International Urogynecology Journal

, Volume 30, Issue 4, pp 603–609 | Cite as

Surgical trends and patient factors associated with the treatment of apical pelvic organ prolapse from a national sample

  • Emily A. SlopnickEmail author
  • Andrey Petrikovets
  • David Sheyn
  • Simon P. Kim
  • Carvell T. Nguyen
  • Adonis K. Hijaz
Original Article


Introduction and hypothesis

Prolapse of the vaginal apex can be treated using multiple surgical modalities. We describe national trends and patient characteristics associated with the surgical approach and compare perioperative outcomes of abdominal versus vaginal repair of apical pelvic organ prolapse (POP).


The 2006–2012 National Surgical Quality Improvement Program Database was queried for abdominal sacrocolpopexy (ASC) and vaginal apical suspensions. Patients were stratified by whether or not concomitant hysterectomy (CH) was performed or whether or not they were post-hysterectomy (PH). Multivariate logistic regressions were adjusted for confounding variables.


A total of 6,147 patients underwent apical POP repair: 33.9% (2,085) ASCs, 66.1% (4,062) vaginal suspensions. 60.0% (3,689) underwent CH. In all cohorts, older patients were less likely to have ASC (CH: OR 0.48, CI 0.28–0.83, p = 0.008 for age ≥ 60; PH: OR 0.28, CI 0.18–0.43, p < 0.001). Over time, the proportion of all vaginal and abdominal repairs remained relatively stable. Use of minimally invasive ASC, however, increased over the study period (trend p < 0.001), and use of mesh for vaginal suspensions decreased (p < 0.001). ASC had a longer median operative time (PH 174 vs 95 min, p < 0.001; CH 192 vs 127 min, p < 0.001). Complication rates were the same for vaginal repairs and ASC, overall and when sub-stratified by hysterectomy status.


Nationally, most apical POP repairs are performed via a vaginal route. Older age was predictive of the vaginal route for both CH and PH groups. ASCs had longer operative times. There has been increased utilization of minimally invasive ASC and decreased use of mesh-augmented vaginal suspensions over time.


Pelvic organ prolapse Outcome assessment (health care) Gynecologic surgical procedures Urologic surgical procedures 



We received no financial funding for this study.

Compliance with ethical standards

Conflicts of interest

Dr Adonis K. Hijaz is a member of the Astellas, Inc. Speaker’s Bureau. The remaining authors declare that they have no conflicts of interest.


  1. 1.
    Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.CrossRefGoogle Scholar
  2. 2.
    Ortman JM Velkoff VA, Hogan H. An aging nation: the older population in the United States. 2014. Available at Accessed 6 Feb 2018.
  3. 3.
    Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. Scholar
  4. 4.
    Chow D, Rodriguez LV. Epidemiology and prevalence of pelvic organ prolapse. Curr Opin Urol. 2013;23(4):293–8. Scholar
  5. 5.
    Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396–403. Scholar
  6. 6.
    Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113(3):609–16. Scholar
  7. 7.
    Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188(1):108–15. Scholar
  8. 8.
    Khan AA, Eilber KS, Clemens JQ, Wu N, Pashos CL, Anger JT. Trends in management of pelvic organ prolapse among female Medicare beneficiaries. Am J Obstet Gynecol. 2015;212(4):463.e461–8. Scholar
  9. 9.
    Fairchild PS, Kamdar NS, Berger MB, Morgan DM. Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse. Am J Obstet Gynecol. 2016;214(2):262.e261–7. Scholar
  10. 10.
    Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. (4):CD004014.
  11. 11.
    Siddiqui NY, Geller EJ, Visco AG. Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol. 2012;206(5):435.e431–5. Scholar
  12. 12.
    American College of Surgeons: About ACS NSQIP. (2016) Available at Accessed 28 April 2016.
  13. 13.
    Sulman A, Piaccitelli J, Su LM. Robot-assisted laparoscopic radical prostatectomy in patients with pre-existing inflatable penile prosthesis. J Robot Surg. 2008;2(1):55–6. Scholar
  14. 14.
    PUF Data Dictionary Items | National Cancer Data Base - Data Dictionary PUF 2013. Available at Accessed 25 April 2016.
  15. 15.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefGoogle Scholar
  16. 16.
    D’Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996;49(12):1429–33.CrossRefGoogle Scholar
  17. 17.
    Kim JY, Khavanin N, Rambachan A, McCarthy RJ, Mlodinow AS, De Oliveria GS Jr, et al. Surgical duration and risk of venous thromboembolism. JAMA surgery. 2015;150(2):110–7. Scholar
  18. 18.
    Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the Perioperative Research Network Investigators. JAMA Surg. 2017;152(2):157–66. Scholar
  19. 19.
    Chen CC, Ou YC, Yang CK, Chiu KY, Wang SS, Su CK, et al. Malfunction of the da Vinci robotic system in urology. Int J Urol. 2012;19(8):736–40. Scholar
  20. 20.
    Juo YY, Mantha A, Abiri A, Lin A, Dutson E. Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013. Surg Endosc. 2018;32(3):1405–13. doi: Scholar
  21. 21.
    Serati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S, et al. Robot-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol. 2014;66(2):303–18. Scholar
  22. 22.
    Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123(1):5–12. Scholar
  23. 23.
    Betschart C, Cervigni M, Contreras Ortiz O, Doumouchtsis SK, Koyama M, Medina C, et al. Management of apical compartment prolapse (uterine and vault prolapse): a FIGO working group report. Neurourol Urodyn. 2017;36(2):507–13. Scholar
  24. 24.
    Jelovsek JE, Barber MD, Brubaker L, Norton P, Gantz M, Richter HE, et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA. 2018;319(15):1554–65. Scholar
  25. 25.
    Ghoniem G, Hammett J. Female pelvic medicine and reconstructive surgery practice patterns: IUGA member survey. Int Urogynecol J. 2015;26(10):1489–94. Scholar
  26. 26.
    Jha S, Cutner A, Moran P. The UK National Prolapse Survey: 10 years on. Int Urogynecol J. 2018;29(6):795–801. Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Division of UrologyMetroHealth Medical CenterClevelandUSA
  2. 2.Urology InstituteUniversity Hospitals Cleveland Medical CenterClevelandUSA
  3. 3.Yale University, Cancer Outcomes Public Policy and Effectiveness Research (COPPER)New HavenUSA

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