Predictive Factors for Poor Outcome after Laparoscopic and Open Colposuspension: A Comparative Analysis Using the...

Area of Science:

• Urogynecology
• Surgical Innovation
• Pelvic Floor Disorders

Background:

• Colposuspension has been a standard surgical treatment for stress urinary incontinence (SUI) since 1961.
• Limited research exists on predictors of poor outcomes for both laparoscopic colposuspension (LC) and open colposuspension (OC).

Purpose of the Study:

• To identify patient-reported predictors of failure following colposuspension surgery.
• To compare outcomes and failure predictors between LC and OC procedures.

Main Methods:

• Retrospective cohort study of women undergoing their first colposuspension surgery.
• Data collected prospectively on the British Society of Urogynaecology database.
• Primary outcome: Patient Global Impression of Improvement (PGII) for incontinence; failure defined as PGII score 3-7.

Main Results:

• Analysis of 3104 women (1181 LC, 1923 OC).
• In LC, cystocele stage ≥2 predicted failure (OR 2.573, p=0.032).
• In OC, previous midurethral sling (MUS) (OR 1.807, p=0.008) and previous prolapse surgery (OR 1.954, p=0.004) predicted failure.
• OC showed higher success rates (p<0.001) with lower adverse events (p<0.001) compared to LC.

Conclusions:

• Predictors of failed colposuspension vary significantly between LC and OC.
• Previous pelvic organ prolapse surgery and/or midurethral sling are key predictors for OC failure.
• Stage ≥2 cystocele is a significant predictor for LC failure.