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Kumbasar S, Salman S, Sogut O, Gencer FK, Bacak HB, Tezcan AD, Timur GY. Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse. J Obstet Gynaecol Res 2023; 49:341-349. [PMID: 36196844 DOI: 10.1111/jog.15459] [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: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. METHODS LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. RESULTS The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p ˂ 0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. CONCLUSION LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.
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Affiliation(s)
- Serkan Kumbasar
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Suleyman Salman
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ozlem Sogut
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Fatma K Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Havva B Bacak
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ayse D Tezcan
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Gözde Y Timur
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
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Gan ZS, Roberson DS, Smith AL. Role of Hysteropexy in the Management of Pelvic Organ Prolapse. Curr Urol Rep 2022; 23:175-183. [PMID: 35789456 DOI: 10.1007/s11934-022-01101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To discuss considerations for hysteropexy for apical pelvic organ prolapse (POP) and summarize available literature comparing various hysteropexy techniques to analogous procedures involving hysterectomy. RECENT FINDINGS Hysteropexy for apical POP has increased in popularity in recent years, although anatomic factors and gynecologic cancer risk must be taken into account. Native tissue hysteropexy options include the LeFort colpocleisis, sacrospinous hysteropexy, and uterosacral hysteropexy. Although vaginal mesh was banned by the Food and Drug Administration in 2019, abdominal mesh sacrohysteropexy done either open or laparoscopically remains an option in the USA. Overall, short-term prolapse outcomes appear to be comparable between uterus-sparing approaches and hysterectomy, with less blood loss and shorter operating room time observed with the uterine-sparing approaches, although long-term outcome data remains variable and limited. Uterine-sparing apical POP repair may be offered to appropriate patients without certain risk factors, although longer-term data will be required to evaluate durability.
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Affiliation(s)
- Zoe S Gan
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, PCAM 3-334W, Philadelphia, PA, 19104, USA.
| | - Daniel S Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, PCAM 3-334W, Philadelphia, PA, 19104, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, PCAM 3-334W, Philadelphia, PA, 19104, USA
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Lipetskaia L, Gonzalez RR, Wu JM, Northington GM, Henley BR, Lane F, Brucker BM, Jarnagin B, Rosenblatt PL. 36-Month Prospective Study of Transvaginal Bovine Graft versus Native Tissue Repair for the Treatment of Pelvic Organ Prolapse. Urology 2022; 167:234-240. [PMID: 35716871 DOI: 10.1016/j.urology.2022.06.003] [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: 02/01/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE(S) To compare the safety and effectiveness of dermal bovine transvaginal graft, Xenform, to native tissue in the surgical treatment of anterior and/or apical pelvic organ prolapse. This study was designed in conjunction with FDA requirements. METHODS This was a prospective, non-randomized, parallel cohort, multi-center trial. The primary objective was to demonstrate non-inferiority between transvaginal graft and native tissue repair at 36 months compared to baseline. Treatment success was based on a composite of objective and subjective measures. The co-primary outcome was the rate of serious device- or procedure-related adverse events. A total of 228 patients at 25 sites were included in the study arm and 485 patients underwent native tissue repair. Propensity score stratification was applied to achieve balance between treatment groups. Study outcomes were compared in per protocol and intent-to-treat analysis. RESULTS The primary outcome, treatment success at 36 months, was 83.6% (191/228) for transvaginal graft and 80.5% (390/485) native tissue repair (0.2%, 90%CI [-5.6%, 5.9%]), demonstrating non-inferiority at a preset margin of -12%. The overall rate of severe adverse events was 5.3% (12/228) in transvaginal graft vs 2.7% (13/485) in native tissue repair groups. The study group demonstrated non-inferiority in serious adverse events at the preset margin of 11.6% (2.0%, 90%CI [-0.8%, 4.7%]). There were no reports of graft erosion, and graft exposure rates were low (0.9% [2/228]). CONCLUSIONS Transvaginal repair of anterior and/or apical prolapse with a biological graft is non-inferior to traditional native tissue repair in effectiveness and safety at 36 months.
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Affiliation(s)
- Lioudmila Lipetskaia
- Program Director, Female Pelvic Medicine & Reconstructive Surgery Fellowship, Department of Obstetrics and Gynecology, Cooper University Health Care, Assistant Professor Cooper Medical School of Rowan University, 3 Cooper Plaza Suite #220, Camden, NJ 08103.
| | - Ricardo R Gonzalez
- Program Director, Urology Fellowship in Female Pelvic Medicine & Reconstructive Surgery, Weill Cornell College of Medicine, Houston Methodist Hospital Academic Institute, 6560 Fannin Street, Suite 2100, Houston, TX 77030
| | - Jennifer M Wu
- Interim Vice Dean for Academic Affairs, Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, 4030 Bondurant Hall, Campus Box 7000, Chapel Hill, NC 27599
| | - Gina M Northington
- Associate Professor and Director, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
| | - Barbara R Henley
- Section Chief & Associate Professor, Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Medical College of Georgia at Augusta University, 1120 15th Street, BB 7514, Augusta, GA 30912
| | - Felicia Lane
- Division Director and Urogynecology Fellowship Director, Department of Obstetrics and Gynecology, University of California, Irvine, 333 City Blvd W Suite 1400, Orange, CA 92868
| | - Benjamin M Brucker
- Director, Division of Female Pelvic Medicine & Reconstructive Surgery and Neurourology, Program Director, FPMRS Fellowship, Departments of Urology and Obstetrics & Gynecology, New York University, Langone Health, 550 First Avenue, New York, NY 10016
| | - Barry Jarnagin
- Medical Director, Center for Pelvic Health, 100 Covey Drive, Suite 205, Franklin, TN 37067
| | - Peter L Rosenblatt
- Director of Urogynecology, Boston Urogynecology Associates / Mount Auburn Hospital, Assistant Professor of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, 725 Concord Avenue, Suite 3500, Cambridge, MA 02138
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Salman S, Kumbasar S, Yeniocak AS. Uterine preserving technique in the treatment of pelvic organ prolapse: Laparoscopic pectopexy. J Obstet Gynaecol Res 2022; 48:850-856. [PMID: 35001452 DOI: 10.1111/jog.15146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/28/2021] [Accepted: 12/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Apical prolapse constitutes an important part of pelvic organ prolapse. In this study, our aim was to investigate the effectiveness of laparoscopic pectopexy that we made by preserving the uterus in the surgical treatment of apical prolapse. METHODS A total of 36 patients with apical prolapse who wanted to preserve their uterus underwent laparoscopic rectopexy. Apical prolapse and sexual function of the patients were evaluated preoperatively and 12 months after surgery using the Pelvic Organ Prolapse Quantification (POP-Q) scale and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) sexual questionnaire form. Preoperative medical records and postoperative clinical results were recorded. RESULTS There were no intraoperative or postoperative complications in the patients who underwent laparoscopic pectopexy. The average duration of surgery was 48.7 ± 9.8 min. Two patients had a recurrence of apical prolapse. In the Aa, Ba, C, and D points in the POP-Q staging, significant changes were observed. Postoperative PISQ-12 scores improved significantly (p < 0.05). CONCLUSION Uterine-preserving laparoscopic pectopexy is a safe, feasible, and effective method for treating pelvic organ prolapse. It also improved the PISQ-12 and POP-Q scores in POP patients. Laparoscopic pectopexy may increase a surgeon's technical perspective for pelvic organ prolapse surgery.
