2143 COMPARATIVE EFFECTIVENESS OF ROBOTIC AND LAPAROSCOPIC SACROCOLPOPEXY FOR APICAL VAGINAL PROLAPSE: ONE YEAR OUTCOMES

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You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20132143 COMPARATIVE EFFECTIVENESS OF ROBOTIC AND LAPAROSCOPIC SACROCOLPOPEXY FOR APICAL VAGINAL PROLAPSE: ONE YEAR OUTCOMES Kimberly Kenton, Elizabeth Mueller, Christopher Tarnay, Linda Brubaker, Amy Rosenman, Bridget Smith, Kevin Stroupe, Catherine Bresee, and Jennifer T. Anger Kimberly KentonKimberly Kenton Maywood, IL More articles by this author , Elizabeth MuellerElizabeth Mueller Maywood, IL More articles by this author , Christopher TarnayChristopher Tarnay Los Angeles, CA More articles by this author , Linda BrubakerLinda Brubaker Maywood, IL More articles by this author , Amy RosenmanAmy Rosenman Los Angeles, CA More articles by this author , Bridget SmithBridget Smith Hines, IL More articles by this author , Kevin StroupeKevin Stroupe Hines, IL More articles by this author , Catherine BreseeCatherine Bresee Los Angeles, CA More articles by this author , and Jennifer T. AngerJennifer T. Anger Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2052AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic (LASC) and robotic (RASC) sacrocolpopexy are considered comparable to open sacrocolpopexy for apical pelvic organ prolapse (POP). However, strong evidence comparing outcomes for the procedures is lacking. In this two−center randomized comparative effectiveness trial (NCT01124916), we prospectively measured clinically relevant clinical outcomes at one year after surgery. METHODS In the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies Trial (ACCESS), participants with symptomatic stage II+ POP including significant apical support loss (to at least .5 total vaginal length) were randomized to LASC or RASC. Though the primary aim compared costs of RASC and LASC (Mueller et al.), our chief secondary outcomes included POP quantification, symptom severity and quality of life. RESULTS 78 women with a mean age of 59 years (range 26−79) were randomized: LASC (38) and RASC (40). There were no significant differences in any of the baseline characteristics of the study population. There was no difference in the rates of drop−out between the two treatment arms (5 patients in LASC group and 7 patients in RASC group, p=0.5952). At one year, there were no differences between groups with respect to POPQ points or responses to the subscales of the PFDI and PFIQ (Table 1). CONCLUSIONS Prolapse outcomes at one year were not significantly different between LASC and RASC. Though this study was not initially powered to detect a significant difference in prolapse outcomes, it nonetheless sheds light on intermediate−term success rates of minimally invasive colpopexy. Table 1. Clinical Outcomes Laparoscopic Robotic Baseline Mean (SD) 12 mo Mean (SD) Baseline Mean (SD) 12 mo Mean (SD) Treatment effect p-value POPQ (cm) Point Ba 2.45 -2.16 2.58 -2.45 0.4186 (1.84) (1.13) (2.01) (0.79) POPQ (cm) Point C 0.74 -8.70 0.25 -7.64 0.8756 (3.64) (1.53) (3.98) (4.64) POPQ (cm) Point Bp 0.21 -2.42 -0.50 -2.24 0.8595 (3.05) (0.81) (2.94) (0.94) UDI⁎ 97.5 24.9 110.1 30.5 0.1716 (60.4) (37.7) (58.7) (33.9) POPDI⁎ 116.5 31.3 126.6 41.0 0.0938 (60.8) (33.7) (63.1) (45.3) CRADI⁎ 99.0 40.1 90.1 51.5 0.4116 (71.7) (42.3) (71.9) (53.2) UIQ⁎ 97.6 17.9 128.3 22.6 0.4236 (96.3) (42.8) (93.8) (41.3) CRAIQ⁎ 67.5 20.1 67.0 27.5 0.8961 (87.5) (35.8) (89.8) (57.1) POPIQ⁎ 83.2 3.0 114.4 10.3 0.1155 (83.7) (8.4) (102.4) (26.4) ⁎ PFDI and PFIQ subscale scores range from 0-400 with higher scores indicating worsening symptoms © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e877-e878 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kimberly Ke