Pelvic Organ Prolapse Repair Using Robotic-Assisted Sacral Hysterocolpopexy vs Vaginal Surgery with the Uphold™ System: 1-Year Clinical Outcomes.

Introduction and hypothesis: The aim of the study was to compare clinical outcomes when using robotic-assisted sacral hysterocolpopexy (RASC) and vaginal surgery using the Uphold™ Vaginal Support System mesh for pelvic organ prolapse repair.

Methods: This was a nonrandomized, prospective, multicenter study in which 72 women underwent RASC, and 73 Uphold™ surgery, for apical prolapse (POP-Q C ≥ stage II). Anatomical outcomes were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system. Subjective outcomes were evaluated using the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Floor Impact Questionnaire - short form (PFIQ-7), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), as well as pain estimation using the visual analog scale (0-10).

Results: One year after surgery, an optimal apical segment outcome (POP-Q C stage 0-1) was achieved in 96.4% and 93.3% for the RASC and Uphold™ respectively, p = 0.49. However, reoperation for prolapse recurrence was significantly more common after RASC (11 out of 72 [15.3%] vs Uphold™ (2 out of 71 [2.8%], p = 0.005), and an optimal outcome of the anterior vaginal wall was higher after Uphold™ (p < 0.001). Postoperative PFDI-20, PFIQ-7, and pain significantly improved for both RASC and Uphold™ (p = 0.004 to < 0.001), but a more pronounced improvement in the total PFDI-20 and POPDI-6 sub-scores was observed after Uphold™ than after RASC (-73 ± 55.6 vs -49.2 ± 43.7, p = 0.005 and -39.6 ± 23.6 vs -27 ± 23.9, p < 0.001 respectively).

Conclusions: Reoperation for prolapse recurrence within 1 year was more common after RASC than after Uphold™. However, the rate of complications was low overall and there were few and largely insignificant differences in outcomes when comparing RASC and Uphold™.