nach oben

International Urogynecology Journal

Erschienen in:

28.05.2020 | Original Article

Hysterectomy with uterosacral suspension or Uphold™ hysteropexy in women with apical prolapse: a parallel cohort study

verfasst von: Mugdha Kulkarni, Natharnia Young, Joseph Lee, Anna Rosamilia

Erschienen in: International Urogynecology Journal | Ausgabe 10/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

The aim was to compare objective and subjective cure rates between Uphold™ hysteropexy (HP) and vaginal hysterectomy (VH) with uterosacral suspension.

Methods

A sample size of 49 in each arm would be required to detect a clinical difference of 20% between the groups. Owing to delayed recruitment, this originally planned randomised controlled trial was changed to a patient preference study after randomising initial 6 participants. Women with symptomatic stage ≥2 uterine descent wishing a surgical solution were included. Routine follow-up was scheduled at 6 weeks, 6 months, 12 months, and annually thereafter. Primary outcome was absence of stage ≥2 apical prolapse. Secondary outcomes included a composite cure of no leading edge beyond the hymen, absence of bulge symptoms and no retreatment; patient-reported outcomes were based on quality-of-life questionnaires (PFDI-20, PFIQ-7, PISQ-12, PGI-I, EQ5D and a health score).

Results

We recruited 50 patients undergoing VH between 2011 and 2013 and 51 patients undergoing HP between 2011 and 2016. Participants were followed up for a median of 25 months (23–96). Five women from the VH (10%) and 7 from the HP (14%) group were lost to follow-up. Combined anatomical and symptomatic outcomes were available for 41 (82%) VH and 39 (76%) in the HP group. There was no difference in objective apical outcomes; the incidence of stage 2 prolapse was 0% in the VH group and 2% in HP group (p = 0.50). We found no difference in the composite cure rate (78% VH vs 85% HP, 0.45) between the groups. There was no significant difference in surgical complications (p = 0.33), assessed using Clavien–Dindo classification. There was a 2% surgery rate for mesh exposure in the HP group.

Conclusions

Uphold™ uterine suspension and VH appear to have similar objective and subjective cure at 25 months, with no significant difference in surgical complications.

Nur mit Berechtigung zugänglich

Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):470 e471–6. https://doi.org/10.1016/j.ajog.2013.08.003.CrossRef

Frick AC, Barber MD, Paraiso MF, Ridgeway B, Jelovsek JE, Walters MD. Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2013;19(2):103–9. https://doi.org/10.1097/SPV.0b013e31827d8667.CrossRefPubMed

Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J. 2013;24(11):1803–13. https://doi.org/10.1007/s00192-013-2171-2.CrossRefPubMed

Hefni M, El-Toukhy T, Bhaumik J, Katsimanis E. Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol. 2003;188(3):645–50. https://doi.org/10.1067/mob.2003.75.CrossRefPubMed

Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P. Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):381–4 discussion 384–385.CrossRefPubMed

Van Brummen HJ, van de Pol G, Aalders CI, Heintz AP, van der Vaart CH. Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(5):350–5; discussion 355. https://doi.org/10.1007/s00192-003-1084-x.CrossRefPubMed

Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J. 2010;21(2):209–16. https://doi.org/10.1007/s00192-009-1014-7.CrossRefPubMed

Jia X, Glazener C, Mowatt G, Jenkinson D, Fraser C, Bain C, et al. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse. Int Urogynecol J. 2010;21(11):1413–31. https://doi.org/10.1007/s00192-010-1156-7.CrossRefPubMed

Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:CD012079. https://doi.org/10.1002/14651858.CD012079.CrossRefPubMed

10.

Goldberg RP, Tomezsko JE, Winkler HA, Koduri S, Culligan PJ, Sand PK. Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation. Obstet Gynecol. 2001;98(2):199–204.PubMed

11.

Vu MK, Letko J, Jirschele K, Gafni-Kane A, Nguyen A, Du H, et al. Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes. Int Urogynecol J. 2012;23(12):1753–61. https://doi.org/10.1007/s00192-012-1780-5.CrossRefPubMed

12.

Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7. https://doi.org/10.1016/s0002-9378(96)70243-0.CrossRefPubMed

13.

Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183(6):1365–73; discussion 1373-4. https://doi.org/10.1067/mob.2000.110910.CrossRefPubMed

14.

Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Int Urogynecol J. 2020;31(3):429–63. https://doi.org/10.1007/s00192-020-04236-1.CrossRef

15.

Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI−20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.CrossRefPubMed

16.

Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(3):164–8; discussion 168. https://doi.org/10.1007/s00192-003-1063-2.CrossRefPubMed

17.

Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21(5):523–8. https://doi.org/10.1007/s00192-009-1069-5.CrossRefPubMed

18.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36. https://doi.org/10.1007/s11136-011-9903-x.CrossRefPubMedPubMedCentral

19.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.CrossRefPubMed

20.

Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22(1):3–15. https://doi.org/10.1007/s00192-010-1324-9.CrossRefPubMed

21.

Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, et al. An International Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Neurourol Urodyn. 2012;31(4):415–21. https://doi.org/10.1002/nau.22238.CrossRefPubMed

22.

Haylen BT, Maher C, Deprest J. IUGA/ICS terminology and classification of complications of prosthesis and graft insertion—rereading will revalidate. Am J Obstet Gynecol. 2013;208(1):e15. https://doi.org/10.1016/j.ajog.2012.08.004.CrossRefPubMed

23.

Nager CW, Visco AG, Richter HE, Rardin CR, Rogers RG, Harvie HS, et al. Effect of vaginal mesh hysteropexy vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: a randomized clinical trial. JAMA. 2019;322(11):1054–65. https://doi.org/10.1001/jama.2019.12812.CrossRefPubMedPubMedCentral

24.

Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG. 2004;111(1):50–6.CrossRefPubMed

25.

Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–92. https://doi.org/10.1097/01.MLR.0000062554.74615.4C.CrossRefPubMed

26.

Pellino G, Ramage L, Simillis C, Warren O, Kontovounisios C, Tan E, et al. Evaluation of sexual dysfunction in female patients presenting with faecal incontinence or defecation disorder. Int J Colorectal Dis. 2017;32(5):667–74. https://doi.org/10.1007/s00384-017-2795-7.CrossRefPubMed

27.

Liao SC, Huang WC, Su TH, Lau HH. Changes in female sexual function after vaginal mesh repair versus native tissue repair for pelvic organ prolapse: a meta-analysis of randomized controlled trials. J Sex Med. 2019;16(5):633–9. https://doi.org/10.1016/j.jsxm.2019.02.016.CrossRefPubMed

28.

Lo TS, Pue LB, Tan YL, Hsieh WC, Kao CC, Uy-Patrimonio MC. Anterior-apical single-incision mesh surgery (uphold): 1-year outcomes on lower urinary tract symptoms, anatomy and ultrasonography. Int Urogynecol J. 2019;30(7):1163–72. https://doi.org/10.1007/s00192-018-3691-6.CrossRefPubMed

29.

Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M, et al. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol. 2018;219(2):129–146.e2. https://doi.org/10.1016/j.ajog.2018.01.018.CrossRefPubMed

30.

Jirschele K, Seitz M, Zhou Y, Rosenblatt P, Culligan P, Sand P. A multicenter, prospective trial to evaluate mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse. Int Urogynecol J. 2015;26(5):743–8. https://doi.org/10.1007/s00192-014-2564-x.CrossRefPubMed

31.

Rahkola-Soisalo P, Mikkola TS, Altman D, Falconer C, Nordic TVMG. Pelvic organ prolapse repair using the uphold vaginal support system: 5-year follow-up. Female Pelvic Med Reconstr Surg. 2019;25(3):200–5. https://doi.org/10.1097/SPV.0000000000000530.CrossRefPubMed

32.

Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol. 2011;118(6):1271–9. https://doi.org/10.1097/AOG.0b013e318236fd12.CrossRefPubMedPubMedCentral

33.

Therapeutic Goods Administration (2019) Transvaginal (urogynaecological) surgical mesh. https://www.tga.gov.au/hubs/transvaginal-mesh.

34.

U.S. Food & Drug Administration (2019) Urogynecologic surgical mesh implants. https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants.

Titel: Hysterectomy with uterosacral suspension or Uphold™ hysteropexy in women with apical prolapse: a parallel cohort study
verfasst von: Mugdha Kulkarni
Natharnia Young
Joseph Lee
Anna Rosamilia
Publikationsdatum: 28.05.2020
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 10/2020
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04328-y

Neu im Fachgebiet Gynäkologie und Geburtshilfe

23.04.2024 | Medikamente in Schwangerschaft und Stillzeit | Nachrichten

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Hysterectomy with uterosacral suspension or Uphold™ hysteropexy in women with apical prolapse: a parallel cohort study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Neu im Fachgebiet Gynäkologie und Geburtshilfe

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Gynäkologie

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2020

The international discussion and the new regulations concerning transvaginal mesh implants in pelvic organ prolapse surgery

Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy?

3D modeling and 3D printing in functional urology: the future perspective

Video of uterovaginal procidentia repair incorporating a high extraperitoneal uterosacral vault suspension

Surgical removal of sacrocolpopexy mesh due to chronic inflammatory reaction

The impact of prior prolapse repairs on surgical outcomes with minimally invasive sacral colpopexy

Neu im Fachgebiet Gynäkologie und Geburtshilfe

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Gynäkologie