Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy
OBJECTIVE:To report long-term outcomes after laparoscopic sacrocolpopexy. METHODS:We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2019-08, Vol.134 (2), p.323-332 |
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| creator | Pacquée, Stefaan Nawapun, Katika Claerhout, Filip Werbrouck, Erika Veldman, Joan D'hoore, André Wyndaele, Jan Verguts, Jasper De Ridder, Dirk Deprest, Jan |
| description | OBJECTIVE:To report long-term outcomes after laparoscopic sacrocolpopexy.
METHODS:We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.
RESULTS:The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.
CONCLUSION:More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%). |
| doi_str_mv | 10.1097/AOG.0000000000003380 |
| format | Article |
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METHODS:We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.
RESULTS:The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.
CONCLUSION:More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).</description><identifier>ISSN: 0029-7844</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/AOG.0000000000003380</identifier><identifier>PMID: 31306334</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Cervix Uteri - surgery ; Cohort Studies ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures - methods ; Gynecologic Surgical Procedures - statistics & numerical data ; Humans ; Laparoscopy - statistics & numerical data ; Middle Aged ; Patient Satisfaction ; Pelvic Organ Prolapse - surgery ; Prospective Studies ; Recurrence ; Reoperation - statistics & numerical data ; Sacrococcygeal Region ; Surgical Mesh ; Treatment Outcome ; Urologic Surgical Procedures - methods ; Urologic Surgical Procedures - statistics & numerical data ; Vagina - surgery</subject><ispartof>Obstetrics and gynecology (New York. 1953), 2019-08, Vol.134 (2), p.323-332</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4010-e8f5b2fedbeff6ee83e08a34c30a1bc02154c6b3786c5ee34b8e9e2d8cb5497e3</citedby><cites>FETCH-LOGICAL-c4010-e8f5b2fedbeff6ee83e08a34c30a1bc02154c6b3786c5ee34b8e9e2d8cb5497e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31306334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pacquée, Stefaan</creatorcontrib><creatorcontrib>Nawapun, Katika</creatorcontrib><creatorcontrib>Claerhout, Filip</creatorcontrib><creatorcontrib>Werbrouck, Erika</creatorcontrib><creatorcontrib>Veldman, Joan</creatorcontrib><creatorcontrib>D'hoore, André</creatorcontrib><creatorcontrib>Wyndaele, Jan</creatorcontrib><creatorcontrib>Verguts, Jasper</creatorcontrib><creatorcontrib>De Ridder, Dirk</creatorcontrib><creatorcontrib>Deprest, Jan</creatorcontrib><title>Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>OBJECTIVE:To report long-term outcomes after laparoscopic sacrocolpopexy.
METHODS:We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.
RESULTS:The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.
CONCLUSION:More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cervix Uteri - surgery</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gynecologic Surgical Procedures - methods</subject><subject>Gynecologic Surgical Procedures - statistics & numerical data</subject><subject>Humans</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Patient Satisfaction</subject><subject>Pelvic Organ Prolapse - surgery</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Reoperation - statistics & numerical data</subject><subject>Sacrococcygeal Region</subject><subject>Surgical Mesh</subject><subject>Treatment Outcome</subject><subject>Urologic Surgical Procedures - methods</subject><subject>Urologic Surgical Procedures - statistics & numerical data</subject><subject>Vagina - surgery</subject><issn>0029-7844</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1P5DAMhiO0CGaBf4BWPe6lrBOnbXocjfiSRgIJkLhFacadKds2JenA8u83s8MixAF8sWw9r229ZuyYwwmHsvg1vTo_gXeBqGCHTbgqMBWI99_YBECUaaGk3GffQ3iIEM9L3GP7yBFyRDlheu76ZXpLvkumIVAIHfVj4urEJNfehYHs2DxRMnMr5__1r83YRCQkd_2C_NI1_TKZm8FE2LqhscmNsd5Z1w5uoD8vh2y3Nm2go9d8wO7OTm9nF-n86vxyNp2nVgKHlFSdVaKmRUV1nRMpJFAGpUUwvLIgeCZtXmGhcpsRoawUlSQWylaZLAvCA_ZzO3fw7nFNYdRdEyy1renJrYMWIlOFlAWIiMotGu8MwVOtB990xr9oDnpjrY7W6o_WRtmP1w3rqqPFm-i_lxFQW-DZtSP58LtdP5PXKzLtuPpqtvxEusFykUEqgJegYpVuXlngX0rVlms</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Pacquée, Stefaan</creator><creator>Nawapun, Katika</creator><creator>Claerhout, Filip</creator><creator>Werbrouck, Erika</creator><creator>Veldman, Joan</creator><creator>D'hoore, André</creator><creator>Wyndaele, Jan</creator><creator>Verguts, Jasper</creator><creator>De Ridder, Dirk</creator><creator>Deprest, Jan</creator><general>Lippincott Williams & Wilkins</general><general>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190801</creationdate><title>Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy</title><author>Pacquée, Stefaan ; Nawapun, Katika ; Claerhout, Filip ; Werbrouck, Erika ; Veldman, Joan ; D'hoore, André ; Wyndaele, Jan ; Verguts, Jasper ; De Ridder, Dirk ; Deprest, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4010-e8f5b2fedbeff6ee83e08a34c30a1bc02154c6b3786c5ee34b8e9e2d8cb5497e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cervix Uteri - surgery</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gynecologic Surgical Procedures - methods</topic><topic>Gynecologic Surgical Procedures - statistics & numerical data</topic><topic>Humans</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Patient Satisfaction</topic><topic>Pelvic Organ Prolapse - surgery</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Reoperation - statistics & numerical data</topic><topic>Sacrococcygeal Region</topic><topic>Surgical Mesh</topic><topic>Treatment Outcome</topic><topic>Urologic Surgical Procedures - methods</topic><topic>Urologic Surgical Procedures - statistics & numerical data</topic><topic>Vagina - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pacquée, Stefaan</creatorcontrib><creatorcontrib>Nawapun, Katika</creatorcontrib><creatorcontrib>Claerhout, Filip</creatorcontrib><creatorcontrib>Werbrouck, Erika</creatorcontrib><creatorcontrib>Veldman, Joan</creatorcontrib><creatorcontrib>D'hoore, André</creatorcontrib><creatorcontrib>Wyndaele, Jan</creatorcontrib><creatorcontrib>Verguts, Jasper</creatorcontrib><creatorcontrib>De Ridder, Dirk</creatorcontrib><creatorcontrib>Deprest, Jan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pacquée, Stefaan</au><au>Nawapun, Katika</au><au>Claerhout, Filip</au><au>Werbrouck, Erika</au><au>Veldman, Joan</au><au>D'hoore, André</au><au>Wyndaele, Jan</au><au>Verguts, Jasper</au><au>De Ridder, Dirk</au><au>Deprest, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>134</volume><issue>2</issue><spage>323</spage><epage>332</epage><pages>323-332</pages><issn>0029-7844</issn><eissn>1873-233X</eissn><abstract>OBJECTIVE:To report long-term outcomes after laparoscopic sacrocolpopexy.
METHODS:We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.
RESULTS:The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.
CONCLUSION:More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>31306334</pmid><doi>10.1097/AOG.0000000000003380</doi><tpages>10</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Cervix Uteri - surgery Cohort Studies Female Follow-Up Studies Gynecologic Surgical Procedures - methods Gynecologic Surgical Procedures - statistics & numerical data Humans Laparoscopy - statistics & numerical data Middle Aged Patient Satisfaction Pelvic Organ Prolapse - surgery Prospective Studies Recurrence Reoperation - statistics & numerical data Sacrococcygeal Region Surgical Mesh Treatment Outcome Urologic Surgical Procedures - methods Urologic Surgical Procedures - statistics & numerical data Vagina - surgery |
| title | Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy |
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