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Affiliation(s)
- Süleyman Salman
- Department of Obstetrics and Gynecology, Gazi Osman Paşa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Serkan Kumbasar
- Department of Obstetrics and Gynecology, Gazi Osman Paşa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Ali S Yeniocak
- Department of Obstetrics and Gynecology, Başakşehir Çam ve Sakura Research and Education Hospital, Istanbul, Turkey
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Hemming C, Constable L, Goulao B, Kilonzo M, Boyers D, Elders A, Cooper K, Smith A, Freeman R, Breeman S, McDonald A, Hagen S, Montgomery I, Norrie J, Glazener C. Surgical interventions for uterine prolapse and for vault prolapse: the two VUE RCTs. Health Technol Assess 2021; 24:1-220. [PMID: 32138809 DOI: 10.3310/hta24130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND New surgical approaches for apical prolapse have gradually been introduced, with few prospective randomised controlled trial data to evaluate their safety and efficacy compared with traditional methods. OBJECTIVE To compare surgical uterine preservation with vaginal hysterectomy in women with uterine prolapse and abdominal procedures with vaginal procedures in women with vault prolapse in terms of clinical effectiveness, adverse events, quality of life and cost-effectiveness. DESIGN Two parallel randomised controlled trials (i.e. Uterine and Vault). Allocation was by remote web-based randomisation (1 : 1 ratio), minimised on the need for concomitant anterior and/or posterior procedure, concomitant incontinence procedure, age and surgeon. SETTING UK hospitals. PARTICIPANTS Uterine trial - 563 out of 565 randomised women had uterine prolapse surgery. Vault trial - 208 out of 209 randomised women had vault prolapse surgery. INTERVENTIONS Uterine trial - uterine preservation or vaginal hysterectomy. Vault trial - abdominal or vaginal vault suspension. MAIN OUTCOME MEASURES The primary outcome measures were women's prolapse symptoms (as measured using the Pelvic Organ Prolapse Symptom Score), prolapse-specific quality of life and cost-effectiveness (as assessed by incremental cost per quality-adjusted life-year). RESULTS Uterine trial - adjusting for baseline and minimisation covariates, the mean Pelvic Organ Prolapse Symptom Score at 12 months for uterine preservation was 4.2 (standard deviation 4.9) versus vaginal hysterectomy with a Pelvic Organ Prolapse Symptom Score of 4.2 (standard deviation 5.3) (mean difference -0.05, 95% confidence interval -0.91 to 0.81). Serious adverse event rates were similar between the groups (uterine preservation 5.4% vs. vaginal hysterectomy 5.9%; risk ratio 0.82, 95% confidence interval 0.38 to 1.75). There was no difference in overall prolapse stage. Significantly more women would recommend vaginal hysterectomy to a friend (odds ratio 0.39, 95% confidence interval 0.18 to 0.83). Uterine preservation was £235 (95% confidence interval £6 to £464) more expensive than vaginal hysterectomy and generated non-significantly fewer quality-adjusted life-years (mean difference -0.004, 95% confidence interval -0.026 to 0.019). Vault trial - adjusting for baseline and minimisation covariates, the mean Pelvic Organ Prolapse Symptom Score at 12 months for an abdominal procedure was 5.6 (standard deviation 5.4) versus vaginal procedure with a Pelvic Organ Prolapse Symptom Score of 5.9 (standard deviation 5.4) (mean difference -0.61, 95% confidence interval -2.08 to 0.86). The serious adverse event rates were similar between the groups (abdominal 5.9% vs. vaginal 6.0%; risk ratio 0.97, 95% confidence interval 0.27 to 3.44). The objective anterior prolapse stage 2b or more was higher in the vaginal group than in the abdominal group (odds ratio 0.38, 95% confidence interval 0.18 to 0.79). There was no difference in the overall prolapse stage. An abdominal procedure was £570 (95% confidence interval £459 to £682) more expensive than a vaginal procedure and generated non-significantly more quality-adjusted life-years (mean difference 0.004, 95% confidence interval -0.031 to 0.041). CONCLUSIONS Uterine trial - in terms of efficacy, quality of life or adverse events in the short term, no difference was identified between uterine preservation and vaginal hysterectomy. Vault trial - in terms of efficacy, quality of life or adverse events in the short term, no difference was identified between an abdominal and a vaginal approach. FUTURE WORK Long-term follow-up for at least 6 years is ongoing to identify recurrence rates, need for further prolapse surgery, adverse events and cost-effectiveness. TRIAL REGISTRATION Current Controlled Trials ISRCTN86784244. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 13. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
| | - Lynda Constable
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professionals Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - Kevin Cooper
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Anthony Smith
- St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Suzanne Breeman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professionals Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - Isobel Montgomery
- Independent patient representative, c/o Health Services Research Unit, Aberdeen, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Akbaba E, Sezgin B. Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery. BMC WOMENS HEALTH 2021; 21:244. [PMID: 34130664 PMCID: PMC8207729 DOI: 10.1186/s12905-021-01388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022]
Abstract
Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.
Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.
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Affiliation(s)
- Eren Akbaba
- Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Burak Sezgin
- Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
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Li PC, Ding DC. Outcomes of laparoscopic hysteropexy and supracervical hysterectomy plus cervicopexy: A retrospective study. Tzu Chi Med J 2020; 32:262-266. [PMID: 32955524 PMCID: PMC7485679 DOI: 10.4103/tcmj.tcmj_131_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives: The objective of this study is to compare the outcomes of laparoscopic hysteropexy (LHP) and laparoscopic supracervical hysterectomy plus cervicopexy (LSHCP) for the treatment of pelvic organ prolapse (POP). Materials and Methods: We retrospectively included patients who had undergone laparoscopic sacral hysteropexy or hysterectomy plus cervicopexy between January 2015 and May 2019 at Hualien Tzu Chi Hospital, Taiwan. Age at surgery, body mass index (BMI) at admission, the initial stage of genital prolapse, operative and postoperative data, and anatomical results were recorded. Cure for uterine prolapse was evaluated objectively through vaginal examinations using the POP quantification scale. Visual analog scale (VAS) scores were recorded at 24 h postoperatively. The Mann–Whitney U-test was used to compare continuous variables. Results: A total of 23 women were included in the study; 12 had received LHP (n = 12) and 11 had received LSHCP (n = 11). No differences existed in age, parity, BMI, blood loss, or hospital stay between groups. The difference in mean surgical times between the LHP and LSHCP groups was nonsignificant (154 and 176 min, respectively; P = 0.2). VAS scores were significantly lower in the LSHCP group than in the LHP group (0.1 vs. 1.75; P = 0.004). Furthermore, mean hospital stay was significantly longer in the LSHCP group than in the LHP group (4.0 vs. 3.1 days; P = 0.016). The procedure was successful in 100% of patients (23 of 23), with no objective evidence of uterine prolapse on examination at follow-up at 6 months. Conclusion: LHP had a significantly shorter hospital stay and a higher VAS score than LSHCP. LHP and LSHCP are both feasible and effective procedures for correcting uterine prolapse.
