Skip to main content

Advertisement

SpringerLink
Log in

Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study

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

Abstract

Introduction and hypothesis

Vaginal apical suspension is essential for the surgical treatment of pelvic organ prolapse (POP). We aim to evaluate whether the method of apical repair is associated with different re-operation rates for POP recurrence or surgical complications.

Methods

Population-based, retrospective cohort study of all Ontario women receiving primary apical POP repairs from 2003 to 2015. Primary exposure was the method of apical POP repair. Primary outcome was re-operation for recurrent POP, and secondary outcomes were surgical procedures for genito-intestinal (GI) or genitourinary (GU) complications, fistula repair, and mesh revision or removal.

Results

Forty-three thousand four hundred fifty-eight women were included. Overall, the number of mesh-based apical repairs decreased over time, while the number of native-tissue repairs slightly increased (p < 0.001). Multivariable Cox proportional hazards (Cox PH) analysis demonstrated a significant increase in repeat POP operations for transvaginal mesh apical repairs (adjusted HR 1.28 [95% CI: 1.10–1.48]), but not in abdominal mesh repairs (adjusted HR 0.96 [95% CI: 0.81–1.13]) compared with vaginal native tissue apical repairs. Overall risk of repeat surgery for fistulas or GI and GU complications remained low (< 0.5%). Risk of mesh removal or revision was 11.5–11.9%, with no difference between abdominal versus vaginal mesh on multivariable analysis (adjusted HR 0.99 [95% CI: 0.78–1.26]).

Conclusions

Re-operation for recurrent POP is highest in transvaginal mesh apical repairs; however, this risk did not differ between abdominal mesh and vaginal native tissue apical repairs. GI and GU re-operations are rare. There is no difference in mesh removal or revision rates between abdominal and vaginal mesh repairs.

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

Similar content being viewed by others

References

  1. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027–38.

    Article  PubMed  Google Scholar 

  2. Shull BL. Pelvic organ prolapse: anterior, superior, and posterior vaginal segment defects. Am J Obstet Gynecol. 1999;181(1):6–11.

    Article  CAS  PubMed  Google Scholar 

  3. Alas AN, Anger JT. Role of apical support defect: correction in women undergoing vaginal prolapse surgery. Curr Opin Obstet Gynecol. 2014;26(5):386–92.

    Article  PubMed  Google Scholar 

  4. Raman SV, Raker CA, Sung VW. Concomitant apical prolapse repair and incontinence procedures: trends from 2001-2009 in the United States. Am J Obstet Gynecol. 2014;211(3):222.e1–5.

    Article  Google Scholar 

  5. Nygaard I, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. Jama. 2013;309(19):2016–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dubuisson J, et al. Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh. Arch Gynecol Obstet. 2013;287(2):307–12.

    Article  PubMed  Google Scholar 

  7. Younger A, et al. Pelvic organ prolapse surgery in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the Food and Drug Administration public health notifications. Urology. 2016;91:46–50.

    Article  PubMed  Google Scholar 

  8. Administration, U.F.a.D. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. Center for Devices and Radiological Health; 2011. p. 15.

  9. Feiner B, Maher C. Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol. 2010;115(2 Pt 1):325–30.

    Article  PubMed  Google Scholar 

  10. Iglesia CB, et al. Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol. 2010;116(2 Pt 1):293–303.

    Article  PubMed  Google Scholar 

  11. Nygaard IE, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23.

    Article  PubMed  Google Scholar 

  12. Jelovsek JE, et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. Jama. 2018;319(15):1554–65.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Siddiqui NY, et al. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol. 2015;125(1):44–55.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Morling JR, et al. Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997-2016: a population-based cohort study. Lancet. 2017;389(10069):629–40.

    Article  PubMed  Google Scholar 

  15. Benchimol EI, et al. The REporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med. 2015;12(10):e1001885.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Williams J, Young W. Appendix I: a summary of studies on the quality of health care administrative databases in Canada. In: Williams J, Goel V, Anderson GM et al., editors. Patterns of Health Care in Ontario: the ICES Practice Atlas, 2nd edition. Canadian Medical Association; 2000. p. 339–347.

  17. Raina P, et al. Agreement between self-reported and routinely collected health-care utilization data among seniors. Health Serv Res. 2002;37(3):751–74.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Iron K, Manuel D. Quality assessment of administrative data (QuAAD): an opportunity for enhancing Ontario’s health data. ICES investigative report. Toronto: Institute for Clinical Evaluative Sciences; 2007.

