Rogers RG, et al. - Researchers performed a retrospective comparison of surgical success and complications between vaginal vault prolapse compared with uterovaginal prolapse in women who underwent apical prolapse repair for stage II–IV prolapse. They observed that at 1–2 years postoperatively, surgical success of stage II–IV vault prolapse and uterovaginal prolapse apical repair was similar whether performed vaginally or abdominally at 1–2 years postoperatively.

Methods

• Researchers included women in one of three Pelvic Floor Disorders Network prolapse surgical trials.
• Success was defined as absence of bothersome bulge symptoms, no prolapse beyond the hymen, and no subsequent prolapse treatment and was assessed as the primary outcome measure.
• Comparison of quality-of-life measures, anatomic changes, and adverse events were the secondary outcomes.
• At baseline and 1–2 years postoperatively, pelvic organ prolapse quantification (POP-Q) and quality-of-life measures were administered.
• They controlled comparisons for study site, age, body mass index, baseline POP-Q, apical and anterior or posterior repair performed, and prior prolapse repair.
• Using longitudinal models, they analyzed outcomes measured at multiple time points to assess whether differences existed across study follow-up.

Results

• In the study population, 421 women underwent vault prolapse, and 601 underwent uterovaginal prolapse apical repair.
• Patients in the vault prolapse group were observed to be older, were more frequently white, and had prior urinary incontinence or prolapse repair, stage IV prolapse, and more prolapse bother on a validated scale (all P≤.034).
• The vault prolapse group more frequently underwent sacrocolpopexy (228/421 [54%] vs 93/601 [15%]); the uterovaginal prolapse group more frequently underwent vaginal repair (508/601 [85%] vs 193/421 [46%] P<.001).
• No differences in success (odds ratio [OR] 0.76 for vault prolapse vs uterovaginal prolapse, 95% CI 0.51–1.15, P=.20), changes in Pelvic Organ Prolapse Distress Inventory scores (-79.4 vs -79.8, P=.89), postoperative POP-Q point C measurements (-7.0 vs -7.1 cm, P=.41), or serious adverse events (86/421 [20%] vs 90/601 [15%], P=.86) were observed between groups.
• Observations revealed that among women who underwent a vaginal approach for repair of vault prolapse (n=193) or uterovaginal prolapse (n=508), no differences in success rates (OR 0.67, 95% CI 0.43–1.04, P=.09) at 1–2 years postoperatively were evident.