04: Transvaginal apical approaches for advanced pelvic organ prolapse

Abstract

Objectives: To compare 2‐year surgical outcomes of sacrospinous ligament fixation (SSLF) vs. uterosacral ligament suspension (ULS) in women with advanced pelvic organ prolapse (POP). Secondarily, to explore the difference in outcomes between advanced vs. mild POP. Materials and Methods: A secondary analysis was conducted in a subset of women with stage 3 or 4 (“advanced”) POP from a multicenter randomized trial comparing 1) SSLF vs. ULS and 2) perioperative behavioral with pelvic floor muscle training (BPMT) vs. usual care. Of 377 subjects, 113/186 (60.7%) in the SSLF group and 117/188 (62.7%) in ULS had advanced POP. The primary outcome was 2‐year surgical success defined as 1) no apical descent > 1/3 into vaginal canal or anterior/posterior vaginal wall beyond the hymen, 2) no bothersome vaginal bulge symptoms, and 3) no retreatment for POP. Secondary outcomes include individual success components, symptom severity measured by the Pelvic Organ Prolapse Distress Inventory (POPDI), and adverse events (AEs). Preoperative stage 2 was considered “mild” POP. Outcomes were evaluated via generalized linear models with a logit link and terms for prolapse severity, surgical group, BPMT assignment, and their interactions, concomitant hysterectomy, and random effect for surgeon. Results: Among women with advanced POP, surgical success did not differ between groups (ULS 58.2% [57/117] vs. SSLF 58.5% [55/113], aOR 1.0; 95% CI 0.5, 1.8). No difference was noted in individual success components (Table). POPDI scores improved in both; no intergroup difference was noted (ULS ‐72.7 ± 67.4 vs. SSLF ‐74.1 ± 72.2, adjusted mean difference 2.4; ‐17.9, 22.6). Serious AEs did not differ (ULS 19.7% vs. SSLF 16.8%, aOR 1.2; 0.6, 2.4) except neurologic pain requiring medication was higher in SSLF (Table). Comparing women with advanced vs. mild POP, success was lower in those with advanced POP compared to mild (58.3% vs. 73.2%, aOR 0.5; 0.3, 0.9). This difference was significant in ULS (58.2% vs. 75.4%, aOR 0.4; 0.2, 0.9), but not in SSLF (58.5% vs. 70.9%, aOR 0.6; 0.3, 1.3) group. Serious AEs did not differ in advanced vs. mild (18.3% vs. 13.9%, aOR 1.4; 0.8, 2.6) POP. Conclusion: At 2 years, surgical success, symptom severity, and serious AEs did not differ between SSLF and ULS in women with advanced POP. Compared to mild POP outcomes, success was lower in advanced POP group. [Figure presented]