Poutakidis Georgios, Falconer Christian, Altman Daniel, Johannesson Ulrika, Zhang Anju, Ericson Charlotta, Stenberg Mats, Altrock Sabine, Morcos Edward
Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, SE- 182 88, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Danderyd University Hospital, SE- 182 88, Stockholm, Sweden.
Int Urogynecol J. 2025 Mar;36(3):585-597. doi: 10.1007/s00192-024-06017-6. Epub 2025 Jan 8.
The aim of the study was to compare clinical outcomes when using robotic-assisted sacral hysterocolpopexy (RASC) and vaginal surgery using the Uphold™ Vaginal Support System mesh for pelvic organ prolapse repair.
This was a nonrandomized, prospective, multicenter study in which 72 women underwent RASC, and 73 Uphold™ surgery, for apical prolapse (POP-Q C ≥ stage II). Anatomical outcomes were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system. Subjective outcomes were evaluated using the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Floor Impact Questionnaire - short form (PFIQ-7), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), as well as pain estimation using the visual analog scale (0-10).
One year after surgery, an optimal apical segment outcome (POP-Q C stage 0-1) was achieved in 96.4% and 93.3% for the RASC and Uphold™ respectively, p = 0.49. However, reoperation for prolapse recurrence was significantly more common after RASC (11 out of 72 [15.3%] vs Uphold™ (2 out of 71 [2.8%], p = 0.005), and an optimal outcome of the anterior vaginal wall was higher after Uphold™ (p < 0.001). Postoperative PFDI-20, PFIQ-7, and pain significantly improved for both RASC and Uphold™ (p = 0.004 to < 0.001), but a more pronounced improvement in the total PFDI-20 and POPDI-6 sub-scores was observed after Uphold™ than after RASC (-73 ± 55.6 vs -49.2 ± 43.7, p = 0.005 and -39.6 ± 23.6 vs -27 ± 23.9, p < 0.001 respectively).
Reoperation for prolapse recurrence within 1 year was more common after RASC than after Uphold™. However, the rate of complications was low overall and there were few and largely insignificant differences in outcomes when comparing RASC and Uphold™.
本研究的目的是比较使用机器人辅助骶骨阴道子宫骶骨固定术（RASC）和使用Uphold™阴道支撑系统网片进行阴道手术治疗盆腔器官脱垂的临床效果。
这是一项非随机、前瞻性、多中心研究，72名女性接受了RASC手术，73名女性接受了Uphold™手术，用于治疗顶端脱垂（盆腔器官脱垂定量分期[POP-Q] C≥II期）。使用盆腔器官脱垂定量（POP-Q）系统评估解剖学结果。使用盆底困扰量表20（PFDI-20）、盆底影响问卷简表（PFIQ-7）、盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）评估主观结果，并使用视觉模拟量表（0-10）评估疼痛程度。
术后一年，RASC组和Uphold™组分别有96.4%和93.3%的患者获得了最佳的顶端节段结果（POP-Q C期0-1），p = 0.49。然而，RASC术后脱垂复发再次手术的情况明显更常见（72例中有11例[15.3%]，而Uphold™组为71例中有2例[2.8%]，p = 0.005），Uphold™术后阴道前壁的最佳结果更高（p < 0.001）。RASC组和Uphold™组术后PFDI-20、PFIQ-7和疼痛程度均显著改善（p = 0.004至< 0.001），但Uphold™组术后PFDI-20总分和POPDI-6子评分的改善比RASC组更明显（-73 ± 55.6 vs -49.2 ± 43.7，p = 0.005；-39.6 ± 23.6 vs -27 ± 23.9，p < 0.001）。
RASC术后1年内因脱垂复发再次手术的情况比Uphold™术后更常见。然而，总体并发症发生率较低，比较RASC和Uphold™时，结果上几乎没有显著差异。
