Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study

Robert E. Gutman, Charles R. Rardin, Eric R. Sokol, Catherine Matthews, Amy J. Park, Cheryl B. Iglesia, Roxana Geoffrion, Andrew I. Sokol, Mickey Karram, Geoffrey W. Cundiff, Joan L. Blomquist, Matthew D. Barber

Research output: Contribution to journalArticle

Abstract

Background There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy. Objective We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy. Study Design This multicenter, prospective parallel cohort study compared laparoscopic sacral hysteropexy to vaginal mesh hysteropexy at 8 institutions. We included women ages 35–80 years who desired uterine conservation, were done with childbearing, and were undergoing 1 of the above procedures for stage 2–4 symptomatic anterior/apical uterovaginal prolapse (anterior descent at or beyond the hymen [Aa or Ba ≥ 0] and apical descent at or below the midvagina [C ≥ –TVL/2]). We excluded women with cervical elongation, prior mesh prolapse repair, cervical dysplasia, chronic pelvic pain, uterine abnormalities, and abnormal bleeding. Cure was defined as no prolapse beyond the hymen and cervix above midvagina (anatomic), no vaginal bulge sensation (symptomatic), and no reoperations. Pelvic Organ Prolapse Quantification examination and validated questionnaires were collected at baseline and 12 months including the Pelvic Floor Distress Inventory Short Form, Female Sexual Function Index, and Patient Global Impression of Improvement. In all, 72 subjects/group were required to detect 94% vs 75% cure (80% power, 15% dropout). Intention-to-treat analysis was used with logistic regression adjusting for baseline differences. Results We performed 74 laparoscopic sacral hysteropexy and 76 vaginal mesh hysteropexy procedures from July 2011 through May 2014. Laparoscopic patients were younger (P <.001), had lower parity (P =.006), were more likely premenopausal (P =.008), and had more severe prolapse (P =.02). Laparoscopic procedure (174 vs 64 minutes, P <.0001) and total operating time (239 vs 112 minutes, P <.0001) were longer. There were no differences in blood loss, complications, and hospital stay. One-year outcomes for the available 83% laparoscopic and 80% vaginal hysteropexy patients revealed no differences in anatomic (77% vs 80%; adjusted odds ratio, 0.48; P =.20), symptomatic (90% vs 95%; adjusted odds ratio, 0.40; P =.22), or composite (72% vs 74%; adjusted odds ratio, 0.58; P =.27) cure. Mesh exposures occurred in 2.7% laparoscopic vs 6.6% vaginal hysteropexy (P =.44). A total of 95% of each group were very much better or much better. Pelvic floor symptom and sexual function scores improved for both groups with no difference between groups. Conclusion Laparoscopic sacral hysteropexy and vaginal mesh hysteropexy had similar 1-year cure rates and high satisfaction.

Original languageEnglish (US)
Pages (from-to)38.e1-38.e11
JournalAmerican Journal of Obstetrics and Gynecology
Volume216
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Prolapse
Cohort Studies
Hymen
Pelvic Floor
Odds Ratio
Uterine Cervical Dysplasia
Pelvic Organ Prolapse
Intention to Treat Analysis
Pelvic Pain
Parity
Reoperation
Cervix Uteri
Chronic Pain
Length of Stay
Logistic Models
Hemorrhage
Safety
Equipment and Supplies

Keywords

  • hysteropexy
  • laparoscopic sacral hysteropexy
  • pelvic organ prolapse
  • uphold
  • uterine conservation
  • uterine preservation
  • vaginal mesh

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Gutman, R. E., Rardin, C. R., Sokol, E. R., Matthews, C., Park, A. J., Iglesia, C. B., ... Barber, M. D. (2017). Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study. American Journal of Obstetrics and Gynecology, 216(1), 38.e1-38.e11. https://doi.org/10.1016/j.ajog.2016.08.035

Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse : a parallel cohort study. / Gutman, Robert E.; Rardin, Charles R.; Sokol, Eric R.; Matthews, Catherine; Park, Amy J.; Iglesia, Cheryl B.; Geoffrion, Roxana; Sokol, Andrew I.; Karram, Mickey; Cundiff, Geoffrey W.; Blomquist, Joan L.; Barber, Matthew D.

In: American Journal of Obstetrics and Gynecology, Vol. 216, No. 1, 01.01.2017, p. 38.e1-38.e11.

