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Wu PC, Hsiao SM, Lin HH. The prevalence of overt, occult, and no-demonstrated stress urinary incontinence and their clinical and urodynamic findings in women with advanced-stage cystoceles. J Formos Med Assoc 2024:S0929-6646(24)00287-0. [PMID: 38918083 DOI: 10.1016/j.jfma.2024.06.011] [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: 02/15/2024] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To elucidate the prevalence of overt, occult and no demonstrated (ND) stress urinary incontinence (SUI) in women with advanced-stage cystoceles. STUDY DESIGN Between November 2011 and January 2017, all women with ≥stage 2 cystoceles were retrospectively enrolled. Overt SUI was diagnosed before the prolapse reduction test, and occult SUI was diagnosed when urine leakage was noted after a reduction test with vaginal gauze. Otherwise, a diagnosis of ND-SUI was made. MAIN OUTCOME MEASURES The prevalence, clinical and urodynamic findings of overt SUI, occult SUI, and ND-SUI. RESULTS In 480 enrolled women, 62% had overt SUI, 17% had occult SUI, and 21% had ND-SUI. The occult SUI group had the most advanced prolapse. The pad weight results after prolapse reduction (37.3 ± 44.3 vs. 13.4 ± 21.9, p < 0.05), the bladder capacity (243 ± 54 vs. 273 ± 48, p < 0.001), and questionnaires regarding life quality were significantly different between the overt SUI and the occult SUI groups. Bladder oversensitivity (BO) was the most common urodynamic diagnosis (389/480, 81%), especially in overt SUI, while urodynamic stress incontinence (56/480, 12%) and detrusor overactivity (60/480, 13%) were uncommon. The cutoff value of stage 3 uterine prolapse was the strongest predictor for predicting occult SUI (sensitivity = 30.3%, specificity = 78.5%; area = 0.60, 95% CI: 0.52-0.68). CONCLUSIONS SUI occurs in a ratio of 3:1:1 among cases with overt, occult, and no demonstrable symptoms. BO is the most common urodynamic diagnosis. Pad test with prolapse reduction remains an important tool, especially for coexistent stage 3 uterine prolapse.
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Affiliation(s)
- Pei-Chi Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
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Braga A, Finazzi Agrò E, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Serati M. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 1 - Female population. MINERVA UROL NEFROL 2020; 72:58-65. [PMID: 31086135 DOI: 10.23736/s0393-2249.19.03443-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Although, until a few years ago, the diagnostic power of urodynamic testing had never been questioned, recent studies in the literature have raised some doubts on the routine use of this tool. The benefits of the urodynamic studies (UDS) should be weighted against costs, time-consumption and patient discomfort. These recommendations are intended to guide clinicians in the right selection of the female patients to submit to a urodynamic evaluation. We reviewed the literature, regarding the use of UDS in female adults with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction. Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and uro-gynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in female population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with lower urinary tract symptoms and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, Beata Vergine Regional Hospital, Mendrisio, Switzerland -
| | | | - Ester Illiano
- Department of Urology and Andrology Clinic, Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Sierra T, Sullivan G, Leung K, Flynn M. The negative predictive value of preoperative urodynamics for stress urinary incontinence following prolapse surgery. Int Urogynecol J 2019; 30:1119-1124. [PMID: 30643978 DOI: 10.1007/s00192-018-03864-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is no consensus for the evaluation of stress urinary incontinence (SUI) in patients planning pelvic organ prolapse (POP) surgery. We sought to determine the negative predictive value (NPV) of prolapse reduction during preoperative urodynamics (UDS) for postoperative SUI. METHODS We performed a retrospective study of 322 women with preoperative UDS and subsequent POP surgery. Abstracted data included demographics, prolapse stage, prior prolapse or incontinence surgery, preoperative SUI complaint, prolapse reduction method, and length of follow-up. Any woman who reported SUI symptoms within 6 months from surgery was considered a diagnostic UDS failure. The NPV was calculated by dividing the number of patients who did not demonstrate SUI on UDS and had no postoperative SUI by the number of patients who did not demonstrate SUI on UDS. RESULTS Patient characteristics (age, race, parity, prolapse stage, prior surgery, and length of follow-up) were similar among those who had urodynamic-proven SUI and those who did not. The NPV of preoperative UDS for postoperative SUI in patients undergoing any POP repair was 97.9.0% [95% confidence interval (CI) 92.7-99.7%]. The NPV remained high in the subset of patients who underwent an apical suspension-98.6% (95% CI 92.7-100.0%)-as well as those without a preoperative SUI complaint-98.6% (95% CI 92.3-100.0%). In most patients (72.9%), a ring pessary with support combined with intraprocedural manipulation allowed for reliable stress testing. CONCLUSIONS Our study supports using preoperative UDS as a screening tool to avoid unnecessary concomitant continence procedures. Further studies are needed to individualize patient preoperative assessment and surgical counseling.
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Affiliation(s)
- Tania Sierra
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA.
| | - Gina Sullivan
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
| | - Katherine Leung
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
| | - Michael Flynn
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
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Hwang SM, de Toledo LGM, da Silva Carramão S, Frade AB, Matos AC, Auge APF. Is urodynamics necessary to identify occult stress urinary incontinence? World J Urol 2018; 37:189-193. [PMID: 29872900 DOI: 10.1007/s00345-018-2366-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods. METHODS This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction. RESULTS The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441-.854). CONCLUSION UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.