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Affiliation(s)
- Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Mereu L, Tateo S, D'Alterio MN, Russo E, Giannini A, Mannella P, Pertile R, Cai T, Simoncini T. Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Eur J Obstet Gynecol Reprod Biol 2019; 244:16-20. [PMID: 31770687 DOI: 10.1016/j.ejogrb.2019.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). STUDY DESIGN A prospective cohort study on 125 patients with vaginal bulge and apical +/- anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa. The main outcome measure was anatomic and symptomatic POP outcome; the secondary outcomes measures were recurrence, reoperation rate, de novo posterior POP and complications. Percentage distribution of the pre- and postoperative POP-Q stages was compared at mean follow-up. Wilcoxon signed rank sum test was used to compare preoperative POP-Q stage and postoperative POP-Q stage ate mean follow up, for each patient (paired data) and for each type of prolapse. RESULTS 120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment. Concerning posterior compartment prolapse 2 (1.7 %) patients referred stage 3 de novo prolapse during follow-up. The complication rate of Clavien-Dindo >3 was 0,8 %. Repeat surgery for POP occurred in 6.4 % of cases. The appearance of POP-Q recurrences was concentrated at 6 months follow-up. BMI > 25 was correlated with de novo posterior compartment appearance during follow-up. CONCLUSIONS LLS for the treatment of apical and anterior POP is a technique with optimal results in term of safety and effectiveness after 2 years follow-up.
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Affiliation(s)
- Liliana Mereu
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy.
| | - Saverio Tateo
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy
| | - Maurizio Nicola D'Alterio
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy; University of Cagliari, Italy
| | - Eleonora Russo
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Andrea Giannini
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Paolo Mannella
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Department - Trento Health Service, Trento, Italy
| | - Tommaso Cai
- Department of Urology, S Chiara Hospital, Trento, Italy
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Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M, Grimes CL, Sleemi A, Singh R, Dieter AA, Crisp CC, Rahn DD. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol 2018; 219:129-146.e2. [PMID: 29353031 DOI: 10.1016/j.ajog.2018.01.018] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to systematically review the literature on apical pelvic organ prolapse surgery with uterine preservation compared with prolapse surgeries including hysterectomy and provide evidence-based guidelines. DATA SOURCES The sources for our data were MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to January 2017. STUDY ELIGIBILITY CRITERIA We accepted randomized and nonrandomized studies of uterine-preserving prolapse surgeries compared with those involving hysterectomy. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality. If 3 or more studies compared the same surgeries and reported the same outcome, a meta-analysis was performed. RESULTS We screened 4467 abstracts and identified 94 eligible studies, 53 comparing uterine preservation to hysterectomy in prolapse surgery. Evidence was of moderate quality overall. Compared with hysterectomy plus mesh sacrocolpopexy, uterine preservation with sacrohysteropexy reduces mesh exposure, operative time, blood loss, and surgical cost without differences in prolapse recurrence. Compared with vaginal hysterectomy with uterosacral suspension, uterine preservation in the form of laparoscopic sacrohysteropexy improves the C point and vaginal length on the pelvic organ prolapse quantification exam, estimated blood loss, postoperative pain and functioning, and hospital stay, but open abdominal sacrohysteropexy worsens bothersome urinary symptoms, operative time, and quality of life. Transvaginal mesh hysteropexy (vs with hysterectomy) decreases mesh exposure, reoperation for mesh exposure, postoperative bleeding, and estimated blood loss and improves posterior pelvic organ prolapse quantification measurement. Transvaginal uterosacral or sacrospinous hysteropexy or the Manchester procedure compared with vaginal hysterectomy with native tissue suspension both showed improved operative time and estimated blood loss and no worsening of prolapse outcomes with uterine preservation. However, there is a significant lack of data on prolapse outcomes >3 years after surgery, the role of uterine preservation in obliterative procedures, and longer-term risk of uterine pathology after uterine preservation. CONCLUSION Uterine-preserving prolapse surgeries improve operating time, blood loss, and risk of mesh exposure compared with similar surgical routes with concomitant hysterectomy and do not significantly change short-term prolapse outcomes. Surgeons may offer uterine preservation as an option to appropriate women who desire this choice during apical prolapse repair.
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Affiliation(s)
- Kate V Meriwether
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY.
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Cedric K Olivera
- Department of Obstetrics and Gynecology, New York University, New York, NY
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Miles Murphy
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, PA
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | | | - Ruchira Singh
- Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, FL
| | - Alexis A Dieter
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | | | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX
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Li C, Shu H, Dai Z. Laparoscopic inguinal ligament suspension with uterine preservation for pelvic organ prolapse: A retrospective cohort study. Int J Surg 2018; 54:28-34. [PMID: 29673691 DOI: 10.1016/j.ijsu.2018.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To introduce an alternative surgical technique of laparoscopic inguinal ligament suspension (LILS) with uterine preservation and evaluate its efficacy and safety for patients with severe pelvic organ prolapse (POP). METHODS Between June 2014 and December 2015, 35 patients with symptomatic stage III or IV were treated by LILS with uterine preservation. The perioperative parameters including surgical time, blood loss, hospital stay and complications were recorded. The anatomical cure rate was evaluated according to the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. The anatomical points were analyzed by dynamic Magnetic Resonance Imaging (MRI). Validated questionnaire of the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12) were recorded to evaluate the symptom severity, quality of life and sexual activity. RESULTS The mean surgical time was 163.8 ± 42.3 min (range: 120-280 min), the mean estimated blood loss was 48.6 ± 60.5 ml (range: 10-200 ml), and the mean hospital stay was 5 days (range: 3-7 days). No intra-operative complications were encountered. The anatomical success rate at postoperative 6-month and 12-month was 97.1% and 94.3%, respectively. The postoperative anatomical points on straining showed a significant improvement on dynamic MRI as compared to baselines. The symptom severity, quality of life and sexual activity also presented significant improvement both 6-month and 12-month after surgery. After a minimal 12 months follow-up, no postoperative complications occurred and the recurrence prolapse were low. CONCLUSION LILS with uterine preservation is a feasible, effective and safe surgical alternative in the treatment of POP for patients who desire to reserve uterus. Longer follow-up data from larger studies are required to confirm the benefits of LILS with uterine preservation as a minimally invasive surgical approach.
