Sears Sarah, Abrams Megan, Palm Kasey, Wherley Susan, Pollard Robert, Mangel Jeffrey, Sheyn David
Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ, USA.
Int Urogynecol J. 2025 Apr 2. doi: 10.1007/s00192-025-06132-y.
Long-term outcomes following vaginal (V-USLS) versus laparoscopic (L-USLS) uterosacral ligament suspension have not been reported in the literature. Our objective was to compare long-term outcomes following V-USLS versus L-USLS following hysterectomy.
This was an ambispective cohort study at a single academic institution comparing patients who underwent a V-USLS following a vaginal hysterectomy or L-USLS following a laparoscopic hysterectomy from 2013 to 2018. The primary outcome was composite prolapse recurrence rate, combining subjective prolapse symptoms and objective failure, including prolapse beyond the hymen on pelvic organ prolapse quantification exam or retreatment. A power calculation determined 68 patients in each group would be required to detect a difference of 15% in recurrence rates. Statistical analysis was performed using Student' t-test, Wilcoxon rank sum test, chi-square test, or Fishers exact test, and multivariable logistic regression where appropriate.
Thirty-six patients in each group presented for a study visit. Preoperative POP-Q measurements were similar between groups. Surgical complication rates were low and similar between groups. Mean follow-up time was 6.8 years, similar between groups. V-USLS had higher rates of recurrent prolapse beyond the hymen on POP-Q (33.2% vs 11.1%, p = 0.016), retreatment (25.0% vs 2.8%, p = 0.006), and composite failure (47.2% vs 22.2%, p = 0.019). Subjective prolapse symptoms were similar between groups. V-USLS was associated with a higher risk of prolapse recurrence (aOR 1.73 (95%CI 1.13-5.78). Anterior prolapse (Aa) was associated with higher recurrence risk, with aOR 2.04 (95%CI 1.15-3.62) per every 1 cm, up to 3 cm beyond the hymen.
On the basis of these results, L-USLS appears to have a decreased association with recurrence compared to V-USLS. Conclusions are limited by a small sample size.
阴道骶韧带悬吊术（V-USLS）与腹腔镜骶韧带悬吊术（L-USLS）后的长期结局在文献中尚无报道。我们的目的是比较子宫切除术后V-USLS与L-USLS的长期结局。
这是一项在单一学术机构进行的双向队列研究，比较了2013年至2018年接受阴道子宫切除术后行V-USLS或腹腔镜子宫切除术后行L-USLS的患者。主要结局是综合脱垂复发率，包括主观脱垂症状和客观失败情况，客观失败包括盆腔器官脱垂定量检查时脱垂超过处女膜或再次治疗。功效计算确定每组需要68例患者才能检测到复发率有15%的差异。采用学生t检验、Wilcoxon秩和检验、卡方检验或Fisher精确检验进行统计分析，并在适当情况下进行多变量逻辑回归分析。
每组36例患者前来进行研究随访。术前两组间盆腔器官脱垂定量（POP-Q）测量结果相似。手术并发症发生率较低且两组间相似。平均随访时间为6.8年，两组间相似。V-USLS组在POP-Q检查中脱垂超过处女膜的复发率更高（33.2%对11.1%，p = 0.016），再次治疗率更高（25.0%对2.8%，p = 0.006），综合失败率更高（47.2%对22.2%，p = 0.019）。两组间主观脱垂症状相似。V-USLS与脱垂复发风险较高相关（调整后比值比1.73（95%置信区间1.13 - 5.78））。前壁脱垂（Aa）与较高的复发风险相关，每超过处女膜1 cm，调整后比值比为2.04（95%置信区间1.15 - 3.62），最多可达处女膜外3 cm。
基于这些结果，与V-USLS相比，L-USLS似乎与复发的相关性更低。结论因样本量小而受限。