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Affiliation(s)
- Susane Mei Hwang
- Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil.
| | | | - Silvia da Silva Carramão
- Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil
| | - Armando Brites Frade
- Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil
| | - Andre Costa Matos
- Department of Surgery, Urology Service, Hospital São Rafael, Salvador, BA, Brazil
| | - Antonio Pedro Flores Auge
- Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil
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Clancy AA, Mallick R, Breau RH, Khalil H, Hickling DR. Complications after minimally invasive sacrocolpopexy with and without concomitant incontinence surgery: A National Surgical Quality Improvement Program (NSQIP) database study. Neurourol Urodyn 2018; 37:2234-2241. [PMID: 29635701 DOI: 10.1002/nau.23574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/27/2018] [Indexed: 11/10/2022]
Abstract
AIMS To compare surgical complications for patients having minimally invasive sacrocolpopexy (MISCP) with concomitant incontinence procedure, to those having MISCP alone. METHODS Patients undergoing MISCP with and without a concomitant incontinence procedure between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. The main outcome of interest was a composite of surgical site infection, bleeding requiring blood transfusion, return to the operating room within 30 days, and surgical stay >48 h. Log-binomial regression was used to identify independent risk factors for the outcome and to generate adjusted effect measures for variables of interest. RESULTS Seven thousand ninety-seven women met the inclusion criteria, of which 2433 (34%) underwent a concomitant incontinence procedure. Patients having incontinence procedures were slightly older (59 ± 11 vs 58 ± 12, P < 0.0001) and had longer total operating time (225 IQR 170-267 vs 184 IQR 120-232 min, P < 0.0001). Pre-operative steroid use, wound class III/IV (vs I/II), and longer operative time were independent predictors of the composite outcome. After adjusting for baseline patient characteristics and co-morbidities, no association was observed between concomitant incontinence procedure and the composite outcome (adjusted RR 0.87, 95%CI 0.65-1.18) but there was an increased likelihood of urinary tract infection (adjusted RR 2.47 95%CI 1.89-3.27). CONCLUSIONS Despite being associated with a longer operative time, performing an incontinence procedure at the time of MSCIP was not associated with an increased risk of clinically important surgical complications other than urinary tract infection.
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Affiliation(s)
- Aisling A Clancy
- Department of Obstetrics and Gynecology, Division of Urogynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodney H Breau
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Surgery, Division of Urology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hisham Khalil
- Department of Obstetrics and Gynecology, Division of Urogynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Duane R Hickling
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Surgery, Division of Urology, The Ottawa Hospital, Ottawa, Ontario, Canada
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Laparoscopic sacrohysteropexy versus vaginal hysterectomy for uterovaginal prolapse using validated questionnaires: 2-year prospective study. Int Urogynecol J 2017; 29:71-79. [DOI: 10.1007/s00192-017-3405-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/14/2017] [Indexed: 12/22/2022]
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[Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines]. Prog Urol 2017; 26 Suppl 1:S8-S26. [PMID: 27595629 DOI: 10.1016/s1166-7087(16)30425-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique? MATERIAL AND METHODS This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]). RESULTS It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology. CONCLUSION Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
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Alas AN, Chinthakanan O, Espaillat L, Plowright L, Davila GW, Aguilar VC. De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence. Int Urogynecol J 2016; 28:583-590. [PMID: 27678145 DOI: 10.1007/s00192-016-3149-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a paucity of data evaluating the risk of de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP) in women with no preoperative occult SUI. We hypothesized that apical suspension procedures would have higher rates of de novo SUI. METHODS This was a retrospective database review of women who had surgery for POP from 2003 to 2013 and developed de novo SUI at ≥6 months postoperatively. Preoperatively, all patients had a negative stress test and no evidence of occult SUI on prolapse reduction urodynamics. The primary objective was to establish the incidence of de novo SUI in women with no objective evidence of preoperative occult SUI after POP surgeries at ≥6 months. RESULTS A total number of 274 patients underwent POP surgery. The overall incidence of de novo SUI was 9.9 % [95 % confidence interval (CI) 0.07-0.14]. However, the incidence of de novo SUI in those with no baseline complaint of SUI was 4.4 % (95 % CI 0.03-0.1). There was no difference in de novo SUI rates between apical [9.7 % (n = 57)] and nonapical [10.5 %, (n = 217] procedures (p = 0.8482). Multivariate logistic regression identified sacrocolpopexy [adjusted odds ratio (OR) 4.54, 95 % CI 1.2-14.7] and those with a baseline complaint of SUI (adjusted OR 5.1; 95 % CI 2.2-12) as risk factors for de novo SUI. CONCLUSIONS The incidence of de novo SUI after surgery for POP without occult SUI was 9.9 %. We recommend counseling patients about the risk of de novo SUI and offering a staged procedure.
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Affiliation(s)
- Alexandriah N Alas
- Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Orawee Chinthakanan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Luis Espaillat
- Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Leon Plowright
- Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - G Willy Davila
- Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Vivian C Aguilar
- Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA. .,Department of Women's Health, Dell School of Medicine, University of Texas at Austin, 1313 Red River Street, Austin, TX, 78701, USA.
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Arora S, Kapoor R, Yadav P, Mittal V, Sureka SK, Kapoor D. Trans-vaginal anterior vaginal wall prolapse repair using a customized tension-free bell-shaped prolene mesh: A single-center experience with long-term functional analysis. Indian J Urol 2015; 31:339-43. [PMID: 26604446 PMCID: PMC4626919 DOI: 10.4103/0970-1591.166470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: The existing literature shows that mesh reinforcement improves the anatomical success rate of cystocele repair. We report the long-term results of a custom bell-shaped mesh with simultaneous urethral support for the repair of cystocele. Materials and Methods: The present study was a single-center, single-surgeon case series of 36 patients. Only patients with Pelvic Organ Prolapse Quantification system (POP-Q) stage 2 and above were included in the study. Patients having rectocele or uterine/vault prolapse were excluded. Body of the mesh was used for reinforcement of the cystocele repair and two limbs were left tension free in the retropubic space. Patients were followed 3 monthly for the first year and yearly thereafter. Recurrence was defined as cystocele ≥stage 2 (Aa or Ba 0) any time after the first follow-up. Results: Mean patient age was 58.5 ± 6.2 years. The mean parity was 3.2 ± 1.6. Of 36 patients, 11 (30.5%) of the patients were POPQ stage 2, 15 (41.7%) were stage 3 and 10 (27.7%) were stage 4 cystocele. The mean follow-up period was 53.4 months, with 32 patients reporting for follow-up till date (88.9%). There was no bladder injury, no mesh erosion or infection. No patient required CIC (clean intermittent catheterization) or had stress urinary incontinence post-operatively at 5 years of follow-up. Conclusion: The bell-shaped mesh is a simple, effective and safe procedure in the surgical management of cystocele with excellent long-term outcome.
