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Reoperation for prolapse recurrence after sacrospinous mesh hysteropexy: characteristics of women choosing retreatment

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Abstract

Introduction and hypothesis

Factors that contribute to reoperation and surgical approaches for the management of recurrent uterovaginal prolapse after vaginal mesh hysteropexy (mesh hysteropexy) are unknown. We aimed to describe surgical management of pelvic organ prolapse recurrence after vaginal mesh hysteropexy, and patient characteristics in those who chose reoperation.

Methods

This is a descriptive analysis of women who experienced treatment failure within 5 years of mesh hysteropexy in a multi-site randomized trial. The composite definition of treatment failure included retreatment (pessary or reoperation), prolapse beyond the hymen, or bothersome prolapse symptoms. Characteristics of those pursuing and not pursuing repeat prolapse surgery, measures of prolapse, and symptom severity are described.

Results

Over 5-year follow up, 31/91 (34%) of the hysteropexy group met treatment failure criteria. All seven women who pursued reoperation reported bothersome prolapse symptoms; six were anatomic failures. Most seeking reoperation were early treatment failures; six (86%) by the 12-month visit and all by the 18-month visit. Compared to those electing expectant management, those pursuing reoperation had more apical prolapse, POP-Q point C median (IQR) −5.5 (−6.0, −4.0) cm versus +1.0 (−1.0, 3.0) cm respectively. Hysterectomy was performed in 6/7 reoperations (three vaginal, three endoscopic), with apical suspension in 5/6 hysterectomies. One participant with posterior compartment prolapse underwent transvaginal enterocele plication, uterosacral ligament suspension with posterior colpoperineorrhaphy. At a mean surgical follow-up of 34.3 (15.8) months, all women remained without anatomic or symptomatic failure.

Conclusions

When recurrent prolapse after mesh hysteropexy occurred, most women did not choose reoperation. Those who pursued surgery experienced more significant apical prolapse and were universally symptomatic.

Clinical trial identification number

NCT01802281

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Acknowledgements

The authors would like to acknowledge those in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network who contributed to the SUPeR Study

Alpert Medical School of Brown University, Providence, RI

Charles R. Rardin, Deborah L. Myers, Cassandra Carberry, B. Star Hampton, Kyle Wohlrab, Nicole Korbly, Ann S. Meers, Samantha Douglas, Elizabeth-Ann Viscione

Cleveland Clinic, Cleveland OH

Matthew Barber, Eric Jelovsek, Cecile Ferrando, Marie Fidela R Paraiso, Ly Pung, Annette Graham, Geetha Krishnan, Kathleen Dastoli, Maryori Edington, Mark Walters

Duke University Medical Center, Durham, NC

Anthony G. Visco, Alison Weidner, Cindy Amundsen, Nazema Siddiqui, Amie Kawasaki, Shantae McLean, Mary Raynor, Nicole Longoria, Akira Hayes, Robin Gilliam, Acacia Harris

Kaiser Permanente – San Diego, San Diego, CA

Shawn A. Menefee, Jasmine Tan-Kim, Gouri B. Diwadkar, Keisha Y. Dyer, Linda M. Mackinnon, Gisselle Zazueta-Damian

Magee-Womens Research Institute, Pittsburgh, PA

Pamela Moalli, Michael Bonidie, Jerry Lowder, Jonathan Shepherd, Gary Sutkin, Judy Gruss, Karen Mislanovich, Kate Amodei, Lindsey Baranski

RTI International, Research Triangle Park, NC

Dennis Wallace, Sonia Thomas, Kimberly McMillian, Ryan Whitworth, Amanda Shaffer, Tracey Grant, Kelly Koeller-Anna, Ben Carper, Emily Honeycutt, Katrina Burson, Kendra Glass, James Pickett

University of Alabama at Birmingham, Birmingham, AL

Holly E Richter, R. Edward Varner, Robert L. Holley, Tracey Wilson, Alicia Ballard, David Ellington, Ryanne Johnson, Alyssa Long, Lisa Pair, Velria Willis, Alice Howell, Nancy Saxon, Kathy Carter, Robin Willingham, Ryanne Johnson, Jill Hyde, Sunita Patel

UC San Diego Health, San Diego, CA

Charles Nager, Emily S. Lukacz, Michael E. Albo, Keisha Y. Dyer, Marianna Alperin, Anna C. Kirby, Kimberly Ferrante, Erika Wasenda, Joann Columbo, Erika Ruppert, Kyle Herrala, Sherella Johnson

University of New Mexico, Albuquerque, NM

Rebecca G Rogers, Yuko Komesu, Gena Dunivan, Peter Jeppson, Sara Cichowski, Julia Middendorf, Karen Box.

University of Pennsylvania, Philadelphia, PA

Lily Arya, Uduak Andy, Ariana Smith, Lorraine Flick. Michelle Kingslee, Teresa Carney, Donna Thompson

Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development grants HD069006, HD069031, HD069025, HD041261, HD069010, HD069013, HD054214, HD041267, HD054215 and NIH Office of Research on Women’s Health. Boston Scientific Corporation provided partial study support through an unrestricted grant.

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Authors and Affiliations

  1. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Gnankang Sarah Napoe & Halina M. Zyczynski

  2. Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA

    Gnankang Sarah Napoe

  3. RTI International, Biostatics and Epidemiology Division, Research Triangle Park, Durham, NC, USA

    Douglas Luchristt

  4. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA

    Amaanti Sridhar & Marie G. Gantz

  5. Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    David Ellington

  6. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    Beri Ridgeway

  7. Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA

    Donna Mazloomdoost

  8. Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA

    Vivian Sung

  9. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Cara Ninivaggio

  10. Department of Urology, University of California - San Diego Health, La Jolla, CA, USA

    Heidi Harvie

  11. Magee-Womens Research Institute, Pittsburgh, PA, USA

    Yahir Santiago-Lastra

Authors
  1. Gnankang Sarah Napoe
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  2. Douglas Luchristt
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  11. Marie G. Gantz
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  12. Halina M. Zyczynski
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Contributions

G.S. Napoe: project development, manuscript writing and editing

D. Luchristt: manuscript writing and editing

A. Sridhar: project development, data analysis, manuscript writing and editing

D. Ellington: manuscript writing and editing

B. Ridgeway: manuscript writing and editing

D. Mazloomdoost: manuscript writing and editing

V. Sung: manuscript writing and editing

C. Ninivaggio: manuscript writing and editing

H. Harvie: manuscript writing and editing

Y. Santiago-Lastra: manuscript writing and editing

M.G. Gantz: project development, data management, data analysis, manuscript writing and editing

H.M. Zyczynski: project development, data collection, manuscript writing and editing

Corresponding author

Correspondence to Gnankang Sarah Napoe.

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Conflicts of interests

Marie Gantz reports that Boston Scientific Corporation provided partial support for the SUPeR study through an unrestricted grant. All other authors report no conflicts of interest.

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An abstract of this paper was presented as a poster at the Society of Gynecologic Surgeons 48th Annual Scientific Meeting in San Antonio, TX, March 27–30, 2022

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Napoe, G.S., Luchristt, D., Sridhar, A. et al. Reoperation for prolapse recurrence after sacrospinous mesh hysteropexy: characteristics of women choosing retreatment. Int Urogynecol J 34, 255–261 (2023). https://doi.org/10.1007/s00192-022-05411-2

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  • DOI: https://doi.org/10.1007/s00192-022-05411-2

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