Laparoscopic Uterosacral Ligament Hysteropexy vs Total Vaginal Hysterectomy with Uterosacral Ligament Suspension for Anterior and Apical Prolapse: Surgical Outcome and Patient Satisfaction |
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| Institution: | 1. University of Witten-Herdecke, Department of Obstetrics and Gynecology, District Hospital Dormagen, Dr. Geldmacherstr. 20, 41539, Dormagen, Germany;2. Department of Obstetrics and Gynecology, University Witten-Herdecke, Marien-Hospital, Witten Marienplatz, 258452, Witten, Germany;3. Department of Obstetrics and Gynecology, St. Marien Hospital Amberg, Klinikum St. Marien Amberg, Mariahilfbergweg 7, 92224, Amberg, Germany;4. Private Department of Surgical Gynecology, GTK Krefeld, Violstrasse 92, 47800, Krefeld, Germany;5. Department of Obstetrics and Gynecology, Regiomed Clinics Coburg, Klinikum Coburg GmbH, Ketschendorfer Str. 33, D – 96450, Coburg, Germany;6. Department of Obstetrics and Gynecology, Clinic Links Der Weser, Klinikverbund Bremen, Senator-Weßling-Straße 1, 28277, Bremen, Germany;7. Department of Obstetrics and Gynecology, Helios Clinic Bad Sarow, Helios Klinikum Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Germany;8. Department of Obstetrics and Gynecology, St Franziskus Hospital Ahlen, Robert-Koch-Str. 55, 59227, Ahlen, Germany;9. Department of Obstetrics and Gynecology, ZNA Middelheim Antwerp, ZNA Campus Middelheim, Lindendreef 1, 2020, Antwerpen, Belgium;10. Department of Obstetrics and Gynecology, NHS Tayside Dundee, NHS Tayside Ninewells Hospital, DD1 9SY, Dundee, Scotland, United Kingdom;11. Department of Obstetrics and Gynecology, University Hospital de Cabueñes, Clínica Asturias, Calle Naranjo de Bulnes, 4, 33012, Oviedo, Gijon, Spain;1. Department of Obstetrics and Gynecology, Isala, The Netherlands;2. Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands;3. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;1. Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy;2. Department of Obstetrics and Gynecology, University of Pisa, Italy;3. Clinical and Evaluative Epidemiology Department – Trento Health Service, Trento, Italy;4. Department of Urology, S Chiara Hospital, Trento, Italy;5. University of Cagliari, Italy;1. MedStar Washington Hospital Center/Georgetown University, Washington, DC;2. Alpert Medical School of Brown University/Women & Infants Hospital of Rhode Island, Providence, RI;3. Stanford University School of Medicine, Stanford, CA;4. University of North Carolina, Chapel Hill, NC;5. University of British Columbia, Vancouver, British Columbia, Canada;6. Christ Hospital/University of Cincinnati, Cincinnati, OH;7. Greater Baltimore Medical Center, Towson, MD;8. Cleveland Clinic, Cleveland, OH;1. Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey;2. Department of Gynecology and Obstetrics, Sanko University School of Medicine, Gazinatep, Turkey |
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| Abstract: | Study ObjectiveTo compare anatomic and clinical cure rates as well as patient satisfaction between uterine-preserving laparoscopic uterosacral ligament suspension and total vaginal hysterectomy with uterosacral ligament suspension in women with apical and anterior prolapse.DesignSingle-center clinical comparative retrospective cohort study.SettingA female pelvic medicine and reconstructive surgery service at a tertiary teaching hospital.PatientsWomen with pelvic organ prolapse who underwent surgical treatment for their condition between July 2010 and December 2015.InterventionsAll women underwent laparoscopic uterosacral ligament suspension or total vaginal hysterectomy with uterosacral ligament suspension for apical and anterior prolapse. Concomitant procedures included anterior and posterior repair, as well as a midurethral sling when indicated.Measurements and Main ResultsPreoperative and postoperative Pelvic Organ Prolapse Quantification (POP-Q) measurements were obtained. The primary outcome was clinical cure rate. Secondary outcomes included anatomic cure rate and outcomes of site-specific POP-Q points Ba, C, and Bp for the whole cohort. Patient satisfaction was measured using the Patient Global Impression of Improvement questionnaire. During the study period, 106 women underwent transvaginal hysterectomy with uterosacral ligament suspension, and 53 women had laparoscopic uterosacral ligament suspension. At a mean follow-up of 14.7 ± 13.23 months for the vaginal group and 17.5 ± 15.84 months for the laparoscopic group (p = .29), there were significant improvements of POP-Q points Ba, C, and Bp (p < .0001 for all comparisons in both groups). The clinical cure rate was 96% in the vaginal group and 98% in the laparoscopic group (p = .50). The anatomic cure rate was 85.4% in the vaginal group and 93.75% in the laparoscopic group (p = .11) Patient satisfaction was high in both groups.ConclusionIn appropriately selected patients, laparoscopic uterosacral ligament suspension is a valid uterus-preserving option for women with anterior and apical prolapse, associated with high anatomic and clinical cure rates and patient satisfaction. |
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