Sonia Guerin, Feras Alhalabi, Kevin Lutz, Philippe Zimmern
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引用次数: 0
Abstract
Objective: To assess the impact of previous pelvic organ prolapse (POP) surgery on the outcomes of robotic-assisted mesh sacrocolpopexy (RASC) in post-hysterectomy women.
Methods: Following IRB approval, a retrospective review of a prospectively-followed cohort of post-hysterectomy women who underwent a RASC for symptomatic multi-compartment prolapse was performed by an investigator not involved in the clinical care of these patients. The cohort was stratified based on history of prior POP repair, as first line repair (FR) and second line repair (SR). Success was defined by a composite of no report of recurrent vaginal bulge, no prolapse beyond the hymen on examination, and no retreatment for prolapse. Secondary outcomes included additional surgeries for prolapse, Clavien-Dindo peri-operative complications, and Kaplan-Meier time interval to recurrent prolapse surgery.
Results: Between 2010 and 2020, 87 patients underwent RASC; 35 as FR and 52 as SR. Demographics were similar in each group. Overall, all three components of success definition were met by 82% of patients (29/35) in FR group, and 73% (38/52) in the SR group (p=0.31) at median follow-up of 42 (range: 20-81) months and 61 (range: 22-116) months, respectively. Additional POP surgery was performed on 6% in the FR group and 12% in the SR group (p=0.3). Grade ≥2 complications were significantly more frequent in the SR group, with 12 cases, compared to two cases in the FR group (p=0.04).
Conclusion: A history of prior POP repair was not significantly associated with an increased POP recurrence rate after RASC, but had a higher perioperative morbidity.
目的：探讨既往盆腔器官脱垂（POP）手术对子宫切除术后机器人辅助网状骶colpop固定术（RASC）疗效的影响。方法：在IRB批准后，由一名未参与这些患者临床护理的研究者对子宫切除术后因症状性多室脱垂而接受RASC的前瞻性随访队列进行回顾性审查。该队列根据先前的POP修复历史进行分层，分为一线修复（FR）和二线修复（SR）。成功的定义是没有复发性阴道隆起的报告，检查时没有脱垂超出处女膜，没有脱垂的再治疗。次要结局包括额外的脱垂手术、Clavien-Dindo围手术期并发症和复发性脱垂手术的Kaplan-Meier时间间隔。结果：2010年至2020年间，87例患者接受了RASC；两组人口统计学相似，FR 35, sr 52。总体而言，在中位随访42个月（范围：20-81）和61个月（范围：22-116）个月时，FR组中82%的患者（29/35）和SR组中73%的患者（38/52）分别达到了成功定义的所有三个组成部分（p=0.31）。FR组和SR组分别有6%和12%的患者接受了额外的POP手术（p=0.3）。SR组≥2级并发症发生率为12例，FR组为2例（p=0.04）。结论：先前的POP修复史与RASC后POP复发率的增加没有显著相关，但有更高的围手术期发病率。
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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