Posterior repair versus no posterior repair for posterior vaginal wall prolapse resolved under simulated apical support at the time of native tissue apical suspension.

Abstract

The aim of this study was to evaluate the impact of an adjuvant posterior repair (PR) on treatment outcomes of native tissue apical suspension. This retrospective cohort study included 194 women who underwent iliococcygeus or uterosacral ligament suspension with or without PR for Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 posterior vaginal wall prolapse that resolved under simulated preoperative apical support and who completed a 1-year follow-up. The primary outcome was composite surgical failure defined as the presence of vaginal bulge symptoms, descent of the vaginal apex more than one-third of the way into the vaginal canal (apical recurrence), anterior or posterior vaginal wall descent beyond the hymen (anterior or posterior recurrence), or retreatment for prolapse. Secondary outcomes included anatomical outcomes, perioperative outcomes, obstructed defecation, dyspareunia, and adverse events. One hundred thirty women underwent concomitant PR, and 64 did not. Surgical failure rates were significantly higher in the group not receiving PR than in the group receiving PR (29.7% vs. 12.3%, p < 0.01). Anatomically, anterior and apical recurrence was more common in the group not receiving PR (p < 0.05). Concomitant PR was associated with a longer operating time and more blood loss (p < 0.01). However, there were few adverse events related to PR, and the rates of de novo obstructed defecation and dyspareunia were low in both groups, with no significant difference between the groups. Concomitant PR at the time of native tissue apical suspension may reduce the recurrence of symptomatic anterior and apical prolapse without significant morbidity.