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Open sacrocolpopexy and vaginal apical repair: retrospective comparison of success and serious complications

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Abstract

Introduction and hypothesis

We compared treatment success and adverse events between women undergoing open abdominal sacrocolpopexy (ASC) vs vaginal repair (VAR) using data from women enrolled in one of three multicenter trials. We hypothesized that ASC would result in better outcomes than VAR.

Methods

Participants underwent apical repair of stage 2–4 prolapse. Vaginal repair included uterosacral, sacrospinous, and iliococcygeal suspensions; sacrocolpopexies were via laparotomy. Success was defined as no bothersome bulge symptoms, no prolapse beyond the hymen, and no retreatment up to 24 months. Adverse events were collected at multiple time points. Outcomes were analyzed using longitudinal mixed-effects models to obtain valid outcome estimates at specific visit times, accounting for data missing at random. Comparisons were controlled for center, age, body mass index (BMI), initial Pelvic Organ Prolapse Quantification (POP-Q) stage, baseline scores, prior prolapse repair, and concurrent repairs.

Results

Of women who met inclusion criteria (1022 of 1159 eligibile), 701 underwent vaginal repair. The ASC group (n = 321) was older, more likely white, had prior prolapse repairs, and stage 4 prolapse (all p < 0.05). While POP-Q measurements and symptoms improved in both groups, treatment success was higher in the ASC group [odds ratio (OR) 6.00, 95% confidence interval (CI) 3.45–10.44). The groups did not differ significantly in most questionnaire responses at 12 months and overall improvement in bowel and bladder function. By 24 months, fewer patients had undergone retreatment (2% ASC vs 5% VAR); serious adverse events did not differ significantly through 6 weeks (13% vs 5%, OR 2.0, 95% CI 0.9–4.7), and 12 months (26% vs 13%, OR 1.6, 95% CI 0.9–2.9), respectively.

Conclusions

Open sacrocolpopexy resulted in more successful prolapse treatment at 2 years.

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Acknowledgements

University of Iowa: CS Bradley, K Kreder; University of Alabama, KL Burgio, RE Varner, A Ballard, J Burge, K Carter, P Goode, AD Markland, C Parker-Autry, TS Wilson; University of Michigan YW Casher, B Marchant, JT Wei, PA Wren, YH Chen, D DiFranco, C Spino, B Marchant; University North Carolina of Chapel Hill AM Connolly, W Whitehead; Johns Hopkins GW Cundiff, VL Handa; Baylor P Fine; Magee Women’s Hospital J Gruss, P Moalli, HM Zyczynski; Duke AG Visco, CL Amundsen, I Harm-Ernandes, M Raynor, J Wu, NY Siddiqui; UCSD ME Albo, C Grimes, ES Lukacz, CW Nager; UTSW S Atnip, EK Moore, D Rahn, C Wai; University of Utah J Baker, M Masters, A Orr; Kaiser San Diego G Diwadkar, KY Dyer, LM Hall, LM Mackinnon, JN Nguyen, G Zazueta-Damian, J Tan-Kim; Cleveland Clinic A Frick, B O’Dougherty, L Pung, B Ridegeway, C Williams; RTI M Gantz, LK Warren, D Matthews, A Shaffer, KA Wilson, RE Whitworth, J Thornberry, TT Terry; Steering Committee Chair K Hartmann; Kaiser Bellflower S Jakus-Waldman; Loyola E Mueller, M Tulke; University of New Mexico Y Komesu, G Dunivan, C Cichowski, P Jeppson.

Funding

Research Support: Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (2U01HD41249, 2 U10 HD41250, 2 U10 HD41261, 2 U10 HD41267, 1 U10 HD54136, 1 U10 HD54214, 1 U10 HD54215, 1 U10 HD54241, U10 HD069013, U10 HD069025, U10 HD069010, and U01 HD069031) and the National Institutes of Health Office of Research on Women’s Health.

Author information

Authors and Affiliations

  1. Department of Women’s Health, Dell Medical School, University of Texas, 1301 W 38th Street, Suite 705, Austin, TX, 78756, USA

    Rebecca G. Rogers

  2. Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA

    Rebecca G. Rogers

  3. RTI International, Research Triangle Park, NC, USA

    Tracy L. Nolen & Dennis Wallace

  4. Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA

    Alison C. Weidner

  5. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA

    Holly E. Richter

  6. Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    J. Eric Jelovsek

  7. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Jonathan P. Shepherd

  8. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Heidi S. Harvie

  9. Department of Obstetrics and Gynecology, Stritch School of Medicine, Maywood, IL, USA

    Linda Brubaker

  10. Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, CA, USA

    Shawn A. Menefee

  11. Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA

    Deborah Myers

  12. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA

    Yvonne Hsu

  13. Department of Obstetrics and Gynecology, University of Texas, Southwestern, Dallas, TX, USA

    Joseph I. Schaffer

  14. Northwest Texas Physician Group, Amarillo, TX, USA

    Susan F. Meikle

Authors
  1. Rebecca G. Rogers
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  2. Tracy L. Nolen
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  3. Alison C. Weidner
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  4. Holly E. Richter
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  5. J. Eric Jelovsek
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  6. Jonathan P. Shepherd
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  7. Heidi S. Harvie
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  8. Linda Brubaker
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  9. Shawn A. Menefee
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  10. Deborah Myers
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  11. Yvonne Hsu
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  12. Joseph I. Schaffer
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  13. Dennis Wallace
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  14. Susan F. Meikle
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Consortia

for the NICHD Pelvic Floor Disorders Network

Corresponding author

Correspondence to Rebecca G. Rogers.

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Conflicts of interest

Rogers: royalties, travel and stipend from ABOG for work on the board; travel and stipend from IUGA for work related to the editor in chief for the IUJ, DSMB chair for the TRANSFORM trial sponsored by American Medical Systems. Richter: Pelvalon, research grant and consultant; Kimberly Clarkt, royalties. Shepherd : site PI for Synergy trial sponsored by Astellas. Brubaker: editorial stipends, Female Pelvic Medicine and Reconstructive Surgery and royalties. Schaffer: McGraw Hill, royalties; Boston Scientific, research; Astellas, speaker. Harvie, Jelovsek, Menefee, Myers, Hsu, Wallace, Meikle: no conflict of interest.

Additional information

Presented at the Society of Gynecologic Surgeons 2014 annual meeting in Orlando, FL, USA.

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Rogers, R.G., Nolen, T.L., Weidner, A.C. et al. Open sacrocolpopexy and vaginal apical repair: retrospective comparison of success and serious complications. Int Urogynecol J 29, 1101–1110 (2018). https://doi.org/10.1007/s00192-018-3666-7

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  • DOI: https://doi.org/10.1007/s00192-018-3666-7

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