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Affiliation(s)
- Sohrab Arora
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Varun Mittal
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Deepa Kapoor
- Department of Obstetrics and Gynaecology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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van der Ploeg JM, Roovers JP. Authors' reply re: Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG 2015; 122:1847-8. [PMID: 26589861 DOI: 10.1111/1471-0528.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jan P Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Occult Stress Urinary Incontinence in Women With Pelvic Organ Prolapse: Is the One Step Surgical Approach a Risky Choice? Female Pelvic Med Reconstr Surg 2015; 22:55-9. [PMID: 26571433 DOI: 10.1097/spv.0000000000000226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Occult stress urinary incontinence (SUI, OSUI) is defined as the demonstration of SUI after pelvic organ prolapse (POP) reduction. The aim of this study was to evaluate the effectiveness and complication rates of the 1-step surgical approach for treating women with POP and OSUI. METHODS Retrospective study of women with POP and OSUI who underwent a concomitant prolapse and midurethral sling procedure was conducted. Main outcome measures were absence of postoperative urodynamic stress incontinence (USI) and absence of postoperative SUI at 12 months. Secondary outcome measures included evaluation of objective and subjective parameters related to the lower urinary tract function and assessment of the quality of life. RESULTS Of the 244 women, 205 women (84%) attended the 12-month postoperative follow-up visit and were included in the study. Overall, 87.8% (180/205) of the patients had absence of postoperative urodynamic stress incontinence, whereas 95.1% (195/205) did not report postoperative SUI. Evaluation of parameters related to the postoperative lower urinary tract dysfunction showed that (a) 43% of women with preexisting urgency symptoms continued to have urgency, (b) 16.7% of patients presented de novo urgency, (c) de novo detrusor overactivity occurred in 9.3% of patients, and (d) 4.9% of women with preoperative obstructive voiding symptoms continued to have obstructive voiding symptoms after combined surgery. King's Health Questionnaire data analysis showed a statistically significant improvement in all domains. CONCLUSIONS This 1-step approach is both safe and effective and could be offered as a valid operative choice for those women who wish or should avoid a repeat surgical procedure for postoperative SUI.
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Kitta T, Mitsui T, Kanno Y, Chiba H, Moriya K, Nonomura K. Postoperative detrusor contractility temporarily decreases in patients undergoing pelvic organ prolapse surgery. Int J Urol 2014; 22:201-5. [DOI: 10.1111/iju.12656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Takahiko Mitsui
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Katsuya Nonomura
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
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Role of urodynamics before prolapse surgery. Int Urogynecol J 2014; 26:165-8. [PMID: 25315173 DOI: 10.1007/s00192-014-2534-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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Two-year urinary outcomes of sacrocolpopexy with or without transobturator tape: results of a prolapse-reduction stress test-based approach. Int Urogynecol J 2014; 25:1517-22. [DOI: 10.1007/s00192-014-2410-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
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Rosier PF. The evidence for urodynamic investigation of patients with symptoms of urinary incontinence. F1000PRIME REPORTS 2013; 5:8. [PMID: 23513180 PMCID: PMC3590786 DOI: 10.12703/p5-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urodynamic studies are the gold standard to objectively diagnose dysfunction of the lower urinary tract. The widely available evidence for the clinical relevance is, however, fragmented. This article summarizes the published knowledge supporting the use of urodynamic studies in urinary incontinence in female, male and frail patients, as well as patients with relevant neurological disease. Five technological innovations are discussed briefly. Standard urodynamic cystometry can, on the basis of a solid body of evidence, objectively unveil the entire function of the lower urinary tract in all patients with urinary incontinence, regardless of the patients' perception of (ab-)normality of signs and or symptoms.
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Affiliation(s)
- Peter F Rosier
- University Medical Centre Utrecht, Department of UrologyC 04.236, P.O. Box 85500, 3580GA UtrechtThe Netherlands
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Kummeling MTM, Rietbergen JBW, Withagen MIJ, Mannaerts GHH, van der Weiden RMF. Sequential urodynamic assessment before and after laparoscopic sacrocolpopexy. Acta Obstet Gynecol Scand 2012; 92:172-7. [PMID: 23157606 DOI: 10.1111/aogs.12045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 11/03/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Controversial data are available as to whether to perform a simultaneous abdominal or vaginal colposuspension operation in laparoscopic sacrocolpopexy procedures. We wanted to evaluate the effect of a modified laparoscopic operation technique on urodynamic parameters and lower urinary tract symptoms. DESIGN Prospective single center cohort study. SETTING Teaching hospital. POPULATION Forty-nine consecutive patients who underwent a modified laparoscopic sacrocolpopexy/hysteropexy operation using bone anchor fixation and synthetic mesh, performed by the same laparoscopic surgeons. METHODS Pre- and postoperative multichannel urodynamic evaluation and validated questionnaires. The same urologist, blinded to the results of the questionnaire survey, interpreted all urodynamic evaluations. MAIN OUTCOME MEASURES The effects of surgery on pelvic anatomy and patient satisfaction, urodynamic observations and diagnoses and symptom scores in validated questionnaires. RESULTS Forty-two patients consented to pre- and postoperative urodynamic evaluation. Laparoscopic sacrocolpopexy successfully corrected vaginal vault prolapse in all 42 patients with urodynamic evaluation six months after surgery. The bladder volume at first desire to void was significantly increased and the maximal detrusor pressure at voiding phase was significantly decreased. In the questionnaires, irritative and storage voiding symptoms were significantly decreased. CONCLUSIONS The results of the study demonstrate that there are no adverse urodynamic findings following this modified technique for laparoscopic sacrocolpopexy. The statistically significant urodynamic improvements are in accordance with the scores on the Urogenital Distress Inventory questionnaires. These results do not support a simultaneous routine prophylactic colposuspension procedure.