Research output: Contribution to journalArticle

Gutman, RE, Rardin, CR, Sokol, ER, Matthews, C, Park, AJ, Iglesia, CB, Geoffrion, R, Sokol, AI, Karram, M, Cundiff, GW, Blomquist, JL & Barber, MD 2017, 'Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study', American Journal of Obstetrics and Gynecology, vol. 216, no. 1, pp. 38.e1-38.e11. https://doi.org/10.1016/j.ajog.2016.08.035
Gutman, Robert E. ; Rardin, Charles R. ; Sokol, Eric R. ; Matthews, Catherine ; Park, Amy J. ; Iglesia, Cheryl B. ; Geoffrion, Roxana ; Sokol, Andrew I. ; Karram, Mickey ; Cundiff, Geoffrey W. ; Blomquist, Joan L. ; Barber, Matthew D. / Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse : a parallel cohort study. In: American Journal of Obstetrics and Gynecology. 2017 ; Vol. 216, No. 1. pp. 38.e1-38.e11.
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title = "Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study",
abstract = "Background There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy. Objective We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy. Study Design This multicenter, prospective parallel cohort study compared laparoscopic sacral hysteropexy to vaginal mesh hysteropexy at 8 institutions. We included women ages 35–80 years who desired uterine conservation, were done with childbearing, and were undergoing 1 of the above procedures for stage 2–4 symptomatic anterior/apical uterovaginal prolapse (anterior descent at or beyond the hymen [Aa or Ba ≥ 0] and apical descent at or below the midvagina [C ≥ –TVL/2]). We excluded women with cervical elongation, prior mesh prolapse repair, cervical dysplasia, chronic pelvic pain, uterine abnormalities, and abnormal bleeding. Cure was defined as no prolapse beyond the hymen and cervix above midvagina (anatomic), no vaginal bulge sensation (symptomatic), and no reoperations. Pelvic Organ Prolapse Quantification examination and validated questionnaires were collected at baseline and 12 months including the Pelvic Floor Distress Inventory Short Form, Female Sexual Function Index, and Patient Global Impression of Improvement. In all, 72 subjects/group were required to detect 94{\%} vs 75{\%} cure (80{\%} power, 15{\%} dropout). Intention-to-treat analysis was used with logistic regression adjusting for baseline differences. Results We performed 74 laparoscopic sacral hysteropexy and 76 vaginal mesh hysteropexy procedures from July 2011 through May 2014. Laparoscopic patients were younger (P <.001), had lower parity (P =.006), were more likely premenopausal (P =.008), and had more severe prolapse (P =.02). Laparoscopic procedure (174 vs 64 minutes, P <.0001) and total operating time (239 vs 112 minutes, P <.0001) were longer. There were no differences in blood loss, complications, and hospital stay. One-year outcomes for the available 83{\%} laparoscopic and 80{\%} vaginal hysteropexy patients revealed no differences in anatomic (77{\%} vs 80{\%}; adjusted odds ratio, 0.48; P =.20), symptomatic (90{\%} vs 95{\%}; adjusted odds ratio, 0.40; P =.22), or composite (72{\%} vs 74{\%}; adjusted odds ratio, 0.58; P =.27) cure. Mesh exposures occurred in 2.7{\%} laparoscopic vs 6.6{\%} vaginal hysteropexy (P =.44). A total of 95{\%} of each group were very much better or much better. Pelvic floor symptom and sexual function scores improved for both groups with no difference between groups. Conclusion Laparoscopic sacral hysteropexy and vaginal mesh hysteropexy had similar 1-year cure rates and high satisfaction.",
keywords = "hysteropexy, laparoscopic sacral hysteropexy, pelvic organ prolapse, uphold, uterine conservation, uterine preservation, vaginal mesh",
author = "Gutman, {Robert E.} and Rardin, {Charles R.} and Sokol, {Eric R.} and Catherine Matthews and Park, {Amy J.} and Iglesia, {Cheryl B.} and Roxana Geoffrion and Sokol, {Andrew I.} and Mickey Karram and Cundiff, {Geoffrey W.} and Blomquist, {Joan L.} and Barber, {Matthew D.}",
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TY - JOUR

T1 - Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse

T2 - a parallel cohort study

AU - Gutman, Robert E.

AU - Rardin, Charles R.

AU - Sokol, Eric R.

AU - Matthews, Catherine

AU - Park, Amy J.

AU - Iglesia, Cheryl B.

AU - Geoffrion, Roxana

AU - Sokol, Andrew I.

AU - Karram, Mickey

AU - Cundiff, Geoffrey W.

AU - Blomquist, Joan L.

