Lavelle ES, et al. - The prolapse recurrence rates following sacrocolpopexy (SCP) and uterosacral ligament suspension (USLS) after stratifying by preoperative POPQ stage, underwent a comparative scrutiny. A lower prolapse recurrence rate was caused by SCP than USLS for stage III prolapse. No variation was reported in the recurrence rate among women with preoperative stage II prolapse. This, in turn, led to the belief that mesh augmentation could not be indicated for such patients.

Methods

• All women who underwent minimally invasive sacrocolpopexy (SCP) or vaginal or minimally invasive uterosacral ligament suspension (USLS) underwent comparative inspection from 2009-2015, at a large academic center.
• The enrollment comprised of all women with pre- and postoperative POPQ data.
• Allocation of groups was performed by preoperative POPQ stage for analysis.
• A comparison was conducted of the recurrence rates following SCP and USLS, for patients presenting with stage II, III and IV prolapse, adjusting for potential confounders in regression models.
• Prolapse recurrence was defined as any retreatment for prolapse or any POPQ point beyond the hymen.

Results

• Among the 756 women, 633 underwent SCP (83.7%) and 123 (16.3%) underwent USLS.
• 189 (25%) had preoperative POPQ stage II prolapse, 527 (69.7%) stage III and 40 (5.3%) stage IV.
• The patients were reported to be Caucasian (97.3%) with a mean age of 59.8±9.5 years.
• A majority of the SCP patients had a history of prior prolapse repair (20.9% vs 5.7%, p<0.001) and fewer had known diabetes mellitus (7.9% vs 13.8%, p=0.034), than the USLS patients.
• The remaining characteristics of the groups were similar. Median follow-up was 41.0 weeks (IQR 13.0-88.8).
• Similar recurrence rates were displayed by women with stage II patients, following SCP or USLS (6.0% vs 5.0 p=1.00).
• Stage III prolapse patients exhibited a greater likelihood of experiencing the recurrence following USLS (25.7% vs 7.8%, p<0.001).
• This variation remained after controlling for age, BMI, smoking, diabetes and prior prolapse repair (OR 4.257 95% CI 2.210-8.200).
• The recurrence rates for women with stage IV prolapse did not bring to light any notable variation, despite limited sample size.