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Illiano E, Giannitsas K, Zucchi A, Di Biase M, Del Zingaro M, Bini V, Costantini E. Sacrocolpopexy for posthysterectomy vaginal vault prolapse: long-term follow-up. Int Urogynecol J 2016; 27:1563-9. [DOI: 10.1007/s00192-016-2998-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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102
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Altman D, Mikkola TS, Bek KM, Rahkola-Soisalo P, Gunnarsson J, Engh ME, Falconer C. Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study. Int Urogynecol J 2016; 27:1337-45. [DOI: 10.1007/s00192-016-2973-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
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103
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Mearini L, Nunzi E, Di Biase M, Costantini E. Laparoscopic Management of Vaginal Vault Prolapse Recurring after Pelvic Organ Prolapse Surgery. Urol Int 2016; 97:158-64. [DOI: 10.1159/000443337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/12/2015] [Indexed: 11/19/2022]
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104
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O’Sullivan OE, Matthews CA, O’Reilly BA. Sacrocolpopexy: is there a consistent surgical technique? Int Urogynecol J 2015; 27:747-50. [DOI: 10.1007/s00192-015-2880-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
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105
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Tsivian M, Weintraub AY, Neuman M, Tsivian A. Introducing a true minimally invasive meshless and dissectionless anchoring system for pelvic organ prolapse repair. Int Urogynecol J 2015; 27:601-6. [PMID: 26531297 DOI: 10.1007/s00192-015-2875-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/16/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to demonstrate the biomechanical properties, feasibility, and potential advantages over conventional techniques of this new anchoring device, NeuGuide™. METHODS We evaluated the pull-out forces required to pull the NeuGuide™ anchor elements from a uniform porcine ligament and a cadaver ligament. We also evaluated the function of the NeuGuide™ and the characteristics of the device for the establishment of verification evidence ensuring the reliability and feasibility of the device. We also evaluated the safety and performance of the NeuGuide™ procedure in female cadavers by palpating the sacro-spinous ligament in real time. We assessed the ability to deploy and fixate the anchor to the sacro-spinous ligament and to stitch the sutures from both sides of the vaginal apex to the cervix, without damaging the surrounding structures. RESULTS All 12 anchors were inserted into the porcine ligament and the cadaver sacro-spinous ligaments successfully (mean pull-out force 34.13 ± 4.32 and 35.68 ± 9.28 respectively). None of the measured forces were below 20 N. No statistically significant difference was noted in the pull-out forces between the porcine and the cadavers (p = 0.60), between the two cadavers (p = 0.19) and between the right and left sacro-spinous ligaments. No abnormalities or malfunctions were noted in the functional performance of the device. Upon laparotomy, dissection of the cadavers revealed that the sacro-spinous ligaments were reached safely with no damage to the surrounding organs and tissues. CONCLUSIONS This novel anchoring device (NeuGuide™) is aimed at facilitating a durable, easy, and short procedure for sacro-spinous ligament fixation with hypothetically fewer operative complications.
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Affiliation(s)
- Masha Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
| | - Menahem Neuman
- Urogynecology, Department of Obstetrics and Gynecology, Galilee Hospital, and the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Assuta Medical Centers, Tel Aviv-Yafo, Israel
| | - Alex Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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106
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Betschart C, Cervigni M, Contreras Ortiz O, Doumouchtsis SK, Koyama M, Medina C, Haddad JM, la Torre F, Zanni G. Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourol Urodyn 2015; 36:507-513. [DOI: 10.1002/nau.22916] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/07/2015] [Indexed: 01/21/2023]
Affiliation(s)
| | - Mauro Cervigni
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Rome Italy
| | | | | | - Masayasu Koyama
- Department of Obstetrics and Gynecology; Osaka City Graduate School of Medicine; Osaka Japan
| | - Carlos Medina
- Department of Obstetrics and Gynecology; University of Miami School of Medicine; Miami Florida
| | | | - Filippo la Torre
- Surgical Department; Policlinico “Umberto I”, Sapienza University; Rome Italy
| | - Giuliano Zanni
- Department of Obstetrics and Gynecology; Hospital of Vicenza; Vicenza Italy
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107
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Abstract
PURPOSE OF REVIEW This article reviews the current literature regarding surgical repair of vaginal apical prolapse and discusses the risks and benefits of various surgical approaches. RECENT FINDINGS Vaginal uterosacral ligament suspension has similar anatomic and subjective outcomes to sacrospinous ligament fixation at 1 year. Native tissue vaginal repairs offer decreased morbidity compared with mesh-augmented sacrocolpopexy; however, sacrocolpopexy has greater anatomic success. Minimally invasive sacrocolpopexy appears to be equivalent to open abdominal sacrocolpopexy. Native tissue repairs and transvaginal mesh kits support the vaginal apex with similar results; however, long-term follow-up is needed. Robotic and laparoscopic sacrocolpopexy are equally effective in restoring the vaginal apex. SUMMARY Surgical restoration of the vaginal apex can be accomplished via a variety of approaches and techniques. When deciding on the proper surgical intervention, the surgeon must carefully calculate the risks and benefits of each procedure while incorporating the patient's individual medical and surgical risk factors. Lastly, a discussion regarding the patient's overall goals of care is paramount to the decision-making process.
