Portal de Periódicos da CAPES

Supracervical Hysterectomy Is Protective against Mesh Complications after Minimally Invasive Abdominal Sacrocolpopexy: A Population-Based Cohort Study of 12,189 Patients

2021; Lippincott Williams & Wilkins; Volume: 207; Issue: 3 Linguagem: Inglês

10.1097/ju.0000000000002262

1527-3792

Kai Dallas, Lior Taich, Paige Kuhlmann, Lisa Rogo-Gupta, Karyn S. Eilber, Jennifer T. Anger, Victoria Scott,

Anorectal Disease Treatments and Outcomes

No AccessJournal of UrologyAdult Urology1 Mar 2022Supracervical Hysterectomy Is Protective against Mesh Complications after Minimally Invasive Abdominal Sacrocolpopexy: A Population-Based Cohort Study of 12,189 PatientsThis article is commented on by the following:Editorial Comment Kai Dallas, Lior Taich, Paige Kuhlmann, Lisa Rogo-Gupta, Karyn Eilber, Jennifer T. Anger, and Victoria Scott Kai DallasKai Dallas Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California , Lior TaichLior Taich Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California , Paige KuhlmannPaige Kuhlmann Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California , Lisa Rogo-GuptaLisa Rogo-Gupta Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California , Karyn EilberKaryn Eilber Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California , Jennifer T. AngerJennifer T. Anger Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California , and Victoria ScottVictoria Scott ‡Correspondence: Cedars-Sinai Medical Center, Department of Surgery, Division of Urology, 99 N. La Cienega Blvd., Suite M102, Los Angeles, California 90048 telephone: 808-542-7811; FAX: 310-385-2973; E-mail Address: [email protected] Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California View All Author Informationhttps://doi.org/10.1097/JU.0000000000002262AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Although minimally invasive (robotic or laparoscopic) abdominal sacrocolpopexy (MISC) has become the new gold standard for durable pelvic organ prolapse repair after the vaginal mesh controversy, current literature is limited. Our objective was to study reoperation for mesh complications after MISC. Materials and Methods: All women undergoing MISC in California from January 2012 to December 2018 were identified from Office of Statewide Health Planning and Development data sets using appropriate ICD-9/10 (International Classification of Diseases 9th/10th Revision) and CPT® (Current Procedural Terminology) codes. Univariate and multivariable analyses were performed to assess associations between patient demographics, surgical details and our primary outcomes: rates of reoperation for a mesh complication. Results: Of 12,189 women undergoing MISC 8,398 (68.9%) had concomitant hysterectomy. Total hysterectomy (TH) and supracervical hysterectomy (SCH) were performed in 5,027 (41.2%) and 3,371 (27.6%) cases, respectively. Reoperation rates for mesh complications were lower after SCH vs TH (overall: 0.7%, mean followup time 1,111 days vs 3.1%, mean followup time 1,095 days, p <0.001; subcohort with at least 4 years of followup: 2.1% vs 8.9%, p <0.001). Additionally, mesh complication rates were higher even if TH was performed remotely, as compared to concomitant SCH (5.2% vs 0.7%, p <0.001). The increased risk for reoperation due to mesh complications after TH was preserved on multivariable analysis (OR 4.20, 95% CI 2.72‒6.50, p <0.001). Conclusions: Concomitant TH at time of MISC is associated with a significantly higher rate of mesh complication as compared to SCH. The increased risk of a mesh complication associated with TH is present even if the TH was performed prior to the MISC. References 1. : Lifetime risk of stress incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014; 123: 1201. Google Scholar 2. : Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014; 311: 1023. Google Scholar 3. : Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010. Obstet Gynecol 2012; 120: 1105. Google Scholar 4. Center for Devices and Radiological Health, Food and Drug Administration: Urogynecologic surgical mesh: update on the safety and effectiveness of vaginal placement for pelvic organ prolapse, 2011. Available at http://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/UCM262760.pdf. Accessed February 12, 2018. Google Scholar 5. : Obstetrics and Gynecology Devices Panel Meeting. U.S. Food and Drug Administration, 12 February 2019. Available at: https://www.fda.gov/advisory-committees/advisory-committee-calendar/february-12-2019-obstetrics-and-gynecology-devices-panel-medical-devices-advisory-committee-meeting. Google Scholar 6. : Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 2013; 309: 2016. Google Scholar 7. : Robot-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol 2014; 66: 303. Google Scholar 8. : Mesh erosion in robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg 2012; 18: 86. Google Scholar 9. : Hysterectomy controversies: ovarian and cervical