Introduction: The US Food and Drug Association has recommended removal of all transvaginal mesh kits from the market for anterior compartment pelvic organ prolapse (POP) repair, stimulating renewed interest in native tissue POP repair. Specifically, anterior vaginal wall suspension (AVWS) has emerged as a reproducible option for stage 2-3 isolated anterior compartment prolapse repair using native tissue. Zimmern et al. (2016) found a 7.4% rate of failure after AVWS in 121 patients over a follow-up of 5.8 years. We sought to update this experience in multiple institutions. The hypothesis is that well selected patients will have durable results supported by validated patient reported outcome measures and pelvic organ prolapse - quantification (POP-Q) exam.
Methods: We reviewed an institutional review board approved prospectively maintained database of women undergoing anterior vaginal wall suspension without concomitant apical support procedures across multiple institutions. The primary outcome was prolapse recurrence in the anterior compartment. Secondary outcomes included preoperative and postoperative POPQ values, Urinary Distress Inventory-6 (UDI6), and Incontinence Impact Questionnaire-7 (IIQ7) scores. Statistical analysis was performed using STATA 17.0. Significance for continuous variables was by 2-tailed T-test. Predictive modeling was logistic regression.
Results: 651 patients underwent AVWS at participating institutions. Table 1 displays preoperative and postoperative POP-Q and validated patient reported outcomes. Failure as defined by Aa >=0 was seen in 8% of patients at 38.3 months follow up. Logistic regression revealed that preoperative POP-Q “Aa” severity was predictive of failure in the anterior compartment (OR 2.6, p<0.05). Preoperative POP-Q “C” severity also weakly predicted failure (OR 1.1, p<0.05). UDI6 item 5 “difficulty emptying your bladder” score was predictive of failure (OR 1.6, p<0.05), however there were no parameters that predicted failure using IIQ7.
Conclusions: AVWS is durable and re-producible. Validated questionnaires are sensitive to improvement in POP-Q measurements and failures in the anterior compartment.
Source of Funding: This project was supported by a Project Development Team within the ICTSI NIH/NCRR Grant Number RR025761 SUBAWARD (Powell, PI) and NIDDK DiaComp Pilot & Feasibility project, sub-award DK076169 (Powell, PI) and Indiana University CTSI MedSTAR program (Song). Indiana Clinical and Translational Sciences Institute is funded in part by Award Number UL1TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award.