Skip to main content

Advertisement

SpringerLink
Log in

Is there an association between 6-month genital hiatus size and 24-month composite prolapse recurrence following minimally invasive sacrocolpopexy?

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Although an enlarged postoperative genital hiatus (GH) size has been identified as a predictor of recurrence following pelvic organ prolapse (POP) surgery, the protective role of concurrent level III support procedures to reduce the GH size at the time of minimally invasive sacrocolpopexy (MI-SCP) remains unclear. The objective of this study was to compare 24-month composite prolapse recurrence following MI-SCP between patients with a 6-month postoperative GH measurement of <3 cm versus ≥3 cm; and to explore the impact of concurrent level III support procedures on prolapse recurrence, bowel, and sexual function.

Methods

This was a secondary analysis of two randomized controlled trials of women who underwent MI-SCP from 2014 to 2020. Our primary outcome was composite prolapse recurrence defined as retreatment with either pessary or surgery, and/or subjective bothersome vaginal bulge. A receiver operating characteristic (ROC) curve was generated to identify a 6-month GH cutoff point associated with 24-month composite recurrence.

Results

Of the 108 women who met the inclusion criteria, 13 (12%) had composite prolapse recurrence at 24 months: 12 patients (11.1%) reported a bothersome vaginal bulge, and 3 patients (2.8%) underwent retreatment with surgery. A ROC curve demonstrated that a 6-month postoperative GH size of 3 cm had 84.6% sensitivity to predict vaginal bulge and/or retreatment at 24 months (area under curve = 0.52). There was no difference in the composite prolapse recurrence between the groups; however, only patients with a 6-month GH >3 cm underwent retreatment.

Conclusions

Twenty-four-month composite prolapse recurrence does not differ based on 6-month GH size; however, surgical failure may be more common in those with a GH size greater than 3 cm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bradley MS, Askew AL, Vaughan MH, Kawasaki A, Visco AG. Robotic-assisted sacrocolpopexy: early postoperative outcomes after surgical reduction of enlarged genital hiatus. Am J Obstet Gynecol. 2018;218(5):514.e1–8. https://doi.org/10.1016/j.ajog.2018.01.046.

    Article  PubMed  Google Scholar 

  2. Chang OH, Davidson ERW, Thomas TN, Paraiso MFR, Ferrando CA. Predictors for pelvic organ prolapse recurrence after sacrocolpopexy: a matched case-control study. Female Pelvic Med Reconstr Surg. 2021;27(1):e165–70. https://doi.org/10.1097/SPV.0000000000000874.

    Article  PubMed  Google Scholar 

  3. Hill AM, Shatkin-Margolis A, Smith BC, Pauls RN. Associating genital hiatus size with long-term outcomes after apical suspension. Int Urogynecol J. 2020;31(8):1537–44. https://doi.org/10.1007/s00192-019-04138-x.

    Article  PubMed  Google Scholar 

  4. Sutkin G, Zyczynski HM, Sridhar A, et al. Association between adjuvant posterior repair and success of native tissue apical suspension. Am J Obstet Gynecol. 2020;222(2):161.e1–8. https://doi.org/10.1016/j.ajog.2019.08.024.

    Article  CAS  PubMed  Google Scholar 

  5. Vakili B, Zheng YT, Loesch H, Echols KT, Franco N, Chesson RR. Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. Am J Obstet Gynecol. 2005;192(5):1592–8. https://doi.org/10.1016/j.ajog.2004.11.022.

    Article  PubMed  Google Scholar 

  6. Vaughan MH, Siddiqui NY, Newcomb LK, Weidner AC, Kawasaki A, Visco AG, et al. Surgical alteration of genital hiatus size and anatomic failure after vaginal vault suspension. Obstet Gynecol. 2018;131(6):1137–44. https://doi.org/10.1097/AOG.0000000000002593.

    Article  PubMed  Google Scholar 

  7. Lowder JL, Oliphant SS, Shepherd JP, Ghetti C, Sutkin G. Genital hiatus size is associated with and predictive of apical vaginal support loss. Am J Obstet Gynecol. 2016;214(6):718.e1. https://doi.org/10.1016/j.ajog.2015.12.027.

    Article  PubMed  Google Scholar 

  8. Chang OH, Yao M, Ferrando CA, Paraiso MFR, Propst K. Determining the ideal intraoperative resting genital hiatus size-balancing surgical and functional outcomes. Urogynecology (Hagerstown). 2022;28(10):649–57. https://doi.org/10.1097/SPV.0000000000001227.

    Article  Google Scholar 

  9. Chang OH, Davidson ERW, Thomas TN, Paraiso MFR, Ferrando CA. Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy? Int Urogynecol J. 2020;31(10):2075–80. https://doi.org/10.1007/s00192-020-04268-7.

    Article  PubMed  Google Scholar 

  10. Ferrando CA, Paraiso MFR. A prospective randomized trial comparing Restorelle Y mesh and flat mesh for laparoscopic and robotic-assisted laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2019;25(2):83–7. https://doi.org/10.1097/SPV.0000000000000655.

    Article  PubMed  Google Scholar 

  11. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.

    Article  CAS  PubMed  Google Scholar 

  12. Ferrando CA, Paraiso MFR. A prospective randomized trial comparing Restorelle® Y mesh and flat mesh for laparoscopic and robotic-assisted laparoscopic sacrocolpopexy: 24-month outcomes. Int Urogynecol J. 2021;32(6):1565–70. https://doi.org/10.1007/s00192-020-04657-y.

    Article  PubMed  Google Scholar 

  13. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(3):164–8; discussion 168. https://doi.org/10.1007/s00192-003-1063-2.

    Article  PubMed  Google Scholar 

  14. Guiahi M, Kenton K, Brubaker L. Sacrocolpopexy without concomitant posterior repair improves posterior compartment defects. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(9):1267–70. https://doi.org/10.1007/s00192-008-0628-5.

    Article  PubMed  Google Scholar 

  15. Carter-Brooks CM, Lowder JL, Du AL, Lavelle ES, Giugale LE, Shepherd JP. Restoring genital hiatus to normative values after apical suspension alone versus with level 3 support procedures. Female Pelvic Med Reconstr Surg. 2019;25(3):226–30. https://doi.org/10.1097/SPV.0000000000000528.

    Article  PubMed  Google Scholar 

  16. Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE. Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol. 2008;198(5):548.e1–6. https://doi.org/10.1016/j.ajog.2008.01.054.

    Article  PubMed  Google Scholar 

  17. Geynisman-Tan J, Kenton KS, Brown O, et al. Mind the gap: changes in levator dimensions after sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2021;27(1):e184–6. https://doi.org/10.1097/SPV.0000000000000881.

    Article  PubMed  Google Scholar 

  18. Siff LN, Barber MD, Zyczynski HM, et al. Immediate postoperative pelvic organ prolapse quantification measures and 2-year risk of prolapse recurrence. Obstet Gynecol. 2020;136(4):792–801. https://doi.org/10.1097/AOG.0000000000004043.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. English EM, Chen L, Sammarco AG, et al. Mechanisms of hiatus failure in prolapse: a multifaceted evaluation. Int Urogynecol J. 2021;32(6):1545–53. https://doi.org/10.1007/s00192-020-04651-4.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kikuchi JY, Muniz KS, Handa VL. Surgical repair of the genital hiatus: a narrative review. Int Urogynecol J. 2021;32(8):2111–7 https://doi.org/10.1007/s00192-021-04680-7.

    Article  PubMed  Google Scholar 

  21. Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol. 1997;104(1):82–6. https://doi.org/10.1111/j.1471-0528.1997.tb10654.x.

    Article  CAS  PubMed  Google Scholar 

  22. Paraiso MF, Barber MD, Muir TW, Walters MD. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol. 2006;195(6):1762–71. https://doi.org/10.1016/j.ajog.2006.07.026.

    Article  PubMed  Google Scholar 

  23. Komesu YM, Rogers RG, Kammerer-Doak DN, Barber MD, Olsen AL. Posterior repair and sexual function. Am J Obstet Gynecol. 2007;197(1):101.e1–6. https://doi.org/10.1016/j.ajog.2007.03.054.

    Article  PubMed  Google Scholar 

  24. Handa VL, Zyczynski HM, Brubaker L, et al. Sexual function before and after sacrocolpopexy for pelvic organ prolapse. Am J Obstet Gynecol. 2007;197(6):629.e1–6. https://doi.org/10.1016/j.ajog.2007.08.016.

    Article  PubMed  Google Scholar 

  25. Lukacz ES, Sridhar A, Chermansky CJ, et al. Sexual activity and dyspareunia 1 year after surgical repair of pelvic organ prolapse. Obstet Gynecol. 2020;136(3):492–500. https://doi.org/10.1097/AOG.0000000000003992.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Barber MD, Brubaker L, Nygaard I, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114(3):600–9. https://doi.org/10.1097/AOG.0b013e3181b2b1ae.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dunivan GC, Sussman AL, Jelovsek JE, et al. Gaining the patient perspective on pelvic floor disorders' surgical adverse events. Am J Obstet Gynecol. 2019;220(2):185.e1–10. https://doi.org/10.1016/j.ajog.2018.10.033.

  28. Glass Clark S, Sassani JC, Zyczynski HM, Bradley MS. Preprocedure and immediate postoperative changes to genital hiatus following minimally invasive sacrocolpopexy. Urogynecology (Hagerstown). 2022;28(8):533–8. https://doi.org/10.1097/SPV.0000000000001204.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Advent Health, 960 Rinehart Road, Lake Mary, FL, USA

    Viviana Casas-Puig

  2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Meng Yao

  3. Urogynecology & Reconstructive Pelvic Surgery, Obstetrics & Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Katie A. Propst

  4. Center for Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    Cecile A. Ferrando

Authors
  1. Viviana Casas-Puig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meng Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katie A. Propst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cecile A. Ferrando
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

V. Casas-Puig: protocol/project development, data collection/management, data analysis, manuscript writing/editing; M. Yao: protocol/project development, data management, data analysis; K.A. Propst: protocol/project development, data analysis, manuscript writing/editing; C.A. Ferrando: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Viviana Casas-Puig.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Casas-Puig, V., Yao, M., Propst, K.A. et al. Is there an association between 6-month genital hiatus size and 24-month composite prolapse recurrence following minimally invasive sacrocolpopexy?. Int Urogynecol J 34, 2593–2601 (2023). https://doi.org/10.1007/s00192-023-05578-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-023-05578-2

Keywords

Search

Navigation