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108
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Ohno MS, Richardson ML, Sokol ER. Abdominal sacral colpopexy versus sacrospinous ligament fixation: a cost-effectiveness analysis. Int Urogynecol J 2015; 27:233-7. [PMID: 26282093 DOI: 10.1007/s00192-015-2819-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS For the surgical correction of apical prolapse the abdominal approach is associated with better outcomes; however, it is more expensive than the transvaginal approach. This cost-effectiveness analysis compares abdominal sacral colpopexy (ASC) with sacrospinous ligament fixation (SSLF) to determine if the improved outcomes of ASC justify the increased expense. METHODS A decision-analytic model was created comparing ASC with SSLF using data-modeling software, TreeAge Pro (2013), which included the following outcomes: post-operative stress urinary incontinence (SUI) with possible mid-urethral sling (MUS) placement, prolapse recurrence with possible re-operation, and post-operative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) of less than $50,000 per quality-associated life year (QALY). Base-case, threshold, and one-way sensitivity analyses were performed. RESULTS At the baseline, ASC is more expensive than SSLF ($13,988 vs $11,950), but is more effective (QALY 1.53 vs 1.45) and is cost-effective (ICER $24,574/QALY) at 2 years. ASC was not cost-effective if the following four thresholds were met: the rate of post-operative SUI was above 36 % after ASC or below 28 % after SSLF; the rate of MUS placement for post-operative SUI was above 60 % after ASC or below 13 % after SSLF; the rate of recurrent prolapse was above 15 % after ASC or below 4 % after SSLF; the rate of post-operative dyspareunia was above 59 % after ASC or below 19 % after SSLF. CONCLUSIONS Abdominal sacral colpopexy can be cost-effective compared with sacrospinous ligament fixation; however, as the post-operative outcomes of SSLF improve, SSLF can be considered a cost-effective alternative.
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Affiliation(s)
- Mika S Ohno
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA.
| | - Monica L Richardson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA
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109
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Jundt K, Peschers U, Kentenich H. The investigation and treatment of female pelvic floor dysfunction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:564-74. [PMID: 26356560 PMCID: PMC4570968 DOI: 10.3238/arztebl.2015.0564] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND 25% of all women report involuntary loss of urine, and 7% may require treatment. METHODS This review is based on a selection of pertinent literature, including guidelines and Cochrane reviews. RESULTS The assessment of pelvic floor dysfunction in women begins with a basic evaluation that is followed by special diagnostic tests if indicated. The physician taking the clinical history should inquire about the patient's behavior, personality, social and other stressors, and eating and drinking habits, as well as any mental disorders that may be present, including anxiety disorders, depression, somatization disorders, and disorders of adaptation. Conservative treatment consists mainly of lifestyle changes, physiotherapy, and medication. Stress incontinence is most commonly treated with pelvic floor exercises, with a documented success rate of 56.1% vs. 6% without such treatment (relative risk 8.38, 95% confidence interval 3.67-19.07). If incontinence persists, surgery may be indicated ( implantation of suburethral tension-free slings, or colposuspension). Feedback and biofeedback training can be used to treat an overactive bladder. If these techniques and drug therapy are unsuccessful, botulinum toxin injections can be considered. CONCLUSION Well-validated treatments for pelvic floor dysfunction are available. Psychosomatic factors must be taken into account and can have a major effect on treatment outcomes.
