Short summary

Pelvic organ prolapse is common and often have a negative impact on women's quality of life. Currently a wide range of surgical procedures are offered in Denmark, including laparoscopic and vaginal procedures. Different recurrence rates have been reported from high to low and comparison between different studies is hampered by high heterogeneity of the studies. Our aim is to investigate recurrence rates, prolapse symptoms and quality of life, for a comparable study population at Odense University Hospital.

Rationale

Pelvic organ prolapse is common and 7-19% undergo surgical repair. One problem is recurrence and re-attachment to ligaments in order to reestablish suspension of the compartments described by Delancey's three levels of support. Vaginal vault prolapse is defined as level I support defects where the cardinal-uterosacral ligament complex has been compromised which is followed by descent of the vaginal cuff below a point that is 2 cm less than the total vaginal length above the plane of the hymen. Vaginal vault prolapse is associated with urinary-, bowel-, and sexual dysfunction as well as pain, and thus often have a negative impact on women's quality of life.

Surgical treatment options intend to restore suspension of the vaginal vault to the remnants of the cardinal-sacrouterine complex. Several surgical methods have previously been described including sacrocolpopexy, sacrospinous fixation and sacrouterine suspension. Most surgical procedures today include laparoscopic or vaginal procedures. The choice of operation depends on a number of factors, which include the severity of the prolapse; whether there are additional symptoms; the general health of the woman; and the surgeon preference and capability.

Although several surgical methods exist the most widely accepted method is the sacrocolpopexy using synthetic mesh. In general, this procedure has been compared with most other vaginal or abdominal procedures and has been shown superior in relation to most outcomes, such as recurrence, sexual function and pain. However, the procedure implies a risk of erosion due to the use of synthetic mesh. Furthermore, it is a complicated surgical procedure.

In order to overcome the mesh complications other procedures such as sacrospinous fixation and sacro-uterine suspension have been introduced. The sacrospinous fixation is a vaginal approach where the vault is suspended to the sacrospinous ligament using non-absorb ably sutures. Although this procedure can be done in local anaesthesia, this method has also been associated with different recurrence rates from low to high.

The sacrouterine suspension can be performed by both the vaginal and laparoscopic route, the latter with improved visual overview and hereby decreased risk of lesion to the ureter, which may be as high as above 4%. However, both approaches have been associated with low to high recurrence rate.

The number of procedures is problematic and as mentioned above depending on the surgeons' choice. This is also reflected in Denmark by the wide variety of surgical treatments offered to women with vault prolapse, which indicates the lack of consensus as to the optimal treatment. The reason is probably due to the fact that the recurrence rate is rather high, and comparison of the studies is difficult due to heterogeneity of the study populations.

The aim of this study is to compare laparoscopic scarocolpopexy with vaginal sacrocolpopexy in a qualitative cohort study design in women with vaginal vault prolapse at Odense University Hospital between 2014-2019.

Primary outcome is recurrence rate, secondary outcomes are pain, incontinence, prolapse symptoms, quality of life, anatomical correction, sexual function.

Description of the cohort

Women who underwent vaginal or laparoscopic sacrouterine surgical treatment for vaginal vault prolapse at Odense University Hospital between 2015-2019.

Data and biological material

Age, previous gynaecological cancer, previous gynaecological surgery.

Gynaecological examination: recurrence rate and anatomical correction.

Questionnaires: pain, incontinence, prolapse symptoms, quality of life, sexual function.

Collaborating researchers and departments

Department of Gynaecology and Obstetrics, Odense University Hospital

• Professor Martin Rudnicki
• Professor Vibeke Rasch