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- W2915694321 abstract "We aimed to determine if an adjuvant posterior repair (PR) at transvaginal apical suspension is associated with improved surgical success. This secondary analysis of a multicenter randomized trial compared 24-month outcomes in 190 participants who had a posterior repair (PR group) and 184 who did not (NoPR) at the time of sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS). Concomitant PR was performed at surgeon’s discretion. Primary outcome of “surgical success” was defined as no prolapse beyond the hymen, C ≤ -2/3 x TVL, no bothersome vaginal bulge, and no retreatment at 24 months. These individual components were secondary outcomes. Propensity score (PS) methods were employed to build models that balanced PR and NoPR groups for ethnographic factors and preoperative POPQ values. Adjusted ORs were calculated to predict surgical success based on the performance of a PR. Groups were also compared with unadjusted Chi Square analyses. An unadjusted probability curve was created for surgical success as predicted by preoperative GH. There were no group differences in surgical success using PS methods (66.7% PR vs 62.0% no PR, aOR 1.07 (0.56, 2.07), p: 0.83) or unadjusted test (66.2% PR vs. 61.7% NoPR, p: 0.47). Individual outcome measures also did not differ (Table). There was high variation in performance of PR by surgeon [IQR 15%-79%]. The PR group was more likely to have greater values of Ap, Bp, GH, and TVL. The unadjusted probability of overall success at 24 months regardless of PR, decreased with increasing GH such that a GH of 4.5 cm was associated with 65.8% success (95% CI: 60.1%, 71.1%) (Figure). Concomitant PR at SSLS or USLS does not improve surgical success after adjusting for baseline covariates using propensity scores. Posterior repair does not compensate for the pathophysiology leading to levator plate attenuation and enlarged pre-operative GH which remains prognostic of prolapse recurrence.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W2915694321 date "2019-03-01" @default.
- W2915694321 modified "2023-09-30" @default.
- W2915694321 title "03: Posterior repair does not affect the success of transvaginal repair of apical prolapse" @default.
- W2915694321 doi "https://doi.org/10.1016/j.ajog.2019.01.013" @default.
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