OBJECTIVE: To evaluate efficacy of the Elevate Anterior and Apical (EAA) in the repair of pelvic organ prolapse (POP) when performed after previous hysterectomy and with or without uterine preservation during POP surgery.
MATERIALS AND METHODS: One hundred forty-two women with anterior vaginal prolapse and/or apical descent ≥ stage II were enrolled. The primary outcome was treatment failure defined as > stage II POP-Q during follow-up using the Last observed Failure Carried Forward method. Three sub-groups were analysed: baseline previous hysterectomy (N = 61); concomitant hysterectomy (N = 29), and preserved uterus/no hysterectomy (N = 51). Demographics, primary and secondary outcomes, and extrusion were compared between the groups. A P value less than 0.05 was considered statistically significant.
RESULTS: Anatomic success shows significant and durable improvement at 24 months. The success for the apical compartment ranged between 93.8% and 100%. Success was slightly lower for the anterior compartment (70.8-89.1%). No statistically significant difference between the 3 subgroups. Age was the only patient characteristic to be found different between the 3 subgroups. In addition, there was no difference in overall intraoperative complications (P = 0.263). Mesh extrusion was found in all groups: 3 of 61 (4.9%) had previous hysterectomy; 4 of 29 (13.8%) had concomitant hysterectomy; and 1 of 51 (2.0%) had uterus preserved (P = 0.094). There appears to be a trend toward higher extrusion when a hysterectomy was performed with the EAA.
CONCLUSIONS: Anatomic success and complications for the EAA do not appear to be significantly impacted when the uterus is removed before or during surgery or preserved. There may be a trend toward increased mesh extrusion when a hysterectomy is performed. However, larger cohort studies are needed to determine if concomitant hysterectomy impact extrusion.
Stanford EJ, Moore RD, Roovers JP, VanDrie DM, Giudice TP, Lukban JC, Bataller E, Sutherland SE. Are you the author?
Oasis International Hospital, Beijing, China; Atlanta Urogynecology, Atlanta, GA; Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; Female Pelvic Medicine & Urogynecology Institute of Michigan, Grand Rapids, MI; South Carolina OB/GYN, Columbia, SC; The Pelvic Solutions Center, Denver, CO; Hospital Clinic i Provincial de Barcelona, Universidad de Barcelona, Barcelona, Spain; and University of Washington Medical Center, Seattle, WA.
Reference: Female Pelvic Med Reconstr Surg. 2015 Jul-Aug;21(4):205-10.