Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Obstetrics and Gynecology, St. Vincent Hospital, Indianapolis, Indiana.
J Endourol. 2021 Jun;35(6):944-949. doi: 10.1089/end.2018.0029. Epub 2020 Mar 26.
Nonabsorbable monofilament suture is traditionally used to secure vaginal mesh for robot-assisted sacral colpopexy (RASC) but can become exposed postoperatively requiring invasive vaginal removal. Polydioxanone delayed absorbable suture may avoid this. We sought to determine the objective and subjective impact of suture choice for mesh fixation. A cohort study was undertaken using a prospective registry and subjects were grouped based on type of suture at the time of RASC. Apical failure was defined as C point descent of >2 cm, anterior compartment failure was defined as pelvic organ prolapse quantification (POP-Q) Ba point of >0, and posterior compartment failure was defined as Bp point of >0. Patient-reported outcomes included urogenital distress inventory (UDI)-6 and QoL. Two-tailed -test and chi-squared were used for analysis. A total of 119 women underwent RASC between 2009 and 2016. Patients had similar preoperative characteristics (Table 1). All POP-Q, UDI-6, and quality of life (QoL) scores improved postoperatively (Tables 1 and 2). Apical failure was noted in 0, anterior failure was noted in 7 (average Ba +1.1 cm in failures), and posterior failure was noted in 4 (mean Bp +1.0 cm) at 16 months' follow-up. Failures in the anterior compartment were much more common in the nonabsorbable monofilament cohort (Table 2). Failures in the apical and posterior compartments were not significantly different between groups. Nine suture erosions were noted in the nonabsorbable monofilament cohort, five requiring excision in the clinic and two in the operating room. Two suture erosions were noted in the delayed absorbable cohort, 0 required excision. Postoperative UDI-6 and QoL scores did not vary significantly between groups (5.3 ± 4.0 5.1 ± 4.0, = not significant (NS), 2.8 ± 2.0 2.8 ± 2.2, = NS). [Table: see text] [Table: see text] Securing mesh with delayed absorbable monofilament did not appear to increase risk of failure in patients undergoing RASC and eliminates the need for suture excision postoperatively.
不可吸收的单丝缝线传统上用于固定机器人辅助骶骨阴道固定术（RASC）中的阴道网片，但术后可能会暴露，需要侵入性阴道切除。聚二氧杂环己酮可吸收缝线可能会避免这种情况。我们旨在确定缝线选择对网片固定的客观和主观影响。
本研究采用前瞻性登记进行队列研究，根据 RASC 时缝线的类型对受试者进行分组。顶点失败定义为 C 点下降>2cm，前室失败定义为盆腔器官脱垂量化（POP-Q）Ba 点>0，后室失败定义为 Bp 点>0。患者报告的结果包括尿生殖窘迫量表（UDI）-6 和生活质量（QoL）。使用双尾 -检验和卡方检验进行分析。
2009 年至 2016 年间，共有 119 名女性接受了 RASC。患者的术前特征相似（表 1）。所有 POP-Q、UDI-6 和 QoL 评分均在术后改善（表 1 和 2）。16 个月随访时，顶点失败 0 例，前室失败 7 例（失败时平均 Ba +1.1cm），后室失败 4 例（平均 Bp +1.0cm）。不可吸收单丝缝线组前室失败更为常见（表 2）。两组间顶点和后室失败无显著差异。不可吸收单丝缝线组有 9 例缝线侵蚀，5 例在诊所切除，2 例在手术室切除。可吸收缝线组有 2 例缝线侵蚀，0 例需要切除。两组术后 UDI-6 和 QoL 评分无显著差异（5.3±4.0 vs. 5.1±4.0， = 无显著差异（NS），2.8±2.0 vs. 2.8±2.2， = NS）。
