Apical Procedures Research Articles

Outcomes of uterosacral ligaments suspension for uterovaginal prolapse native-tissue repair: Over 1000-patient single-center study

Introduction and hypothesisSurgical repair is the mainstay of genital prolapse management. Among native-tissue apical procedures, high uterosacral ligaments suspension is considered a valid and effective option for central compartment repair. In this study, we aimed to evaluate the effectiveness, complications rate, and functional results of high USL suspension as a primary prolapse repair technique in a large cohort of patients. MethodsPatients who underwent vaginal hysterectomy followed by high uterosacral ligaments suspension for POP between January 2008 and December 2020 were retrospectively analyzed. Questionnaires and clinical interviews were preoperatively performed to assess symptoms and severity of urinary, bowel, and sexual dysfunctions. After surgical procedure, diagnostic cystoscopy was performed to evaluate ureteral patency. Postoperative data, objective, and subjective cure rate were then noted at the follow-up evaluation. ResultsA total of 1099 patients underwent high uterosacral ligaments suspension. The total complication rate was 3.4 % and recurrence in any of the vaginal compartments was 12.4 %. Reoperation for symptomatic prolapse recurrence or pessary treatment was required in 9 women (0.9 %). In the evaluation of postoperative questionnaires, functional outcomes analysis revealed a significant improvement (p < 0.05) in terms of stress urinary incontinence, urge urinary incontinence, voiding symptoms, constipation, and dyspareunia after prolapse repair. ConclusionUterosacral ligament suspension is a safe and effective procedure for primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and the reoperation rate for recurrence was below 1%.

Outcome of Difficult Pelvis Surgeries done by Gynecologist versus General Surgeons

Objective: To evaluate the outcomes of difficult pelvis surgeries done by gynecologist versus general surgeons. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, CMH Kharian Medical College, Kharian, Department of Surgery, Wah Medical College POF Hospital, Wah Cantt and Ghulam Muhammad Mahar Medical College, Teaching Hospital, Sukkur from 1st August 2015 to 31st July 2018. Methodology: Fifty professionals (who conducted 500 pelvic surgeries) were included either from the surgery or obstetrics gynecology departments. The study was initiated post-consent of each participant. Surgeons National Surgical Quality Improvement Program (NSQIP) data base software was applied for designing the questionnaire. The NSQIP database collects information from 10 perioperative-variables, as well as preoperative-comorbidities, parity, previous history of pelvic surgery, ureteral obstruction and vesico-vaginal fistula, intraoperative-variables, as well as 30-day mortality and morbidity outcomes including the rate of reoperation and re-admission. Other information regarding ASA classification and malignancy were also collected. Result: There were 341 procedures performed by surgeons while 159 procedures were conducted obstetrics gynecologists’ surgeons. The mean age of the patients was 62.5±11.5 years. The ASA classification presented higher number of surgeries in class 1 and 2 of the ASA class. The apical procedures as Sacrospinous and Sacrocolpopexy were performed highest by obstetrics gynecologists. The 30 days postoperative complication rate was increased significantly in the obstetrics gynecologists group than the surgeons. Conclusion: Prolapse surgery completed by a surgeon is linked with lower odds of 30-day postoperative-complications than the one performed by the obstetrician-gynecologist. Keywords: Outcome, Pelvis surgery, Prolapse surgery, Complication

Apexification with apical plug in immature permanent maxillary incisor teeth: case report

This article describes about the apexification of open apex with apical plug in immature permanent maxillary incisor teeth. A 12-year-old girl came to the Dental Hospital Hasanuddin University with a complaint of cavities in her upper front teeth. The teeth were filled one year ago, and it fell out about six months later. The right upper tooth had been swollen and sore a few days be-fore. There is a history of colliding at the age of 8 years. Radiographic examination showed a wide root canal on tooth 11 and an open apex with radiolucency in the apical area on teeth 11 and 21. So the diagnosis of these teeth was chronic apical abscess and asymptomatic apical periodontitis, respectively. After performing open access, the root canal was prepared using conventional cir-cumferential techniques, then dressing using calcium hydroxide was given for 2 weeks. Next, the apical plug procedure was per-formed using MTA. The patient showed no complaints of pain after treatment, and the size of the radiolucency image in the pe-riapical area of ​​the tooth was reduced. So, it is concluded that apexification treatment with apical plug is one of the effective treatment methods to overcome the problem of open apex in immature permanent teeth.&#x0D; Keywords: apexification, apical plug, mineral trioxide aggregate, open apex

Effect of Enhanced Recovery Protocol on Opioid Use in Pelvic Organ Prolapse Surgery.