    Google Scholar 

  19. Gibson D, Richards H, Chapman A. The National Ambulatory Care Reporting System: factors that affect the quality of its emergency data. Int J Inf Qual. 2008;2(2):97–114.

    Google Scholar 

  20. Jha P, et al. Characteristics and mortality outcomes of thrombolysis trial participants and nonparticipants: a population-based comparison. J Am Coll Cardiol. 1996;27(6):1335–42.

    Article  CAS  PubMed  Google Scholar 

  21. Weiner JP. The Johns Hopkins ACG® Case-Mix System Version 10.0 Release Notes., H.S.R.D.C. The Johns Hopkins University Bloomberg School of Public Health, Editor. 2011: The Johns Hopkins University.

  22. Austin PC, et al. Using the Johns Hopkins aggregated diagnosis groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada. Med Care. 2011;49(10):932–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94(446):496–509.

    Article  Google Scholar 

  24. LO T-S, WANG AC. Abdominal Colposacropexy and sacrospinous ligament suspension for severe Uterovaginal prolapse: a comparison. J Gynecol Surg. 1998;14(2):59–64.

    Article  Google Scholar 

  25. Chen Y, Hua K. Medium-term outcomes of laparoscopic sacrocolpopexy or sacrohysteropexy versus vaginal sacrospinous ligament fixation for middle compartment prolapse. Int J Gynaecol Obstet. 2017;137(2):164–9.

    Article  PubMed  Google Scholar 

  26. Larouche M, Geoffrion R, Walter J-E. No. 351-transvaginal mesh procedures for pelvic organ prolapse. J Obstet Gynaecol Can. 2017;39(11):1085–97.

    Article  PubMed  Google Scholar 

  27. Stewart JR, Hamner JJ, Heit MH. Thirty years of cystocele/rectocele repair in the United States. Female Pelvic Med Reconstr Surg. 2016;22(4):243–7.

    Article  PubMed  Google Scholar 

  28. Kelly EC, Winick-Ng J, Welk B. Surgeon experience and complications of transvaginal prolapse mesh. Obstet Gynecol. 2016;128(1):65–72.

    Article  PubMed  Google Scholar 

  29. Diwadkar GB, et al. Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol. 2009;113(2 Pt 1):367–73.

    Article  PubMed  Google Scholar 

  30. Committee Opinion No. 694: Management of Mesh and Graft Complications in gynecologic surgery. Obstet Gynecol 2017;129(4):e102-e108.

Download references

Acknowledgements

The opinions, results and conclusions are those of the authors and are independent from the funding sources. No endorsement by the LHSC Women’s Development Council, ICES, AMOSO, SSMD, LHRI or MOHLTC is intended or should be inferred. This research project was conducted in collaboration with members of the ICES Kidney, Dialysis and Transplantation team, at the ICES Western facility, who are supported by a grant from the Canadian Institutes of Health Research (CIHR).

Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s) and not necessarily those of CIHI.

Disclosure of financial support

This study was funded by the Women’s Development Council at London Health Sciences Centre (LHSC), London Ontario, Canada. The Women’s Development Council is funded in part by donors of the London Health Sciences Foundation (LHSF) and by the Department of Obstetrics and Gynecology at LHSC. This study was supported by the Institute for Clinical Evaluative Sciences (ICES) Western site, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University and the Lawson Health Research Institute (LHRI).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, London Health Sciences Centre, Victoria Hospital, Room B4-401, 800 Commissioners Road, East London, ON, N6H 5W9, Canada

    You (Maria) Wu, Queena Chou, Barry MacMillan & Yvonne Leong

  2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Jennifer Reid & Blayne Welk

  3. Department of Epidemiology and Biostatistics, London Health Sciences Centre, London, ON, Canada

    Blayne Welk

  4. Department of Surgery, London Health Sciences Centre, London, ON, Canada

    Blayne Welk

Authors
  1. You (Maria) Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Queena Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barry MacMillan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yvonne Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Blayne Welk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to You (Maria) Wu.

Ethics declarations

Conflicts of interest

None.

Electronic supplementary material

ESM 1

(DOCX 113 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, Y.(., Reid, J., Chou, Q. et al. Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study. Int Urogynecol J 30, 537–544 (2019). https://doi.org/10.1007/s00192-018-3792-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-018-3792-2

Keywords

Search

Navigation