RISK FACTORS FOR ANATOMIC FAILUREAFTER LAPAROSCOPIC OR ABDOMINAL SACRAL COLPOPEXY
R. ROLSTON1, A.SHARMA 2, A. K. PAHWA 2, C. E. DANCZ 2,B. OZEL 2;
1Female Pelvic Medicine &Reconstructive Surgery, LAC+USC Med. Ctr., Los Angeles, CA, 2LAC+USCMed. Ctr., Los Angeles, CA.
Introduction: Sacral colpopexyis one of the various surgical procedures performed to repairadvanced pelvic organ prolapse. Both abdominal and laparoscopicsacral colpopexy have been shown to be very effective, however thereis still a risk of surgical failure and prolapse recurrence. Prolapserecurrence rates after sacral colpopexy have not been well describedin the literature and there is limited data about risk factors thatmay contribute to surgical failure and prolapserecurrence.
Objective: To describe risk factors associatedwith anatomic failure after sacral colpopexy.
Methods: Aretrospective analysis was performed on all patients who had anabdominal (ASC) or laparoscopic sacral colpopexy (LSC) at a singleinstitution from January 2010 to May 2015. Patient characteristicsincluding age, parity, body mass index (BMI), presence of diabetesmellitus (DM), prior hysterectomy, prior reconstructive surgery andpreoperative and post-operative 3 month, 6 month and 12 month POP-Qexams were recorded. Among the patients with DM, HgA1c values rangedfrom 5.9-7.4%. Anatomic surgical failure was defined as Ba failure ifBa > 0, C failure if C > 0, Bp failure if Bp > 0, and Anyanatomic failure if Ba, C, or Bp > 0. Descriptive analysisincluded the Fisher’s exact test for categorical variables, andKruskal-Wallis test for continuous variables. Univariatecox-regression analysis for age, parity, BMI, DM, priorreconstructive surgery, prior hysterectomy and surgery type (ASC vs.LSC) was performed. Statistically significant risk factors identifiedfrom the univariate analysis (p<0.05) were then included in amultivariate cox-regression for Ba failure, Bp failure, C failure, orAny anatomic failure.
Results: There were 143 sacralcolpopexy procedures performed. 95 women had post-operativeexaminations with a documented POP-Q exam: 69 LSC and 26 ASC. Themedian follow-up time was 382 (8-546) days. The median age was 59(35-73) years; median parity was 4 (1-10); and median BMI was 28.2(25.8-43.7) kg/m2. A total of 16 (16.8%) women had DM; 44 (46.3%)women had prior hysterectomy; and 14 (14.7%) women had priorreconstructive surgery. Baseline characteristics were similar betweenASC and LSC groups.
Of the 95 patients analyzed, 21 (25.3%) had Bafailure, 11 (11.6%) C failure, 10 (10.5%) Bp failure, and 31 (32.6%)had Any anatomic failure. On univariate cox regression analysis,surgery type was not significantly associated with anatomic failure.No variables were found to be significantly associated with Bafailure. For Bp failure and C failure, parity was found to be a riskfactor (HR=1.29, p=0.042 for Bp failure and HR=1.28, p=0.046 for Cfailure). Prior hysterectomy was found to be protective for Bpfailure (HR=0.112, p=0.038) and C failure (HR=0.096, p=0.026). DM wasnoted to be a risk factor for Any anatomic failure (HR=2.65,p=0.016).
On multivariate cox regression analysis, for C failure,prior hysterectomy was still a protective factor (HR=0.096, p=0.026),after controlling for surgery types, but parity was no longersignificant. For Bp failure, parity persisted as a risk factor(HR=1.35, p=0.043) and prior hysterectomy was still noted to be aprotective factor (HR=0.092, p=0.027), after controlling for age.Analysis for Any anatomic failure, DM persisted as a risk factorafter controlling for surgery types (HR=2.83, p=0.011).
Conclusions:Parity, DM, and concomitant hysterectomy at time of sacral colpopexywere found to be significant risk factors for anatomic failure. Wefound no difference in risk of anatomic failure between open andlaparoscopic sacral colpopexy. These findings may be useful incounseling patients and planning for surgery.