Our primary objective was to compare the total opioid use by patients undergoing apical pelvic organ prolapse surgery before and after implementation of an enhanced recovery protocol (ERP). Participants of this ambispective cohort study included a "pre-ERP" retrospective cohort and an "ERP" cohort of patients prospectively enrolled after the full implementation of the ERP in January 2019. Demographic and clinical data were collected from the electronic record. Descriptive statistics were used for demographic variables. Total opioid use was calculated for each participant using morphine milligram equivalents (MMEs) and compared between cohorts using the Student t test. Study participants (n = 65) were similar between cohorts and had a mean (SD) age of 62.4 (9.7) years and body mass index of 28.9 (4.8), and had a median parity of 3 (interquartile range, 2-4). Comorbid conditions, assessed with the Charlson Comorbidity Index, were also similar, with a mean (SD) of 2 (2.9). Hysterectomy approach and apical procedures did not differ between groups. After ERP implementation, mean (SD) intraoperative and postoperative MMEs decreased significantly (59.4 [31.6] vs 36.9 [20.5], P < 0.01). Total MMEs prescribed at discharge also decreased (392.3 [88.4] vs 94.6 [61.3], P < 0.01). Total anesthesia time and surgical time were similar, whereas mean total admission time decreased (27.3 [10.8] vs 18 [8.6] hours, P < 0.01). Telephone calls within 30 days increased from mean 1 (1.0) to 2.2 (1.9) (P < 0.01), whereas clinic visits and 30-day readmissions did not differ. Women undergoing apical pelvic organ prolapse surgery at an academic medical center received significantly fewer opioids after implementation of an ERP without a change in postoperative pain scores.

49 Effect of enhanced recovery protocol in urogynecologic surgery

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based, multidisciplinary and outcome-driven measures developed to provide best practice guidelines for surgical care. Limited data exists to support conventional perioperative interventions of caloric restriction, prolonged immobilization, and liberal administration of fluids and opioids. ERAS protocols for urogynecologic populations are being adopted with limited population and procedure-specific outcome data. Our primary aim was to compare opioid use by patients undergoing major pelvic organ prolapse (POP) surgery before and after implementation of an ERAS protocol. Secondary aims included comparing length of stay and 30-day follow-up characteristics. This ambispective cohort study included a retrospective, pre-ERAS cohort of consecutive patients who underwent major POP surgery starting January 2016. A comprehensive ERAS protocol was implemented in October 2019 (Table 1). A prospective, ERAS cohort consisted of consecutive patients undergoing POP surgery starting in January 2020, 3 months after full implementation of the ERAS protocol. ERAS patients were screened for eligibility and enrolled on the day of surgery. Major POP surgery was defined as including an apical procedure. Demographic and clinical data were abstracted. Descriptive statistics were used for demographic variables. Opioid use was converted to morphine milligram equivalents (MME) and compared between cohorts using the t-test. Other outcomes were compared between groups using t-test or Chi-Square as appropriate. Participants (33 pre-ERAS, 32 ERAS) were similar between cohorts and had mean (SD) age 62.4 (9.7) years, body-mass index 28.9 (4.8) kg/m2, and median (IQR) parity 3 (2-4). Similarly, medical co-morbidities and type of apical POP procedure did not differ between groups. Following ERAS implementation, mean total intra- and post-operative MME decreased (59.4 (31.6) vs 36.6 (20.5), P<0.01). Total discharge prescription MME also decreased (392.3 (88.4) vs 94.6 (61.3), P<0.01). Despite decreased opioid use, post-operative pain scores were not different between groups (Table 2). The ERAS cohort had decreased length of stay and were more likely to be discharged on the day of surgery. Mean number of telephone calls within 30 days of surgery increased (1.0 (1.0) to 2.2 (1.9), P<0.01) while clinic visits, emergency room visits and readmissions did not differ. Implementation of an ERAS protocol in women undergoing major POP surgery resulted in decreased opioid use and length of stay without impacting post-operative pain scores.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

I-STOP Sling Tape: Is It Associated With Reduced Exposure Rates in Apical Prolapse and Urinary Incontinence Procedures?

I-STOP Sling Tape: Is It Associated With Reduced Exposure Rates in Apical Prolapse and Urinary Incontinence Procedures?

