Concomitant Anterior Repair, Preoperative Prolapse Severity, and Anatomic Prolapse Outcomes After Vaginal Apical Procedures. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Nager, Charles W.; Grimes, Cara L.; Nolen, Tracy L.; Wai, Clifford Y.; Brubaker, Linda; Jeppson, Peter C.; Wilson, Tracey S.; Visco, Anthony G.; Barber, Matthew D.; Sutkin, Gary; Norton, Peggy; Rardin, Charles R.; Arya, Lily; Wallace, Dennis; Meikle, Susan F.
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 25:Issue 1(2019)
• Publication Date: 2019-01
• Subjects: pelvic organ prolapse -- surgery -- anterior repair -- uterosacral ligament suspension -- sacrospinous ligament fixation -- surgical trial; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000000526
• Languages: English
• ISSNs: 2151-8378

Abstract

Abstract : Objective: The aim of the study was to compare anterior and overall prolapse prevalence at 1 year in surgical participants with or without concomitant anterior repair (AR) at the time of sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (ULS). Methods: This is a secondary analysis of two surgical trials; concomitant AR was performed at surgeon's discretion. Anterior anatomic success was defined as pelvic organ prolapse quantification of prolapse point Ba ⩽0 and overall success was defined as pelvic organ prolapse quantification points Ba, Bp, and C ⩽0 at 12 months. Results: Sixty-three percent (441/701) of the participants underwent concomitant AR and were older, more often postmenopausal, had previous hysterectomy, and had higher-stage anterior, but not apical prolapse. Anterior anatomic success was marginally but statistically better in the combined group (SSLF and ULS) with concomitant AR (82% vs 80%, P = 0.03). In subanalyses, the improvement in anatomic support with AR was observed only in the SSLF subgroup (81% vs 73%, P = 0.02) and mostly in the SSLF subgroup with higher preoperative stage (74% vs 57%, P = 0.02). Anterior repair did not improve success rates in participants with lower-stage prolapse or undergoing ULS. Overall success rates were similar to anterior anatomic success rates. Participants with higher-stage preoperative anterior prolapse had significantly lower success rates. Conclusions: In the absence of clinical trial data, this analysis suggests an AR should be considered for women with higher-stage prolapse undergoing an SSLF. Preoperative prolapse severity is a strong predictor of poor anatomic outcomes with native tissue vaginal apical surgeries. Abstract : Concomitant anterior repair improves anatomic outcomes in women undergoing sacrospinous ligament suspension for advanced prolapse.