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The effect of uterine volume on surgical outcomes following uterine preserving apical prolapse repair

  • Author Footnotes
    1 The first and second authors contributed equally to this manuscript.
    Henry H. Chill
    Correspondence
    Corresponding author.
    Footnotes
    1 The first and second authors contributed equally to this manuscript.
    Affiliations
    Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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  • Author Footnotes
    1 The first and second authors contributed equally to this manuscript.
    Adiel Cohen
    Footnotes
    1 The first and second authors contributed equally to this manuscript.
    Affiliations
    Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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  • Aharon Dick
    Affiliations
    Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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  • Adi Reuveni-Salzman
    Affiliations
    Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel

    Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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  • David Shveiky
    Affiliations
    Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel

    Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah – Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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  • Author Footnotes
    1 The first and second authors contributed equally to this manuscript.
Published:December 15, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.12.019

      Abstract

      Objective

      In recent years uterine preservation has become a popular option in women undergoing pelvic organ prolapse repair. The aim of this study was to evaluate the effect of uterine volume on outcomes following uterine preserving surgical treatment for apical prolapse.

      Methods

      We performed a retrospective comparative study at a tertiary university hospital. Included were women who had uterine preserving surgical treatment for apical prolapse. The cohort was divided into two groups: 1) Patients with a uterine volume ≥ 35 cm3 (large uterus group); 2) Patients with uterine volume < 35 cm3 (small uterus group). Pre-, intra-, and post-operative data were compared between groups. Our primary outcome was composite outcome success including clinical and anatomical success and no need for reoperation. Secondary outcomes included clinical success, anatomical success, and patient satisfaction evaluated using the PGI-I questionnaire.

      Results

      Eighty-four patients were included in the final analysis. The large uterus group (≥35 cm3) consisted of 37 patients as opposed to 47 in the small uterus group (<35 cm3). Clinical (91.9 % vs 87.1 %, p = 0.725) and anatomical success (84.8 % vs 90.9 %, p = 0.508) were high and did not differ between groups. Composite outcome success was 76.1 % in the small uterus group compared to 87.9 % in the large uterus group, but this difference was not statistically significant. Post-operative points Ba, C and Bp were similar between groups. No difference was found in patient satisfaction measured using the PGI-I questionnaire.

      Conclusion

      Women undergoing uterine preserving apical prolapse repair with uterine volume ≥ 35 cm3 have comparable surgical outcomes to patients with a smaller uterus.

      Keywords

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      References

        • Barber M.D.
        • Maher C.
        Epidemiology and outcome assessment of pelvic organ prolapse.
        Int Urogynecol J. 2013; 24: 1783-1790https://doi.org/10.1007/s00192-013-2169-9
        • Haylen B.T.
        • Maher C.F.
        • Barber M.D.
        • et al.
        An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP).
        Int Urogynecol J. 2016; 27: 165-194https://doi.org/10.1007/s00192-015-2932-1
        • Maher C.
        • Feiner B.
        • Baessler K.
        • Schmid C.
        Surgical management of pelvic organ prolapse in women.
        Cochrane Database Syst Rev. 2013; 4: CD004014
        • Wright J.D.
        • Herzog T.J.
        • Tsui J.
        • et al.
        Nationwide trends in the performance of inpatient hysterectomy in the United States.
        Obstet Gynecol. 2013; 122: 233-241
        • Gutman R.E.
        Does the uterus need to be removed to correct uterovaginal prolapse?.
        Curr Opin Obstet Gynecol. 2016; 28: 435-440
        • Costantini E.
        • Lazzeri M.
        What part does mesh play in urogenital prolapse management today?.
        Curr Opin Urol. 2015; 25: 300-304
        • Chill H.H.
        • Gutman-Ido E.
        • Navon I.
        • Reuveni-Salzman A.
        • Haj-Yahya R.
        • Shveiky D.
        Laparoscopic uterosacral ligament suspension versus vaginal colposuspension using the Uphold Lite™ mesh system: clinical outcome and patient satisfaction.
        Int Urogynecol J. 2021; 32: 1513-1518
        • Azadi A.
        • Marchand G.
        • Masoud A.T.
        • et al.
        Complications and objective outcomes of uterine preserving surgeries for the repair of pelvic organ prolapse versus procedures removing the Uterus, a systematic review.
        Eur J Obstet Gynecol Reprod Biol. 2021; 267: 90-98
        • Meriwether K.V.
        • Antosh D.D.
        • Olivera C.K.
        • et al.
        Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines.
        Am J Obstet Gynecol. 2018; 219: 129-146.e2
      1. (Jefferis H, Jackson SR, Price N. Management of uterine prolapse: is hysterectomy necessary? The Obstetrician & Gynaecologist 2016;18: 17–23.

        • Kurtz A.B.
        • Shaw W.M.
        • Kurtz R.J.
        • et al.
        The inaccuracy of total uterine volume measurements: Sources of error and a proposed solution.
        J Ultrasound Med. 1984; 3: 289-297
        • Sheth S.S.
        • Hajari A.R.
        • Lulla C.P.
        • Kshirsagar D.
        Sonographic evaluation of uterine volume and its clinical importance.
        J Obstet Gynaecol Res. 2017; 43: 185-189
        • Chill H.H.
        • Shusel O.
        • Dick A.
        • et al.
        The effect of age on surgical outcomes following uterine preserving surgery for treatment of apical prolapse.
        J Minim Invasive Gynecol. 2022; S1553–4650: 00330-00332
        • Gerges B.
        • Mongelli M.
        • Casikar I.
        • Bignardi T.
        • Condous G.
        Three-dimensional transvaginal sonographic assessment of uterine volume as preoperative predictor of need to morcellate in women undergoing laparoscopic hysterectomy.
        Ultrasound Obstet Gynecol. 2017; 50: 255-260
      2. McPencow AM, Erekson EA, Guess MK, Martin DK, Patel DA, Xu X. Cost-effectiveness of endometrial evaluation prior to morcellation in surgical procedures for prolapse. Am J Obstet Gynecol. 2013;209(1):22.e1-9.

        • Gutman R.
        • Maher C.
        Uterine-preserving POP surgery.
        Int Urogynecol J. 2013; 24: 1803-1813