U.S. Food and Drug Administration Statements About Transvaginal Mesh and Changes in Apical Prolapse Surgery.

To assess the effects of the U.S. Food and Drug Administration (FDA) safety communication and the reclassification of transvaginal mesh to a class III device on national trends in the treatment of apical prolapse. A retrospective cohort study of surgical cases from 2008 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program was conducted. Patients were included if they underwent apical prolapse repair, as identified by Current Procedural Terminology codes. We identified 36,523 eligible surgical cases. There were no clinically meaningful differences in postoperative complications when stratified by surgical approach. The use of transvaginal mesh decreased from 35.0% to 11.0% from 2008 to 2017. In the year immediately after the first FDA safety communication in 2011, there was a decrease in the proportion of apical procedures using transvaginal mesh of 4.4% per quarter (P<.001), and the proportion of intraperitoneal, extraperitoneal, and abdominal colpopexy all increased. The greatest increase was seen for abdominal colpopexy procedures, which rose by 2.6% per quarter (P<.001). In the year after the FDA reclassification of transvaginal mesh in 2016, there was no significant change in the proportion of apical procedures using transvaginal mesh (P=.56). The first FDA safety communication in 2011 was associated with a significant decline in the use of transvaginal mesh and a concurrent rise in abdominal colpopexy procedures using transabdominal mesh. We speculate that the 2019 FDA ban of transvaginal mesh will result in an even more substantial shift toward abdominal colpopexy procedures.

REVASCULARISATION OF AN IMMATURE PERMANENT TOOTH USING PLATELET RICH FIBRIN AND BIODENTIN AS A MATRIX - A CASE REPORT

Any injury to the pulp during its development lead to cessation of dentin formation and root growth. Status of the pulp and root development are the decisive factors in the treatment approach. Various treatment options include surgery with rood end sealing, apexification using calcium hydroxide ,placement of apical plug and regenerative endodontic procedures to induce&#x0D; apexogenesis. This study describes the treatment of an immature permanent tooth which was treated with regenerative approach using 3% NaOCl and 17% ethylenediaminetetraacetic acid as irrigants,and then medicated with triple antibiotic paste, after that platelet rich fibrin (PRF) and Biodentine were place in the canal. On follow up at 3 ,6,12 months healing of periapical lesion, dentinal thickening, and apical closure were evident. So, PRF can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic procedures.&#x0D; Keywords: Platelet rich fibrin (PRF), Biodentine, open apex, revascularisation

Self-expanding apical closure device for full-percutaneous closed-chest transapical valve procedures with large-sized introducer sheaths: first study in an animal model.

Available apical occluders do not fulfil requirements for full-percutaneous transapical valve procedures with large-sized introducer sheaths. A self-expanding closure device designed for closed-chest transapical valve procedures was tested in an animal model to verify safety, efficacy and thrombogenicity. Large-sized 21-Fr introducer sheaths (Certitude™ system for Sapien™ valves) were percutaneously placed in the ventricles of nine 3-month old minipigs. To seal the apical access, delivery catheters carrying folded self-expanding plugs were inserted. Then, the plugs were deployed while sheaths were removed. Echocardiograms verified tamponade and cardiac function, drains were not placed and a 3-month long aspirin therapy was administered. After 6 and 9 months, animals were euthanized and organs were analysed for macroembolic lesions search. Histological analysis was also performed. Nine minipigs (weight: 28±3kg) were used for this study. Eight plugs were successfully deployed in 8 ventricles without cardiac tamponade or ventricular dysfunction (success rate: 88.9%). In a failed procedure (the animal died after 1 month of cardiac tamponade), the outer disc of the apical plug got stuck in the intercostal space and did not correctly deploy. Post-mortem analysis in 8 minipigs at 6 (n = 4) and 9 months (n = 4) confirmed full deployment and good fixation of all plugs with internal surfaces covered by new endocardium. Macroscopic analysis of myocardium and vital organs showed absence of embolic lesions. Histological analysis showed absence of significant inflammatory infiltration and thrombosis. In this animal model, self-expanding closure devices sealed 21-Fr large percutaneous apical accesses without acute tamponade, thrombosis or embolization. Further tests to evaluate full-percutaneous closed-chest apical procedures are required.

Trends in Hysteropexy and Apical Support for Uterovaginal Prolapse in the United States from 2002 to 2012.

