Noor N, et al. - Here, the researchers compared anatomic outcomes 1-year after surgery between patients who underwent minimally invasive sacrocolopopexy (MISC) (laparoscopic or robotic) with synthetic mesh to those who underwent vaginal uterosacral suspension (USLS) for management of apical prolapse. Compared to USLS, MISC had longer operative times and risk of mesh erosion, while the anterior and apical compartment prolapse recurrence rates were lower at 1 year.

Methods

• A multi-center, retrospective cohort study was performed through the Fellows Pelvic Research Network.
• Researchers included patients with prolapse who underwent apical suspension with USLS or MISC from January 2013 to January 2016 with at least 1-year postoperative anatomic data.
• They excluded patients with prior apical repairs, prior vaginal repair with biologic/synthetic graft, or history of connective tissue disorders.
• Using current procedural terminology codes, eligible patients were identified.
• They abstracted relevant pre, intra, and postoperative data from medical records.
• They identified prolapse recurrence beyond the hymen and/or POPQ stage 2 or higher at 1-year postoperatively.
• Using chi-square and Fisher’s exact tests, categorical data were compared.
• Continuous data were compared using the Wilcoxon rank sum test.

Results

• A total of 311 patients underwent MISC (159 laparoscopic and 152 robotic) and 129 patients underwent USLS during the study period; all of these had 1-year POPQ data available.
• In terms of stage of prolapse, the proportion of patients in MISC and USLS group were similar (47.3% vs 44.2% with stage 2 and 47.9% vs 46.5% with stage 3).
• In the MISC group at -2.5 (-4.0, 1.0), the median (interquartile range) preoperative apical point C was higher than in the USLS group at 0.0 (-4.0, 2.5).
• In this study, the anterior and posterior walls were similar: Aa/Ba at 1.0 (0.0, 2.0) and Ap/Bp at -1.0 (-2.0, 0.0).
• In the USLS group, intra and perioperative complications such as blood loss (P < 0.0001), conversion to laparotomy (P=0.002), urinary dysfunction (P=0.02), and fever (P=0.007) were higher, but operative time was longer in MISC group (P=0.002).
• In the MISC group, 3 patients had mesh erosion and in the USLS group, 5 patients were presented with suture erosions.
• In the 2 groups, postoperative pelvic pain, dyspareunia, voiding and bowel dysfunction were comparable.
• In the USLS group, 50 patients (38.8%) had apical descent beyond the hymen compared to 77 (24.8%) patients in the MISC group (P=0.003) at 1-year postoperatively.
• In the USLS vs MISC group, recurrence in the anterior compartment beyond the hymen was also higher: 29 (22.5%) vs 19 (6.1%) patients (P < 0.0001), respectively.
• Posterior compartment recurrences were comparable: 5 (3.9%) vs 16 (5.1%) patients in the USLS vs MISC group (P=0.57), respectively.
• Stage 2 prolapse or greater were noted in 69 (45.7%) patients in the USLS group vs 108 (34.7%) patients in the MISC group at 1-year postoperatively.