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Segal S, Arya LA, Smith AL. Functional Outcomes for Incontinence and Prolapse Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2012; 7:179-186. [PMID: 23066437 PMCID: PMC3468911 DOI: 10.1007/s11884-012-0136-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of women with pelvic organ prolapse and stress urinary incontinence report more than one symptom that affects urinary, bowel, or sexual function. Most research studies on outcomes following surgery for pelvic organ prolapse and stress incontinence focus on anatomic outcomes and relief of symptoms specific to prolapse and/or stress incontinence. Pelvic symptoms related to voiding function such as de novo urgency or incontinence, bowel function, and sexual function are clinically important outcomes but are infrequently reported. Deterioration of pelvic symptoms postoperatively is associated with decreased patient satisfaction, which underscores the importance of effectively assessing functional and anatomic treatment outcomes. Future studies of reconstructive pelvic surgery should routinely include multiple domain functional outcomes specifically addressing voiding, defecatory, and sexual function.
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Affiliation(s)
- Saya Segal
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lily A. Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ariana L. Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, 299 South 8th Street, Philadelphia, PA 19104, USA
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Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J 2012; 24:485-91. [DOI: 10.1007/s00192-012-1888-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
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Khoshbakht N, Alarab M, Lovatsis D. Stress Urinary Incontinence Six Months Post Laparoscopic Sacrocolpopexy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:653-6. [DOI: 10.1016/s1701-2163(16)35318-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J 2012; 23:851-5. [PMID: 22581237 DOI: 10.1007/s00192-012-1765-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/18/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients with genital prolapse and occult stress urinary incontinence (OSUI) are typically treated with prolapse surgery and anti-incontinence surgery based on either a one-step approach or a two-step approach. The aim of our study was to determine whether anti-incontinence surgery is necessary based on the occurrence of OSUI in a study cohort with a long follow-up period. METHODS Prolapse surgery was performed using a vaginal approach. Preoperatively, a stress test, a pad test and an assessment of the urodynamics were performed with and without prolapse reduction. Over a follow-up period of 2-8 years, the patients with preoperative evidence of OSUI underwent urogynaecological examinations, stress tests and pad tests. RESULTS Of 113 patients with preoperative evidence of OSUI, 57 (50.4 %) were followed up for an average of 5.7 years (range 2-8) after prolapse surgery. Of 57 patients, 16 (28.1 %) had objective and/or subjective stress urinary incontinence (SUI) during the follow-up period, but only 3 patients (5.3 %) required subsequent tension-free vaginal tape (TVT) surgery. In 17 of 57 patients (29.8 %), prolapse recurred. CONCLUSIONS Despite the preoperative evidence of OSUI, the manifestation of SUI rarely occurs, with 28.1 % of patients experiencing SUI over long-term follow-up after vaginal prolapse surgery. Anti-incontinence surgery was necessary in only three cases (5.3 %). These results indicate that with the one-step approach, 54 of 57 patients (94.7 %) would have received prophylactic anti-incontinence surgery unnecessarily. In conclusion, we recommend the two-step approach in the management of vaginal prolapse surgery in patients with OSUI.
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Seisen T, Rouprêt M. [Treatment of vaginal prolapse and urinary stress incontinence]. Prog Urol 2012; 22:H1-3. [PMID: 22445520 DOI: 10.1016/s1166-7087(12)70023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T Seisen
- Service d'Urologie de l'Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Université Paris VI, Faculté de médecine Pierre et Marie Curie, France, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Incontinence urinaire d’effort de novo après promontofixation. Prog Urol 2011; 21:631-5. [DOI: 10.1016/j.purol.2011.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Prevention of postoperative stress urinary incontinence at the time of prolapse repair is controversial. There has been a shift away from colposuspension procedures to midurethral slings. As with any surgery, midurethral slings are associated with risks, which must be balanced against the benefits of preventing postoperative stress urinary incontinence. The aim of this overview is to review the controversy, discuss potential complications of midurethral slings, discuss the efficacy of concomitant sling placement, and suggest a method of systematically approaching patients with high-grade anterior compartment prolapse. RECENT FINDINGS Several studies have recently advocated for the routine use of anti-incontinence procedures at the time of prolapse surgery; however, applying these data to midurethral slings is problematic. Ultimately, the issue of treatment of the urethra at the time of prolapse repair should be discussed with the patient with treatment rendered depending on the risk the patient is willing to bear. SUMMARY The aim of this study is to discuss the risks and benefits of applying a midurethral sling in patients with high-grade anterior compartment prolapse. In these patients, placement of a suburethral sling may be approached systematically, taking into account the patients' variables and their own goals of therapy.
