The following is a summary of “Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs. vaginal hysterectomy with uterosacral ligament suspension,” published in the January 2023 issue of Obstetrics and Gynecology by Richter, et al.
Sacrospinous hysteropexy with graft (hysteropexy) had a lower composite surgical failure rate than vaginal hysterectomy with uterosacral suspension over a 5-year period among women with symptomatic uterovaginal prolapse who underwent vaginal surgery in the Vaginal hysterectomy with Native Tissue Vault Suspension vs. Sacrospinous Hysteropexy with Graft Suspension (Study for Uterine Prolapse Procedures Randomized Trial) trial. For a study, researchers compared vaginal hysterectomy with uterosacral suspension to sacrospinous hysteropexy with graft among women who had uterovaginal prolapse to determine characteristics related to surgical failure during a 5-year period.
Surgery failure was defined as retreatment of prolapse, return of prolapse beyond the hymen, or bothersome prolapse symptoms in the planned secondary analysis of a comparative efficacy study of two transvaginal apical suspensions. Using rank-based tests, baseline clinical and sociodemographic characteristics of eligible subjects undergoing the randomized procedure (N=173) were compared across failure groups (≤1 year, >1 year, and no failure). Utilizing piecewise exponential survival models with randomized apical repair and clinical site adjustments, factors with sufficient frequency and clinical relevance were evaluated for least adjusted bivariate relationships. Apical repair, extra clinically significant variables, covariates with bivariate P<.2, and clinical site were also included in the multivariable model. Final retained risk variables were identified via backward selection (P=.1), with statistical significance established by the Bonferroni correction (P=.005). At P<.1, it was evaluated how final variables interacted with the type of apical repair. Adjusted hazard ratios are used to show the association, and the classification of risk variables serves as further evidence.
In the final multivariable model, body mass index (an increase of 5 kg/m2: adjusted hazard ratio, 1.7; 95% CI, 1.3-2.2; P<.001) and duration of prolapse symptoms (an increase of 1 year: adjusted hazard ratio, 1.1; 95% CI, 1.0-1.1; P<.005) were associated with composite surgical failure, with rates of failure 2.9 and 1.8 times higher in women with obesity and women who are overweight than in women with normal weight and women are underweight (95% CI, 1.5–5.8 and 0.9–3.5) and 3.0 times higher in women experiencing >5 years prolapse symptoms than women experiencing ≤5 years prolapse symptoms (95% CI, 1.8–5.0). Sacrospinous hysteropexy with graft had a lower failure rate than hysterectomy with uterosacral suspension (adjusted hazard ratio, 0.6; 95% CI, 0.4-1.0; P=.05). Failure was less likely after hysteropexy than a hysterectomy for patients with symptom duration of ≤5 years (adjusted hazard ratio, 0.5; 95% CI, 0.2-0.9), but not for patients with symptom duration of >5 years (adjusted hazard ratio, 1.0; 95% CI, 0.5-2.1), according to the interaction between symptom duration and apical repair (P=.07).
Regardless of surgical technique, obesity and the length of prolapse symptoms had been identified as risk factors for surgical failure after 5 years following transvaginal prolapse treatment. Therefore, when considering treatment options for troublesome prolapse, healthcare professionals and patients should consider these modifiable risk factors.
Reference: ajog.org/article/S0002-9378(22)00619-6/fulltext
