Supracervical Hysterectomy is Protective Against Mesh Complications After Robotic-Assisted Abdominal Sacrocolpopexy: A Population Based Cohort Study of 12,189 Patients. The Journal of urology Dallas, K., Taich, L., Kuhlmann, P., Rogo-Gupta, L., Eilber, K., Anger, J. T., Scott, V. 2021: 101097JU0000000000002262

Abstract

INTRODUCTION: Although Minimally Invasive (robotic or laparoscopic) Abdominal Sacrocolpopexy (MISC) has become the new gold-standard for durable pelvic organ prolapse (POP) repair after the vaginal mesh controversy, current literature is limited. Our objective here is to study of mesh complications after MISC.METHODS: All women undergoing MISC in California from 01/2012-12/2018 were identified from the Office of Statewide Health Planning and Development datasets using appropriate ICD-9/10 and CPT codes. Univariate and multivariable analyses was performed to assess associations between patient demographics, surgical details and our primary outcomes: rates of reoperation for a mesh complication.RESULTS: Of 12,189 women undergoing MISC, 8,398 (68.9%) had concomitant hysterectomy. Total hysterectomy (TH) and supracervical hysterectomy (SCH) were performed in 5,027 (41.2%), and 3,371 (27.6%) cases, respectively. Reoperation rates for mesh complications were lower after SCH versus TH cases (overall: 0.7%-mean follow up time 1,111 days vs. 3.1%-mean follow up time 1,095 days, p <0.001; subcohort with at least 4 years of follow-up: 2.1% vs. 8.9%, p <0.001). Additionally, mesh complication rates were higher even if TH was performed remotely, as compared to concomitant SCH (5.2% vs. 0.7%, p <0.001). The increased risk for reoperation due to mesh complications after TH was preserved on multivariable analysis (OR 4.20, 95% CI 2.72-6.50, p <0.001).CONCLUSIONS AND RELEVANCE: Concomitant total hysterectomy at time of MISC is associated with a significantly higher rate of mesh complication as compared to supracervical hysterectomy. The increased risk of a mesh complication associated with TH is present even if the TH was performed prior to the MISC.

View details for DOI 10.1097/JU.0000000000002262

View details for PubMedID 34694142