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Karateke A, Tug N, Cam C, Selcuk S, Asoglu MR. Concomitant surgical correction of occult stress urinary incontinence by TOT in patients with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2011; 154:105-7. [DOI: 10.1016/j.ejogrb.2010.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/01/2010] [Accepted: 08/02/2010] [Indexed: 12/01/2022]
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Mixed incontinence and cystocele: postoperative urge symptoms are not predicted by preoperative urodynamics. Int Urogynecol J 2010; 22:321-5. [PMID: 20842495 DOI: 10.1007/s00192-010-1261-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 08/21/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) frequently presents with urinary incontinence, either urge (UUI), stress (SUI), or mixed (MUI). We sought to determine the effect of high-grade prolapse repair on MUI. METHODS A retrospective review was performed for 111 patients with anterior POP repair and sling over 4 years. RESULTS Sixty patients (54%) presented symptomatically with MUI, 25% with SUI, and 9% with UUI, 12% asymptomatic. Occult SUI was found in 21% (UUI plus asymptomatic). Success was seen for SUI in 92% and for POP in 89%. Urge symptoms were present in 63% pre-op and 30% post-op. MUI patients were significantly more likely to experience post-op urgency (p = 0.033). Detrusor overactivity (DO) was seen in 22 MUI patients, but was not predictive of post-op urgency (p = 0.91). CONCLUSIONS Cystocele patients with MUI are at significant risk for postoperative urge symptoms regardless of DO, and counseling regarding persistent urgency is imperative.
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Jundt K, Wagner S, von Bodungen V, Friese K, Peschers UM. Occult incontinence in women with pelvic organ prolapse - Does it matter? Eur J Med Res 2010; 15:112-6. [PMID: 20452895 PMCID: PMC3352216 DOI: 10.1186/2047-783x-15-3-112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Many surgeons perform an anti-incontinence procedure during prolapse surgery in women in whom occult stress urinary incontinence has been demonstrated. Others prefer a two-step approach. It was the aim of the study to find out how many women really need a second operation and if a positive cough stress test with the prolapse reduced is associated with the development of stress urinary incontinence after prolapse surgery. Methods 233 women were operated for primary or recurrent prolapse without complaining of SUI. Preoperatively, 53/233 women had a full urogynecological workup with the prolapse reduced. Postoperatively, if the patient suffered from stress urinary incontinence, an anti-incontinence surgery was performed. Results 19/53 (35.8%) women who had a stress test with the prolapse reduced before surgery were defined as occult stress incontinent. Only 3 women (15.8%) of these 19 women developed symptoms of incontinence after prolapse surgery and had to be operated because of that. 18/233 (7.7%) complained of SUI 6 weeks to 6 months after surgery and received a TVT-tape. Conclusion The incidence of stress urinary incontinence manifesting after prolapse surgery is low in this study with 7.7%. This fact and the possible severe side effects of an incontinence operation justify a two-step approach if the patient is counseled and agrees. However, there is a small subgroup of women (3/19, 15.8%) with preoperative OSUI and SUI after surgery, who would benefit from a one-step approach. Further research is required to identify these women before surgical intervention.
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Affiliation(s)
- K Jundt
- I. Department of Obstetrics and Gynecology, Beckenbodenzentrum der LMU, Ludwig-Maximilians-Universität, Munich, Germany.
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van der Steen A, van der Ploeg M, Dijkgraaf MGW, van der Vaart H, Roovers JPWR. Protocol for the CUPIDO trials; multicenter randomized controlled trials to assess the value of combining prolapse surgery and incontinence surgery in patients with genital prolapse and evident stress incontinence (CUPIDO I) and in patients with genital prolapse and occult stress incontinence (CUPIDO II). BMC WOMENS HEALTH 2010; 10:16. [PMID: 20459818 PMCID: PMC2879229 DOI: 10.1186/1472-6874-10-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 05/11/2010] [Indexed: 11/11/2022]
Abstract
Background About 40% of all patients with genital prolapse report stress-incontinence. In about half of the 60% patients that do not report stress-incontinence, occult urinary stress-incontinence can be detected. In these patients stress-incontinence is masked due to kinking or compression of the urethra by the prolapse. In case surgical correction is indicated there are two strategies to manage patients with combined prolapse and (occult) stress incontinence. This strategy is either (i) a combination of prolapse surgery and stress-incontinence surgery or (ii) to correct the prolapse first and evaluate afterwards whether additional stress-incontinence surgery is indicated. The advantage of combining prolapse and stress-incontinence surgery is that only few patients report stress-incontinence following such combination. However, this combination has been associated with an increased risk on complications, of which the development of obstructive micturition symptoms, overactive bladder symptoms and bladder retention are the most important ones. Furthermore, combining two procedures may be unnecessary as performing only prolapse surgery may cure stress-incontinence In the randomized CUPIDO trials both strategies are compared in patients with prolapse and evident stress incontinence (CUPIDO I trial) and in patients with prolapse and occult stress incontinence (CUPIDO II trial). Methods/Design The CUPIDO trials are two multicenter randomized controlled trials in which women with stress urinary incontinence (SUI) or occult stress urinary incontinence (OSUI) are randomized to prolapse surgery combined with anti incontinence surgery (concomitant surgery) or to prolapse surgery only. Patients with at least stage 2 POP are eligible, women with evident SUI are randomized in CUPIDO I. Patients without SUI are eligible for CUPIDO II and will have urodynamic evaluation or a standardized redression test. Women with OSUI are randomized, women without OSUI are followed up but not randomized. The primary outcome measure is absence of SUI twelve months after surgery. Furthermore, economic evaluations are conducted, and the effectiveness of urodynamic investigation is evaluated against a non-invasive way to determine SUI in women with POP. A total of 450 women will be included in the study. Trial Registration Trial registration http://www.trialregister.nl NTRR 1197 en 1070
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Affiliation(s)
- Annemarie van der Steen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
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Elser DM, Moen MD, Stanford EJ, Keil K, Matthews CA, Kohli N, Mattox F, Tomezsko J. Abdominal sacrocolpopexy and urinary incontinence: surgical planning based on urodynamics. Am J Obstet Gynecol 2010; 202:375.e1-5. [PMID: 19683689 DOI: 10.1016/j.ajog.2009.06.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/20/2009] [Accepted: 06/05/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the use of urodynamics to determine the need for incontinence surgery at the time of abdominal sacrocolpopexy (ASC). STUDY DESIGN The records of 441 women undergoing ASC during 2005-2007 were reviewed. Group 1 consisted of 204 women (46.3%) with urodynamic stress incontinence (USI), including occult USI, who underwent incontinence surgery with ASC. Group 2 consisted of 237 women (53.7%) without USI who underwent ASC alone. Primary outcome measures were any complaint of postoperative incontinence (stress or urge) or new-onset urgency/frequency (UF). RESULTS At a mean follow-up of 46.6 weeks, the overall rate of incontinence was low and similar for both groups (13.4% in group 1 and 13.3% in group 2 [P = .967]), as was new-onset UF: 18.6% in group 1 and 11.5% in group 2 (P = .195). CONCLUSION Urodynamic evaluation appears to be useful in determining the need for incontinence surgery at the time of ASC.
