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

Presented in oral and poster format at the annual meeting of the International Continence Society, Rio de Janeiro, Brazil, Oct. 20-24, 2014.
https://doi.org/10.1016/j.ajog.2014.11.034Get rights and content

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.

Section snippets

Materials and Methods

This was a retrospective chart review of all women who underwent uterosacral colpopexy with or without hysterectomy for POP from January 2006 through December 2011 at a single tertiary care referral center. Institutional review board approval for the study was obtained. Subjects were identified by their Current Procedural Terminology code for intraperitoneal colpopexy (57283). All subjects underwent transvaginal uterosacral colpopexy for either uterovaginal prolapse or posthysterectomy vaginal

Results

In all, 1038 subjects were identified and 983 met study inclusion criteria. Concomitant procedures included the following: vaginal hysterectomy (88%), unilateral salpingo-oophorectomy (5.2%), bilateral salpingo-oophorectomy (9.8%), cystocele repair (80%), rectocele repair (58.1%), anal sphincter repair (1.1%), and midurethral sling placement (58.8%). Of subjects, 46.2% (454/983) underwent uterosacral ligament suspension with 2 sutures on each side (1 permanent and 1 delayed-absorbable), 36.7%

Comment

The objective of this study was to report on the rates of adverse events after uterosacral colpopexy and to determine the recurrent POP rate in a large cohort of women undergoing this procedure. We found that in subjects undergoing uterosacral colpopexy for uterovaginal and posthysterectomy vaginal vault prolapse from 2006 through 2011, the overall rates of perioperative and postoperative adverse events were low. We also found that our composite recurrent POP rate was similar to the rates

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    M.D.W. is a consultant for Ethicon Inc. M.F.R.P. is a consultant for Boston Scientific Inc. The authors report no conflict of interest.

    Cite this article as: Unger CA, Walters MD, Ridgeway B, et al. Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am J Obstet Gynecol 2015;212:603.e1-7.

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