Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy

Aslam, Muhammad Faisal; Osmundsen, Blake; Edwards, S. Renee; Matthews, Catherine A.; Gregory, W. Thomas

doi:10.1097/spv.0000000000000233

Cited by 27 publications

(14 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Postoperatively a higher percentage of recurrent cystocele was seen after RSHS, which could possibly be explained by the higher sPOPQ stage A reported preoperatively, this is associated with a higher risk of recurrence . Comparisons between the two types of surgeries must be analysed carefully, however, as this study was not set up as a randomised controlled trial.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Zanten

Koops

O’Sullivan

et al. 2019

BJOG

View full text Add to dashboard Cite

Objective Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.Design Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery.Setting Two European tertiary referral hospitals.Population Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).Methods Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7).Main outcome measures Primary outcome: anatomical and subjective cure. Secondary outcomes: surgical safety and intraoperative variables.Results A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 AE 62.3 to 13.5 AE 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 AE 38.2 versus 145.3 AE 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).Conclusions This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results.

show abstract

Section: Discussionmentioning

confidence: 99%

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Zanten

Koops

O’Sullivan

et al. 2019

BJOG

View full text Add to dashboard Cite

show abstract

“…The use of anterior vaginal mesh in particular has been associated with a higher apical recurrence rate as opposed to the SSLF procedure where there appears to be more of a risk for a recurrent cystocele [24]. It is also appreciated that the present clinical methods do not sufficiently predict the outcome of specific operative approaches [25,26] particularly where there is no consensus regarding what represents a surgical success. Future prospective work will be required to define whether symptoms relate more readily to the measurable ordinal POP-Q values rather than to a particular POP stage with the most distal point more closely reflecting an anatomical (as opposed to a stage) correction [27].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

Levy¹,

Beck²,

From³

et al. 2019

Gynecol Reprod Health

View full text Add to dashboard Cite

Objective: The study aimed to determine if a single preoperative objective measure of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Ba, (which represents the distal leading point of the anterior vaginal wall), predicts a successful outcome in patients presenting with ≥ stage 3 pelvic organ prolapse (POP) who undergo a transvaginal repair. Methods: Patients with ≥ stage 3 POP managed with transvaginal mesh implantation were divided into 2 groups based on preoperative Ba measurement (Group 1; Ba = 2-3 cm and Group 2; Ba ≥ 4 cm). An anatomically successful outcome was defined as Ba <1cm. Results: There were 138 women surgically managed between 2009 and 2013 with complete follow-up available on 113 cases (median age 62.5 years; range 42-83 years). The median follow-up period was 29 months (range 8-38 months). Of 89 women with stage ≥ 3 POP there were 39 cases in Group 1 and 50 patients in Group 2. There was a significantly lower postoperative Ba in Group 1 cases when compared with Group 2 patients (-2.61 cm vs.-1.74 cm; P = 0.03). Logistic regression analysis failed to discern any effect on a successful outcome of factors normally responsible for prolapse (age, parity, BMI, prior surgery or operative delivery). Conclusion: A favorable anatomic outcome after transvaginal surgery for POP can be anticipated with a preoperative Ba < 4 cm. Future studies are required assessing the value of the preoperative POP-Q measurements in patients with ≥ 3rd degree POP using different types of surgery.

show abstract

“…In that study, the success rates dropped to 50-60% for the same procedures when they were performed for recurrent prolapse (44). A multicenter cohort study demonstrated that a higher preoperative prolapse stage increased the risk of recurrence at 1 year by a factor of 3.8 (45). Like in cancer surgery, standard therapies are less effective when used on the more advanced and recurrent disease.…”

Section: Ancillary Factors Impacting Efficacymentioning

confidence: 99%

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

Schachar¹,

Matthews²

2020

Transl Androl Urol

View full text Add to dashboard Cite

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.

show abstract

Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy

Abstract: Much like a higher stage of disease in oncology, we found that increasing stage of prolapse preoperatively increased the risk of recurrence at 1 year after sacrocolpopexy.

Cited by 27 publications

References 25 publications

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

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

Contact Info

Product

Resources

About