Ronsini Carlo, Vitale Clorinda, Romeo Paola, Sarpietro Giuseppe, Torella Marco, Cianci Stefano
Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy.
Gynecology and Obstetrics Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University of Messina, 98122, Messina, Italy.
Int Urogynecol J. 2025 Jan;36(1):197-203. doi: 10.1007/s00192-024-05997-9. Epub 2024 Dec 9.
The objective was to compare the vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms.
This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS).
The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group. Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001).
Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP.
目的是比较盆腔器官脱垂（POP）的阴道和腹腔镜手术方法与天然组织阴道修复术在复发率和症状完全缓解率（CRR）方面的差异。
这项回顾性队列研究分析了2021年10月至2023年3月期间在两家意大利医院因子宫脱垂接受子宫切除术的女性。A组包括89例接受阴道子宫切除术和阴道悬吊术（VCH）的患者，而B组包括58例接受腹腔镜子宫切除术并随后进行腹腔镜Shull阴道悬吊术（LPSS）的患者。
该研究纳入了147例在绝经年龄和体重指数方面具有可比基线特征的患者。关于术前数据，值得一提的是，A组中既往分娩次数超过两次的患者比例更高，总体而言脱垂阶段更严重。关于术后结果，接受腹腔镜手术的患者手术时间比A组长。此外，B组术后复发率更高（5.6%对13%，p = 0.057）。Kaplan-Meier分析表明，随着时间的推移，B组无脱垂患者的比例较低。Cox回归显示，LCSS组的复发风险比VCH组更高。泌尿系统症状的完全缓解率各不相同，B组在压力性尿失禁方面的CRR更高（33%对71%，p < 0.001）。
VCH和LCSS对POP治疗均有效，VCH在症状缓解和手术时间较短方面显示出更好的结果。同时，LCSS在压力性尿失禁方面的CRR更好，但复发率更高。需要进一步的高质量前瞻性研究来证实这些发现，并确定POP的最佳手术方法。