Our objective was to describe trends in hysteropexy and apical support for uterovaginal prolapse (UVP) from 2002 to 2012 in the United States. We identified patient and hospital variables associated with hysteropexy and apical support. We used the Nationwide Inpatient Sample and International Classification of Diseases, Ninth Revision codes to identify a population of women 18 years or older with UVP undergoing pelvic organ prolapse surgery from January 1, 2002, to December 31, 2012. Procedures were categorized as (1) hysteropexy, (2) obliterative with uterine preservation, (3) hysterectomy with apical support, (4) hysterectomy without apical support, and (5) other reconstruction without apical support. Categories were dichotomized into those with and without apical support. We used survey weights to obtain nationally representative estimates; χ and linear and logistic regression compared procedure groups. An estimated 815,184 hospital discharges of pelvic organ prolapse procedures for UVP occurred from 2002 to 2012. During this time, hysteropexies increased from 1.81% to 5.00% (P < 0.0001). From 2002 to 2012, hysterectomies with apical support increased (10.07% to 32.51%, P < 0.0001), hysterectomy without apical support decreased (27.14% to 17.12%, P < 0.0001), and reconstruction without apical support decreased (59.07% to 40.48%, P < 0.0001). In most recent years 2011 to 2012, 60% of women with UVP underwent inpatient surgery without an apical procedure. Age 52 years or older, Medicare payment, Northeast region, and urban teaching hospitals were associated with increased odds of apical support for UVP (P < 0.001 for all). Hysteropexy significantly increased in the United States from 2002 to 2012, although the overall proportion remains low. While hysterectomy without apical support is decreasing, approximately 60% of inpatient procedures performed for UVP do not address the apex.

Endo-surgical management of foreign bodies in the periapical region

Foreign objects present in root canals and surrounding areas are troublesome incidents in endodontics. Chances of these objects getting impacted are more when the chamber is open either due to caries or traumatic injury. Moreover, when pushed apically, retrieval becomes complicated and apical surgical procedures unavoidable. A young male patient presented with a chief complaint of discolored anterior teeth. During routine radiographic examination, a linear appearing radio-opaque foreign body (approximately 15 mm in length), extending apically through the apex into the periapical region, was identified. There was also large periapical radiolucency (approximately 10 mm × 15 mm in size) on an adjacent tooth. This case report describes the successful retrieval of two foreign objects from the periapical region, and the management of a cystic lesion, through periapical surgery.

A Rare Complication of Sacrocolpopexy

Pelvic organ prolapse is a prevalent condition with up to 12% of women requiring surgery in their lifetime. Various apical procedures have been performed vaginally, abdominally, and laparoscopically and include uterosacral, sacrospinous, and Sacrocolpopexy. There is little evidence of ureteral injury/kinking with placement of stitches to secure the vaginal graft at time of laparoscopic sacrocolpopexy. This video highlights information on sacrocolpopexy and associated complications. This is followed by a case presentation of a 65-year-old para 2 that underwent a laparoscopic sacrocolpopexy for stage 3 POP on POPQ exam and presented post-operatively with a hydronephrosis. Ultimately, caution should be taken when placing lateral anchor sutures so as to avoid the ureter and prevent kinking and obstruction.

Apical Procedures and Anterior Vaginal Prolapse: Practice Patterns in the United States in 2011

Apical Procedures and Anterior Vaginal Prolapse: Practice Patterns in the United States in 2011

Apical support at the time of hysterectomy for uterovaginal prolapse.

The aim was to determine factors associated with performing concurrent apical support procedures in hysterectomies carried out for uterovaginal prolapse. Hysterectomies performed for uterovaginal prolapse from 2000 to 2010 were identified by ICD-9 codes. Uterovaginal prolapse was a proxy for apical descent. Primary outcome was the rate of concurrent apical procedures. Secondary outcomes included concurrent surgeries, complications, and surgeon training. Chi-squared tests compared categorical variables. Logistic regression determined factors associated with concurrent apical support. A total of 2,465 hysterectomies were performed for uterovaginal prolapse. In only 1,358 cases (55.1%) were concurrent apical support procedures carried out. Cases without apical procedures were more likely to undergo cystocele repair (23.8% vs 9.4%, p < 0.001), but less likely to have rectocele (3.4% vs 12.2%, p < 0.001) or combined cystocele/rectocele repair (16.4% vs 25.6%, p < 0.001). Of those without apical procedures, 95.7% were performed by generalists. Urogynecologists and minimally invasive gynecologists were more likely to perform apical procedures (97.1% and 88.8% vs 23.6%, p < 0.001). Older patients (>75 years) were more likely to undergo apical procedures (OR 5.096, 95% CI 3.127-8.304). Surgeons practicing for 10-14 years and >20 years were less likely to perform apical procedures than those practicing <5 years (p < 0.001 vs. p = 0.01). At a tertiary hospital, a significant proportion of hysterectomies are carried out for uterovaginal prolapse without concurrent apical support procedures, with the majority performed by generalists. Urogynecologists and minimally invasive gynecologists are more likely to perform an apical suspension at the time of hysterectomy for uterovaginal prolapse than generalists. This supports the need for continued education about apical support to appropriately manage uterovaginal prolapse.