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Affiliation(s)
- Chunbo Li
- Department of Gynaecology and Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huimin Shu
- Department of Gynaecology and Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiyuan Dai
- Department of Gynaecology and Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
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Bradley S, Gutman RE, Richter LA. Hysteropexy: an Option for the Repair of Pelvic Organ Prolapse. Curr Urol Rep 2018; 19:15. [DOI: 10.1007/s11934-018-0765-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Owing to growing interest in uterine preservation, this evidence-based review compares hysteropexy with hysterectomy during surgery for uterovaginal prolapse. RECENT FINDINGS LeFort colpocleisis is preferred over vaginal hysterectomy and total colpocleisis. The majority of studies show no differences in outcomes comparing sacrospinous hysteropexy with vaginal hysterectomy native tissue prolapse repair except for a single randomized controlled trial showing increased apical recurrences with advanced prolapse. Results comparing uterosacral hysteropexy and sacral hysteropexy with hysterectomy native tissue repairs are inconclusive. Potentially better outcomes are reported when laparoscopic hysterectomy (total or supracervical) is performed with sacral colpopexy compared with laparoscopic sacral hysteropexy, but mesh and morcellation risks should be considered. Data comparing vaginal mesh hysteropexy with currently available products with hysterectomy prolapse repairs are lacking but a high-quality study is underway. SUMMARY High satisfaction and low reoperation rates can be accomplished using a variety of hysteropexy techniques. The advantages and disadvantages of uterine conservation must be considered when planning uterovaginal prolapse surgery. The type of hysteropexy and possible graft configuration may impact reoperation rates for recurrent prolapse. Vaginal mesh risks must be considered and laparoscopic mesh risks must be balanced with potential difficulty of future hysterectomy if needed.
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Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis. Int Urogynecol J 2017; 28:1617-1630. [PMID: 28780651 DOI: 10.1007/s00192-017-3433-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate. METHODS We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life. RESULTS Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88-3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26-88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13-3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference -12.43 min; 95% CI -14.11 to -10.74 ; p < 0.00001) and less blood loss (mean difference -60.42 ml; 95% CI -71.31 to -49.53 ml; p < 0.00001). Other variables were similar between the groups. CONCLUSIONS Overall, the rate of recurrence of uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.
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Fink K, Shachar IB, Braun NM. Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction. Int Braz J Urol 2017; 42:773-8. [PMID: 27564289 PMCID: PMC5006774 DOI: 10.1590/s1677-5538.ibju.2015.0656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/19/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus. MATERIALS AND METHODS This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient's satisfaction. RESULTS Sixty-six patients with pelvic organ prolapse stage 3, including uterine prolapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at -6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus. CONCLUSIONS Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.
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Affiliation(s)
- Keshet Fink
- Bar Ilan University - Faculty of health, Safed, Israel
| | - Inbar Ben Shachar
- Bar Ilan University - Faculty of health, Safed, Israel.,Ziv Medical Center - Ob/Gyn, Safed, Israel
| | - Naama Marcus Braun
- Bar Ilan University - Faculty of health, Safed, Israel.,Ziv Medical Center - Ob/Gyn, Safed, Israel
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Pere M, Gomelsky A. Uterine Prolapse and Preservation Methods: a Literature Review. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Forde JC, Chughtai B, Anger JT, Mao J, Sedrakyan A. Role of concurrent vaginal hysterectomy in the outcomes of mesh-based vaginal pelvic organ prolapse surgery. Int Urogynecol J 2017; 28:1183-1195. [PMID: 28091710 DOI: 10.1007/s00192-016-3244-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Hysterectomy is often performed at the time of pelvic organ prolapse (POP) surgery; yet, there is insufficient evidence regarding the specific effect of hysterectomy on outcomes. We sought to determine the outcomes and associated short-term complications of mesh-based POP surgery with and without concurrent hysterectomy. METHODS We utilized the New York Statewide Planning and Research Cooperation System (SPARCS) database to identify patients under 55 years of age undergoing surgeries for POP with mesh between 2009 and 2014. Patients who had a hysterectomy at the time of mesh-based POP surgery were compared with those who underwent mesh-based POP surgery without hysterectomy. Outcome measures of the patient groups before and after propensity score matching were compared. We assessed the difference Chi-squared tests and log-rank tests in the entire cohort and Mantel-Haenszel stratified Chi-squared tests and Prentice-Wilcoxon tests in the matched cohort. RESULTS A total of 1,601 women underwent mesh-based POP surgery. 921 patients underwent concurrent hysterectomy, whereas 680 had mesh-based uterine-preserving POP surgery. After propensity score matching, there was no difference in reintervention rates between groups for up to 3 years. Concurrent hysterectomy with mesh-based POP repair was consistently associated with longer hospitalization (20.0% vs 12.8% stayed longer than 2 days) and higher charges (median charges were $22,689 vs $19,273). CONCLUSIONS Concurrent hysterectomy during mesh-based POP surgery in patients under 55 years led to more expensive charges and a longer stay compared with uterine-preserving mesh surgery. There was no difference in reintervention rates between groups for up to 3 years.
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Affiliation(s)
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA.
| | - Jennifer T Anger
- Department of Urologic Reconstruction, Urodynamics, and Female Urology, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
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Nair R, Nikolopoulos K, Claydon L. Clinical outcomes in women undergoing laparoscopic hysteropexy: A systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 208:71-80. [DOI: 10.1016/j.ejogrb.2016.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/18/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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SONG W, KIM TH, CHUNG JW, CHO WJ, LEE HN, LEE YS, LEE KS. Anatomical and Functional Outcomes of Prolift Transvaginal Mesh for Treatment of Pelvic Organ Prolapse. Low Urin Tract Symptoms 2016; 8:159-164. [DOI: 10.1111/luts.12090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Wan SONG
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Tae Heon KIM
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jin Woo CHUNG
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Won Jin CHO
- Department of Urology; Chosun University Hospital, Chosun University School of Medicine; Gwangju Korea
| | - Ha Na LEE
- Department of Urology; Ewha Womans University Medical Center, Seoul Seonam Hospital; Seoul Korea
| | - Young Suk LEE
- Department of Urology; Samsung Changwon Hospital, Sungkyunkwan University School of Medicine; Changwon Korea
| | - Kyu-Sung LEE
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
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Cayrac M, Warembourg S, Le Normand L, Fatton B. L’hystérectomie modifie-t-elle les résultats anatomiques et fonctionnels de la cure de prolapsus ? : Recommandations pour la pratique clinique. Prog Urol 2016; 26 Suppl 1:S73-88. [DOI: 10.1016/s1166-7087(16)30430-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ilhan TT, Sivaslioglu A, Ilhan T, Uçar MG, Dolen İ. Comparison of the Efficiency of Posterior Intravaginal Sling (PIVS) Procedure in Older and Younger Groups. J Clin Diagn Res 2016; 10:QC05-7. [PMID: 27630908 PMCID: PMC5020235 DOI: 10.7860/jcdr/2016/18360.8104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Vaginal vault prolapsus is a challenging problem for the patients and physicians. There may be differences between young and elderly patients in terms of efficiency and safety of surgical procedures. AIM The aim of our study was to compare the efficiency of the Posterior Intravaginal Sling (PIVS) procedure in older versus younger patient groups. MATERIALS AND METHODS A total of 40 patients who underwent the PIVS procedure were chosen. Twenty of these patients were younger than 60 years of age (Group I) while the other 20 patients were 60 years of age or older (Group II). Preoperative Pelvic Organ Prolapsed Quantification (POP-Q) reference points were compared with postoperative data at the first year following surgery. Student's t-test was used to analyse continuous variables and the χ(2) test was used to analyse categorical data. The Mann-Whitney test was used for data that were not normally distributed. RESULTS Anatomical cure rates were 90 percent in both groups (p=1.00). There were significantly greater improvements in POP-Q points in group I than group II. CONCLUSION It could be concluded that PIVS as minimally invasive procedure for vaginal vault prolapsed and is effective in all age groups.
