{"title":"经质量调整的生命年结果：机器人辅助的骶骨子宫阴道固定术与阴道补片进行盆腔器官脱垂修复术后1年。","authors":"Georgios Poutakidis, Kirk Geale, Edward Morcos","doi":"10.1007/s00192-025-06242-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The aim of this study was to compare the quality-adjusted life-years (QALYs) attained 1 year after robotics-assisted sacral hystero-colpopexy (RASC) versus Uphold™ vaginal mesh surgery for pelvic organ prolapse repair.</p><p><strong>Methods: </strong>This was a secondary analysis of a previously published cohort study. A total of 65 patients who underwent RASC and 71 who underwent the Uphold™ procedure completed the 15-dimensional (15D) and the EuroQol five-dimensional three-level (EQ-5D-3L) instruments measuring health-related quality of life (HR-QoL). All patients had symptomatic and anatomical apical prolapse (POP-Q C ≥ stage II) with or without other vaginal wall defects. Changes in HR-QoL instruments were calculated and compared with minimal important change (MIC) thresholds and QALYs gained were estimated for each intervention.</p><p><strong>Results: </strong>The 15D and EQ-5D-3L mean index scores were improved from preoperatively to 1 year after RASC ([0.88 ± 0.10 to 0.90 ± 0.01] and [0.85 ± 0.1 to 0.90 ± 0.1]) and after Uphold™= ([0.87 ± 0.1 to 0.89 ± 0.1] and [0.86 ± 0.1 to 0.93 ± 0.1], p 0.024 to p < 0.001) with no significant difference between cohorts. Prolapse-related 15D profile index measures, including discomfort, sexual activity, and distress were significantly improved after RASC (p = 0.039 to < 0.001), whereas excretion, discomfort, and sexual activity were significantly improved after the Uphold™ (p = 0.009 to < 0.001). The improvement in 15D scores from baseline to 1-year follow-up of + 0.026 for RASC and + 0.025 for Uphold™ exceeded the MIC, indicating meaningful improvements in patient quality of life. The overall 1-year QALY gain was estimated to be 0.90 ± 0.1 in the RASC and 0.88 ± 0.1 in the Uphold™ cohorts (p < 0.001), with no significant difference between the two interventions (p = 0.514).</p><p><strong>Conclusions: </strong>The RASC and Uphold™ are both meaningful surgical treatments for prolapse, with significant improvement in the HR-QoL and the 1-year QALY gain and with no significant difference between the two surgeries.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Quality-Adjusted Life-Years Outcome 1 Year After Surgery by Robotics-Assisted Sacral Hystero-Colpopexy Versus Vaginal Mesh for Pelvic Organ Prolapse Repair.\",\"authors\":\"Georgios Poutakidis, Kirk Geale, Edward Morcos\",\"doi\":\"10.1007/s00192-025-06242-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction and hypothesis: </strong>The aim of this study was to compare the quality-adjusted life-years (QALYs) attained 1 year after robotics-assisted sacral hystero-colpopexy (RASC) versus Uphold™ vaginal mesh surgery for pelvic organ prolapse repair.</p><p><strong>Methods: </strong>This was a secondary analysis of a previously published cohort study. A total of 65 patients who underwent RASC and 71 who underwent the Uphold™ procedure completed the 15-dimensional (15D) and the EuroQol five-dimensional three-level (EQ-5D-3L) instruments measuring health-related quality of life (HR-QoL). All patients had symptomatic and anatomical apical prolapse (POP-Q C ≥ stage II) with or without other vaginal wall defects. Changes in HR-QoL instruments were calculated and compared with minimal important change (MIC) thresholds and QALYs gained were estimated for each intervention.</p><p><strong>Results: </strong>The 15D and EQ-5D-3L mean index scores were improved from preoperatively to 1 year after RASC ([0.88 ± 0.10 to 0.90 ± 0.01] and [0.85 ± 0.1 to 0.90 ± 0.1]) and after Uphold™= ([0.87 ± 0.1 to 0.89 ± 0.1] and [0.86 ± 0.1 to 0.93 ± 0.1], p 0.024 to p < 0.001) with no significant difference between cohorts. Prolapse-related 15D profile index measures, including discomfort, sexual activity, and distress were significantly improved after RASC (p = 0.039 to < 0.001), whereas excretion, discomfort, and sexual activity were significantly improved after the Uphold™ (p = 0.009 to < 0.001). The improvement in 15D scores from baseline to 1-year follow-up of + 0.026 for RASC and + 0.025 for Uphold™ exceeded the MIC, indicating meaningful improvements in patient quality of life. The overall 1-year QALY gain was estimated to be 0.90 ± 0.1 in the RASC and 0.88 ± 0.1 in the Uphold™ cohorts (p < 0.001), with no significant difference between the two interventions (p = 0.514).