Concomitant apical prolapse repair and incontinence procedures: trends from 2001-2009 in the United States

Recent evidence supports improved outcomes in women who undergo an incontinence procedure at the time of apical prolapse repair compared with apical repair alone. Our primary objective was to describe national trends in concomitant apical repair and incontinence procedures that were performed in the United States from 2001-2009. A secondary objective was to describe complications and length of stay. We used the Nationwide Inpatient Sample to collect data on hospital discharges for women who had inpatient apical prolapse surgery from 2001-2009. We included women whose records included the International Classification of Disease-9 Clinical Modification procedure codes for apical procedures with and without incontinence procedures. We examined annual trends in the proportion of concomitant procedures using chi-square testing and multiple logistic regression. Of all apical procedures, the percentage of concomitant incontinence procedures performed increased from 37.9% in 2001 to 47% in 2009 (P= .0002 for trend). In-hospital complications (hemorrhage, bowel obstruction, and/or abscess) were less common with concomitant procedures (6.8% vs 11.7%; P= .02). All geographic regions had increasing trends of concomitant incontinence procedures with no difference among regions (P= .7 for interaction). Both community and academic institutions had increasing trends of concomitant procedures over the study period, with no difference among the types of institutions. Age was not associated with increasing trends in concomitant procedures. The proportion of concomitant apical and incontinence procedures increased in the United States from 2001-2009. Length of stay was slightly longer for the concomitant group, but complications were not increased.

Thoracoscopic 360 degree apical pleurodesis with turned-over parietal pleura

Apical pleurodesis procedures, in addition to the resection of bullae or blebs, proved to lower the recurrence rate in spontaneous pneumothoraces. Here, we describe our thoracoscopic technique of making a 360° apical pleurodesis. After resecting responsible bullae or blebs thoracoscopically, we dissect the parietal pleura off the chest wall up, turn it over on the mediastinal side, clip it on the mediastinal pleura and place the lung apex against the rough surface to promote extensive apical pleurodesis. The technique has been performed for 18 patients so far and no late recurrence of pneumothorax has been noted.

Root Reconstructed with Mineral Trioxide Aggregate and Guided Tissue Regeneration in Apical Surgery: A 5-year Follow-up

Apical surgery should be considered as the last treatment option and employed when conventional endodontic treatment does not provide the expected result. In teeth undergoing apical surgery, the type of retrograde filling material is one of the factors interfering with the repair of periapical tissues. The material in intimate contact with the periapical tissues plays a fundamental role in the repair process. Several materials have been studied and indicated for use in apical surgery procedures, but the mineral trioxide aggregate (MTA) is still the most frequently used one. Guided tissue regeneration (GTR) techniques have been proposed as an adjunct to apical surgery to enhance bone healing. Here is reported a clinical case in which apical surgery was performed in conjunction with MTA-based root reconstruction of the maxillary right second incisor. After the apical surgery, a root-end cavity was prepared at the vestibular face of the involved tooth and filled with MTA. A bovine bone graft and a cortical collagen membrane were placed on the bone defect. After 5 years, clinical and radiographic assessments showed that the treatment was successful. It may be concluded that MTA presents favorable characteristics in adverse conditions and can be used in conjunction with GTR in cases involving root reconstruction.

