title: Does Pelvic Organ Prolapse Quantification Examination D Point Predict Uterosacral Ligament Suspension Outcomes?
abstract: The best predictors for postoperative anatomic apical success after transvaginal uterosacral ligament suspension remain unknown. The aim of this study was to determine if there is a correlation between the preoperative D point and anatomic outcomes for apical prolapse after 1 year.
  
  
  
  This retrospective cohort study included subjects undergoing transvaginal uterosacral ligament suspension from 2008 through 2013 who had at least 1 year follow-up. Demographic information, preoperative and postoperative Pelvic Organ Prolapse Quantification (POPQ) examination measurements, need for retreatment or repeat surgery, and assessment of pelvic floor symptoms were reviewed. Postoperative apical success was defined as C point descent no more than one third into the vaginal canal.
  
  
  
  One hundred twenty-five women met inclusion criteria and had follow-up at 1 year or more. Concomitant procedures included anterior/posterior repair and midurethral sling. Mean follow-up time was 22.8 months (range, 12-63 months). At last follow-up, 96% met criteria for apical success. A more negative preoperative D point was significantly related to improved postoperative apical support, with each 1-cm descent in preoperative D point resulting in a postoperative C point that was 0.21 cm lower (P = 0.0005). Based on the receiver operating characteristic curve, a "cutoff" D point value of -4.25 (sensitivity, 0.8; specificity, 0.65) was determined to be a predictor of postoperative apical success at 1 year or more.
  
  
  
  The preoperative D point correlates with postoperative apical support, and a clinically meaningful relationship exists between the preoperative D point and anatomic apical success.
authors.affiliation: From the *National Center for Advanced Pelvic Surgery, MedStarWashington Hospital Center; †Departments of Obstetrics and Gynecology and Urology, ‡Georgetown University School of Medicine; and §Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Washington, DC.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Richter
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Park
authors.forename: Jenine E
authors.initials: JE
authors.lastname: Boileau
authors.forename: Megan
authors.initials: M
authors.lastname: Janni
authors.forename: Sameer
authors.initials: S
authors.lastname: Desale
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D012372:ROC Curve; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh; D017211:Treatment Failure