Recurrence of Anterior Vaginal Prolapse After Robotic Sacrocolpopexy: Does Cervical Preservation Affect Outcome?

Abstract

ImportanceAnterior vaginal prolapse (AVP) is the most common site of recurrence after sacrocolpopexy (SCP). Supracervical hysterectomy helps to prevent mesh exposure, but it is unclear if cervical preservation (CP) affects adequate reduction of AVP.ObjectiveOur primary objective was to determine the difference in AVP recurrence rates in patients who have undergone SCP with or without CP. Secondary outcomes were composite failure and complications rates.Study DesignThis was a retrospective cohort analysis of women who underwent robotic SCP between 2012 and 2019 at Kaiser Permanente Southern California. The first cohort included women with CP (prior or concomitant supracervical hysterectomy). The second included women without CP (prior or concomitant total hysterectomy). Primary outcome was defined as recurrent AVP beyond the hymen. Patients without 12-month follow-up were included in demographic and surgical data analysis only.ResultsThe charts of 373 patients with CP and 175 without CP were reviewed. Women with CP were more likely to undergo concomitant anterior repair at the time of SCP (14% vs 6%, P < 0.01); however, rates of AVP recurrence were not significantly different between groups (5% vs 3%, P = 0.26). Median follow-up time was 26 months (interquartile range, 14–38 months). Composite failure was similar between groups (17% vs 11%, P = 0.12). Women with CP were more likely to experience asymptomatic apical failure (6% vs 1%, P = 0.03).ConclusionsCervical preservation at the time of SCP is associated with an increased need for concomitant anterior repair but is not associated with higher rates of AVP recurrence or composite failure.