusions Robot-assisted sacrocolpopexy and RSHS show sustainable results in the treatment of prolapse. Symptoms of bulge, urinary symptoms, and quality of life improved substantially 50 months postoperatively. Patients should be counseled about the risk of anterior wall recurrence and the small chance of recurrent symptoms that need treatment.

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“…Roboticassisted total hysterectomy and sacrocolpopexy have been associated with higher rates of mesh exposure (please see complication section of paper) (41,49,50) but lower rates of recurrent anterior vaginal wall prolapse. In a retrospective cohort study of 83 women undergoing robotic supracervical versus total hysterectomy and sacrocolpopexy, those in the supracervical group demonstrated a significantly higher rate of recurrent anterior compartment prolapse (41.9% vs. 20.0%, P=0.03) (51). Similarly, in a prospective cohort study of women undergoing robotic-assisted sacrocolpopexy versus supracervical hysterectomy and cervicosacropexy, rates of recurrent anterior wall prolapse were higher in the cervical preservation group (28).…”

Section: Robotic-assisted Hysterectomy and Sacrocolpopexymentioning

confidence: 93%

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

Schachar¹,

Matthews²

2020

Transl Androl Urol

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The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females.Sacrocolpopexy is the "gold standard" repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques.The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients.Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.

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Differences in recurrent prolapse at 1 year after total vs supracervical hysterectomy and robotic sacrocolpopexy

Abstract: Women who underwent an SRH were 2.8 times more likely to have a recurrent prolapse, ≥ stage II, at 1 year, compared with those who underwent a TRH, but when composite assessment scores were used there was no difference between the groups.

Cited by 44 publications

References 18 publications

Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes

Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes

Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study

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

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