MedStar National Center for Advanced Pelvic Surgery, Georgetown University School of Medicine, Washington, DC, USA.
Department of Obstetrics and Gynecology, Mission Hospital, Asheville, NC, USA.
Int Urogynecol J. 2021 Aug;32(8):2179-2184. doi: 10.1007/s00192-021-04687-0. Epub 2021 Mar 12.
The objective was to determine the relationship between the preoperative D-point and apical outcomes at 24 months, using the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) dataset.
This was a secondary analysis of the OPTIMAL trial, a randomized multi-centered study comparing outcomes of sacrospinous ligament fixation and transvaginal uterosacral ligament suspension (USLS). The 2-year dataset utilized included women undergoing USLS with concomitant hysterectomy. The primary outcome was the relationship between preoperative D-point and apical outcomes at 24 months. Secondary objectives were to determine the relationship between preoperative D-point and anatomical, composite and subjective outcomes, and to determine a D-point cut-off that could be used to predict success in each of these categories.
Of the 186 women in the USLS arm, 120 were available for analysis of anatomical failure at 24 months. A higher preoperative D-point correlated with improved apical outcome (C-point) at 24 months (r = 0.34; p value = 0.0002). Using ROC curves, a moderate association was found between the preoperative D-point and apical and anatomical success, (AUC 0.689 and 0.662). There was no relationship between preoperative D-point and composite or subjective success (AUC 0.577 and 0.458). Based on the ROC curves, a "cut-off" D-point value of -4.25 cm (sensitivity = 0.58, specificity = 0.67) was determined to be a predictor of postoperative anatomical success at 2 years.
Preoperative D-point correlates with postoperative anatomical and apical support, but is less successful at predicting subjective outcomes. The strongest predictive D-point cut-off for anatomical and apical success at 24 months was -4.25 cm.
目的是使用 Operations and Pelvic Muscle Training in the Management of Apical Support Loss（OPTIMAL）数据集，确定术前 D 点与术后 24 个月时顶点结局之间的关系。
这是 OPTIMAL 试验的二次分析，该试验是一项比较骶棘韧带固定术和经阴道子宫骶骨韧带悬吊术（USLS）结局的随机多中心研究。使用的 2 年数据集包括接受 USLS 联合子宫切除术的女性。主要结局是术前 D 点与术后 24 个月时顶点结局的关系。次要目标是确定术前 D 点与解剖学、综合和主观结局的关系，并确定可用于预测这些类别中每个类别的成功的 D 点截止值。
在 USLS 组的 186 名女性中，有 120 名女性可分析术后 24 个月时的解剖学失败。较高的术前 D 点与术后 24 个月时顶点结局（C 点）改善相关（r=0.34；p 值=0.0002）。使用 ROC 曲线，术前 D 点与顶点和解剖学成功之间存在中度关联（AUC 0.689 和 0.662）。术前 D 点与综合或主观成功之间无相关性（AUC 0.577 和 0.458）。基于 ROC 曲线，术前 D 点值为-4.25cm（敏感性=0.58，特异性=0.67）被确定为术后 2 年时解剖学成功的预测因子。
术前 D 点与术后解剖学和顶点支撑相关，但在预测主观结局方面效果较差。预测术后 24 个月时解剖学和顶点成功的最佳预测 D 点截止值为-4.25cm。
