Non-Oral Poster 32

Abstract

OBJECTIVES: To determine the efficacy of abdominal sacral hysteropexy (ASH) with respect to subjective patient impression of improvement, anatomical cure and symptom change compared to abdominal sacral colpopexy with concomitant total abdominal hysterectomy (ASC/TAH). MATERIALS AND METHODS: We performed a retrospective cohort study of 29 patients who underwent abdominal sacral hysteropexy (n = 20) or abdominal sacral colpopexy with concomitant total abdominal hysterectomy (n = 9) for Stage 2 or greater pelvic organ prolapse. All patients were assessed preoperatively and at 1 year with history, examination (pelvic organ prolapse quantification system (POPQ)) and questionnaires (PFDI-20, PFIQ-7). At 1 year patients also completed a Global Impression of improvement question. The primary outcome measure was impression of improvement, and secondary outcome measures were anatomical cure, change in symptoms and complication rates including mesh erosion. Anatomical cure was defined separately for the apical, anterior and posterior compartments as follows; apical cure as point C/D + (TVL −2) ≤0, anterior/posterior cure as point Aa/Ba or Ap/Bp >-2. Symptom change was assessed using change in symptom subscales of the PFDI-20 and PFIQ-7. RESULTS: There were no significant differences in baseline characteristics between groups. Median age was 50 years (range 37–71) with 48% of patients being menopausal. 9 patients had had previous vaginal or incontinence surgery. 23 patients had polypropylene and 6 had porcine dermis as the suspensory graft. Mean follow up was 12 months (range 10–15 months). All patients, irrespective of surgery, indicated improvement being “much better” or “very much better”. One patient in the ASH group had anterior wall recurrence. There were no failures in the ASC/TAH group. There were no significant inter-group differences in symptom subscales. Mean operating time for ASH and ASC/TAH was 200 min and 230 min respectively (P = 0.13). Estimated blood loss was not significantly different (189ml (ASH) vs 333 ml (ASC/TAH), P = 0.1). Hospital stay did not differ significantly between the groups. Operative and post-operative complications were rare. 3 mesh erosions occurred, all in the ASC/TAH group, at a mean of 5.3 months (range 3–8 months). CONCLUSION: There were no differences in patient impression of improvement, anatomical cure or symptom change between groups. Given the small numbers, this pilot study was not powered to detect significant differences in the outcome measures. We are undertaking a prospective, multicentre study in order to provide definitive data.