Publication:

Selective allocation of patients with vaginal apical prolapse to either mesh augmented open abdominal repair or vaginal sacrospinous colpopexy improve functional and anatomical outcomes

Background To evaluate the functional and anatomical outcomes after allocation of patients with apical vaginal prolapse to either mesh augmented abdominal repair or vaginal sacrospinous-colpopexy based on proposed selection criteria.

Methods A non-randomized trial was conducted at Ain-Shams university maternity hospital on patients with apical vaginal prolapse stage ≥2 based on pelvic organ prolapse quantification system. Certain criteria were proposed for patient selection to either mesh augmented abdominal repair or vaginal sacrospinous-colpopexy. Seventy-eight patients were assigned for sacrospinous-colpopexy and 47-patients for abdominal repair. Primary outcomes were the functional outcome using urogenital distress inventory questionnaire and patient global impression of improvement (PGI-I). Both were measured at 1-year’s follow-up. Secondary outcomes involved the anatomical success (defined as no apical prolapse ≥POP-Q stage 2), perioperative data and long-term complications.

Results There was improvement in all UDI domains for sacrospinous-colpopexy and abdominal repair groups with genital prolapse domain of median (interquartile range) 0 (0-10), 0 (0-0) respectively. Eighty-nine percent of abdominal repair group and 85% of sacrospinous-colpopexy group reported scale of 1 or 2 on PGI-I scale at 1-year follow-up. PGI-I score and improvements in UDI domains were maintained till 5-year follow-up. The anatomic success rate at 1-year follow-up was 97.9% in abdominal repair group and 78.2% in the sacrospinous-colpopexy group. No long-term mesh complications were detected in mesh augmented abdominal repair over the whole follow-up periods.

Conclusion The resulting meritorious functional and anatomical outcomes favor adoption of our proposed selection criteria in the initiation of guidelines and recommendations for managing vaginal apical prolapse.