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Letouzey V, Fritel X, Pierre F, Courtieu C, Marès P, de Tayrac R. [Informing a patient about surgical treatment for pelvic organ prolapse]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:255-260. [PMID: 20362480 DOI: 10.1016/j.gyobfe.2010.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 02/13/2010] [Indexed: 05/29/2023]
Abstract
Inform consent is a major objective in the relation patient-physician. Patient's information becomes doubt when it is insufficient. To answer to medical persons asking about patient's information, pretreatment clinical and paraclinical assessment will be discussed. Reflexion delay, surgical alternative therapy and pre-operatory examination will be exposed. Several critical situations, such as associated hysterectomy, patient's comorbidity (tobacco, obesity) or synthetic mesh reinforcement have to be well-known to inform patient about failures and outcomes.
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Affiliation(s)
- V Letouzey
- Service de gynécologie-obstétrique, hôpital Carémeau, CHU de Nîmes, Nîmes, France.
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Rosier PFWM, Gajewski JB, Sand PK, Szabó L, Capewell A, Hosker GL. Executive summary: The International Consultation on Incontinence 2008--Committee on: "Dynamic Testing"; for urinary incontinence and for fecal incontinence. Part 1: Innovations in urodynamic techniques and urodynamic testing for signs and symptoms of urinary incontinence in female patients. Neurourol Urodyn 2010; 29:140-5. [PMID: 19693949 DOI: 10.1002/nau.20764] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS The members of The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of faecal incontinence is also discussed. METHODS Evidence based and consensus committee report. RESULTS The chapter 'Dynamic Testing' is a continuation of previous Consultation-reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. CONCLUSION This first part of a series of three articles summarizes the committees recommendations about the innovations in urodynamic study techniques 'in general', about the test characteristics and normal values of urodynamic studies as well as the assessment of female with signs and or symptoms of incontinence and includes only the most recent and relevant literature references.
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Maintaining standards for surgery for female urinary incontinence. Maturitas 2010; 65:5-10. [DOI: 10.1016/j.maturitas.2009.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 10/22/2009] [Indexed: 11/20/2022]
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Hermieu JF. Bilan urodynamique et prolapsus. Prog Urol 2009; 19:970-4. [DOI: 10.1016/j.purol.2009.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 09/17/2009] [Indexed: 11/26/2022]
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Incontinence and detrusor dysfunction associated with pelvic organ prolapse: clinical value of preoperative urodynamic evaluation. Int Urogynecol J 2009; 20:1301-6. [PMID: 19597715 DOI: 10.1007/s00192-009-0954-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 06/21/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We examined how preoperative urodynamic findings are related to the urinary problems following surgical repair of pelvic organ prolapse (POP). METHODS The clinical records of 87 women who underwent surgery for POP were reviewed retrospectively. Preoperatively, cough stress test and urodynamic testing, including pressure-flow study, were performed with prolapse reduction. Postoperative evaluation included uroflowmetry, postvoid residuals, and symptom assessment using questionnaires. RESULTS A cough stress test with simple filling was sufficient for diagnosis of occult stress urinary incontinence (SUI). The presence of detrusor overactivity was a good predictor of postoperative persistence of urgency and urge urinary incontinence. Postvoid residuals (PVR) largely increased immediately after surgery, but usually recovered within 1 month. Poor detrusor contractility was the best predictor of large PVR occurrence. CONCLUSIONS Preoperative urodynamic evaluation of SUI and detrusor function was useful for predicting postoperative urinary conditions in POP patients. Its cost-effectiveness remains to be examined.
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Predictive value of urodynamics on outcome after midurethral sling surgery for female stress urinary incontinence. Am J Obstet Gynecol 2009; 200:649.e1-12. [PMID: 19344879 DOI: 10.1016/j.ajog.2008.12.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 09/28/2008] [Accepted: 12/22/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the value of urodynamic investigation in the preoperative workup of midurethral sling surgery and to identify risk factors for failure after 3 different midurethral sling procedures. STUDY DESIGN Retrospective cohort study. 437 women who underwent a tension-free vaginal tape, Monarc, or tension-free vaginal tape-obturator procedure without other simultaneously performed urogynecological surgery were included. Preoperative data were collected from the medical files. Patients who reported any amount of leakage were considered failures. The mean follow-up of the study population was 14 months. RESULTS After multivariate analysis, mixed urinary incontinence (P = .04), previous incontinence surgery (P = .022), and detrusor overactivity (P = .02) were significantly related to failure of midurethral sling procedures. There were no predictive urodynamic parameters for failure in patients with mixed urinary incontinence or previous incontinence surgery. CONCLUSION The standard use of urodynamic investigation in the preoperative workup of midurethral sling surgery needs to be revisited.
