Impact of Genital Hiatus Size on Anatomic Outcomes After Mesh-Augmented Sacrospinous Ligament Fixation.

Autor:	Vaughan MH; From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC., Giugale LE; Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Women's Center for Bladder and Pelvic Health, University of Pittsburgh Medical Center, Pittsburgh, PA., Siddiqui NY; From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC., Bradley MS; Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Women's Center for Bladder and Pelvic Health, University of Pittsburgh Medical Center, Pittsburgh, PA.
Jazyk:	angličtina
Zdroj:	Female pelvic medicine & reconstructive surgery [Female Pelvic Med Reconstr Surg] 2021 Sep 01; Vol. 27 (9), pp. 564-568.
DOI:	10.1097/SPV.0000000000000986
Abstrakt:	Objective: Our objective is to compare anatomic outcomes at medium term after mesh-augmented sacrospinous ligament fixation among women categorized by their preoperative and postoperative genital hiatus size. Methods: We performed a retrospective cohort study in women undergoing Uphold mesh-augmented sacrospinous ligament fixation between 2010 and 2017. We compared 3 groups: (1) women with a wide genital hiatus preoperatively and 6 weeks postoperatively ("Persistently Wide" cohort), (2) women with a wide genital hiatus preoperatively but normal hiatus 6 weeks postoperatively ("Improved" cohort), and (3) women with a normal genital hiatus preoperatively and 6 weeks postoperatively ("Stably Normal" cohort). We defined a wide hiatus as 4 cm or greater and a normal hiatus as less than 4 cm. The primary outcome was anatomic failure, defined as recurrent prolapse beyond the hymen or retreatment for prolapse with surgery or pessary. Results: Ninety-seven women were included in the study. Overall, mean age was 68 years (±7.15 years), mean body mass index was 28.36 kg/m2 (±5.34 kg/m2) and mean follow up time was 400 ± 216 days. Anatomic failure did not differ between groups (Persistently Wide, 15.4%; Improved, 11.1%; Stably Normal, 10.0%; P = 0.88). In logistic regression, the odds of anatomic failure remained similar among all groups (P = 0.93). Conclusions: A persistently wide genital hiatus alone was not associated with anatomic failure in this small study cohort. Therefore, surgical reduction of the genital hiatus with level III support procedures may not affect prolapse recurrence at the time of mesh-augmented sacrospinous ligament fixation. Further studies are needed to confirm this relationship and investigate other potential mechanisms for these findings. Competing Interests: N.Y.S. receives research funding from Medtronic, Inc which includes salary support, and she receives royalties from UpToDate. Neither company provided financial support for the study. All other authors have declared they have no conflicts of interest. (Copyright © 2021 American Urogynecologic Society. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu