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#Grand Rounds

Pelvic Organ Prolapse: Uterosacral Ligament Suspension or Robotic Sacrocolpopexy?

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Uterosacral Ligament Suspension Versus Robotic Sacrocolpopexy for Treatment of Apical Pelvic Organ Prolapse

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Related ObG Topics:

Results From the OPTIMAL Trial Five Years Out: Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation for Prolapse?
Apical Prolapse Surgery Using Extraperitoneal Uterosacral Suspension: Long-Term Results
Robotic vs Vaginal vs Open Surgery for Vaginal Prolapse – How Do They Compare?

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