Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse.

Unger, Cecile A

Walters, Mark D

Ridgeway, Beri

Jelovsek, J Eric

Barber, Matthew D

Paraiso, Marie Fidela R

United States

2017-08-01T13:59:44Z

2017-08-01T13:59:44Z

2015-05

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.

https://www.ncbi.nlm.nih.gov/pubmed/25434838

S0002-9378(14)02358-8

1097-6868

https://hdl.handle.net/10161/15143

eng

Elsevier BV

Am J Obstet Gynecol

10.1016/j.ajog.2014.11.034

apical prolapse

uterosacral colpopexy

uterosacral ligament suspension

uterovaginal prolapse

vaginal vault suspension

Age Factors

Aged

Female

Humans

Hysterectomy

Hysterectomy, Vaginal

Ileus

Incidence

Middle Aged

Operative Time

Pelvic Organ Prolapse

Postoperative Complications

Reconstructive Surgical Procedures

Recurrence

Retrospective Studies

Suture Techniques

Sutures

Urinary Bladder

Urinary Tract Infections

Uterine Prolapse

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse.

Journal article

Jelovsek, J Eric|0000-0002-7196-817X

https://www.ncbi.nlm.nih.gov/pubmed/25434838

603.e1

603.e7

5

Clinical Science Departments

Duke

Obstetrics and Gynecology

Obstetrics and Gynecology, Urogynecology

School of Medicine

Published

212