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Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study
INTRODUCTION AND HYPOTHESIS: Surgery for pelvic organ prolapse (POP) has high recurrence rates. Long-term anatomical and patient-reported outcomes after pelvic floor repair are therefore required. METHODS: This prospective observational cohort study was conducted in a teaching hospital with tertiary...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803761/ https://www.ncbi.nlm.nih.gov/pubmed/34159402 http://dx.doi.org/10.1007/s00192-021-04740-y |
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author | van Zanten, Femke Lenters, Egbert Broeders, Ivo A. M. J. Schraffordt Koops, Steven E. |
author_facet | van Zanten, Femke Lenters, Egbert Broeders, Ivo A. M. J. Schraffordt Koops, Steven E. |
author_sort | van Zanten, Femke |
collection | PubMed |
description | INTRODUCTION AND HYPOTHESIS: Surgery for pelvic organ prolapse (POP) has high recurrence rates. Long-term anatomical and patient-reported outcomes after pelvic floor repair are therefore required. METHODS: This prospective observational cohort study was conducted in a teaching hospital with tertiary referral function for patients with POP. Patients with symptomatic vaginal vault or uterine prolapse (simplified POP Quantification [sPOPQ] stage ≥2), who underwent robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS), were included. Follow-up visits with sPOPQ evaluations were planned 4 years after surgery. Patients received pre- and postoperative questionnaires reporting symptoms of vaginal bulge, Urogenital Distress Inventory (UDI-6), and Pelvic Floor Impact Questionnaire (PFIQ-7). Primary outcome was patient self-reported symptoms. Secondary outcome was anatomical cure (sPOPQ stage 1) for all vaginal compartments. RESULTS: Seventy-seven patients were included. Sixty-one patients (79%) were evaluated after 50 months (physical examination n = 51). Symptoms of bulge (95% vs 15% p ˂ 0.0005), median UDI-6 scores (26.7 vs 22.2, p = 0.048), median PFIQ-7 scores (60.0 vs 0, p = 0.008), and median sPOPQ stages in all landmarks improved significantly from the pre- to the postoperative visit. Thirty patients (59%) were completely recurrence free and 96% of patients had no apical recurrence. Most recurrences were asymptomatic cystoceles (20%). There was one surgical re-intervention for recurrent prolapse (1.6%). CONCLUSIONS: Robot-assisted sacrocolpopexy and RSHS show sustainable results in the treatment of prolapse. Symptoms of bulge, urinary symptoms, and quality of life improved substantially 50 months postoperatively. Patients should be counseled about the risk of anterior wall recurrence and the small chance of recurrent symptoms that need treatment. |
format | Online Article Text |
id | pubmed-8803761 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-88037612022-02-02 Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study van Zanten, Femke Lenters, Egbert Broeders, Ivo A. M. J. Schraffordt Koops, Steven E. Int Urogynecol J Original Article INTRODUCTION AND HYPOTHESIS: Surgery for pelvic organ prolapse (POP) has high recurrence rates. Long-term anatomical and patient-reported outcomes after pelvic floor repair are therefore required. METHODS: This prospective observational cohort study was conducted in a teaching hospital with tertiary referral function for patients with POP. Patients with symptomatic vaginal vault or uterine prolapse (simplified POP Quantification [sPOPQ] stage ≥2), who underwent robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS), were included. Follow-up visits with sPOPQ evaluations were planned 4 years after surgery. Patients received pre- and postoperative questionnaires reporting symptoms of vaginal bulge, Urogenital Distress Inventory (UDI-6), and Pelvic Floor Impact Questionnaire (PFIQ-7). Primary outcome was patient self-reported symptoms. Secondary outcome was anatomical cure (sPOPQ stage 1) for all vaginal compartments. RESULTS: Seventy-seven patients were included. Sixty-one patients (79%) were evaluated after 50 months (physical examination n = 51). Symptoms of bulge (95% vs 15% p ˂ 0.0005), median UDI-6 scores (26.7 vs 22.2, p = 0.048), median PFIQ-7 scores (60.0 vs 0, p = 0.008), and median sPOPQ stages in all landmarks improved significantly from the pre- to the postoperative visit. Thirty patients (59%) were completely recurrence free and 96% of patients had no apical recurrence. Most recurrences were asymptomatic cystoceles (20%). There was one surgical re-intervention for recurrent prolapse (1.6%). CONCLUSIONS: Robot-assisted sacrocolpopexy and RSHS show sustainable results in the treatment of prolapse. Symptoms of bulge, urinary symptoms, and quality of life improved substantially 50 months postoperatively. Patients should be counseled about the risk of anterior wall recurrence and the small chance of recurrent symptoms that need treatment. Springer International Publishing 2021-06-23 2022 /pmc/articles/PMC8803761/ /pubmed/34159402 http://dx.doi.org/10.1007/s00192-021-04740-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article van Zanten, Femke Lenters, Egbert Broeders, Ivo A. M. J. Schraffordt Koops, Steven E. Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study |
title | Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study |
title_full | Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study |
title_fullStr | Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study |
title_full_unstemmed | Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study |
title_short | Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study |
title_sort | robot-assisted sacrocolpopexy: not only for vaginal vault suspension? an observational cohort study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803761/ https://www.ncbi.nlm.nih.gov/pubmed/34159402 http://dx.doi.org/10.1007/s00192-021-04740-y |
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