Robotic Versus Vaginal Urogynecologic Surgery

The primary objective was to compare perioperative complications after robotic surgery (RS) versus vaginal surgery (VS) for apical prolapse repair in elderly women. The secondary objectives were to (1) assess whether tools designed to predict surgical morbidity, the American Society of Anesthesiologists (ASA) class and the Charlson Comorbidity Index (CCI), are useful in the elderly urogynecologic population and (2) to classify complications during urogynecologic apical procedures using the Dindo classification system. We reviewed medical records of women 65 years or older who underwent RS or VS between March 2006 and April 2011. Procedures included robotic sacrocolpopexy and sacrocervicopexy, vaginal uterosacral ligament suspension, sacrospinous ligament suspension, colpocleisis, and Uphold vaginal mesh placement. We assessed preoperative risks using ASA and CCI classification and complications using Dindo grade. There were 136 eligible cases (RS, 70; and VS, 66) during the 5-year study period. Women who underwent RS were younger (70 vs 74 years; P < 0.001). Vaginal surgery had more severe comorbidities as measured by the CCI (P = 0.012) but similar ASA profiles (P = 0.10). Robotic surgery had longer operative times (P < 0.001) but a lower estimated blood loss (P < 0.001). There were fewer postoperative complications in RS (P = 0.005). However, complication severity based on Dindo grade was similar between RS and VS, with most surgeries having no complications. In the elderly women, RS was associated with fewer postoperative complications than VS. Overall, all procedures were associated with few complications, and either route may be reasonable in the elderly population.

Pelvic organ prolapse surgery in Western Australia: a population-based analysis of trends and peri-operative complications

We previously described a declining rate of surgery in the treatment of pelvic organ prolapse (POP) in Western Australia. This paper builds on previous work by examining temporal trends and the post-operative risk of in-hospital complications, following first time incident prolapse surgery in a population-based cohort of women. We investigated rates of prolapse surgery between 1988 and 2005 according to age group and concomitant procedure type for 34,509 women whose data were extracted from the WA Data Linkage System. We investigated changes over time in the demographic characteristics of women undergoing surgery and whether the presence of selected concomitant procedures increased the risk of in-hospital complications. During the study period, 34,509 women underwent an incident surgery for POP. Concomitant hysterectomy was performed in more than half of all surgeries (52.4 %) and a concomitant urinary incontinence (UI) surgery was noted in 25.8 %. 10.9 % of patients experienced a complication of interest, with the highest percentage of complications recorded in women who underwent multi-concomitant surgery. After controlling for age, comorbidity and time period we found that concomitant UI surgery increases in-hospital complications (OR 1.61 95 % CI 1.42-1.83) only in women who have a repair procedure (colporrhaphy and/or enterocele repair). There was no significant effect of concomitant procedures in women who underwent a combined repair and apical prolapse procedure. Surgery to treat prolapse is common, has low mortality and concomitant surgery only increases complications when combined with simpler prolapse surgery.

2141 OUTCOMES OF VAGINAL PROLAPSE SURGERY AMONG FEMALE MEDICARE BENEFICIARIES: THE ROLE OF APICAL SUPPORT

MPHOBJECTIVE: Recurrent pelvic organ prolapse (POP) hasbeen attributed to many factors, one of which is lack ofvaginal apical support. To assess the role of vaginal apicalsupport and POP, we analyzed a national dataset tocompare long-term reoperation rates after prolapsesurgery performed with and without apical support.METHODS: Public use file data on a 5% random nationalsample of female Medicare beneficiaries were obtainedfrom the Centers for Medicare and Medicaid Services.Women with POP who underwent surgery during 1999were identified by relevant International Classification ofDiseases, 9th Revision, Clinical Modification, and CurrentProcedural Terminology, Fourth Edition codes. Individualpatients were followed-up through 2009. Prolapse repairwas categorized as anterior, posterior, or anterior–posteriorwith or without a concomitant apical suspension procedure.TheprimaryoutcomewastherateofretreatmentforPOP.RESULTS: In 1999, 21,245 women had a diagnosis ofPOP. Of these, 3,244 (15.3%) underwent prolapse surgerythat year. There were 2,756 women who underwent ananterior colporrhaphy, posterior colporrhaphy, or bothwith or without apical suspension. After 10 years, cumu-lative reoperation rates were highest among women whohad an isolated anterior repair (20.2%) and significantlyexceeded reoperation rates among women who hada concomitant apical support procedure (11.6%; P,.01).CONCLUSION: Ten years after surgery for POP, thereoperation rate was significantly reduced when a con-comitant apical suspension procedure was performed.This analysis of a national cohort suggests that theappropriate use of a vaginal apical support procedureat the time of surgical treatment of POP might reduce thelong-term risk of prolapse recurrence.