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International Urogynecology Journal

, Volume 30, Issue 4, pp 545–555 | Cite as

Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh

  • Eduardo Bataller
  • Cristina RosEmail author
  • Sonia Anglès
  • Miriam Gallego
  • Montserrat Espuña-Pons
  • Francisco Carmona
Original Article

Abstract

Introduction and hypothesis

Few studies have compared the different approaches of mesh surgery in patients with severe pelvic organ prolapse (POP). In addition to laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx), anterior vaginal mesh (AVM) may be an effective approach for correcting anterior vaginal wall associated with apical POP in women with advanced POP.

Methods

A randomised controlled trial (RCT; January 2011 to March 2016) including 120 patients (60/group) with advanced symptomatic POP, with a predominant anterior vaginal wall descent stage III or greater in combination with a stage II or III apical defect (uterus or vaginal vault). Patients underwent four visits: baseline, 3, 6 and12 months after surgery. The main outcome was anatomical success defined as anterior and posterior vaginal wall not descending beyond the hymen and vaginal apex descent no more than one third into the vagina. Secondary variables: PFDI, ICIQ-UI-SF, intraoperative variables, postoperative morbidity and complications.

Results

Anatomical success was achieved with LSC-Cx in 79% and with AVM in 76% (NS). No statistically significant differences were found among POP-Q anterior vaginal wall points between groups, whereas better results were obtained with LSC-Cx in posterior vaginal wall points and total vaginal length. Intraoperative outcomes were similar in the two groups, except for operating time (78.05 min LSC-Cx vs 44.28 min AVM). There were no statistically significant differences related to de novo stress urinary incontinence and dyspareunia. Worse results were found in the CRADI-8 in the LSC-Cx group, owing to constipation. Late postoperative complications and reinterventions were similar in the two groups.

Conclusions

No differences were found in the anatomical correction of anterior and apical POP. The LSC-Cx group presented better correction of posterior vaginal wall defects and a longer total vaginal length.

Keywords

Pelvic organ prolapse Prolapse recurrence Mesh surgery Laparoscopic sacral colpopexy/cervicopexy Anterior vaginal mesh 

Notes

Acknowledgements

We would like to thank Dr Lluís Aragonès for his contribution to the statistical analyses.

Funding

The Elevate® Anterior and Apical kits were donated by AMS as a grant for the study without any other support or supervision.

Compliance with ethical standards

Conflicts of interest

Dr Bataller was a consultant for AMS (Astora, women’s health). The remaining authors claim no conflicts of interest.

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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Eduardo Bataller
    • 1
  • Cristina Ros
    • 1
    • 2
    Email author
  • Sonia Anglès
    • 1
  • Miriam Gallego
    • 1
  • Montserrat Espuña-Pons
    • 1
  • Francisco Carmona
    • 1
  1. 1.Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic i Provincial de BarcelonaUniversitat de BarcelonaBarcelonaSpain
  2. 2.Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), ICGONHospital Clínic de BarcelonaBarcelonaSpain

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