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Habib N, Giorgi M, Tahtouh T, Hamdi A, Centini G, Cannoni A, Bader G. Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy. Arch Gynecol Obstet 2024:10.1007/s00404-024-07719-4. [PMID: 39322854 DOI: 10.1007/s00404-024-07719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/25/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE To investigate the relationship between the anatomical position of the anterior arm of the mesh, measured by ultrasound through the bladder neck-mesh distance technique and the surgical outcomes after laparoscopic sacrocolpopexy (SCP) for apical prolapse. STUDY DESIGN It was a retrospective analysis of prospectively collected data in a tertiary care hospital. Between January 2019 and September 2019, 63 women who underwent laparoscopic SCP due to apical prolapse were included. Bladder neck-mesh distance was measured immediately after surgery. The pelvic floor was evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System before, 1 month, and 2.7 years (mid-term) after the surgery. Post-operative stress urinary incontinence (SUI) and Patient Global Impression of Improvement (PGI-I) scores were also assessed. The correlation between bladder neck-mesh distance and the post-operative outcomes was investigated using the Spearman rank correlation coefficient. RESULTS At mid-term follow-up visit, bladder neck-mesh distance was inversely correlated with the correction of apical prolapse and post-operative SUI. No correlation was detected with the anterior compartment prolapse correction. PGI-I scores were high in all patients at mid-term follow-up, irrespective of bladder neck-mesh distance values. CONCLUSION The shorter the bladder neck-mesh distance, the better the outcome for apical compartment repair. Bladder neck-mesh distance had no correlation with the anterior anatomical correction. Shorter bladder neck-mesh distance values were positively correlated to better PGI-I scores and a higher risk of SUI.
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Affiliation(s)
- Nassir Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201, Mantes-La-Jolie, France
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Tania Tahtouh
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, 59911, Abu Dhabi, United Arab Emirates
| | - Amel Hamdi
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, 59911, Abu Dhabi, United Arab Emirates
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Alberto Cannoni
- Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Georges Bader
- Medical and Surgical Center, Ambroise Paré - Pierre Cherest - Hartmann Hospital, 92200, Neuilly-Sur-Seine, France
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Zargham M, Dehghani M, Gholipour F, Emami M, Daneshvari M, Aminsharifi A. Triple-compartment strategy for abdominal sacral colpopexy using PVDF mesh: one-year report of anatomical and subjective outcomes. Int Urogynecol J 2023; 34:1907-1914. [PMID: 36795111 DOI: 10.1007/s00192-023-05471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/08/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse. METHODS Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively. RESULTS Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation. CONCLUSIONS Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication.
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Affiliation(s)
- Mahtab Zargham
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran.
| | - Mehdi Dehghani
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran.
| | - Farshad Gholipour
- Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Emami
- Department of Urology, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Daneshvari
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran
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Sebastian L, Alina J, Fabinshy T, Dominik R, Axel S, Jens H, Kilian W, Claudia R, Leonidas K, Julia R, Nadja T, Christian E. AbsorbaTack ™ vs. ProTack ™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2023; 307:863-871. [PMID: 36404354 PMCID: PMC9984508 DOI: 10.1007/s00404-022-06827-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. METHODS A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. RESULTS There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. CONCLUSION The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.
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Affiliation(s)
- Ludwig Sebastian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.