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Affiliation(s)
- Katharina Jundt
- Private practice for gynecology at Pasinger Bahnhof, München
- PD Dr. Jundt and Prof. Dr. Kentenich have equally contributed to the article
| | - Ursula Peschers
- Pelvic Floor Center München, Surgical Hospital München-Bogenhausen
- PD Dr. Jundt and Prof. Dr. Kentenich have equally contributed to the article
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De Gouveia De Sa M, Claydon LS, Whitlow B, Dolcet Artahona MA. Laparoscopic versus open sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J 2015; 27:3-17. [DOI: 10.1007/s00192-015-2765-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
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111
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Moen M, Gebhart J, Tamussino K. Systematic reviews of apical prolapse surgery: are we being misled down a dangerous path? Int Urogynecol J 2015; 26:937-9. [PMID: 25963061 DOI: 10.1007/s00192-015-2733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Moen
- Illinois Urogynecology, Ltd, 1875 Dempster St, Suite 665, Park Ridge, IL, 60068, USA,
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112
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Iliococcygeus fixation for the treatment of apical vaginal prolapse: efficacy and safety at 5 years of follow-up. Int Urogynecol J 2015; 26:1007-12. [PMID: 25653034 DOI: 10.1007/s00192-015-2629-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
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113
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Serati M, Bogani G, Sorice P, Di Dedda MC, Ghezzi F. Words of wisdom. Re: Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. Eur Urol 2014; 67:172. [PMID: 25528392 DOI: 10.1016/j.eururo.2014.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
| | - Giorgio Bogani
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Paola Sorice
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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114
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Update on Robotic Versus Laparoscopic Sacrocolpopexy: Outcomes and Costs. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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115
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Myers EM, Siff L, Osmundsen B, Geller E, Matthews CA. Differences in recurrent prolapse at 1 year after total vs supracervical hysterectomy and robotic sacrocolpopexy. Int Urogynecol J 2014; 26:585-9. [DOI: 10.1007/s00192-014-2551-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/13/2014] [Indexed: 11/24/2022]
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116
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Grigoriadis T, Protopapas A, Chatzipapas I, Athanasiou S. Vaginally assisted laparoscopic sacrocolpopexy for the treatment of complete uterovaginal prolapse. Int Urogynecol J 2014; 26:449-50. [PMID: 25338729 DOI: 10.1007/s00192-014-2541-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Women with complete uterovaginal prolapse (UVP) present multicompartmental pelvic defects. The vaginally assisted laparoscopic sacrocolpopexy (VALS) has been introduced to address such defects by combining a vaginal and a laparoscopic approach. METHOD This is a video demonstration of a VALS procedure performed on a 60-year-old patient with a complete UVP. The presented procedure comprises two steps: an initial vaginal surgery, followed by a laparoscopic approach. The vaginal surgery initially includes a vaginal hysterectomy and full-thickness dissection of the vaginal walls. The meshes are then sutured on the fascias and the free ends are placed in the pelvic cavity. The vaginal vault is closed transvaginally and then suspended laparoscopically on the sacral promontory. CONCLUSIONS The VALS procedure is a valid minimally invasive surgical alternative for patients with severe or complete UVP. This combined procedure facilitates the surgical steps and minimizes the need to perform difficult pelvic laparoscopic dissections.
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Affiliation(s)
- Themos Grigoriadis
- First Department of Obstetrics and Gynecology, Urogynecology Unit, National and Kapodistrian University of Athens, "Alexandra" Hospital, 105-107 Vas. Sofias Avenue, Athens, 11521, Greece,
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117
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Farthmann J, Watermann D, Erbes T, Roth K, Nanovska P, Gitsch G, Gabriel B. Functional outcome after pelvic floor reconstructive surgery with or without concomitant hysterectomy. Arch Gynecol Obstet 2014; 291:573-7. [PMID: 25200688 DOI: 10.1007/s00404-014-3435-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/22/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE When counseling patients about surgical alternatives for pelvic organ prolapse (POP) repair, numerous things have to be considered. Uterine preservation vs. hysterectomy is one relevant issue. Hysterectomy has been traditionally performed for POP, but its benefit regarding outcome has never been proven. Furthermore, a growing number of women ask for uterine preservation. METHODS In this retrospective cohort study, 384 patients who had undergone surgery for POP between 2000 and 2012 at Freiburg University Medical Center were included. Using a standardized questionnaire, further surgeries, urinary incontinence, recurrent POP, pessary use, and satisfaction with the surgical outcome were evaluated. The functional results after uterine preservation vs. concomitant hysterectomy were compared using t test. RESULTS 196 (51.04%) women were available for follow-up and agreed to participate (n = 122 with hysterectomy, n = 72 with uterine-preserving surgery, respectively). After a mean follow-up time of 67 months, vaginal bulge symptoms and urinary incontinence did not differ between treatment groups. We observed higher success rates and satisfaction scores in the uterine-preserving group. Regarding satisfaction with surgery and whether the patients thought it had been successful, we observed a trend toward better results in the uterine-preserving group (mean satisfaction score: 8.45 ± 2.15 vs. 7.76 ± 2.91, range 0-10, p = 0.061; success: 91.4 vs. 81.7 %, p = 0.087). CONCLUSIONS There was no difference with regard to functional outcome between patients with or without concomitant hysterectomy. Satisfaction with the operation was slightly higher after uterus preserving surgery. Therefore, uterine-preserving surgery is a valuable option unless there are contraindications.
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Affiliation(s)
- Juliane Farthmann
- Department of Obstetrics and Gynecology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany,
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118
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Rosati M, Bramante S, Conti F. A review on the role of laparoscopic sacrocervicopexy. Curr Opin Obstet Gynecol 2014; 26:281-9. [DOI: 10.1097/gco.0000000000000079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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119
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Cosma S, Menato G, Preti M, Petruzzelli P, Chiadò Fiorio Tin M, Riboni F, Benedetto C. Advanced utero-vaginal prolapse and vaginal vault suspension: synthetic mesh vs native tissue repair. Arch Gynecol Obstet 2013; 289:1053-60. [DOI: 10.1007/s00404-013-3104-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
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