Charelle M Carter-Brooks, Jerry L Lowder1, Angela L Du2, Erin S Lavelle, Lauren E Giugale, Jonathan P Shepherd3. 1. Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO. 2. University of Pittsburgh, School of Medicine, Pittsburgh, PA. 3. Department of Obstetrics and Gynecology, St. Francis Hospital and Medical Center, Hartford, CT.
Abstract
OBJECTIVE: The aim of the study was to evaluate postoperative genital hiatus after apical suspension procedures without a level 3 support procedure (L3SP), posterior repair, and perineorrhaphy, compared with normative-value genital hiatus of 3.4 cm. METHODS: This an analysis of a pre-existing retrospectively collected database that included all minimally invasive sacrocolpopexies and uterosacral ligament suspensions performed at a tertiary medical center from January 2009 to August 2015. RESULTS: We identified 1006 surgical cases: 160 (15.9%) apical suspensions with L3SPs and 846 (84.1%) without. Mean (SD) age was 59 (9) years and body mass index was 27.6 (4.7) kg/m. Women were mainly white (97.4%) with stage III prolapse (67.8%). Those who underwent L3SPs were more likely to be premenopausal and undergo hysterectomy and USLS.Baseline genital hiatus was similar with and without L3SPs (4.8 [1.2] cm vs 4.6 [1.1] cm, P = 0.096). Postoperative genital hiatus was reduced beyond normative (3.4 cm) after apical suspension without (3.0 [0.7] cm, P < 0.001) and with (2.8 [0.9] cm, P < 0.001) L3SPs. Postoperative genital hiatus after L3SPs was similar to those without (2.8 [0.9] cm vs 3.0 [0.7] cm, P = 0.06). We found that change in genital hiatus was greater, by 0.7 cm, when L3SP was performed versus not performed (2.3 [1.2] cm vs 1.6 [1.1] cm, P < 0.001). CONCLUSIONS: Level 3 support procedures may be unnecessary to restore genital hiatus to normal at time of apical suspension procedures and should be reserved for select patients.
OBJECTIVE: The aim of the study was to evaluate postoperative genital hiatus after apical suspension procedures without a level 3 support procedure (L3SP), posterior repair, and perineorrhaphy, compared with normative-value genital hiatus of 3.4 cm. METHODS: This an analysis of a pre-existing retrospectively collected database that included all minimally invasive sacrocolpopexies and uterosacral ligament suspensions performed at a tertiary medical center from January 2009 to August 2015. RESULTS: We identified 1006 surgical cases: 160 (15.9%) apical suspensions with L3SPs and 846 (84.1%) without. Mean (SD) age was 59 (9) years and body mass index was 27.6 (4.7) kg/m. Women were mainly white (97.4%) with stage III prolapse (67.8%). Those who underwent L3SPs were more likely to be premenopausal and undergo hysterectomy and USLS.Baseline genital hiatus was similar with and without L3SPs (4.8 [1.2] cm vs 4.6 [1.1] cm, P = 0.096). Postoperative genital hiatus was reduced beyond normative (3.4 cm) after apical suspension without (3.0 [0.7] cm, P < 0.001) and with (2.8 [0.9] cm, P < 0.001) L3SPs. Postoperative genital hiatus after L3SPs was similar to those without (2.8 [0.9] cm vs 3.0 [0.7] cm, P = 0.06). We found that change in genital hiatus was greater, by 0.7 cm, when L3SP was performed versus not performed (2.3 [1.2] cm vs 1.6 [1.1] cm, P < 0.001). CONCLUSIONS: Level 3 support procedures may be unnecessary to restore genital hiatus to normal at time of apical suspension procedures and should be reserved for select patients.
Authors: Gary Sutkin; Halina M Zyczynski; Amaanti Sridhar; J Eric Jelovsek; Charles R Rardin; Donna Mazloomdoost; David D Rahn; John N Nguyen; Uduak U Andy; Isuzu Meyer; Marie G Gantz Journal: Am J Obstet Gynecol Date: 2019-08-23 Impact factor: 8.661
Authors: Wenjin Cheng; Emily English; Whitney Horner; Carolyn W Swenson; Luyun Chen; Fernanda Pipitone; James A Ashton-Miller; John O L DeLancey Journal: Int Urogynecol J Date: 2022-09-21 Impact factor: 1.932
Authors: Olivia H Chang; Emily R W Davidson; Tonya N Thomas; Marie Fidela R Paraiso; Cecile A Ferrando Journal: Int Urogynecol J Date: 2020-03-07 Impact factor: 2.894
Authors: Mildrede Bonglack; Erin Maetzold; Kimberly A Kenne; Catherine S Bradley; Joseph T Kowalski Journal: Int Urogynecol J Date: 2022-03-17 Impact factor: 1.932
Authors: Lauren N Siff; Matthew D Barber; Halina M Zyczynski; Charles R Rardin; Sharon Jakus-Waldman; David D Rahn; Ariana L Smith; Donna Mazloomdoost; Amaanti Sridhar; Marie G Gantz Journal: Obstet Gynecol Date: 2020-10 Impact factor: 7.623