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Affiliation(s)
- Tolgay Tuyan Ilhan
- Assistant Professor, Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | - Akin Sivaslioglu
- Associate Professor, Katip Celebi University, Ataturk Training and Research Hospital, Obstetrics and Gynecology Clinics, Izmir, Turkey
| | - Türkan Ilhan
- Assistant Professor, Beyhekim State Hospital, Konya, Turkey
| | - Mustafa Gazi Uçar
- Assistant Professor, Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | - İsmail Dolen
- Associate Professor, Etlik Zubeyde Hanım Women’s and Maternity Research and Training Hospital, Ankara, Turkey
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Jefferis H, Jackson SR, Price N. Management of uterine prolapse: is hysterectomy necessary? ACTA ACUST UNITED AC 2016. [DOI: 10.1111/tog.12220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helen Jefferis
- Department of Urogynaecology; Women's Centre; John Radcliffe Hospital; Headley Way Oxford OX3 9DU UK
| | - Simon Robert Jackson
- Department of Urogynaecology; Women's Centre; John Radcliffe Hospital; Headley Way Oxford OX3 9DU UK
| | - Natalia Price
- Department of Urogynaecology; Women's Centre; John Radcliffe Hospital; Headley Way Oxford OX3 9DU UK
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Huang LY, Chu LC, Chiang HJ, Chuang FC, Kung FT, Huang KH. Medium-term comparison of uterus preservation versus hysterectomy in pelvic organ prolapse treatment with Prolift™ mesh. Int Urogynecol J 2015; 26:1013-20. [DOI: 10.1007/s00192-015-2630-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/27/2014] [Indexed: 11/28/2022]
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Coskun B, Lavelle RS, Alhalabi F, Christie AL, Zimmern PE. Anterior Vaginal Wall Suspension Procedure for Moderate Bladder and Uterine Prolapse as a Method of Uterine Preservation. J Urol 2014; 192:1461-7. [DOI: 10.1016/j.juro.2014.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Burhan Coskun
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Feras Alhalabi
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Alana L. Christie
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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Gracia M, Perelló M, Bataller E, Espuña M, Parellada M, Genís D, Balasch J, Carmona F. Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: A pilot study. Neurourol Urodyn 2014; 34:654-8. [DOI: 10.1002/nau.22641] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/29/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Meritxell Gracia
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Maria Perelló
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Eduardo Bataller
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Montserrat Espuña
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Montserrat Parellada
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Dolores Genís
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Joan Balasch
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
| | - Francisco Carmona
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Hospital Clínic Barcelona; Barcelona Spain
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Abstract
INTRODUCTION AND HYPOTHESIS The aim was to determine the incidence and prevalence of pelvic organ prolapse surgery and describe how outcomes are reported. METHODS Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews, level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. A grade A recommendation usually depends on consistent level 1 evidence. A grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. A grade C recommendation usually depends on level 4 studies or "majority evidence" from level 2/3 studies or Delphi processed expert opinion. A grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi . RESULTS Pelvic organ prolapse (POP) when defined by symptoms has a prevalence of 3-6% and up to 50% when based upon vaginal examination. Surgery for prolapse is performed twice as commonly as continence surgery and prevalence varies widely from 6 to 18%. The incidence of POP surgery ranges from 1.5 to 1.8 per 1,000 women years and peaks in women aged 60-69. When reporting outcomes of the surgical management of prolapse, authors should include a variety of standardised anatomical and functional outcomes. Anatomical outcomes reported should include all POP-Q points and staging, utilising a traditional definition of success with the hymen as the threshold for success. Assessment should be prospective and assessors blinded as to the surgical intervention performed if possible and without any conflict of interest related to the assessment undertaken (grade C). Subjective success postoperatively should be defined as the absence of a vaginal bulge (grade C). Functional outcomes are best reported using valid, reliable and responsive symptom questionnaires and condition-specific HRQOL instruments (grade C). Sexual function is best reported utilising validated condition-specific HRQOL that assess sexual function or validated sexual function questionnaires such as the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ) or the Female Sexual Function Index (FSFI). The sexual activity status of all study participants should be reported pre- and postoperatively under the following categories: sexually active without pain, sexually active with pain or not sexually active (grade C). Prolapse surgery should be defined as primary surgery, and repeat surgery sub-classified as primary surgery different site, repeat surgery, complications related to surgery and surgery for non-prolapse-related conditions (grade C). CONCLUSION Significant variation exists in the prevalence and incidence of pelvic organ prolapse surgery and how the outcomes are reported. Much of the variation may be improved by standardisation of definitions and outcomes of reporting on pelvic organ prolapse surgery.
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Affiliation(s)
- Matthew D Barber
- Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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de Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J 2014; 24:1859-72. [PMID: 24142061 DOI: 10.1007/s00192-013-2177-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim was to review complications associated with pelvic organ prolapse surgery. METHODS Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. RESULTS AND CONCLUSIONS Transvaginal mesh has a higher re-operation rate than native tissue vaginal repairs (grade A). If a synthetic mesh is placed via the vaginal route, it is recommended that a macroporous polypropylene monofilament mesh should be used. At sacral colpopexy mesh should not be introduced or sutured via the vaginal route and silicone-coated polyester, porcine dermis, fascia lata and polytetrafluoroethylene meshes are not recommended as grafts. Hysterectomy should also be avoided (grade B). There is no evidence to recommend routine local or systemic oestrogen therapy before or after prolapse surgery using mesh. The first cases should be undertaken with the guidance of an experienced surgeon in the relevant technique (grade C). Expert opinion suggests that by whatever the surgical route pre-operative urinary tract infections are treated, smoking is ceased and antibiotic prophylaxis is undertaken. It is recommended that a non-absorbable synthetic mesh should not be inserted into the rectovaginal septum when a rectal injury occurs. The placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after a bladder injury has been repaired, if the repair is considered to be satisfactory. It is possible to perform a hysterectomy in association with the introduction of a non-absorbable synthetic mesh inserted vaginally, but this is not recommended routinely.
