Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

• Published in: American journal of obstetrics and gynecology 2015-05, Vol.212 (5), p.603.e1-603.e7
• Main Authors: Unger, Cecile A., MD, MPH, Walters, Mark D., MD, Ridgeway, Beri, MD, Jelovsek, J. Eric, MD, MMed, Barber, Matthew D., MD, MHS, Paraiso, Marie Fidela R., MD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; apical prolapse; Female; Humans; Hysterectomy; Hysterectomy, Vaginal - adverse effects; Ileus - epidemiology; Incidence; Middle Aged; Obstetrics and Gynecology; Operative Time; Pelvic Organ Prolapse - surgery; Postoperative Complications - epidemiology; Reconstructive Surgical Procedures - adverse effects; Recurrence; Retrospective Studies; Suture Techniques - adverse effects; Sutures; Urinary Bladder - injuries; Urinary Tract Infections - epidemiology; Uterine Prolapse - surgery; uterosacral colpopexy; uterosacral ligament suspension; uterovaginal prolapse; vaginal vault suspension
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.11.034

Objective We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. Study Design This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. Results In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2–38.6), which included 20.3% (95% CI, 17.9–23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6–1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4–6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6–3.5) and 0.8% (95% CI, 0.4–1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02–0.6) and 0.8% (95% CI, 0.4–1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4–16.8): 10.6% (95% CI, 8.8–12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2–13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4–4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. Conclusion Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse.