Twelve Month Outcomes of Pelvic Organ Prolapse Surgery in Patients With Uterovaginal or Posthysterectomy Vaginal Prolapse Enrolled in the Multicenter Pelvic Floor Disorders Registry.

Objective: The aim of the study was to compare 12-month subjective and objective outcomes between 3 approaches to apical pelvic organ prolapse (POP) surgery in patients presenting with uterovaginal or posthysterectomy vaginal prolapse enrolled in the Pelvic Floor Disorders Registry for Research.
Study Design: This was an analysis of a multicenter, prospective registry that collected both patient- and physician-reported data for up to 3 years after conservative (pessary) and surgical treatment for POP. Twelve-month subjective and anatomic outcomes for patients who underwent surgical treatment were extracted from the registry for analysis. Pelvic organ prolapse recurrence was defined as a composite outcome and compared between the 3 apical surgery groups (native tissue repair, sacrocolpopexy, colpocleisis) as well as the 2 reconstructive surgery groups (native tissue repair and sacrocolpopexy).
Results: A total of 1,153 women were enrolled in the registry and 777 (67%) opted for surgical treatment, of whom 641 underwent apical repair and were included in this analysis (404 native tissue repair, 187 sacrocolpopexy, and 50 colpocleisis). The overall incidence of recurrence was as follows: subjective 6.5%, anatomic 4.7%, retreatment 7.2%, and composite 13.6%. The incidence of recurrence was not different between the 3 surgical groups. When baseline patient characteristics were controlled for, composite POP recurrence between the native tissue and sacrocolpopexy groups remained statistically nonsignificant. Concurrent perineorrhaphy with any type of apical POP surgery was associated with a lower risk of recurrence (adjusted odds ratio, 0.43; 95% confidence interval, 0.25-0.74; P = 0.002) and prior hysterectomy was associated with a higher risk (adjusted odds ratio, 1.77, 95% confidence interval, 1.04-3.03; P = 0.036).
Conclusion: Pelvic Floor Disorders Registry for Research participants undergoing native tissue apical POP repair, sacrocolpopexy, and colpocleisis surgery had similar rates of POP recurrence 12 months after surgery.
Competing Interests: C.F. received royalties from UpToDate and Elsevier. C.B. received research grants from the National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, travel support and textbook royalties from Elsevier, travel support and honorarium for FPMRS Division membership and oral board examiner work from the American Board of Obstetrics and Gynecology, and travel support for board of directors membership from the American Urogynecologic Society. R.G. is a consultant strategic advisory board member of Boston Scientific, UpToDate Royalties Urethral diverticulum section; expert witness slings of Johnson and Johnson. P.M. received NIH R012R01 HD083383-06, Mesh complications: The role of local mechanical stresses on tissue remodeling following mesh implantation; NIH R01 HD097187, Overcoming complications of polypropylene prolapse meshes: Development of novel elastomeric auxetic devices; and NIH UG3UG1HD06900-10S1, Pittsburgh Pelvic Floor Research Program; Pelvic Floor Disorders Network. J.A. received research grants from the Agency for Healthcare Research and Quality, Patient Centered Outcomes Research Institute. The other authors have declared they have no conflicts of interest.
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