Does Pelvic Organ Prolapse Quantification Examination D Point Predict Uterosacral Ligament Suspension Outcomes?.

MedStar author(s):
Citation: Female Pelvic Medicine & Reconstructive Surgery. 22(3):146-50, 2016 May-JunPMID: 26829342Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery | Obstetrics and Gynecology/UrogynecologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Hysterectomy, Vaginal/mt [Methods] | *Ligaments/su [Surgery] | *Pelvic Organ Prolapse/su [Surgery] | *Preoperative Care/mt [Methods] | Aged | Female | Follow-Up Studies | Humans | Hysterectomy, Vaginal/ae [Adverse Effects] | Middle Aged | Pelvic Organ Prolapse/cl [Classification] | Pelvic Organ Prolapse/pp [Physiopathology] | Postoperative Period | Retrospective Studies | ROC Curve | Suburethral Slings | Surgical Mesh | Treatment FailureYear: 2016ISSN:
  • 2151-8378
Name of journal: Female pelvic medicine & reconstructive surgeryAbstract: CONCLUSIONS: The preoperative D point correlates with postoperative apical support, and a clinically meaningful relationship exists between the preoperative D point and anatomic apical success.METHODS: This retrospective cohort study included subjects undergoing transvaginal uterosacral ligament suspension from 2008 through 2013 who had at least 1 year follow-up. Demographic information, preoperative and postoperative Pelvic Organ Prolapse Quantification (POPQ) examination measurements, need for retreatment or repeat surgery, and assessment of pelvic floor symptoms were reviewed. Postoperative apical success was defined as C point descent no more than one third into the vaginal canal.OBJECTIVES: The best predictors for postoperative anatomic apical success after transvaginal uterosacral ligament suspension remain unknown. The aim of this study was to determine if there is a correlation between the preoperative D point and anatomic outcomes for apical prolapse after 1 year.RESULTS: One hundred twenty-five women met inclusion criteria and had follow-up at 1 year or more. Concomitant procedures included anterior/posterior repair and midurethral sling. Mean follow-up time was 22.8 months (range, 12-63 months). At last follow-up, 96% met criteria for apical success. A more negative preoperative D point was significantly related to improved postoperative apical support, with each 1-cm descent in preoperative D point resulting in a postoperative C point that was 0.21 cm lower (P = 0.0005). Based on the receiver operating characteristic curve, a "cutoff" D point value of -4.25 (sensitivity, 0.8; specificity, 0.65) was determined to be a predictor of postoperative apical success at 1 year or more.All authors: Boileau JE, Desale S, Iglesia CB, Janni M, Park AJ, Richter LAFiscal year: FY2016Digital Object Identifier: Date added to catalog: 2017-05-24
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Journal Article MedStar Authors Catalog Article 26829342 Available 26829342

CONCLUSIONS: The preoperative D point correlates with postoperative apical support, and a clinically meaningful relationship exists between the preoperative D point and anatomic apical success.

METHODS: This retrospective cohort study included subjects undergoing transvaginal uterosacral ligament suspension from 2008 through 2013 who had at least 1 year follow-up. Demographic information, preoperative and postoperative Pelvic Organ Prolapse Quantification (POPQ) examination measurements, need for retreatment or repeat surgery, and assessment of pelvic floor symptoms were reviewed. Postoperative apical success was defined as C point descent no more than one third into the vaginal canal.

OBJECTIVES: The best predictors for postoperative anatomic apical success after transvaginal uterosacral ligament suspension remain unknown. The aim of this study was to determine if there is a correlation between the preoperative D point and anatomic outcomes for apical prolapse after 1 year.

RESULTS: One hundred twenty-five women met inclusion criteria and had follow-up at 1 year or more. Concomitant procedures included anterior/posterior repair and midurethral sling. Mean follow-up time was 22.8 months (range, 12-63 months). At last follow-up, 96% met criteria for apical success. A more negative preoperative D point was significantly related to improved postoperative apical support, with each 1-cm descent in preoperative D point resulting in a postoperative C point that was 0.21 cm lower (P = 0.0005). Based on the receiver operating characteristic curve, a "cutoff" D point value of -4.25 (sensitivity, 0.8; specificity, 0.65) was determined to be a predictor of postoperative apical success at 1 year or more.

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