SU102 - Bowel and Bladder Symptoms Improve After Multicompartment Surgery: 6 Month Results of Prospective Multicenter Robotic Prolapse Surgery Trial

Sunday, June 2, 2024

11:28 AM – 11:34 AM ET, USA

Location: Room 314-317

Abstract Podium Presenter(s)

James Ogilvie, Jr., MD, MS

Clinical Assistant Professor
Michigan State University
MIchigan State University
Grand Rapids, Michigan, United States

All relevant financial disclosures have been managed and will be listed below.
Cook Surgical: Teaching (Ongoing)

Author(s)

Liliana Bordeianou, MD

Professor of Surgery
Harvard Medical School / Massachusetts General Hospital
Harvard
Boston

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.
RP

Raisa O. Platte, MD

Surgeon
Corewell Health - Michigan State University
Grand Rapids, Michigan, United States

Disclosure information not submitted.
MW

Milena M. Weinstein, MD

Chief, Division of Urogynecology and Reconstructive Pelvic Surgery
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.
ES

Eric R. Sokol, MD

Associate Professor, Urogynecology and Pelvic Reconstructive Surgery
Stanford University School of Medicine
Palo Alto, California, United States

Disclosure information not submitted.
EE

Ekene Enemchukwu, MD, MPH

Assistant Professor
Stanford University, Department of Urology
Palo Alto, California, United States

Disclosure information not submitted.
KM

Kavita Mishra, M.D.

Clinical Assistant Professor
Stanford University
Stanford, California, United States

Disclosure information not submitted.
SW

Shannon L. Wallace, MD

Assistant Professor
Cleveland Clinic Obstetrics and Gynecology Institute
Moreland Hills, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

Brooke Gurland, MD, FACS, FASCRS

Clinical Professor of Surgery
Stanford University
Stanford Surgery
Stanford, California, United States

All relevant financial disclosures have been managed and will be listed below.
Cook Surgical: Educational Grant (Ongoing); intuitive surgical, inc: Teaching (Ongoing)

Purpose/Background: Prospective quality of life assessments for women with both rectal and/or pelvic organ prolapse (POP) are not well described. We report our interim analysis detailing 6-month surveys and 30-day complications after robotic prolapse procedures.

Methods/Interventions: This is an IRB approved, multicenter, multidisciplinary, prospective, ASCRS funded study assessing quality of life after robotic prolapse surgery. Three geographically diverse sites recruited women with external rectal prolapse and/or POP undergoing either rectopexy (RR), POP surgery (RPOP), or both (RR+POP). Demographics, Charlson Comorbidity Index (CCI), POP stage, procedure data and Clavian-Dindo complications were collected. Validated surveys for bowel/bladder function, POP (Pelvic Floor Distress Inventory [PFDI], Pelvic Floor Impact Questionnaire [PFIQ]) constipation (PACSYM, PACQoL), fecal incontinence (FI) (Wexner, Vaizey), mental health (Hospital Anxiety and Depression [HADS]), sexual function (PISQ-IR), and quality of life (EQ5D, Patient Global Impression of Change [PGIC]) were electronically distributed at baseline and 6 months after surgery. Differences between treatment groups were evaluated using a Fisher’s exact or Kruskal-Wallis test. Multivariable linear mixed-effects models were used to evaluate changes in survey scores over time and to compare those changes by treatment group.

Results/Outcomes: 47 women (RR=14, RPOP=16, RR+POP=17) with similar demographics and comorbidities (Table 1) were included. Recruitment was similar between sites. At baseline RPOP and RR+POP had significantly higher POP stage compared to RR (IQR Stage 3 (2,4) vs 2(2,2) vs 1.5(0,2), p< 0.001). POP and urinary dysfunction were present in RR alone patients. Rectal prolapse patients (RR and RR+POP) had higher rates of bowel dysfunction (see CRADI, Wexner, Vaizey, PAC SYM, PAC QOL and PFIQ-bowel scores in table 1). Combined patients (RR+POP) had higher rates of urinary dysfunction (PFIQ- bladder domain, PFDI- bladder domain) and POP symptoms (POP -domain) compared to RR patients. Overall baseline QOL surveys (EQ5D, HADS, PISQ-IR) were similar between groups, although a history of depression was higher in patients with rectal prolapse.

In the RR+POP total operating time (IQR 278 (258,305) vs RR 181 (163, 210) vs RPOP 202 (170, 225) minutes p< 0.001) and length of stay was longer (IQR 1(1,1), 1(1,2) days vs 0(0) in RPOP (p < .001)). Overall readmission rate was 2% and complications were similar between groups. At 6 months, symptom improvement over baseline was significant on all measured parameters. PGIC scores (5 to 7) were best for RPOP (100%) compared to RR+POP (91%) and RR (73%), p=0.09). Postoperative HADS scores were unchanged in any of the 3 groups. Despite similar baseline PISQ-IR scores, at 6 months a significant improvement was observed only in the RPOP group.

Conclusion/Discussion: Patients undergoing single and multicompartment robotic prolapse surgery report significantly improved symptom-specific scores related to bladder, bowel and urinary dysfunction as well as an improved overall quality of life. Although constipation, fecal incontinence and bowel-related symptoms improve after rectal prolapse surgery, sexual function, anxiety and depression did not. Multidisciplinary evaluation of rectal prolapse identifies concomitant pelvic organ prolapse and urinary dysfunction.