Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Abstract

OBJECTIVE:We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN:This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS:In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2e38.6), which included 20.3% (95% CI, 17.9e23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6e1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4e6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6e3.5) and 0.8% (95% CI, 0.4e1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02e0.6) and 0.8% (95% CI, 0.4e1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4e16.8): 10.6% (95% CI, 8.8e12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2e13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4e4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION:Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse. P elvic organ prolapse (POP) is a common problem in women and is associated with considerable morbidity and a decreased quality of life. In the United States, the prevalence of POP is approximately 2.9% 1 and nearly 300,000 women undergo surgery annually for prolapse. 2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterec...

Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates

“…30,33,34 In our population, the use of D10 was associated with a 22% increase in UTI with a number needed to harm of 4.5 (absolute rate in D10 group of 47.8%). Patients whose cystoscopy was performed with D10 had a 3.4 times greater odds of being treated for a UTI in the 6 weeks following surgery, even after adjusting for a history of prolonged postoperative catheterization and preoperative recurrent UTI, which are among the most modifiable risk factors of postoperative UTI in patients undergoing urogynecological procedures.…”

“…In a retrospective chart review of 983 women who underwent uterosacral colpopexy for pelvic organ prolapse between January 2006 and December 2011, the overall rate of UTI was 20.3% (95% confidence interval [CI], 17.9e23.6). 30 Presuming a 20% baseline UTI rate in our control group and a fixed sample size of 110 patients in the D10 arm and 180 patients in the NS arm, this study had 80% power to detect an absolute increase of 15% in the UTI rate. We used PASS 11 software ajog.org GYNECOLOGY Original Research from NCSS (Kaysville, UT) to perform our power analysis.…”

“…This is comparable with the published rates of ureteral obstruction or LUT injury during gynecological surgeries that range from 1.3% to 11%. 11,12,30,[38][39][40] Gustilo-Ashby et al 12 performed a retrospective review of 700 patients who underwent routine intraoperative cystoscopy with indigo carmine at the time of surgery for pelvic organ prolapse at our institution, and the incidence of transient intraoperative ureteral obstruction was 5.1% and the true ureteral injury rate was 0.9%. Intraoperative cystoscopy performed with intravenous indigo carmine was found to be accurate in 99.3% of cases.…”

Laparoscopic Management of Vaginal Vault Prolapse Recurring after Pelvic Organ Prolapse Surgery

“…It has also been demonstrated that a mesh repair of POP in only one compartment leads to a significantly higher percentage of clinically relevant de novo prolapse of the untreated vaginal compartment [15,16]. Sacropexy, which is considered the most durable procedure for advanced POP, in the long term demonstrated failure in the anatomical support [17] with a recurrent POP rate of 14.4%, requiring surgery in 3.4% of cases [18]. …”

Comparison between Laparoscopic High Uterosacralligament Suspension and Laparoscopic Sacrocolpopexy: A Retrospective Study

“…On the other hand, the laparoscopic high uterosacral ligament suspension (LHULS) has shown good anatomic outcome for vault prolapse [9][10][11][12]. Interestingly, this procedure does not require any graft, therefore, the concerns about the graft-related complications are dispelled [11].…”