LONG-TERM OUTCOMES OF SACROSPINOUSCOLPOPEXY AND SACROSPINOUS HYSTERECTOMY FOR TREATING FEMALE PELVICORGAN PROLAPSE
G. CHEN1, S. NG 2;
1Department of OB/GYN, Chung Shan Med. Univ. Hosp.,Taichung, Taiwan, 2Chung Shan Med. Univ. Hosp., Taichung,,Taichung, Taiwan.
Objective:The aims of this study were to evaluate the postoperative subjectiveoutcome and satisfaction in female patients who underwentsacrospinous ligament fixation (SSLF) with and without concomitanthysterectomy for treating pelvic organ prolapse (POP).
Methods:Female patients who underwent surgery for POP at Chung Shan MedicalUniversity Hospital from January 1994 to December 2007 were includedin this study. In this retrospective study, all patients underwent aunilateral vaginal SSLF with or without vaginal hysterectomy andconcomitant anterior-posterior vaginal wall repair. We reviewed thechart records for preoperative and postoperative history, pelvicexaminations, urodynamic studies, early postoperative complications,or adverse effects related to this procedure. The subjective outcomeof the operation was measured by patient self-reports as successful,improved, or failure of treatment, assessed by a nursing coordinatorwho interviewed patients by telephone in May 2008 and July 2016.Kaplan-Meier analysis was used to demonstrate the operative outcomesand self-reported satisfaction. Cox proportional hazard model wasused to evaluate the correlation between various associated factorsand the outcome of the operation in 2008 and 2016.
Results:A total of 210 patients were included in this study. After a meanfollow-up of 13.58years (range: 9-23 years), 171 (81.4%) patientsresponded to the telephone interview by July 31, 2016. The mean agewas 59 years (range 27-88) at operation and median parity was 4(range 0-11). A total of 107 (62.6%) patients had a history ofhysterectomy or concomitant vaginal hysterectomy during the operationand 64 (37.4%) patients had sacrospinous hysteropexy with uterinepreservation. Voiding difficulty (11.6%) is the most commonpost-operative complication. De novo frequency/urgency and buttockpain presented as 8.1% and 6.1 % respectively. The subjectivepatient-reported outcomes were: 41% (70/171) said that the operationwas successful, 49.1% (84/170) had improved, and 9.9% (17/171) hadfailed. One hundred and forty-nine (87.1%) women were satisfied withthe outcome of the operation in 2016. The adjusted hazard ratio foruterine preservation in 2008 was significantly better than patientswithout uterine preservation. However, the adjusted hazard ratio foruterine preservation was 0.7 (95% CI 0.2-2) in 2016.
Conclusions:Our results imply that SSLF with uterine preservation hassignificantly better outcome at mid-term (< 10 years) follow-upthan SSLF with concomitant hysterectomy for treating POP. However,there is no significantly statistical difference between SSLF withand without hysterectomy.
Coxproportion hazard model for SSLF without hysterectomy compared toSSLF with hysterectomy (N=148)