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Associating genital hiatus size with long-term outcomes after apical suspension

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Abstract

Introduction and hypothesis

To describe associations between postoperative genital hiatus (GH) measurements and long-term anatomical and subjective outcomes following pelvic reconstructive surgery involving apical suspension.

Methods

This IRB-approved secondary analysis reports outcomes 3–7 years following robotic sacrocolpopexy (RSC) and uterosacral ligament suspension (USLS). Objective and subjective measures were obtained through clinical examinations and validated questionnaires. Subjective success was defined as the absence of a symptomatic bulge or retreatment. Objective success was defined as all Pelvic Organ Prolapse Quantification (POP-Q) points at or above −1 at the long-term examination. Postoperative GH measures were obtained at 6 weeks (early) and 3–7 years (long term) postoperatively. GH measurements were classified as either normal (<4 cm) or wide (≥4 cm). Logistic regression identified associations between postoperative GH measurements and long-term subjective and objective outcomes.

Results

A total of 154 subjects completed long-term POP-Q examinations (74 RSC and 80 USLS). The median time to follow-up (minimum, maximum) was 59 months (range 34–89); 97.4% were Caucasian. Subjective success was achieved in 134 (87%), and objective success in 139 (90.2%) subjects. The majority (79%) underwent a posterior repair during their index surgery. An early postoperative GH of less than 4 cm was associated with an 11-fold higher likelihood of subsequent objective success (11.8, 2.7–51.7; p = 0.001). Furthermore, a postoperative GH less than 4 cm was not associated with dyspareunia at long-term follow-up.

Conclusions

Early postoperative GH <4 cm was associated with superior long-term objective success, without increasing dyspareunia. These data support correcting GH to <4 cm during prolapse repair with apical suspension to reduce objective long-term failure.

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Sources of support

The parent study was supported by an educational grant from the TriHealth Medical Education Research Fund.

National Trials Registry: NCT02741830.

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Authors and Affiliations

  1. TriHealth, 3219 Clifton Avenue, Suite 100, Cincinnati, OH, 45220, USA

    Austin M. Hill & Rachel N. Pauls

  2. Kaiser Permanente Northern California, Oakland, CA, USA

    Abigail Shatkin-Margolis

  3. Premier Urogynecology, Dallas, TX, USA

    Benjamin C. Smith

Authors
  1. Austin M. Hill
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  2. Abigail Shatkin-Margolis
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  3. Benjamin C. Smith
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  4. Rachel N. Pauls
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Correspondence to Austin M. Hill.

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Hill, A.M., Shatkin-Margolis, A., Smith, B.C. et al. Associating genital hiatus size with long-term outcomes after apical suspension. Int Urogynecol J 31, 1537–1544 (2020). https://doi.org/10.1007/s00192-019-04138-x

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  • DOI: https://doi.org/10.1007/s00192-019-04138-x

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