Ferrando Cecile A, Bradley Catherine S, Meyn Leslie A, Brown Heidi W, Moalli Pamela A, Heisler Christine A, Murarka Shivani M, Foster Raymond T, Chung Doreen E, Whitcomb Emily L, Gutman Robert E, Andy Uduak U, Shippey Stuart H, Anger Jennifer, Yurteri-Kaplan Ladin A
From the Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA.
Urogynecology (Phila). 2023 Oct 1;29(10):787-799. doi: 10.1097/SPV.0000000000001410.
The aim of the study was to compare 12-month subjective and objective outcomes between 3 approaches to apical pelvic organ prolapse (POP) surgery in patients presenting with uterovaginal or posthysterectomy vaginal prolapse enrolled in the Pelvic Floor Disorders Registry for Research.
This was an analysis of a multicenter, prospective registry that collected both patient- and physician-reported data for up to 3 years after conservative (pessary) and surgical treatment for POP. Twelve-month subjective and anatomic outcomes for patients who underwent surgical treatment were extracted from the registry for analysis. Pelvic organ prolapse recurrence was defined as a composite outcome and compared between the 3 apical surgery groups (native tissue repair, sacrocolpopexy, colpocleisis) as well as the 2 reconstructive surgery groups (native tissue repair and sacrocolpopexy).
A total of 1,153 women were enrolled in the registry and 777 (67%) opted for surgical treatment, of whom 641 underwent apical repair and were included in this analysis (404 native tissue repair, 187 sacrocolpopexy, and 50 colpocleisis). The overall incidence of recurrence was as follows: subjective 6.5%, anatomic 4.7%, retreatment 7.2%, and composite 13.6%. The incidence of recurrence was not different between the 3 surgical groups. When baseline patient characteristics were controlled for, composite POP recurrence between the native tissue and sacrocolpopexy groups remained statistically nonsignificant. Concurrent perineorrhaphy with any type of apical POP surgery was associated with a lower risk of recurrence (adjusted odds ratio, 0.43; 95% confidence interval, 0.25-0.74; P = 0.002) and prior hysterectomy was associated with a higher risk (adjusted odds ratio, 1.77, 95% confidence interval, 1.04-3.03; P = 0.036).
Pelvic Floor Disorders Registry for Research participants undergoing native tissue apical POP repair, sacrocolpopexy, and colpocleisis surgery had similar rates of POP recurrence 12 months after surgery.
本研究旨在比较盆底疾病研究注册中心登记的子宫阴道或子宫切除术后阴道脱垂患者，采用3种方法进行盆腔器官脱垂（POP）顶端手术的12个月主观和客观结果。
这是一项对多中心前瞻性注册研究的分析，该研究收集了保守治疗（子宫托）和POP手术治疗后长达3年的患者和医生报告的数据。从注册研究中提取接受手术治疗患者的12个月主观和解剖学结果进行分析。盆腔器官脱垂复发被定义为一个综合结果，并在3个顶端手术组（自体组织修复、骶骨阴道固定术、阴道闭合术）以及2个重建手术组（自体组织修复和骶骨阴道固定术）之间进行比较。
共有1153名女性登记入组，777名（67%）选择手术治疗，其中641名接受顶端修复并纳入本分析（404名自体组织修复、187名骶骨阴道固定术、50名阴道闭合术）。复发的总体发生率如下：主观复发率6.5%，解剖学复发率4.7%，再次治疗率7.2%，综合复发率13.6%。3个手术组之间的复发率无差异。在控制基线患者特征后，自体组织组和骶骨阴道固定术组之间的综合POP复发率在统计学上仍无显著差异。任何类型的顶端POP手术同时进行会阴修补术与较低的复发风险相关（调整后的优势比，0.43；95%置信区间，0.25 - 0.74；P = 0.002），而既往子宫切除术与较高的风险相关（调整后的优势比，1.77，95%置信区间，1.04 - 3.03；P = 0.036）。
盆底疾病研究注册中心中接受自体组织顶端POP修复、骶骨阴道固定术和阴道闭合术的参与者，术后第12个月的POP复发率相似。
