Site-specific prolapse surgery. I. Reliability and durability of native tissue paravaginal repair

• Published in: International Urogynecology Journal 2011-05, Vol.22 (5), p.591-599
• Main Authors: Reid, Richard I., You, Hui, Luo, Kehui
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Chi-Square Distribution; Cicatrix; Female; Gynecologic Surgical Procedures - methods; Gynecology; Humans; Kaplan-Meier Estimate; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Proportional Hazards Models; Reproducibility of Results; Retrospective Studies; Sutures; Treatment Outcome; Urology; Uterine Prolapse - surgery; Vagina - surgery
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-010-1347-2

Introduction and hypothesis This study aims to compare native tissue abdominal and vaginal paravaginal repair, and to investigate whether surgical outcome was independent of operative route. Methods Retrospective comparison of 111 displacement cysto-urethrocoeles, repaired between 1997 and 2007. Treatment was by surgeon assignment, 52 women having abdominal (APVR) and 59 vaginal paravaginal repairs. Main outcome measures were same-site prolapse recurrence, time to failure and surgical complications. Initial reliability was evaluated by chi-square test, 10-year durability by Kaplan–Meier survival analysis and Cox proportional hazards model. Results When examined in the Cox proportional hazards model, anatomic results of APVR were more durable than a mechanically analogous transvaginal operation done [95% CI = 1.029–2.708 ( p value = 0.038)]. Kaplan–Meier curves plateaued within 38 months. Symptom resolution was broadly equivalent. Surgical complication rate was 3.6%. Conclusions Site-specific re-suture of torn native tissue has genuine curative potential. Most of the long-term success was attributable to site-specific repair, rather than non-specific scar formation.