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Pakbaz M, Mogren I, Löfgren M. Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care. BMC WOMENS HEALTH 2009; 9:9. [PMID: 19379514 PMCID: PMC2675521 DOI: 10.1186/1472-6874-9-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 04/20/2009] [Indexed: 11/24/2022]
Abstract
Background Vaginal hysterectomy is often used to correct uterovaginal prolapse, however, there is little information regarding outcomes after surgery in routine clinical practice. The objective of this study was to investigate complications, sexual activity, urinary symptoms, and satisfaction with health care after vaginal hysterectomy due to prolapse. Methods We analyzed data from the Swedish National Register for Gynecological Surgery (SNRGS) from January 1997 to August 2005. Women participating in the SNRGS were asked to complete surveys at two and six months postoperatively. Of 941 women who underwent vaginal hysterectomy for uterovaginal prolapse, 791 responded to questionnaires at two months and 682 at six months. Complications during surgery and hospital stay were investigated. The two-month questionnaire investigated complications after discharge, and patients' satisfaction with their health care. Sexual activity and urinary symptoms were reported and compared in preoperative and six-month postoperative questionnaires. Results Almost 60% of women reported normal activity of daily life (ADL) within one week of surgery, irrespective of their age. Severe complications occurred in 3% and were mainly intra-abdominal bleeding and vaginal vault hematomas. Six months postoperative, sexual activity had increased for 20% (p = 0.006) of women and urinary urgency was reduced for 50% (p = 0.001); however, 14% (n = 76) of women developed urinary incontinence, 76% (n = 58) of whom reported urinary stress incontinence. Patients were satisfied with the postoperative result in 93% of cases and 94% recommended the surgery. Conclusion Vaginal hysterectomy is a patient-evaluated efficient treatment for uterovaginal prolapse with swift recovery and a low rate of complication. Sexual activity and symptoms of urinary urgency were improved. However, 14% developed incontinence, mainly urinary stress incontinence (11%). Therefore efforts to disclose latent stress incontinence should be undertaken preoperatively.
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Affiliation(s)
- Mojgan Pakbaz
- Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
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Aungst MJ, Mamienski TD, Albright TS, Zahn CM, Fischer JR. Prophylactic Burch colposuspension at the time of abdominal sacrocolpopexy: a survey of current practice patterns. Int Urogynecol J 2009; 20:897-904. [PMID: 19582381 DOI: 10.1007/s00192-009-0881-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the utilization of the prophylactic Burch procedure with abdominal sacrocolpopexy since the publication of the Colpopexy and Urinary Reduction Efforts (CARE) trial. METHODS Using an Internet survey, 1,134 members of the American Urogynecological Society (AUGS) were contacted in May 2008 and questioned regarding their practice patterns to prevent de novo stress incontinence after sacrocolpopexy. RESULTS Two hundred sixty-six responses were obtained for a 23% response rate. Of the 235 respondents actively performing sacrocolpopexies, 133 (57%) would not perform a prophylactic Burch colposuspension at the time of sacrocolpopexy in a woman without symptoms of stress urinary incontinence. Respondents were more likely to perform a prophylactic Burch if it had been more than 6 years since they completed residency or fellowship training. CONCLUSIONS Prophylactic Burch colposuspension at the time of abdominal sacrocolpopexy has not been uniformly implemented into clinical practice by AUGS members since the publication of the CARE Trial.
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Affiliation(s)
- Matthew J Aungst
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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A review of the concordance of diagnoses made after multi-channel urodynamics and video urodynamics in women with urinary incontinence. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:156-60. [PMID: 19327215 DOI: 10.1016/s1701-2163(16)34100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Symptoms of urinary incontinence often do not correlate well with the diagnosis provided by urodynamic investigations. Video urodynamics has been described as the "gold standard" investigation for patients with lower urinary tract symptoms. The aim of our study was to determine the concordance of diagnoses made on multi-channel and video urodynamics in women presenting with urinary incontinence to a tertiary care urogynaecology unit. MATERIALS AND METHODS We performed a retrospective chart review of 38 women who had video urodynamics and a multi-channel study completed within a one-year period. All patients had a complete history and pelvic floor assessment. The investigators completing each study were blinded to the clinical diagnoses, the physical findings, and the other urodynamics diagnoses. International Continence Society standards were followed for completion of all urodynamics investigations. Multi-channel studies were completed with the patient lying supine and video studies were performed with the patient sitting on a commode. The level of agreement of the diagnoses was calculated using a kappa (kappa) statistic with 95% confidence intervals (CI). RESULTS The median age of subjects was 61 years (range 14-79), with a median duration of lower urinary tract symptoms of 6.0 years (range 0.5-41). Patients had had a median of two previous bladder surgeries (range 0-5). The level of concordance of the two diagnoses gave a kappa of 0.16 (95% CI 0.06-0.26). CONCLUSIONS There was poor concordance between the diagnoses made on multi-channel and video urodynamics when the two tests were performed on the same patient. Prospective studies are required to evaluate the reproducibility of diagnoses made on cystometry.
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Clinical-decision taking in primary pelvic organ prolapse; the effects of diagnostic tests on treatment selection in comparison with a consensus meeting. Int Urogynecol J 2009; 20:711-9. [DOI: 10.1007/s00192-009-0846-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 02/15/2009] [Indexed: 12/20/2022]
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Shek KL, Rane A, Goh J, Dietz HP. Stress urinary incontinence after transobturator mesh for cystocele repair. Int Urogynecol J 2008; 20:421-5. [DOI: 10.1007/s00192-008-0789-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 12/02/2008] [Indexed: 11/28/2022]
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Ricci Arriola P, Solà Dalenz V, Pardo Schanz J. [Occult stress incontinence identified by preoperative urodynamic study in women with severe pelvic organ prolapse]. Actas Urol Esp 2008; 32:827-32. [PMID: 19013982 DOI: 10.1016/s0210-4806(08)73942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the effectiveness of preoperative urodynamic study made with correction of the severe genital prolapse by Bresky valve in the diagnosis of urinary occult incontinence, in order to plan a correction with a prophylactic sub-mid urethral mesh in the prolapse surgery. PATIENTS AND METHOD Patients of the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic, between January 2006 and December 2007, with grade III or IV cystocele. A condition was patients without previous prolapse and/or incontinence surgeries. A non multichannel urodynamics test was made with prolapse correction by a Bresky valve. The urethra retro resistance measurement and cystometry was made. In the women in whom the occult urinary incontinence was discards the prolapse surgery was made with Prolift mesh. In the women with occult incontinence a prophylactic sub-mid urethral tape was applied in the prolapse surgery, to avoid the appearance of incontinence after surgery. RESULTS Thirty eight women fulfilled the criterion to enter in this study, 14 (36.8%) of them did not register occult urinary incontinence in the urodynamic test. In the 24 (63.2%) with occult incontinence: Type I in 1: type II in 2: type III in 1 and type II+III in 10. During the cystometry 3 of them registered an asymptomatic hyperactive detrusor. In 1 (4.2%) of the 24 patients with prophylactic incontinence surgery, in the immediate postoperative time a failure was observed. The rest 23 women did not present incontinence during the observation period between 4 to 24 months. In the 14 women only with prolapse surgery incontinence was not registered. CONCLUSIONS The preoperative urodynamic test with correction of severe genital prolapse by Bresky valve is an efficient method to detect the occult urinary incontinence. This allows planning a prophylactic incontinence surgery. According to our experience this method is safe and effective to avoid that the occult incontinence appears after a severe cystocele surgery repair and allows to given an integral solution to the pelvic floor problems that frequently sees associate, because they risk factors are the same to these conditions and both cause a high degree of deterioration of quality of life.
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Affiliation(s)
- P Ricci Arriola
- Unidad de Uroginecología, Departamento de Ginecología, Clínica Las Condes, Santiago, Chile.
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Reutilization of the Prolift™ system for the simultaneous correction of prolapse and incontinence in patients with pelvic organ prolapse and stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2008; 141:79-82. [DOI: 10.1016/j.ejogrb.2008.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Revised: 02/05/2008] [Accepted: 03/23/2008] [Indexed: 11/23/2022]
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Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? An overview. Int Urogynecol J 2008; 20:235-45. [PMID: 18936868 DOI: 10.1007/s00192-008-0734-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 09/18/2008] [Indexed: 11/27/2022]
Abstract
Postoperative SUI prevention at the time of prolapse surgery is still a challenging issue. Recent findings suggested that a systematic prophylactic Burch colposuspension could be performed in continent women undergoing a sacral colpopexy. The aim of this paper is to collect relevant literature in order to suggest a management strategy. A thorough PubMed research of all papers in the English language was conducted. Evidence-based medicine was analyzed and current unanswered questions were discussed. Despite evident limitations, it appears to be some benefit from preoperative screening with a stress test during prolapse reduction. In continent patient with a positive stress test, adding a preventive procedure could be fully justified. In regard to contradictory published data, when negative stress test, patient counseling is important and the ratio of risk-benefit should be rigorously discussed. Further randomized controlled studies are needed to support either a prophylactic or a second-step strategy.
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De Vita D, Araco F, Gravante G, Sesti F, Piccione E. Vaginal reconstructive surgery for severe pelvic organ prolapses: a 'uterine-sparing' technique using polypropylene prostheses. Eur J Obstet Gynecol Reprod Biol 2008; 139:245-51. [PMID: 18321633 DOI: 10.1016/j.ejogrb.2008.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 01/09/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Ulmsten's "Integral Theory" for pelvic floor dysfunctions is based on the need to reinforce fascias and ligaments with prostheses to obtain a reconstitution of the pelvic floor's anatomy. In September 2004 we developed a "uterine-sparing" surgical technique to correct such pathologies and in this paper we present results obtained. Primary outcome was to evaluate the technique's efficacy, secondary outcomes the resolution of stress urinary incontinence, postoperative pain (VAS scale), safety and complications. STUDY DESIGN This prospective study included patients affected by stage 3 and 4 uterine-vaginal prolapse who wished to conserve their uterus. Those with (1) minor degrees of severity, (2) unfit for surgery, (3) with a clear indication to hysterectomy (i.e. endometrial cancer), (4) with an elevated operative risk (American Society of Anaesthesiologists-ASA score III and IV), (5) previous vaginal surgeries and (6) with moderate/severe defecation problems were excluded. The technique consisted in a sacrospinous colposuspension with polypropylene mesh. The pelvic status was classified according to the international Pelvic Organ Prolapse staging system (POP-Q). Postoperative pain was scored with the VAS Scale. All patients were given the King's Health questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Wexner questionnaire. RESULTS From September 2004 to November 2006 we treated 80 patients. Polypropylene prostheses (Gynemesh-Soft PS, 10cmx15cm - GyneMesh, Gynecare Ethicon - Somerville, NJ, USA) were used to reconstruct the pubo-cervix or the recto-vaginal fascia. We performed an anterior-central vaginal reconstruction in 35 (43.8%) patients, central-posterior in 25 (31%) and total reconstruction in 20 (25%). The median follow-up was 21 months (range 18-26). The severe pelvic prolapse, evaluated with the POP-Q System, was completely treated in all the patients and no recurrences were observed. The urodynamic examination showed a complete resolution of the stress urinary incontinence in 10 patients (83%). Sexual activities improved in all patients. We recorded three vaginal erosions and one patient complained of a postoperative dyspareunia. CONCLUSIONS This pilot study suggests that our technique is safe and effective and can efficiently repair the pelvic organs prolapse, without undergoing hysterectomy and with a low rate of vaginal erosions.
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Affiliation(s)
- D De Vita
- Section of Obstetrics and Gynecology, S.Francesco D'Assisi, Oliveto Citra, SA, Italy
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