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Affiliation(s)
- Renaud de Tayrac
- Department of Obstetrics and Gynecology, Caremeau University Hospital, Place du Prof Robert Debré, 30900, Nîmes, France,
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Sekiguchi Y, Kinjo M, Maeda Y, Kubota Y. Reinforcement of suspensory ligaments under local anesthesia cures pelvic organ prolapse: 12-month results. Int Urogynecol J 2014; 25:783-9. [PMID: 24318563 PMCID: PMC4032464 DOI: 10.1007/s00192-013-2281-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In 2005, a new minimally invasive procedure, the tissue fixation system (TFS) was reported. Like TVT (tension-free vaginal tape), the TFS works by creating a foreign body collagenous tissue reaction that reinforces a weakened pelvic ligament. The objective was to assess the effectiveness and perioperative safety of TFS in a day surgery clinic for the treatment of pelvic organ prolapse (POP). METHODS The TFS tape was applied in a tunnel adjacent to natural ligaments to repair the anterior cervical ring and cardinal ligament, paravaginal tissues and uterosacral ligaments under local anesthesia/sedation. We prospectively studied 60 patients, mean age 67, between October 2008 and February 2010 at Women's Clinic LUNA. Levels of POP were grade 2 (n = 20; 7 %), grade 3 (n = 30; 55 %), and grade 4 (n = 4; 7 %) according to the ICS POPQ classification. Fifty-four patients (90 %) who underwent a total of 162 POP operations presented for review. Follow-up was performed at 12 months. We defined surgical failure according to the ICS POPQ classification. We used prolapse quality of life (P-QOL) questions for QOL measurement. RESULTS Ninety-eight percent of patients were discharged on the day of surgery. Of the 162 TFS operations reviewed, 157 were successful and 5 failed. The 5 failed operations comprised 4 cystoceles and 1 rectocele. Two patients developed cervical protrusions at the introitus at 6 months with no prolapse of the uterine body. We found 5 cases of erosion in 162 tape insertions. The total number of patients who had no complications, no surgical failures, no erosions, no sensation of bulging, and no cervical protrusions was 47 (87 %). CONCLUSIONS The TFS uses the same surgical principle for repair as the TVT; this principle vastly minimizes the volume of mesh used, erosions, and other complications.
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Affiliation(s)
- Yuki Sekiguchi
- Yokohama Motomachi Women's Clinic LUNA, 3-115 Hyakudan-kan 5F, Motomach, Nakaku, Yokohama, 231-0861, Japan,
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Cosma S, Menato G, Preti M, Petruzzelli P, Chiadò Fiorio Tin M, Riboni F, Benedetto C. Advanced utero-vaginal prolapse and vaginal vault suspension: synthetic mesh vs native tissue repair. Arch Gynecol Obstet 2013; 289:1053-60. [DOI: 10.1007/s00404-013-3104-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
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Khunda A, Vashisht A, Cutner A. New procedures for uterine prolapse. Best Pract Res Clin Obstet Gynaecol 2013; 27:363-79. [DOI: 10.1016/j.bpobgyn.2012.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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Effect of Uterine Preservation on Outcome of Laparoscopic Uterosacral Suspension. J Minim Invasive Gynecol 2013; 20:172-7. [DOI: 10.1016/j.jmig.2012.10.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/10/2012] [Accepted: 10/18/2012] [Indexed: 11/22/2022]
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Primary and Repeated Surgeries for Ectopic Pregnancies and Distribution by Patient Age, Surgeon Age, and Hospital Levels: An 11-Year Nationwide Population-Based Descriptive Study in Taiwan. J Minim Invasive Gynecol 2012; 19:598-605. [DOI: 10.1016/j.jmig.2012.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/06/2012] [Accepted: 05/22/2012] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE The objective of this study was to describe a technique for uterine-sparing hysteropexy. CASE REPORT A 50-year-old multiparous woman with pelvic organ prolapse underwent laparoscopic sacrohysteropexy utilizing polypropylene mesh with good clinical result. CONCLUSIONS Placement of mesh arms medial to the uterine vessels during a laparoscopic sacrohysteropexy can be facilitated by using blunt needles to introduce the mesh arms.
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Sivaslioglu AA, İlhan TT, Aydogmus S, Uzun M, Dolen İ. The comparison of the anatomical and symptomatic outcomes of sacrocolpopexy and posterior intravaginal slingoplasty. Int Urogynecol J 2011; 22:1363-8. [DOI: 10.1007/s00192-011-1442-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/17/2011] [Indexed: 10/18/2022]
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Abstract
Attitudes to sexuality and the psychological value of reproductive organs have changed in Western countries over the last few decades. Nevertheless, repair of pelvic support defects with concomitant hysterectomy is still considered the standard treatment for pelvic organ prolapse. Over the last 10 years, however, interest has been growing in uterus-sparing surgery, which can be divided into vaginal, abdominal, and laparoscopic procedures. The majority of studies on uterus-sparing surgery, with the exception of abdominal techniques, report few cases with short follow-up. Sacrospinous hysteropexy is the most studied vaginal technique for uterus preservation and favorable results have been demonstrated, although the majority of studies are flawed by selection and information bias, short follow-up and lack of adequate control groups. Abdominal and laparoscopic procedures are promising, providing similar functional and anatomical results to hysterectomy and sacrocolpopexy. Consensus is growing that the uterus can be preserved at the time of pelvic reconstructive surgery in appropriately selected women who desire it. The results of comparison trials and prospective studies confirm that uterus-sparing surgery is feasible and is associated with similar outcomes to hysterectomy, as well as shorter operating times. Surgeons should be ready to respond to the wishes of female patients who want to preserve vaginal function and the uterus.
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Posterior intravaginal slingplasty: efficacy and complications in a continuous series of 118 cases. Int Urogynecol J 2011; 22:611-9. [DOI: 10.1007/s00192-010-1350-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 12/13/2010] [Indexed: 11/26/2022]
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Hefni M, El-Toucky T. Uterine prolapse in young women. Best Pract Res Clin Obstet Gynaecol 2010; 25:157-65. [PMID: 21163709 DOI: 10.1016/j.bpobgyn.2010.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 11/02/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
Abstract
Contemporary understanding of the dynamic anatomy of pelvic floor support has lead us to new conservative surgery for the management uterine prolapse. The uterus itself does not play any role in the pathogenesis of uterine prolapse. Therefore, hysterectomy should not be the prime treatment, and fixing of the cervix to strong ligament such as sacrospinous ligament could give a more successful result and conservation of the uterus in young women. Other techniques, such as abdominal mesh hysteropexy or posterior intravaginal slingoplasty with conservation of the uterus, are alternative surgical options.
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Affiliation(s)
- Mohamed Hefni
- Benenden Hospital Trust, Benenden, Kent TN17 4AX, UK.
