Rebecca G Rogers1,2, Tracy L Nolen3, Alison C Weidner4, Holly E Richter5, J Eric Jelovsek6, Jonathan P Shepherd7, Heidi S Harvie8, Linda Brubaker9, Shawn A Menefee10, Deborah Myers11, Yvonne Hsu12, Joseph I Schaffer13, Dennis Wallace3, Susan F Meikle14. 1. Department of Women's Health, Dell Medical School, University of Texas, 1301 W 38th Street, Suite 705, Austin, TX, 78756, USA. rebecca.rogers@austin.utexas.edu. 2. Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA. rebecca.rogers@austin.utexas.edu. 3. RTI International, Research Triangle Park, NC, USA. 4. Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA. 5. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. 6. Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. 7. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 8. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA. 9. Department of Obstetrics and Gynecology, Stritch School of Medicine, Maywood, IL, USA. 10. Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, CA, USA. 11. Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA. 12. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA. 13. Department of Obstetrics and Gynecology, University of Texas, Southwestern, Dallas, TX, USA. 14. Northwest Texas Physician Group, Amarillo, TX, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: We compared treatment success and adverse events between women undergoing open abdominal sacrocolpopexy (ASC) vs vaginal repair (VAR) using data from women enrolled in one of three multicenter trials. We hypothesized that ASC would result in better outcomes than VAR. METHODS: Participants underwent apical repair of stage 2-4 prolapse. Vaginal repair included uterosacral, sacrospinous, and iliococcygeal suspensions; sacrocolpopexies were via laparotomy. Success was defined as no bothersome bulge symptoms, no prolapse beyond the hymen, and no retreatment up to 24 months. Adverse events were collected at multiple time points. Outcomes were analyzed using longitudinal mixed-effects models to obtain valid outcome estimates at specific visit times, accounting for data missing at random. Comparisons were controlled for center, age, body mass index (BMI), initial Pelvic Organ Prolapse Quantification (POP-Q) stage, baseline scores, prior prolapse repair, and concurrent repairs. RESULTS: Of women who met inclusion criteria (1022 of 1159 eligibile), 701 underwent vaginal repair. The ASC group (n = 321) was older, more likely white, had prior prolapse repairs, and stage 4 prolapse (all p < 0.05). While POP-Q measurements and symptoms improved in both groups, treatment success was higher in the ASC group [odds ratio (OR) 6.00, 95% confidence interval (CI) 3.45-10.44). The groups did not differ significantly in most questionnaire responses at 12 months and overall improvement in bowel and bladder function. By 24 months, fewer patients had undergone retreatment (2% ASC vs 5% VAR); serious adverse events did not differ significantly through 6 weeks (13% vs 5%, OR 2.0, 95% CI 0.9-4.7), and 12 months (26% vs 13%, OR 1.6, 95% CI 0.9-2.9), respectively. CONCLUSIONS: Open sacrocolpopexy resulted in more successful prolapse treatment at 2 years.
INTRODUCTION AND HYPOTHESIS: We compared treatment success and adverse events between women undergoing open abdominal sacrocolpopexy (ASC) vs vaginal repair (VAR) using data from women enrolled in one of three multicenter trials. We hypothesized that ASC would result in better outcomes than VAR. METHODS:Participants underwent apical repair of stage 2-4 prolapse. Vaginal repair included uterosacral, sacrospinous, and iliococcygeal suspensions; sacrocolpopexies were via laparotomy. Success was defined as no bothersome bulge symptoms, no prolapse beyond the hymen, and no retreatment up to 24 months. Adverse events were collected at multiple time points. Outcomes were analyzed using longitudinal mixed-effects models to obtain valid outcome estimates at specific visit times, accounting for data missing at random. Comparisons were controlled for center, age, body mass index (BMI), initial Pelvic Organ Prolapse Quantification (POP-Q) stage, baseline scores, prior prolapse repair, and concurrent repairs. RESULTS: Of women who met inclusion criteria (1022 of 1159 eligibile), 701 underwent vaginal repair. The ASC group (n = 321) was older, more likely white, had prior prolapse repairs, and stage 4 prolapse (all p < 0.05). While POP-Q measurements and symptoms improved in both groups, treatment success was higher in the ASC group [odds ratio (OR) 6.00, 95% confidence interval (CI) 3.45-10.44). The groups did not differ significantly in most questionnaire responses at 12 months and overall improvement in bowel and bladder function. By 24 months, fewer patients had undergone retreatment (2% ASC vs 5% VAR); serious adverse events did not differ significantly through 6 weeks (13% vs 5%, OR 2.0, 95% CI 0.9-4.7), and 12 months (26% vs 13%, OR 1.6, 95% CI 0.9-2.9), respectively. CONCLUSIONS: Open sacrocolpopexy resulted in more successful prolapse treatment at 2 years.
Authors: R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith Journal: Am J Obstet Gynecol Date: 1996-07 Impact factor: 8.661
Authors: Nazema Y Siddiqui; Cara L Grimes; Elizabeth R Casiano; Husam T Abed; Peter C Jeppson; Cedric K Olivera; Tatiana V Sanses; Adam C Steinberg; Mary M South; Ethan M Balk; Vivian W Sung Journal: Obstet Gynecol Date: 2015-01 Impact factor: 7.661
Authors: Matthew D Barber; Linda Brubaker; Kathryn L Burgio; Holly E Richter; Ingrid Nygaard; Alison C Weidner; Shawn A Menefee; Emily S Lukacz; Peggy Norton; Joseph Schaffer; John N Nguyen; Diane Borello-France; Patricia S Goode; Sharon Jakus-Waldman; Cathie Spino; Lauren Klein Warren; Marie G Gantz; Susan F Meikle Journal: JAMA Date: 2014-03-12 Impact factor: 56.272
Authors: John T Wei; Ingrid Nygaard; Holly E Richter; Charles W Nager; Matthew D Barber; Kim Kenton; Cindy L Amundsen; Joseph Schaffer; Susan F Meikle; Cathie Spino Journal: N Engl J Med Date: 2012-06-21 Impact factor: 91.245
Authors: Ingrid E Nygaard; Rebecca McCreery; Linda Brubaker; AnnaMarie Connolly; Geoff Cundiff; Anne M Weber; Halina Zyczynski Journal: Obstet Gynecol Date: 2004-10 Impact factor: 7.661
Authors: Matthew D Barber; Linda Brubaker; Ingrid Nygaard; Thomas L Wheeler; Joeseph Schaffer; Zhen Chen; Cathie Spino Journal: Obstet Gynecol Date: 2009-09 Impact factor: 7.661
Authors: Christopher F Maher; Aymen M Qatawneh; Peter L Dwyer; Marcus P Carey; Ann Cornish; Philip J Schluter Journal: Am J Obstet Gynecol Date: 2004-01 Impact factor: 8.661