| | - Jansen Alina
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Thangarajah Fabinshy
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Ratiu Dominik
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Sauerwald Axel
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Hachenberg Jens
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wegmann Kilian
- Department for Trauma, Hand and Elbow Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rudroff Claudia
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Karapanos Leonidas
- Department of Urology, Uro-Oncology, Faculty of Medicine and University Hospital Cologne, Robot- Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany
| | - Radosa Julia
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Trageser Nadja
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Eichler Christian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.,Breast Cancer Center, St. Franziskus-Hospital Münster, 48145, Münster, Germany
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Page AS, Page G, Deprest J. Cervicosacropexy or vaginosacropexy for urinary incontinence and apical prolapse: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 279:60-71. [DOI: 10.1016/j.ejogrb.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
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Jansen AK, Ludwig S, Malter W, Sauerwald A, Hachenberg J, Pahmeyer C, Wegmann K, Rudroff C, Karapanos L, Radosa J, Trageser N, Eichler C. Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2021; 305:631-639. [PMID: 34842976 PMCID: PMC8918131 DOI: 10.1007/s00404-021-06343-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 12/01/2022]
Abstract
Purpose There is a novel surgical procedure, called cervicosacropexy (CESA) and vaginosacropexy (VASA) to treat pelvic organ prolapse and a concomitant urgency and mixed urinary incontinence. As there is little experience with the tapes so far and literature is scanty, the aim of this study was to investigate biomechanical properties for the fixation of the PVDF-tapes with three different fixation methods in context of apical fixations. Methods Evaluation was performed on porcine, fresh cadaver sacral spines. A total of 40 trials, divided into 4 subgroups, was performed on the anterior longitudinal ligament. Recorded biomechanical properties were displacement at failure, maximum load and stiffness in terms of the primary endpoints. The failure mode was a secondary endpoint. Group 4 was a reference group to compare single sutures on porcine tissue with those on human tissue. Biomechanical parameters for single sutures on the human anterior longitudinal ligament were evaluated in a previous work by Hachenberg et al. Results The maximum load for group 1 (two single sutures) was 65 ± 12 N, for group 2 (three titanium tacks arranged in a row) it was 25 ± 10 N and for group 3 (three titanium tacks arranged in a triangle) it was 38 ± 12 N. There was a significant difference between all three groups. The most common failure mode was a “mesh failure” in 9/10 trials for groups 1–3. Conclusion The PVDF-tape fixation with two single sutures endures 2.6 times more load than titanium tacks arranged in a row and 1.7 times more load than titanium tacks arranged in a triangle. The presacral fixation with titanium tacks reduced surgical time compared to the fixation with sutures, nevertheless sutures represent the significantly stronger and cheaper fixation method.
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Affiliation(s)
- Alina Katharina Jansen
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany.
| | - Sebastian Ludwig
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Axel Sauerwald
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Jens Hachenberg
- Department of Gynacology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Caroline Pahmeyer
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital Cologne, Department for Trauma, Hand and Elbow Surgery, University of Cologne, Cologne, Germany
| | - Claudia Rudroff
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Leonidas Karapanos
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Radosa
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Nadja Trageser
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
- Breast Cancer Center, St. Franziskus- Hospital Münster, 48145, Münster, Germany
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Stewart CA, Popat S, Zhao H, Dallas K, Gonzalez G, Gonzales-Alabastro C, Ackerman AL, Eilber K, Anger JT. Outcomes of Prophylactic Mid-Urethral Sling at the Time of Robotic Sacrocolpopexy. Urology 2020; 150:130-133. [PMID: 32683067 DOI: 10.1016/j.urology.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare outcomes of patients who underwent robotic sacrocolpopexy (RSC) with and without concomitant mid-urethral sling (MUS) placement for prophylaxis or treatment of preoperative stress urinary incontinence (SUI) METHODS: We performed a retrospective review of all patients without prior incontinence procedures who underwent RSC with or without MUS placement by 3 surgeons (JA, LA, KE) at a single institution from 2012 to 2017 for treatment of pelvic organ prolapse. Patients had a MUS placed for either documented SUI or prophylaxis of SUI. We compared patient characteristics, operative details, postoperative outcomes, and complications between the groups. RESULTS A total of 134 patients were identified. 58 (43%) had a MUS placed for documented SUI, 43 (32%) had prophylactic MUS, and 33 (25%) did not have a MUS placed. There were no differences in baseline characteristics between the 3 groups. Patients who did not have a MUS placed had less estimated blood loss (76.4 vs 63.8 vs 36.9 mL, P = .018) but no difference in operative time (P = .408), length of stay (P = .427), or postoperative urinary retention (P = .988). A total of 4 (7%) patients who had a MUS placed for SUI had persistent SUI postoperatively. There were 2 (5%) patients who had a MUS placed prophylactically and 4 (12%) patients who did not have a MUS that developed de novo SUI. CONCLUSION In this series, we demonstrate the safety and efficacy of prophylactic MUS placement at the time of RSC. Randomized studies evaluating concomitant prophylactic sling at time of robotic sacrocolpopexy could further guide preoperative patient counseling and decision-making.
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Affiliation(s)
- Carrie A Stewart
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA
| | - Shreeya Popat
- Department of Urology, Baylor College of Medicine, Houston TX
| | - Hanson Zhao
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA
| | - Kai Dallas
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA
| | | | | | | | - Karyn Eilber
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA
| | - Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA.
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