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Five-year outcome of uterus sparing surgery for pelvic organ prolapse repair: a single-center experience. Int Urogynecol J 2010; 22:287-92. [DOI: 10.1007/s00192-010-1342-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 11/24/2010] [Indexed: 11/25/2022]
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Jia X, Glazener C, Mowatt G, Jenkinson D, Fraser C, Bain C, Burr J. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse. Int Urogynecol J 2010; 21:1413-31. [PMID: 20552168 DOI: 10.1007/s00192-010-1156-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 03/24/2010] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to estimate efficacy and safety of mesh in surgery for uterine or vault prolapse. METHODS Seventeen electronic databases were searched for relevant studies that were published from 1980 onwards. RESULTS Fifty-four studies involving 7,054 women were included. For sacrocolpopexy (average follow-up 23 months), the risk of clinical recurrence ranged from 0% to 6%, persistent symptoms ranged from 3% to 31% and mesh erosion from 0% to 12%. For infracoccygeal sacropexy (average follow-up 13 months), the risk of clinical recurrence ranged from 0% to 25%, persistent symptoms from 2% to 21% and mesh erosion 0% to 21%. Limited evidence was available for sacrocolpoperineopexy and uterine suspension sling to draw reliable estimates. CONCLUSIONS Sacrocolpopexy was associated with a low risk of recurrence but with a relatively high risk of mesh erosion. Ranges of estimates for outcomes for other mesh techniques were wide.
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Affiliation(s)
- Xueli Jia
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK.
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Lee YS, Han DH, Lee JY, Kim JC, Choo MS, Lee KS. Anatomical and functional outcomes of posterior intravaginal slingplasty for the treatment of vaginal vault or uterine prolapse: a prospective, multicenter study. Korean J Urol 2010; 51:187-92. [PMID: 20414395 PMCID: PMC2855447 DOI: 10.4111/kju.2010.51.3.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/23/2010] [Indexed: 11/22/2022] Open
Abstract
Purpose We aimed to evaluate the anatomical and functional outcomes of posterior intravaginal slingplasty (P-IVS) for the treatment of a vaginal vault or uterine prolapse (VP/UP). Materials and Methods This was a 12-month prospective, multicenter, observational study. Women aged over 30 years who presented with stage II or greater VP/UP underwent P-IVS by four urologists at four university hospitals. Preoperatively, pelvic examination by use of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Pelvic Floor Distress Inventory (PFDI) questionnaire, the 3-day frequency volume chart, and uroflowmetry were completed. At the 12-month follow-up, changes in the POP-Q, PFDI, frequency volume chart, and uroflowmetry parameters were assessed. Cure was defined as VP/UP stage 0 and improvement as stage I. Results The cure and improvement rates among the 32 women were 65.6% and 34.4%, respectively. All subscale scores of the Urinary Distress Inventory, the general subscale score of the Pelvic Organ Prolapse Distress Inventory, and the rectal prolapse subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. There were no significant changes in the frequency volume chart or uroflowmetry parameters. There was one case of surgery-related transfusion. Conclusions Trans-vaginal repair by P-IVS is an effective and safe procedure for restoring the anatomical defect and improving the associated pelvic floor symptoms in women with VP/UP.
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Affiliation(s)
- Young-Suk Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Fatton B, Savary D, Amblard J, Jacquetin B. [How to manage multicompartment pelvic organe prolapse?]. Prog Urol 2009; 19:1086-97. [PMID: 19969280 DOI: 10.1016/j.purol.2009.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
Abstract
Repair of pelvic organ prolapse by vaginal route may use native tissues or meshes, which have been in extensive use over the last decades. Traditional surgery, and particularly sacrospinous fixation, has been proven to be effective with long term follow-up with well-known specific risks that could be avoided by skilled surgeons on condition that he observes basic vaginal surgery rules. This surgery is still recommended as first choice in patients over 70 years old with high-grade prolapse. Nevertheless recurrence rate after high-grade cystocele repair using native tissues as been reported between 30 and 50% depending on the technique used. Mesh repair and particularly the use of mesh kits is a valid option in case of prolapse with cystocele behind the hymen, specifically in case of paravaginal defect. Meshes use is licit in patients with prolapse recurrence as well. In contrast, spread use of transvaginal meshes in young patients with grade 3 or 4 prolapse whom tissues have a poor quality, has to be considered very carefully because of the lack of knowledge about long term results and sexual outcome.
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Affiliation(s)
- B Fatton
- Service de Gynécologie-Obstétrique, CHU de Clermont-Ferrand, Université d'Auvergne Clermont-Ferrand 1, 63058 Clermont-Ferrand, France.
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Inoue H, Sekiguchi Y, Kohata Y, Satono Y, Hishikawa K, Tominaga T, Oobayashi M. Tissue fixation system (TFS) to repair uterovaginal prolapse with uterine preservation: a preliminary report on perioperative complications and safety. J Obstet Gynaecol Res 2009; 35:346-53. [PMID: 19708181 DOI: 10.1111/j.1447-0756.2008.00947.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the effectiveness, perioperative safety and invasiveness of the Tissue Fixation System (TFS) sling operation when used for repair of uterovaginal prolapse with uterine preservation. METHODS Operations using the TFS anchor system were performed on 25 women aged between 44 and 84 years (average 65) for grade 3 or 4 uterine prolapse with or without urinary incontinence. Details of the procedures were as follows: midurethral sling (n=2); posterior sling of the uterosacral ligaments (n=25); U-sling for lateral/central anterior vaginal wall defects (n=24). The defect of the perineal body and rectovaginal fascia were repaired in all cases. RESULTS All patients were followed up for a minimum of 3 months. The mean +/- standard deviation of the operating time and loss of blood were 94.2 (+/-19.3) minutes and 98.1 (+/-129.6) mL, respectively. Twelve patients (48%) were discharged on the same day of surgery and 13 patients (52%) on the following day, with a return to normal activities within 1-7 days. There were no intra- or postoperative complications. At the 3-month follow up, cure rates of symptoms due to pelvic laxity were: urinary frequency 85.7% (n=14); nocturia 66.6% (n=12); urgency 93.3% (n=15); and dragging pain 100% (n=6). There was one recurrent uterovaginal prolapse and one recurrent cystocele. CONCLUSION The TFS procedure delivers satisfactory results for uterine prolapse repair with uterine preservation. The procedure is useful because of the short duration of the operation, the short term of recovery, its safety profile and minimal invasiveness. There is a significant improvement in the quality of life, especially for older women. However, long-term results are currently unknown.
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Affiliation(s)
- Hiromi Inoue
- Division of the ULrogynecological Center, Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan.
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Loertzer H, Ringert RH, Fechner A, Thelen P, Kümmel C, Strauss A. [Vaginal pelvic repair. Always with mesh or not?]. Urologe A 2009; 48:1038-43. [PMID: 19669726 DOI: 10.1007/s00120-009-2080-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Several surgical methods are possible when aiming at reconstruction of pelvic organ prolapse in women, and the experienced surgeon implements the knowledge gained from open, laparoscopic, and vaginal techniques. These feature different rates of success and relapse as well as different complication risks. Because of the accumulating morbidity of aging patients, there is a search for a safe minimally invasive technique. With the advent of synthetic meshes, surgeons have used them frequently and often uncritically for reconstruction of the female pelvic floor. In these cases the vaginal approach is preferred as opposed to alternative techniques, as it is less invasive and allows for better convalescence. Furthermore, this approach leads to low complication and relapse rates even when synthetic meshes are omitted.
