Poutakidis Georgios, Geale Kirk, Morcos Edward
Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, 176 77, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Danderyd University Hospital, 182 88, Danderyd, Stockholm, Sweden.
Int Urogynecol J. 2025 Aug 13. doi: 10.1007/s00192-025-06242-7.
The aim of this study was to compare the quality-adjusted life-years (QALYs) attained 1 year after robotics-assisted sacral hystero-colpopexy (RASC) versus Uphold™ vaginal mesh surgery for pelvic organ prolapse repair.
This was a secondary analysis of a previously published cohort study. A total of 65 patients who underwent RASC and 71 who underwent the Uphold™ procedure completed the 15-dimensional (15D) and the EuroQol five-dimensional three-level (EQ-5D-3L) instruments measuring health-related quality of life (HR-QoL). All patients had symptomatic and anatomical apical prolapse (POP-Q C ≥ stage II) with or without other vaginal wall defects. Changes in HR-QoL instruments were calculated and compared with minimal important change (MIC) thresholds and QALYs gained were estimated for each intervention.
The 15D and EQ-5D-3L mean index scores were improved from preoperatively to 1 year after RASC ([0.88 ± 0.10 to 0.90 ± 0.01] and [0.85 ± 0.1 to 0.90 ± 0.1]) and after Uphold™= ([0.87 ± 0.1 to 0.89 ± 0.1] and [0.86 ± 0.1 to 0.93 ± 0.1], p 0.024 to p < 0.001) with no significant difference between cohorts. Prolapse-related 15D profile index measures, including discomfort, sexual activity, and distress were significantly improved after RASC (p = 0.039 to < 0.001), whereas excretion, discomfort, and sexual activity were significantly improved after the Uphold™ (p = 0.009 to < 0.001). The improvement in 15D scores from baseline to 1-year follow-up of + 0.026 for RASC and + 0.025 for Uphold™ exceeded the MIC, indicating meaningful improvements in patient quality of life. The overall 1-year QALY gain was estimated to be 0.90 ± 0.1 in the RASC and 0.88 ± 0.1 in the Uphold™ cohorts (p < 0.001), with no significant difference between the two interventions (p = 0.514).
The RASC and Uphold™ are both meaningful surgical treatments for prolapse, with significant improvement in the HR-QoL and the 1-year QALY gain and with no significant difference between the two surgeries.
本研究旨在比较机器人辅助骶骨子宫阴道固定术（RASC）与Uphold™阴道网片手术治疗盆腔器官脱垂1年后所获得的质量调整生命年（QALY）。
这是对先前发表的队列研究的二次分析。共有65例行RASC手术的患者和71例行Uphold™手术的患者完成了测量健康相关生活质量（HR-QoL）的15维度（15D）和欧洲五维度三级（EQ-5D-3L）量表。所有患者均有症状性和解剖学上的顶端脱垂（盆腔器官脱垂定量分期系统[POP-Q] C≥II期），伴有或不伴有其他阴道壁缺陷。计算HR-QoL量表的变化，并与最小重要变化（MIC）阈值进行比较，同时估计每种干预措施所获得的QALY。
RASC术后1年和Uphold™术后1年，15D和EQ-5D-3L的平均指数评分均较术前有所改善（[0.88±0.10至0.90±0.01]和[0.85±0.1至0.90±0.1]以及[0.87±0.1至0.89±0.1]和[0.86±0.1至0.93±0.1]，p值为0.024至p<0.001），两组之间无显著差异。RASC术后，与脱垂相关的15D剖面指数测量值，包括不适、性活动和困扰均有显著改善（p=0.039至<0.001），而Uphold™术后排泄、不适和性活动有显著改善（p=0.009至<0.001）。从基线到1年随访，RASC组15D评分提高了+0.026，Uphold™组提高了+0.025，均超过了MIC，表明患者生活质量有有意义的改善。RASC组1年总的QALY增益估计为0.90±0.1，Uphold™组为0.88±0.1（p<0.001），两种干预措施之间无显著差异（p=0.514）。
RASC和Uphold™都是治疗脱垂的有效手术方法，均能显著改善HR-QoL和1年的QALY增益，两种手术之间无显著差异。
