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Association of Pelvic Organ Prolapse Quantification examination D point with uterosacral ligament suspension outcomes: the “OPTIMAL” D point

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Abstract

Introduction and hypothesis

The objective was to determine the relationship between the preoperative D-point and apical outcomes at 24 months, using the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) dataset.

Methods

This was a secondary analysis of the OPTIMAL trial, a randomized multi-centered study comparing outcomes of sacrospinous ligament fixation and transvaginal uterosacral ligament suspension (USLS). The 2-year dataset utilized included women undergoing USLS with concomitant hysterectomy. The primary outcome was the relationship between preoperative D-point and apical outcomes at 24 months. Secondary objectives were to determine the relationship between preoperative D-point and anatomical, composite and subjective outcomes, and to determine a D-point cut-off that could be used to predict success in each of these categories.

Results

Of the 186 women in the USLS arm, 120 were available for analysis of anatomical failure at 24 months. A higher preoperative D-point correlated with improved apical outcome (C-point) at 24 months (r = 0.34; p value = 0.0002). Using ROC curves, a moderate association was found between the preoperative D-point and apical and anatomical success, (AUC 0.689 and 0.662). There was no relationship between preoperative D-point and composite or subjective success (AUC 0.577 and 0.458). Based on the ROC curves, a “cut-off” D-point value of −4.25 cm (sensitivity = 0.58, specificity = 0.67) was determined to be a predictor of postoperative anatomical success at 2 years.

Conclusions

Preoperative D-point correlates with postoperative anatomical and apical support, but is less successful at predicting subjective outcomes. The strongest predictive D-point cut-off for anatomical and apical success at 24 months was −4.25 cm.

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Authors and Affiliations

  1. MedStar National Center for Advanced Pelvic Surgery, Georgetown University School of Medicine, Washington, DC, USA

    Lee A. Richter & Cheryl B. Iglesia

  2. Department of Obstetrics and Gynecology, Mission Hospital, Asheville, NC, USA

    Sarah E. Bradley

  3. Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Washington, DC, USA

    Sameer Desale

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

    Holly E. Richter

  5. OB/GYN & Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    Amy J. Park

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  1. Lee A. Richter
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Contributions

L.A. Richter: protocol/project development, data analysis, manuscript writing; S.E. Bradley: project development, data analysis, manuscript editing; A.J. Park: protocol/project development, manuscript editing; H.E. Richter: protocol/project development review, manuscript editing; S. Desale: data analysis; C.B. Iglesia: protocol/project development, manuscript editing.

Corresponding author

Correspondence to Lee A. Richter.

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Conflicts of interest

Holly E. Richter: no conflicts of interest. Disclosures: Renovia—research funding (SUI, FI), Allergan—research funding (UUI), UpToDate—Royalties, NIA—research funding, NICHD—research funding, Obstet Gynecol and IUJ—travel reimbursement related to editor duties, Worldwide Fistula Fund—board; DSMB Bluewind, Symposia Medicus—CME speaker. Amy J. Park: speaker for Allergan, UpToDate royalties. Cheryl B. Iglesia: UpToDate contributor. None of the other authors has any conflicts of interest.

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Richter, L.A., Bradley, S.E., Desale, S. et al. Association of Pelvic Organ Prolapse Quantification examination D point with uterosacral ligament suspension outcomes: the “OPTIMAL” D point. Int Urogynecol J 32, 2179–2184 (2021). https://doi.org/10.1007/s00192-021-04687-0

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  • DOI: https://doi.org/10.1007/s00192-021-04687-0

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