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Affiliation(s)
- H Loertzer
- Klinik für Urologie, Medizinische Fakultät, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
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Bjelic-Radisic V, Hartmann G, Abendstein B, Tamussino K, Riss PA. The posterior intravaginal slingplasty operation: Results of the Austrian registry. Eur J Obstet Gynecol Reprod Biol 2009; 144:88-91. [DOI: 10.1016/j.ejogrb.2009.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 01/29/2009] [Accepted: 02/04/2009] [Indexed: 11/16/2022]
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Short-term results of posterior intravaginal slingplasty in grade 4 uterine prolapse. Arch Gynecol Obstet 2009; 281:55-8. [DOI: 10.1007/s00404-009-1062-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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Feiner B, Jelovsek JE, Maher C. Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG 2009; 116:15-24. [PMID: 19087076 DOI: 10.1111/j.1471-0528.2008.02023.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vaginal mesh kits are being used to surgically treat apical vaginal prolapse; however, their safety and efficacy are currently unknown. OBJECTIVES To summarise success and complication rates for commonly used vaginal mesh kits in the treatment of apical prolapse. SEARCH STRATEGY MEDLINE and other scientific databases were queried for primary research addressing the use of vaginal mesh kits for apical prolapse published between 1950 and 2007, including abstracts presented in major scientific meetings. SELECTION CRITERIA Studies describing the use of mesh to support either the anterior or posterior compartment alone, for incontinence or fistula repair or not addressing the vaginal apex were excluded. DATA COLLECTION AND ANALYSIS Identified studies were grouped by the mesh kit and complications categorised using the Dindo classification system. Weighted averages and confidence intervals were calculated on objective success, follow-up length and complications. MAIN RESULTS Thirty studies totalling 2653 women met inclusion criteria. Objective success rates (95% CI) were Apogee (American Medical Systems Inc., Minnetonka, MN, USA) 95% (95-96), Prolift (Ethicon Women's Health and Urology, Somerville, NJ, USA) 87% (86-87) and posterior intravaginal slingplasty 88% (87-89). Reoperations not requiring anaesthesia (Dindo IIIa) occurred in 0.4-2.3% and requiring anaesthesia (Dindo IIIb) in 1.5-6.0%, with a follow up between 26 and 78 weeks. Mesh erosion was the most commonly reported complication occurring in 4.6-10.7%. AUTHOR'S CONCLUSIONS Overall objective success using transvaginal mesh kits in restoring apical vaginal prolapse is high. However, an increasing number of women require surgical intervention for mesh-related complications based on limited data quality and short follow up. Further research addressing functional outcomes and the impact of these procedures on women's symptoms and quality of life is mandatory.
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Affiliation(s)
- B Feiner
- Division of Urogynaecology and Reconstructive Pelvic Surgery, Royal Women's, Mater and Wesley Hospitals, Brisbane, Queensland, Australia.
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Carramão S, Auge APF, Pacetta AM, Duarte E, Ayrosa P, Lemos NLML, Aoki T. Estudo randômico da correção cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando histerectomia versus preservação uterina. Rev Col Bras Cir 2009; 36:65-72. [DOI: 10.1590/s0100-69912009000100012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 11/13/2008] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Comparar os resultados anatômicos pós-operatórios de pacientes portadoras de prolapso uterino tratadas utilizando tela de polipropileno para correção dos defeitos do assoalho pélvico, comparando histerectomia vaginal com a preservação do útero. MÉTODO: Estudo randomizado com 31 mulheres portadoras de prolapso uterino estádio III ou IV (POP-Q) divididas em dois grupos: Grupo HV- 15 mulheres submetidas à histerectomia vaginal e reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) e Grupo HP- 16 mulheres mulheres submetidas à reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) preservando o útero. Raça, urgência miccional, constipação intestinal, dor sacral, sangramento e tempo de operação foram os parâmetros analisados. RESULTADOS: O tempo de seguimento médio foi de nove meses. Não se observou diferença entre os grupos nas complicações funcionais. O tempo cirúrgico foi 120 minutos para grupo HV versus 58.9 minutos para grupo HP ( p < 0.001 ) e o volume de perda sanguínea intraoperatória foi 120 mL no grupo HV versus 20 mL para grupo HP ( p < 0.001*). A taxa de sucesso objetivo foi 86.67% para grupo HV e 75% para grupo HP (p = 0,667). A taxa de erosão de tela foi 20% (3/15) de extrusão no grupo HV versus 18,75% (3/16) no grupo HP (p = 1,000). CONCLUSÃO: A correção cirúrgica do assoalho pélvico com telas nas portadoras de prolapso uterino apresentaram similaridade quer sendo ela feita com histeropexia quer com histerectomia. Contudo, o tempo cirúrgico e o volume da perda sanguínea foram significantemente maiores no grupo com histerectromia (HV). Operações vaginais com telas são procedimentos efetivos para a correção do prolapso.
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Kuo TN, Wu MP. The use of a concomitant tension-free vaginal mesh technique and a tension-free midurethral sling in treating pelvic organ prolapse and occult stress urinary incontinence. Taiwan J Obstet Gynecol 2009; 47:466-70. [PMID: 19126521 DOI: 10.1016/s1028-4559(09)60022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Vaginal surgery for uterine descent; which options do we have? A review of the literature. Int Urogynecol J 2008; 20:349-56. [DOI: 10.1007/s00192-008-0779-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 11/23/2008] [Indexed: 10/21/2022]
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Savary D, Fatton B, Velemir L, Amblard J, Jacquetin B. [What about transvaginal mesh repair of pelvic organ prolapse? Review of the literature since the HAS (French Health Authorities) report]. ACTA ACUST UNITED AC 2008; 38:11-41. [PMID: 18996650 DOI: 10.1016/j.jgyn.2008.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 09/14/2008] [Accepted: 09/25/2008] [Indexed: 11/30/2022]
Abstract
The French Health Authorities' (HAS) report of November 2006 concluded that the use of mesh at the time of transvaginal repair of pelvic organ prolapse (POP) should be limited to clinical research. This review intends to analyse and comment the recent data on this topic. A review on PubMed, on a personal database and actualisation until May 2008 has been performed choosing French or English language series concerning prolapse surgery with mesh disposed by the vaginal route. It includes six randomised controlled trials comparing transvaginal repair of POP with or without mesh: four about cystocele, one about rectocele and one about apical prolapse. Both surgical techniques and recurrence criteria are poorly standardised. The four randomised trials focusing on cystocele repair support the anatomical superiority of techniques using mesh, with similar functional results with or without mesh reinforcement. In the other indications, the results remain unclear or controversial. According to the randomised trials, the complications rate, except mesh exposure, is similar with and without mesh. However there are some specific complications when using mesh, such as mesh infection, mesh exposure or shrinkage and visceral extrusion. We recommend using vaginal reinforcement mesh with specific care in selected patients and we suggest some guidelines to be proposed for consensus at concerned French scientific societies.
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Affiliation(s)
- D Savary
- Unité d'urogynécologie, service de maternité, hôpital Hôtel-Dieu, CHU de Clermont-Ferrand, Clermont-Ferrand cedex 1, France.
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