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. 2023 May 1;29(5):479-488.
doi: 10.1097/SPV.0000000000001309. Epub 2022 Dec 23.

Association Between Enlarged Genital Hiatus and Composite Surgical Failure After Vaginal Hysterectomy With Uterosacral Ligament Suspension

Megan S Bradley  1 , Amaanti Sridhar  2 , Kimberly Ferrante  3 , Uduak U Andy  4 , Anthony G Visco  5 , Maria E Florian-Rodriguez  6 , Deborah Myers  7 , Edward Varner  8 , Donna Mazloomdoost  9 , Marie G Gantz  2 ; NICHD Pelvic Floor Disorders Network
Affiliations

Association Between Enlarged Genital Hiatus and Composite Surgical Failure After Vaginal Hysterectomy With Uterosacral Ligament Suspension

Megan S Bradley et al. Urogynecology (Phila). .

Abstract

Importance: The impact of a persistently enlarged genital hiatus (GH) after vaginal hysterectomy with uterosacral ligament suspension on prolapse outcomes is currently unclear.

Objectives: This secondary analysis of the Study of Uterine Prolapse Procedures Randomized trial was conducted among participants who underwent vaginal hysterectomy with uterosacral ligament suspension. We hypothesized that women with a persistently enlarged GH size would have a higher proportion of prolapse recurrence.

Study design: Women who underwent vaginal hysterectomy with uterosacral ligament suspension as part of the Study of Uterine Prolapse Procedures Randomized trial (NCT01802281) were divided into 3 groups based on change in their preoperative to 4- to 6-week postoperative GH measurements: (1) persistently enlarged GH, 2) improved GH, or (3) stably normal GH. Baseline characteristics and 2-year surgical outcomes were compared across groups. A logistic regression model for composite surgical failure controlling for advanced anterior wall prolapse and GH group was fitted.

Results: This secondary analysis included 81 women. The proportion with composite surgical failure was significantly higher among those with a persistently enlarged GH (50%) compared with a stably normal GH (12%) with an unadjusted risk difference of 38% (95% confidence interval, 4%-68%). When adjusted for advanced prolapse in the anterior compartment at baseline, the odds of composite surgical failure was 6 times higher in the persistently enlarged GH group compared with the stably normal group (95% confidence interval, 1.0-37.5; P = 0.06).

Conclusion: A persistently enlarged GH after vaginal hysterectomy with uterosacral ligament suspension for pelvic organ prolapse may be a risk factor for recurrent prolapse.

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Conflict of interest statement

M.S.B. received research support from Hologic, Axonics. K.L.F. received grant support from Valencia Technologies and BlueWind Medical. A.G.V has stock ownership in Ninomed. M.G.G received research grant to RTI as the PFDN DCC from Boston Scientific. The remaining authors have declared they have no conflicts of interest.

Figures

Figure 1:
Figure 1:
Study Flow Diagram
See this image and copyright information in PMC

References

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