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Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence.

Publication ,  Journal Article
Meyer, I; Whitworth, RE; Lukacz, ES; Smith, AL; Sung, VW; Visco, AG; Ackenbom, MF; Wai, CY; Mazloomdoost, D; Gantz, MG; Richter, HE ...
Published in: Int Urogynecol J
October 2020

INTRODUCTION AND HYPOTHESIS: Limited data exist comparing different surgical approaches in women with advanced vaginal prolapse. This study compared 2-year surgical outcomes of uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) in women with advanced prolapse (stage III-IV) and stress urinary incontinence. METHODS: This was a secondary analysis of a multicenter 2 × 2 factorial randomized trial comparing (1) ULS versus SSLF and (2) behavioral therapy with pelvic floor muscle training versus usual care. Of 374 subjects, 117/188 (62.7%) in the ULS and 113/186 (60.7%) in the SSLF group had advanced prolapse. Two-year surgical success was defined by the absence of (1) apical descent > 1/3 into the vaginal canal, (2) anterior/posterior wall descent beyond the hymen, (3) bothersome bulge symptoms, and (4) retreatment for prolapse. Secondary outcomes included individual success outcome components, symptom severity measured by the Pelvic Organ Prolapse Distress Inventory, and adverse events. Outcomes were also compared in women with advanced prolapse versus stage II prolapse. RESULTS: Success did not differ between groups (ULS: 58.2% [57/117] versus SSLF: 58.5% [55/113], aOR 1.0 [0.5-1.8]). No differences were detected in individual success components (p > 0.05 for all components). Prolapse symptom severity scores improved in both interventions with no intergroup differences (p = 0.82). Serious adverse events did not differ (ULS: 19.7% versus SSLF: 16.8%, aOR 1.2 [0.6-2.4]). Success was lower in women with advanced prolapse compared with stage II (58.3% versus 73.2%, aOR 0.5 [0.3-0.9]), with no retreatment in stage II. CONCLUSIONS: Surgical success, symptom severity, and overall serious adverse events did not differ between ULS and SSLF in women with advanced prolapse. ClinicalTrials.gov Identifier: NCT01166373.

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Published In

Int Urogynecol J

DOI

EISSN

1433-3023

Publication Date

October 2020

Volume

31

Issue

10

Start / End Page

2155 / 2164

Location

England

Related Subject Headings

  • Uterine Prolapse
  • Urinary Incontinence, Stress
  • Treatment Outcome
  • Suburethral Slings
  • Pelvic Organ Prolapse
  • Obstetrics & Reproductive Medicine
  • Humans
  • Gynecologic Surgical Procedures
  • Female
  • 4204 Midwifery
 

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Meyer, I., Whitworth, R. E., Lukacz, E. S., Smith, A. L., Sung, V. W., Visco, A. G., … NICHD Pelvic Floor Disorders Network and the National Institutes of Health Office of Research on Women’s Health, . (2020). Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J, 31(10), 2155–2164. https://doi.org/10.1007/s00192-020-04271-y
Meyer, Isuzu, Ryan E. Whitworth, Emily S. Lukacz, Ariana L. Smith, Vivian W. Sung, Anthony G. Visco, Mary F. Ackenbom, et al. “Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence.Int Urogynecol J 31, no. 10 (October 2020): 2155–64. https://doi.org/10.1007/s00192-020-04271-y.
Meyer I, Whitworth RE, Lukacz ES, Smith AL, Sung VW, Visco AG, et al. Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J. 2020 Oct;31(10):2155–64.
Meyer, Isuzu, et al. “Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence.Int Urogynecol J, vol. 31, no. 10, Oct. 2020, pp. 2155–64. Pubmed, doi:10.1007/s00192-020-04271-y.
Meyer I, Whitworth RE, Lukacz ES, Smith AL, Sung VW, Visco AG, Ackenbom MF, Wai CY, Mazloomdoost D, Gantz MG, Richter HE, NICHD Pelvic Floor Disorders Network and the National Institutes of Health Office of Research on Women’s Health. Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J. 2020 Oct;31(10):2155–2164.
Journal cover image

Published In

Int Urogynecol J

DOI

EISSN

1433-3023

Publication Date

October 2020

Volume

31

Issue

10

Start / End Page

2155 / 2164

Location

England

Related Subject Headings

  • Uterine Prolapse
  • Urinary Incontinence, Stress
  • Treatment Outcome
  • Suburethral Slings
  • Pelvic Organ Prolapse
  • Obstetrics & Reproductive Medicine
  • Humans
  • Gynecologic Surgical Procedures
  • Female
  • 4204 Midwifery