Concomitant Anterior Repair, Preoperative Prolapse Severity, and Anatomic Prolapse Outcomes After Vaginal Apical...

Area of Science:

• Urogynecology
• Pelvic reconstructive surgery
• Female pelvic floor disorders

Background:

• Pelvic organ prolapse (POP) affects many women, with surgical repair often involving native tissue techniques.
• Anterior repair (AR) is sometimes performed concurrently with apical suspension procedures like sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (ULS).
• The benefit of concomitant AR in relation to prolapse severity and apical suspension type is not fully elucidated.

Purpose of the Study:

• To compare anterior and overall prolapse prevalence at 1 year post-surgery.
• To evaluate the impact of concomitant anterior repair (AR) on surgical outcomes.
• To assess outcomes based on the type of apical suspension (SSLF vs. ULS) and prolapse stage.

Main Methods:

• Secondary analysis of two surgical trials.
• Participants underwent either SSLF or ULS, with AR performed at surgeon's discretion.
• Anterior anatomic success defined as Ba ≤0; overall success defined as Ba, Bp, and C ≤0 at 12 months.

Main Results:

• 63% of participants had concomitant AR.
• Anterior anatomic success was marginally better with AR (82% vs. 80%, P=0.03).
• AR improved outcomes in the SSLF subgroup, especially for higher-stage anterior prolapse (74% vs. 57%, P=0.02). AR did not benefit lower-stage prolapse or ULS procedures.

Conclusions:

• Anterior repair should be considered for women with higher-stage prolapse undergoing SSLF.
• Preoperative prolapse severity is a significant predictor of anatomic outcomes in native tissue apical surgeries.
• Further clinical trial data is needed to confirm these findings.