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International Urogynecology Journal

, Volume 30, Issue 4, pp 649–655 | Cite as

Route of hysterectomy during minimally invasive sacrocolpopexy does not affect postoperative outcomes

  • Emily R. W. DavidsonEmail author
  • Tonya N. Thomas
  • Erika J. Lampert
  • Marie Fidela R. Paraiso
  • Cecile A. Ferrando
Original Article

Abstract

Introduction and hypothesis

Hysterectomy can be performed during sacrocolpopexy, but there are limited studies comparing the effect of route of hysterectomy on adverse events. We hypothesized there would be no difference in adverse events or patient-reported outcomes in women who underwent minimally invasive sacrocolpopexy with either vaginal or supracervical hysterectomy.

Methods

This was a retrospective chart review with a cross-sectional survey component sent to all consenting patients. Patients were identified by procedure code for sacrocolpopexy and hysterectomy from January 2005 to June 2016.

Results

Of the 161 subjects meeting the inclusion criteria, 116 underwent supracervical and 45 vaginal hysterectomy. Overall incidence of perioperative adverse events was low. Vaginal hysterectomy cases were faster (276 vs. 324 min, p < 0.001) and had higher rates of postoperative stress incontinence (22 vs. 9%, p = 0.03). Thirty-one (19%) of all subjects had recurrent prolapse; 10 (6%) underwent repeat surgery. Three (1%) subjects had a mesh exposure (no difference between groups), all treated conservatively. Ninety-six (60%) subjects responded to the survey with a median follow-up of 56 (9–134) months. Ninety-one percent (87) of respondents reported being better since surgery, and 91% (87) reported they would choose the surgery again. Twenty-eight percent (27) reported a surgery-related complication including pain, urinary and bowel symptoms; 8% (8) reported evaluation for recurrent prolapse symptoms, all treated conservatively; 4% (4) of respondents reported a mesh exposure.

Conclusions

Incidence of adverse events is low and not different between patients undergoing minimally invasive sacrocolpopexy with concurrent supracervical or vaginal hysterectomy. One in three patients report pelvic floor symptoms postoperatively, but long-term satisfaction is high.

Keywords

Minimally invasive hysterectomy Patient-reported outcomes Prolapse Sacrocolpopexy Vaginal hysterectomy 

Notes

Compliance with ethical standards

Conflicts of interest

The authors report no relevant conflicts of interest or disclosure for this work. Our full list of disclosures is listed below for full transparency.

• Dr. Davidson is an independent consultant for the International Academy of Pelvic Surgery.

• Dr. Thomas is an author for and receives royalties from UpToDate®.

• Ms. Lampert has no conflicts of interest.

• Dr. Paraiso is an author for and receives royalties from UpToDate® and has unrestricted research grants from Coloplast and Caldera.

• Dr. Ferrando is an author for and receives royalties from UpToDate® and has unrestricted research grants from Coloplast and Caldera.

References

  1. 1.
    Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.CrossRefGoogle Scholar
  2. 2.
    Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547 e1–8.CrossRefGoogle Scholar
  3. 3.
    Osmundsen BC, Clark A, Goldsmith C, Adams K, Denman MA, Edwards R, et al. Mesh erosion in robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(2):86–8.CrossRefGoogle Scholar
  4. 4.
    Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205–12.CrossRefGoogle Scholar
  5. 5.
    Nosti PA, Carter CM, Sokol AI, Tefera E, Iglesia CB, Park AJ, et al. Transvaginal versus transabdominal placement of synthetic mesh at time of sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(3):151–5.CrossRefGoogle Scholar
  6. 6.
    Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (pgi-i) for urogenital prolapse. Int Urogynecol J. 2010;21(5):523–8.CrossRefGoogle Scholar
  7. 7.
    Yalcin I, Bump RC. Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003;189(1):98–101.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Sandvik H, Espuna M, Hunskaar S. Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(5):520–4.CrossRefGoogle Scholar
  10. 10.
    Rogers RG, Espuña Pons ME. The pelvic organ prolapse incontinence sexual questionnaire, IUGA-revised (pisq-ir). Int Urogynecol J. 2013;24(7):1063–4.CrossRefGoogle Scholar
  11. 11.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (redcap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefGoogle Scholar
  12. 12.
    SAS Institute I. Jmp®. 14 ed. Cary, NC1989-2007.Google Scholar
  13. 13.
    Myers EM, Siff L, Osmundsen B, Geller E, Matthews CA. Differences in recurrent prolapse at 1 year after total vs supracervical hysterectomy and robotic sacrocolpopexy. Int Urogynecol J. 2015;26(4):585–9.CrossRefGoogle Scholar
  14. 14.
    Vandendriessche D, Sussfeld J, Giraudet G, Lucot JP, Behal H, Cosson M. Complications and reoperations after laparoscopic sacrocolpopexy with a mean follow-up of 4 years. Int Urogynecol J. 2017;28(2):231–9.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Center for Urogynecology & Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women’s Health InstituteCleveland ClinicClevelandUSA
  2. 2.Cleveland Clinic Lerner College of MedicineCase Western UniversityClevelandUSA

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