Grand Rounds

Pelvic Organ Prolapse: Uterosacral Ligament Suspension or Robotic Sacrocolpopexy?

BACKGROUND AND PURPOSE:

Smith et al. (Female Pelvic Medicine & Reconstructive Surgery, 2019) compared long-term outcomes of uterosacral ligament suspension (USLS) vs robotic sacrocolpopexy (RSC) in patients with pelvic organ prolapse

Retrospective cohort study
Participants had either
- USLS
- RSC
Contacted 3 to 7 years after surgery
Participants completed validated questionnaires and participated in physical examinations
Primary outcomes
- No symptoms of bulge or retreatment for prolapse (subjective)
- POP-Q examination demonstrating prolapse equal to -1 (objective)
Statistical analysis
- Subjective outcome: 10% noninferiority margin (comparing USLS to RSC) assuming a 92% success rate and 80% power
  - 91 subjects in each group (182 total) required
- Objective outcome: Standard sample size analysis
  - 65 per group (130 total) required

186 subjects participated in the study
- 92 subjects per group in analysis for the primary subjective outcome
- 84% of the above had POP-Q exam
Baseline characteristics were overall similar
- Previous prolapse surgery was more common in the RSC group (P < 0.001)
Subjective success not significantly different (P = 0.265)
- USLS group: 90.2%
- RSC group: 84.4%
- 95% CI, −0.036 to 1.000
Objective success not significantly different (P = 0.869)
- USLS group: 93.2%
- RSC group: 91.3%
Postoperative complication rates
- Overall low and not statistically different between groups
- Mesh complications were noted in 6.6% of the RSC group
- One subject in the USLS group reported pain related to surgery

At 3-7 years follow up
- Subjective symptoms: Uterosacral ligament suspension was non-inferior to robotic sacrocolpopexy
- Objective outcomes: Were similar in both groups
Both approaches had high success rates and patients from both groups were satisfied with their treatment

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