preservation. Clin Obstet Gynecol 2014; 57: 95. Google Scholar 10. : Association between concomitant hysterectomy and repeat surgery for pelvic organ prolapse repair in a cohort of nearly 100,000 women. Obstet Gynecol 2018; 132: 1328. Google Scholar 11. Office of Statewide Health Planning and Development: MIRCaldGeneral FAQs. Available at http://www.oshpd.ca.gov/HID/MIRCal/FAQsGeneral. html. Accessed February 1, 2021. Google Scholar 12. : Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature. Int Urogynecol J 2020; 31: 1423. Google Scholar 13. : What impacts the all cause risk of reoperation after pelvic organ prolapse repair? A comparison of mesh and native tissue approaches in 110,329 women. J Urol 2018; 200: 389. Link, Google Scholar 14. : Will hysterectomy at the time of sacrocolpopexy increase the rate of polypropylene mesh erosion?Int Urogynecol J Pelvic Floor Dysfunct 2008; 19: 199. Google Scholar 15. : Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol 2008; 199: 688.e1. Google Scholar 16. : Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations. Eur J Obstet Gynecol Reprod Biol 2016; 205: 60. Google Scholar 17. : Laparoscopic sacrocolpopexy (LSCP) using an ultra-lightweight polypropylene mesh. Eur J Obstet Gynecol Reprod Biol X 2019; 2: 100008. Google Scholar 18. : Permanent compared with absorbable suture for vaginal mesh fixation during total hysterectomy and sacrocolpopexy: a randomized controlled trial. Obstet Gynecol 2020; 136: 355. Google Scholar 19. : Do African American patients treated with radical cystectomy for bladder cancer have worse overall survival? Accounting for pathologic staging and patient demographics beyond race makes a difference. Bladder Cancer 2016; 2: 225. Google Scholar 20. : Effects of socioeconomic status and treatment disparities in colorectal cancer survival. Cancer Epidemiol Biomarkers Prev 2008; 17: 1950. Google Scholar 21. : Racial and socioeconomic disparities in short-term urethral sling surgical outcomes. Urology 2017; 110: 70. Google Scholar 22. : Payer type, race/ethnicity, and the timing of surgical management of urinary stone disease. J Endourol 2019; 33: 152. Google Scholar 23. : Factors influencing selection of concomitant total versus supracervical hysterectomy at the time of sacrocolpopexy and associated perioperative outcomes. Female Pelvic Med Reconstr Surg 2021; 27: 415. Google Scholar 24. : Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 2002; 347: 1318. Google Scholar 25. : Randomized controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG 2003; 110: 1088. Google Scholar 26. : A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol 2003; 102: 453. Google Scholar 27. : Hysterectomy and women satisfaction: total versus subtotal technique. Arch Gynecol Obstet 2008; 278: 405. Google Scholar 28. : [Supravaginal or total hysterectomy?]Ugeskrift for laeger 1994; 156: 6229. Google Scholar 29. : Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: Risk stratification, shared decision making, and care options. J Urol 2018; 199: 683. Link, Google Scholar 30. : Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg 2012; 18: 113. Google Scholar Study was exempt from institutional review board approval. Editor's Note: This article is the fifth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 744 and 745. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyDec 16, 2021, 12:00:00 AMEditorial Comment Volume 207Issue 3March 2022Page: 669-676Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsuterine prolapsesurgical meshrobotic surgical procedurestreatment outcomepelvic organ prolapseMetricsAuthor Information Kai Dallas Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California Equivalent manuscript contribution. More articles by this author Lior Taich Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California Equivalent manuscript contribution. More articles by this author Paige Kuhlmann Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California More articles by this author Lisa Rogo-Gupta Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California More articles by this author Karyn Eilber Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California Financial interest and/or other relationship with Boston Scientific, Coloplast and Allergan. More articles by this author Jennifer T. Anger Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California More articles by this author Victoria Scott Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California ‡Correspondence: Cedars-Sinai Medical Center, Department of Surgery, Division of Urology, 99 N. La Cienega Blvd., Suite M102, Los Angeles, California 90048 telephone: 808-542-7811; FAX: 310-385-2973; E-mail Address: [email protected] More articles by this author Expand All Study was exempt from institutional review board approval. Editor's Note: This article is the fifth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 744 and 745. Advertisement PDF DownloadLoading ...