Preoperative ultrasound findings as risk factors of recurrence of pelvic organ prolapse after laparoscopic sacrocolpopex
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ORIGINAL ARTICLE
Preoperative ultrasound findings as risk factors of recurrence of pelvic organ prolapse after laparoscopic sacrocolpopexy Fernanda Santis-Moya 1
&
Rodrigo Pineda 1 & Victor Miranda 1
Received: 27 April 2020 / Accepted: 17 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The objective of this study is to evaluate levator ani muscle avulsion (LAMA) and ballooning as risk factors for recurrence of pelvic organ prolapse (POP) after laparoscopic sacrocolpopexy (SCP). We hypothesize that these ultrasound findings are associated with a higher risk of POP recurrence. Methods Retrospective cohort study of patients who underwent laparoscopic SCP between January 2015 and December 2018. Baseline translabial 3D ultrasound of the pelvic floor was performed. Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were applied. Both univariate and multivariate analyses were carried out. Results One hundred thirty-four patients were included. On ultrasound, 32% of patients had levator ani muscle avulsion, and 36.5% had ballooning. Mean follow-up time was 16 months. There was a 13.4% anatomic recurrence; five of them (3.7%) also had symptomatic recurrence. After multivariate analysis we found that LAMA and ballooning were not significant: OR 0.99 (95% CI 0.098–10.1; p = 0.99) and OR 1.1 (95% CI 0.99–1.2; p = 0.06), respectively. Conclusions LAMA and ballooning on pelvic floor US are not significant risk factors for anatomic POP recurrence after laparoscopic SCP. Laparoscopic SCP has a 13.4% and 3.4% anatomic and symptomatic recurrence rate, respectively, and the majority of patients reported significant improvement in quality of life. Keywords Pelvic organ prolapse . Recurrence . Risk factors . Laparoscopy . Sacrocolpopexy
Introduction Pelvic organ prolapse (POP) is a highly prevalent problem, affecting around 30 to 50% of women, and is expected to increase by 46% by the year 2050 because of rising life expectancy [1]. Women have a lifetime risk of POP surgery by age 85 years of 19% [2]. Surgical treatment includes pelvic reconstructive procedures with vaginal and abdominal approaches and obliterative procedures. Abdominal sacrocolpopexy (SCP) is associated with better anatomic and subjective outcomes and a lower recurrence rate compared to vaginal procedures [3–5].
* Fernanda Santis-Moya [email protected] 1
Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile
Recurrence of POP after reconstructive surgery is difficult to estimate because of a lack of agreed definition [6]. Cure rates vary dramatically depending on the definition of treatment success used, and for abdominal SCP, it can range from 19% for an anatomic support definition to 97% for no retreatment for POP definition [7]. The LAS study by Freeman et al. has shown anatomical equivalence between the laparoscopic and open abdominal approach for SCP [8], and laparoscopic
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