The Impact of Diabetes Mellitus on Pelvic Organ Prolapse Recurrence After Robotic Sacrocolpopexy

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2023 Feb 13

PMID 36780019

Authors

Sarah Eckhardt

Katharina Laus

Samantha DeAndrade

Janet Lee

John Nguyen

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: Data examining the effect of diabetes mellitus (DM) on prolapse recurrence after sacrocolpopexy (SCP) is limited. The primary objective of this study was to determine if DM affects prolapse recurrence after robotic SCP.

Methods: This was a retrospective cohort study of women who underwent robotic SCP between 2012 and 2019 at Kaiser Permanente Southern California. The cohort was divided into women with and without DM at the time of SCP. The primary outcome was composite failure. Secondary outcomes included recurrent compartment-specific prolapse, reoperation rates, and surgical complications.

Results: Of 547 patients included, 100 had DM. Women with DM were older, had higher BMI, higher parity, and were more likely to be nonwhite. Women with DM had more advanced prolapse at baseline but were not more likely to undergo concomitant procedures at the time of SCP. Over a median follow-up of 2.1 years (IQR 1.3, 3.4), women with DM had significantly increased risk of anterior vaginal prolapse (AVP) recurrence (13% vs 3%, p<0.01), but not composite failure (21% vs 14%, p=0.14). On multivariate regression, women with DM were almost 4 times as likely to experience AVP recurrence over time (AVP hazard ratio (HR) 3.93, 95% CI 1.29-12.03, p=0.02).

Conclusion: In our cohort, DM was a risk factor for AVP recurrence but not composite failure after robotic SCP.

Citing Articles

Composite Failure Associated With Sacrohysteropexy and Sacrocolpopexy With Supracervical Hysterectomy for Advanced Pelvic Organ Prolapse.

Sato H, Otsuka S, Sugita K, Abe H, Tsukada S Neurourol Urodyn. 2024; 44(2):434-442.

PMID: 39704264 PMC: 11788943. DOI: 10.1002/nau.25640.

Expression of insulin-like growth factor binding protein 5 in the vaginal wall tissues of older women with pelvic organ prolapse.

Duan Y, Chen Y, He Y, Gong R, Xia Z Sci Rep. 2024; 14(1):18353.

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The Outcome of Sacrocolpopexy/Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure.

Alsahabi J, AlSary S, Abolfotouh M Int J Womens Health. 2023; 15:1093-1105.

PMID: 37483888 PMC: 10362893. DOI: 10.2147/IJWH.S413729.

References

Swift S, Woodman P, OBoyle A, Kahn M, Valley M, Bland D . Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005; 192(3):795-806. DOI: 10.1016/j.ajog.2004.10.602. View

Nygaard I, Bradley C, Brandt D . Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004; 104(3):489-97. DOI: 10.1097/01.AOG.0000136100.10818.d8. View

Whitcomb E, Rortveit G, Brown J, Creasman J, Thom D, Van Den Eeden S . Racial differences in pelvic organ prolapse. Obstet Gynecol. 2009; 114(6):1271-1277. PMC: 2879888. DOI: 10.1097/AOG.0b013e3181bf9cc8. View

Kudish B, Iglesia C, Gutman R, Sokol A, Rodgers A, Gass M . Risk factors for prolapse development in white, black, and Hispanic women. Female Pelvic Med Reconstr Surg. 2012; 17(2):80-90. PMC: 4354733. DOI: 10.1097/SPV.0b013e31820e5d06. View

Smith F, Holman C, Moorin R, Tsokos N . Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010; 116(5):1096-100. DOI: 10.1097/AOG.0b013e3181f73729. View

Deng T, Liao B, Luo D, Shen H, Wang K . Risk factors for mesh erosion after female pelvic floor reconstructive surgery: a systematic review and meta-analysis. BJU Int. 2015; 117(2):323-43. DOI: 10.1111/bju.13158. View

Liang R, Fisk A, King G, Meyn L, Xiao X, Moalli P . Characterization of vaginal immune response to a polypropylene mesh: Diabetic vs. normoglycemic conditions. Acta Biomater. 2022; 143:310-319. PMC: 9035125. DOI: 10.1016/j.actbio.2022.03.007. View

Padoa A, Shiber Y, Fligelman T, Tomashev R, Tsviban A, Smorgick N . Advanced Cystocele is a Risk Factor for Surgical Failure after Robotic-assisted Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol. 2021; 29(3):409-415. DOI: 10.1016/j.jmig.2021.11.002. View

Chang O, Davidson E, Thomas T, Paraiso M, Ferrando C . Predictors for Pelvic Organ Prolapse Recurrence After Sacrocolpopexy: A Matched Case-Control Study. Female Pelvic Med Reconstr Surg. 2020; 27(1):e165-e170. DOI: 10.1097/SPV.0000000000000874. View

10.

Aslam M, Osmundsen B, Edwards S, Matthews C, Gregory W . Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2015; 22(3):156-60. DOI: 10.1097/SPV.0000000000000233. View

11.

Okonkwo U, DiPietro L . Diabetes and Wound Angiogenesis. Int J Mol Sci. 2017; 18(7). PMC: 5535911. DOI: 10.3390/ijms18071419. View

12.

Ljungqvist O, Nygren J, Soop M, Thorell A . Metabolic perioperative management: novel concepts. Curr Opin Crit Care. 2005; 11(4):295-9. DOI: 10.1097/01.ccx.0000166395.65764.71. View

13.

Yang J, He Y, Zhang X, Wang Z, Zuo X, Gao L . Robotic and laparoscopic sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis. Ann Transl Med. 2021; 9(6):449. PMC: 8039662. DOI: 10.21037/atm-20-4347. View

14.

Serati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S . Robot-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol. 2014; 66(2):303-18. DOI: 10.1016/j.eururo.2014.02.053. View

15.

Wen Q, Zhao Z, Wen J, Yang Y, Wang L, Wu J . Impact of obesity on operative complications and outcome after sacrocolpopexy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021; 258:309-316. DOI: 10.1016/j.ejogrb.2021.01.032. View

16.

Dubinskaya A, Hernandez-Aranda D, Wakefield D, Shepherd J . Comparing laparoscopic and robotic sacrocolpopexy surgical outcomes with prior versus concomitant hysterectomy. Int Urogynecol J. 2019; 31(2):401-407. DOI: 10.1007/s00192-019-04017-5. View

17.

Friedman T, Eslick G, Dietz H . Risk factors for prolapse recurrence: systematic review and meta-analysis. Int Urogynecol J. 2017; 29(1):13-21. DOI: 10.1007/s00192-017-3475-4. View

18.

Coolen A, Bui B, Dietz V, Wang R, van Montfoort A, Mol B . The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017; 28(12):1767-1783. PMC: 5705749. DOI: 10.1007/s00192-017-3493-2. View

19.

Nygaard I, Brubaker L, Zyczynski H, Cundiff G, Richter H, Gantz M . Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013; 309(19):2016-24. PMC: 3747840. DOI: 10.1001/jama.2013.4919. View