AU - Barber, Matthew D.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy. Objective We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy. Study Design This multicenter, prospective parallel cohort study compared laparoscopic sacral hysteropexy to vaginal mesh hysteropexy at 8 institutions. We included women ages 35–80 years who desired uterine conservation, were done with childbearing, and were undergoing 1 of the above procedures for stage 2–4 symptomatic anterior/apical uterovaginal prolapse (anterior descent at or beyond the hymen [Aa or Ba ≥ 0] and apical descent at or below the midvagina [C ≥ –TVL/2]). We excluded women with cervical elongation, prior mesh prolapse repair, cervical dysplasia, chronic pelvic pain, uterine abnormalities, and abnormal bleeding. Cure was defined as no prolapse beyond the hymen and cervix above midvagina (anatomic), no vaginal bulge sensation (symptomatic), and no reoperations. Pelvic Organ Prolapse Quantification examination and validated questionnaires were collected at baseline and 12 months including the Pelvic Floor Distress Inventory Short Form, Female Sexual Function Index, and Patient Global Impression of Improvement. In all, 72 subjects/group were required to detect 94% vs 75% cure (80% power, 15% dropout). Intention-to-treat analysis was used with logistic regression adjusting for baseline differences. Results We performed 74 laparoscopic sacral hysteropexy and 76 vaginal mesh hysteropexy procedures from July 2011 through May 2014. Laparoscopic patients were younger (P <.001), had lower parity (P =.006), were more likely premenopausal (P =.008), and had more severe prolapse (P =.02). Laparoscopic procedure (174 vs 64 minutes, P <.0001) and total operating time (239 vs 112 minutes, P <.0001) were longer. There were no differences in blood loss, complications, and hospital stay. One-year outcomes for the available 83% laparoscopic and 80% vaginal hysteropexy patients revealed no differences in anatomic (77% vs 80%; adjusted odds ratio, 0.48; P =.20), symptomatic (90% vs 95%; adjusted odds ratio, 0.40; P =.22), or composite (72% vs 74%; adjusted odds ratio, 0.58; P =.27) cure. Mesh exposures occurred in 2.7% laparoscopic vs 6.6% vaginal hysteropexy (P =.44). A total of 95% of each group were very much better or much better. Pelvic floor symptom and sexual function scores improved for both groups with no difference between groups. Conclusion Laparoscopic sacral hysteropexy and vaginal mesh hysteropexy had similar 1-year cure rates and high satisfaction.

AB - Background There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy. Objective We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy. Study Design This multicenter, prospective parallel cohort study compared laparoscopic sacral hysteropexy to vaginal mesh hysteropexy at 8 institutions. We included women ages 35–80 years who desired uterine conservation, were done with childbearing, and were undergoing 1 of the above procedures for stage 2–4 symptomatic anterior/apical uterovaginal prolapse (anterior descent at or beyond the hymen [Aa or Ba ≥ 0] and apical descent at or below the midvagina [C ≥ –TVL/2]). We excluded women with cervical elongation, prior mesh prolapse repair, cervical dysplasia, chronic pelvic pain, uterine abnormalities, and abnormal bleeding. Cure was defined as no prolapse beyond the hymen and cervix above midvagina (anatomic), no vaginal bulge sensation (symptomatic), and no reoperations. Pelvic Organ Prolapse Quantification examination and validated questionnaires were collected at baseline and 12 months including the Pelvic Floor Distress Inventory Short Form, Female Sexual Function Index, and Patient Global Impression of Improvement. In all, 72 subjects/group were required to detect 94% vs 75% cure (80% power, 15% dropout). Intention-to-treat analysis was used with logistic regression adjusting for baseline differences. Results We performed 74 laparoscopic sacral hysteropexy and 76 vaginal mesh hysteropexy procedures from July 2011 through May 2014. Laparoscopic patients were younger (P <.001), had lower parity (P =.006), were more likely premenopausal (P =.008), and had more severe prolapse (P =.02). Laparoscopic procedure (174 vs 64 minutes, P <.0001) and total operating time (239 vs 112 minutes, P <.0001) were longer. There were no differences in blood loss, complications, and hospital stay. One-year outcomes for the available 83% laparoscopic and 80% vaginal hysteropexy patients revealed no differences in anatomic (77% vs 80%; adjusted odds ratio, 0.48; P =.20), symptomatic (90% vs 95%; adjusted odds ratio, 0.40; P =.22), or composite (72% vs 74%; adjusted odds ratio, 0.58; P =.27) cure. Mesh exposures occurred in 2.7% laparoscopic vs 6.6% vaginal hysteropexy (P =.44). A total of 95% of each group were very much better or much better. Pelvic floor symptom and sexual function scores improved for both groups with no difference between groups. Conclusion Laparoscopic sacral hysteropexy and vaginal mesh hysteropexy had similar 1-year cure rates and high satisfaction.

KW - hysteropexy

KW - laparoscopic sacral hysteropexy

KW - pelvic organ prolapse

KW - uphold

KW - uterine conservation

KW - uterine preservation

KW - vaginal mesh

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