</p><p><strong>Conclusions: </strong>The RASC and Uphold™ are both meaningful surgical treatments for prolapse, with significant improvement in the HR-QoL and the 1-year QALY gain and with no significant difference between the two surgeries.</p>\",\"PeriodicalId\":14355,\"journal\":{\"name\":\"International Urogynecology Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-08-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Urogynecology Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00192-025-06242-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Urogynecology Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00192-025-06242-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Quality-Adjusted Life-Years Outcome 1 Year After Surgery by Robotics-Assisted Sacral Hystero-Colpopexy Versus Vaginal Mesh for Pelvic Organ Prolapse Repair.
Introduction and hypothesis: The aim of this study was to compare the quality-adjusted life-years (QALYs) attained 1 year after robotics-assisted sacral hystero-colpopexy (RASC) versus Uphold™ vaginal mesh surgery for pelvic organ prolapse repair.
Methods: This was a secondary analysis of a previously published cohort study. A total of 65 patients who underwent RASC and 71 who underwent the Uphold™ procedure completed the 15-dimensional (15D) and the EuroQol five-dimensional three-level (EQ-5D-3L) instruments measuring health-related quality of life (HR-QoL). All patients had symptomatic and anatomical apical prolapse (POP-Q C ≥ stage II) with or without other vaginal wall defects. Changes in HR-QoL instruments were calculated and compared with minimal important change (MIC) thresholds and QALYs gained were estimated for each intervention.
Results: The 15D and EQ-5D-3L mean index scores were improved from preoperatively to 1 year after RASC ([0.88 ± 0.10 to 0.90 ± 0.01] and [0.85 ± 0.1 to 0.90 ± 0.1]) and after Uphold™= ([0.87 ± 0.1 to 0.89 ± 0.1] and [0.86 ± 0.1 to 0.93 ± 0.1], p 0.024 to p < 0.001) with no significant difference between cohorts. Prolapse-related 15D profile index measures, including discomfort, sexual activity, and distress were significantly improved after RASC (p = 0.039 to < 0.001), whereas excretion, discomfort, and sexual activity were significantly improved after the Uphold™ (p = 0.009 to < 0.001). The improvement in 15D scores from baseline to 1-year follow-up of + 0.026 for RASC and + 0.025 for Uphold™ exceeded the MIC, indicating meaningful improvements in patient quality of life. The overall 1-year QALY gain was estimated to be 0.90 ± 0.1 in the RASC and 0.88 ± 0.1 in the Uphold™ cohorts (p < 0.001), with no significant difference between the two interventions (p = 0.514).
Conclusions: The RASC and Uphold™ are both meaningful surgical treatments for prolapse, with significant improvement in the HR-QoL and the 1-year QALY gain and with no significant difference between the two surgeries.
期刊介绍：
The International Urogynecology Journal is the official journal of the International Urogynecological Association (IUGA).The International Urogynecology Journal has evolved in response to a perceived need amongst the clinicians, scientists, and researchers active in the field of urogynecology and pelvic floor disorders. Gynecologists, urologists, physiotherapists, nurses and basic scientists require regular means of communication within this field of pelvic floor dysfunction to express new ideas and research, and to review clinical practice in the diagnosis and treatment of women with disorders of the pelvic floor. This Journal has adopted the peer review process for all original contributions and will maintain high standards with regard to the research published therein. The clinical approach to urogynecology and pelvic floor disorders will be emphasized with each issue containing clinically relevant material that will be immediately applicable for clinical medicine. This publication covers all aspects of the field in an interdisciplinary fashion
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