Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse.
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OBJECTIVE: We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN: This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS: In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2-38.6), which included 20.3% (95% CI, 17.9-23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6-1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4-6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6-3.5) and 0.8% (95% CI, 0.4-1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02-0.6) and 0.8% (95% CI, 0.4-1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4-16.8): 10.6% (95% CI, 8.8-12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2-13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4-4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION: Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse.
uterosacral ligament suspension
vaginal vault suspension
Pelvic Organ Prolapse
Reconstructive Surgical Procedures
Urinary Tract Infections
Published Version (Please cite this version)10.1016/j.ajog.2014.11.034
Publication InfoBarber, Matthew Don; Jelovsek, John E; Paraiso, Marie Fidela R; Ridgeway, Beri M; Unger, CA; & Walters, Mark D (2015). Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am J Obstet Gynecol, 212(5). pp. 603.e1-603.e7. 10.1016/j.ajog.2014.11.034. Retrieved from http://hdl.handle.net/10161/15143.
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Edwin Crowell Hamblen Professor of Reproductive Biology and Family Planning
Associate Professor of Obstetrics and Gynecology
Dr. Jelovsek is the Vice Chair of Education and the Director of Data Science for Women’s Health in Department of Obstetrics & Gynecology (OBGYN) at Duke University. He is Board Certified in OBGYN by the American Board of OBGYN and Board Certified in Female Pelvic Medicine & Reconstructive Surgery by the American Board of OBGYN and American Board of Urology. He currently practices Female Pelvic Medicine and Reconstructive Surgery (FPMRS). He has expertise in the development and v
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Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial. Barber, Matthew Don; Brubaker, Linda; Gantz, Marie G; Jelovsek, John; Meikle, Susan; Menefee, Shawn; NICHD Pelvic Floor Disorders Network,; ... (12 authors) (JAMA, 2018-04)Uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) are commonly performed pelvic organ prolapse procedures despite a lack of long-term efficacy data.To compare outcomes in women randomized to ...
Long-Term Effectiveness of Uterosacral Colpopexy and Minimally Invasive Sacral Colpopexy for Treatment of Pelvic Organ Prolapse. Barber, Matthew Don; Jelovsek, John E; Paraiso, Marie Fidela R; Ridgeway, Beri M; Unger, CA; Walters, Mark D (Female Pelvic Med Reconstr Surg, 2017-08-01)OBJECTIVES: The objective of this study was to estimate rates of recurrent pelvic organ prolapse (POP) 6 years after patients underwent transvaginal uterosacral colpopexy, or laparoscopic or robotic sacral colpopexy at a ...
Barber, Matthew Don; Jelovsek, John E; Paraiso, Marie Fidela R; Walters, Mark D (Female Pelvic Med Reconstr Surg, 2010-07)OBJECTIVES: : To compare the relative frequencies of constipation and other functional bowel disorders between patients with and without pelvic organ prolapse (POP). METHODS: : This was a case-control study design. Cases ...