Preprocedure and Immediate Postoperative Changes to Genital Hiatus Following Minimally Invasive Sacrocolpopexy

Importance This study assesses resting genital hiatus (GH) measurements under anesthesia as compared with in-office measurements for intraoperative planning purposes. Objectives The aim of this study was to determine the influence of general anesthesia and apical suspension on GH measurements compared with office measurements. Study Design This was a retrospective cohort of women who underwent minimally invasive sacrocolpopexy within an academic urogynecology practice. Genital hiatus for each patient was measured at 4 time points: (1) preoperative office examination (baseline) at rest (GHrest) and with strain (GHstrain); (2) following anesthesia induction, at rest (GHinduction); (3) immediately after sacrocolpopexy, at rest (GHcolpopexy); and (4) 4- to 6-week postoperative visit, strain (GHpostop). Enlarged baseline GHstrain was defined as ≥4 cm. Paired statistics and analysis of variance were used for comparisons. Results Fifty-one women were included, whose mean age was 61.3 ± 8.2 years; the majority had stage ≥3 prolapse (n = 39 [76.4%]). Concomitant procedures included hysterectomy (n = 33 [64.7%]) and posterior colporrhaphy or perineorrhaphy (n = 8 [15.7%]). The majority had an enlarged baseline GHstrain (n = 39 [76.4%]), and overall cohort mean was 4.7 ± 1.3 cm. Compared with baseline GHrest, mean GHinduction was larger (GHinduction: 4.6 ± 1.4 cm vs GHrest: 3.8 ± 1.2 cm, P < 0.01) but not different from baseline GHstrain (GHinduction: 4.6 ± 1.4 cm vs GHstrain: 4.7 ± 1.3 cm, P = 0.81). GHcolpopexy was decreased from baseline GHstrain with a mean difference of 1.1 ± 1.3 cm (P < 0.01). This difference was driven by women with enlarged baseline GHstrain who experienced a mean decrease of 1.5 ± 1.1 cm (P < 0.01). Conclusions Genital hiatus after induction of anesthesia does not significantly differ from preoperative straining GH. Apical suspension with sacrocolpopexy alone resulted in immediate reduction in GH measures, with greater decreases observed in women with enlarged preoperative GH.