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OBJECTIVES The aim of this study was to determine anatomical and clinical cure, as well as patient satisfaction in uterine-preserving laparoscopic uterosacral ligament suspension (LUSLS) in women with anterior and apical prolapse. METHODS This was a retrospective cohort study including all women who underwent LUSLS for anterior and apical prolapse between January 2012 and December 2015 at a tertiary-care university hospital. All women had LUSLS hysteropexy and anterior colporrhaphy. Pre- and postoperative pelvic organ prolapse quantification (POP-Q) measurements were taken. Prolapse symptoms were queried via standardized history. Patient satisfaction was measured by the Patient Global Impression of Improvement (PGI-I). RESULTS Fifty-three women underwent the procedure during the study period. Follow-up data were available for 48 women. The mean preoperative POP-Q Ba point was 2.7 ± 1.6 and C point was -0.8 ± 2.8. At a mean follow-up of 17.5 ± 16.0 months with a median of 12 months (range, 1-54 months), there was a significant improvement of POP-Q points Ba, C, and Bp (P < 0.001 for all comparisons). Anatomical cure, defined as no prolapse of any POP-Q point at or below 1 cm above the hymen (-1), was 85.4%. Clinical cure, defined as a composite outcome of no prolapse outside the hymen, C point above total vaginal length/2, no prolapse symptoms, and no need for further treatment, was 95.8%. At a mean of 22.2 ± 12.4 months postoperatively, patient satisfaction was high, with 95.5% stating their condition was very much better (PGI-I-A) or much better (PGI-I-B). CONCLUSION Laparoscopic uterosacral ligament suspension is a valid uterine-preserving option for women with anterior and apical prolapse, with high anatomical and clinical cure rates and patient satisfaction.

Objective This study aimed to compare operative times and short-term outcomes between robotic and laparoscopic sacral colpopexy. Methods A retrospective cohort study using a convenience sample was performed comparing patients who underwent robotic and laparoscopic sacral colpopexy during a 4-year period. Operative time, blood loss, perioperative complications, and objective cure of prolapse at 3 months were compared. Results Robotic procedures in 65 women and laparoscopic sacral colpopexy procedures in 23 women were performed. Median preoperative prolapse was stage 3 for both groups. There was no statistically significant difference in the median operative time between the robotic and laparoscopic groups, although this did not include robot setup time and did include concurrent procedures that differed significantly between groups (334 vs 325 minutes, P = 0.30). Estimated blood loss was lower in the robotic group (50 vs 100 mL, P = 0.003). Median hospital stay was 1 day in both groups (P = 0.23). There were no differences in overall objective cure rates between robotic and laparoscopic groups at 3 months of follow-up (87.1% vs 91.3%, P = 0.72). Perioperative complications, including visceral injury and mesh erosion, did not differ significantly between these groups. Conclusions Robotic and laparoscopic sacral colpopexy had similar operative times, short-term anatomic cure rates, perioperative complications, and length of hospital stay.

PURPOSE : The primary objective of this study was to compare improvement and/or cure of mixed urinary incontinence (MUI) symptoms after retropubic (RP) versus transobturator (TO) slings. The secondary objective was to compare improvement and/or cure of the urge urinary incontinence (UUI) component of MUI. METHODS : This retrospective cohort study included all patients with MUI who underwent a midurethral sling from January 2006 to May 2007. IRB approval was obtained to perform telephone interviews to collect the Patient Global Impression of Improvement (PGI-I) questionnaire for MUI and to elicit any changes in the SUI and/or UUI components of MUI. The primary outcome was based on a 7-point Likert scale for the PGI-I questionnaire. The secondary outcome was improvement or resolution of the UUI component of MUI based on a 4-point Likert scale of patient responses to the question, "Is your urge incontinence worse, the same, or improved after surgery?" Subjects who had RP slings were compared with those with TO with respect to these outcomes. Patient satisfaction, adverse events, urinary retention, and worsening of urge incontinence symptoms were also assessed. RESULTS : For the primary outcome (MUI), no significant difference was found in the PGI-I scores between the 2 groups. Similarly, no difference was found in UUI improvement/resolution between the 2 groups. UUI improvement was noted in 46.4% of the TO group and 56.5% of the RP group, and UUI cure in 39.3% of the TO group and 26.1% of the RP group. An 84.3% overall improvement/cure rate of UUI was noted when both groups were combined. Ten (19.6%) women required anticholinergic use after slings. A total of 52.6% of subjects were "completely satisfied" and 14.3% were "not at all satisfied" with the procedure in the TO group, versus 65.2% and 7.7% in the RP group (Mann-Whitney U test, P = 0.23). There was no difference in perioperative adverse events between the 2 groups. CONCLUSIONS : RP and TO slings result in similar global improvement in MUI symptoms. A total of 84.3% of patients undergoing RP or TO sling for MUI have improvement/cure of the UUI component.