1
|
Lo TS, Harun F, Chua S, Shen YH, Tan YL, Hsieh WC. Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up. J Formos Med Assoc 2024; 123:331-339. [PMID: 37996329 DOI: 10.1016/j.jfma.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND PURPOSE We present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. METHODS This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. RESULTS Objective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. CONCLUSION The UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Yu-Hua Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ Healthcare Group, Sarawak, Malaysia
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC
| |
Collapse
|
2
|
Park J, Bak S, Song JY, Chung YJ, Yuki G, Lee SJ, Mun J, Kim MR. Robotic surgery in Gynecology: the present and the future. Obstet Gynecol Sci 2023; 66:518-528. [PMID: 37465847 PMCID: PMC10663391 DOI: 10.5468/ogs.23132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
Since its introduction, laparoscopic surgery has been often preferred over open surgery in obstetrics and gynecology due to its advantages, such as less bleeding, lower incidence of adhesions, reduced postoperative pain, short hospital stay, and quick return to daily life. However, in the case of complex surgeries, laparoscopy presented some limitations. Nonetheless, since the 1980s, medical robots have been introduced to overcome the technical limitations of laparoscopy and start a new age for minimally invasive surgery. In this review, we explore the indications and advantages and disadvantages of robotic surgery in the field of gynecology, and try to assess the recent trend of robotic surgery.
Collapse
Affiliation(s)
- JungYoon Park
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - SeongEun Bak
- Department of Obstetrics and Gynecology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jae-Yen Song
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Youn-Jee Chung
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Gen Yuki
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Su Jeong Lee
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jisu Mun
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| |
Collapse
|
3
|
Munno GM, La Verde M, Lettieri D, Nicoletti R, Nunziata M, Fasulo DD, Vastarella MG, Pennacchio M, Scalzone G, Pieretti G, Fortunato N, De Simone F, Riemma G, Torella M. Pelvic Organ Prolapse Syndrome and Lower Urinary Tract Symptom Update: What's New? Healthcare (Basel) 2023; 11:healthcare11101513. [PMID: 37239801 DOI: 10.3390/healthcare11101513] [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: 03/15/2023] [Revised: 04/15/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: This narrative review aimed to analyze the epidemiological, clinical, surgical, prognostic, and instrumental aspects of the link between pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS), collecting the most recent evidence from the scientific literature. (2) Methods: We matched the terms "pelvic organ prolapse" (POP) and "lower urinary tract symptoms" (LUTS) on the following databases: Pubmed, Embase, Scopus, Google scholar, and Cochrane. We excluded case reports, systematic reviews, articles published in a language other than English, and studies focusing only on a surgical technique. (3) Results: There is a link between POP and LUTS. Bladder outlet obstruction (BOO) would increase variation in bladder structure and function, which could lead to an overactive bladder (OAB). There is no connection between the POP stage and LUTS. Prolapse surgery could modify the symptoms of OAB with improvement or healing. Post-surgical predictive factors of non-improvement of OAB or de novo onset include high BMI, neurological pathologies, age > 65 years, and the severity of symptoms; predictors of emptying disorders are neurological pathologies, BOO, perineal dysfunctions, severity of pre-surgery symptoms, and severe anterior prolapse. Urodynamics should be performed on a specific subset of patients (i.e., stress urinary incontinence, correct surgery planning), (4) Conclusions: Correction of prolapse is the primary treatment for detrusor underactivity and for patients with both POP and OAB.
Collapse
Affiliation(s)
- Gaetano Maria Munno
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Marco La Verde
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Davide Lettieri
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Roberta Nicoletti
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Nunziata
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Diego Domenico Fasulo
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Giovanna Vastarella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Marika Pennacchio
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gaetano Scalzone
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gorizio Pieretti
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Nicola Fortunato
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Fulvio De Simone
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| |
Collapse
|
4
|
Hosni W, Schmidt CM, Mallmann P, Ludwig S. Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse. BMC Urol 2023; 23:48. [PMID: 36991400 PMCID: PMC10061786 DOI: 10.1186/s12894-023-01213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse is a bothersome condition affecting many women at advanced age, but also frequently observed in young women with certain risk factors. Various surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. The vaginal bilateral sacrospinous colposuspension surgery (BSC) with ultralight mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus. The objective of this study is to evaluate the anatomical and functional outcomes of bilateral sacrospinous colposuspension with ultralight mesh in 30 Patients treated with the vaginal single incision standardized technique. METHODS In this retrospective study, 30 patients were treated by BSC for significant vaginal, uterovaginal or cervical prolapse. A simultaneous anterior colporrhaphy, posterior colporrhaphy or both were performed when indicated. Anatomical and functional outcomes were assessed 1 year postoperatively using the Pelvic Organ Prolapse Quantification system (POP-Q) and the standardised Prolapse Quality of Life (P-QOL) questionnair. RESULTS The POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were asymptomatic and expressed high satisfaction one year after surgery. No intraoperative adverse events were recorded for all patients. Only minimal postoperative complications were recorded and they all resolved completely with conservative management. CONCLUSION This study highlights the functional and anatomical outcomes of the minimally invasive vaginal bilateral sacrospinal colposuspension with ultralight mesh for the management of apical prolapse. The one year postoperative results of the proposed procedure reflect excellent outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects. TRIAL REGISTRATION The study protocol was approved by the Ethics Committee at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered).
Collapse
Affiliation(s)
- Wael Hosni
- Department of Obstetrics & Gynecology, Marienhospital Brühl, A teaching hospital of the University of Cologne, Cologne, Germany.
| | - Carl-Michael Schmidt
- Department of Obstetrics & Gynecology, Marienhospital Brühl, A teaching hospital of the University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics & Gynecology, University hospital, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics & Gynecology, University hospital, Cologne, Germany
| |
Collapse
|
5
|
Rusavy Z, Grinstein E, Gluck O, Abdelkhalek Y, Deval B. Long-term development of surgical outcome of laparoscopic sacrohysteropexy with anterior and posterior mesh extension. Int Urogynecol J 2023; 34:191-200. [PMID: 35416498 DOI: 10.1007/s00192-022-05102-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Long-term durability and functional outcome of laparoscopic sacrohysteropexy (LSH) remains to be confirmed. We set out to assess the development of surgical outcome in women with increasing minimal follow-up. METHODS All women after LSH with anterior and posterior mesh extension operated for advanced apical uterine prolapse at Geoffroy Saint-Hilaire clinic from July 2005 to June 2020 were enrolled in this retrospective study. Last known follow-up information was used for the analysis and allocation into groups. The surgical success was defined as no prolapse beyond hymen, no symptomatic recurrence or no retreatment. Functional outcome was evaluated from validated questionnaires and presence of pelvic floor disorders. The outcomes were compared with preoperative state using chi-square and Fisher's test; p < 0.05 was considered significant. RESULTS In total, 270 patients after LSH with a follow-up of up to 14.5 years were enrolled and divided into groups according to their last follow-up length: ≥ 1 year 242, ≥ 3 years 112, ≥ 5 years 76, ≥ 7 years 45 and ≥ 10 years 18 women. Increase of minimal follow-up was associated with gradual decrease in surgical success. Rates of stress urinary incontinence were unchanged by the surgery, while anal incontinence and constipation rates decreased significantly; 14.5% of women were operated on for SUI in the follow-up. The PFDI-20, PFIQ-7 and VAS bother scores decreased significantly regardless of minimal follow-up length. CONCLUSIONS LSH with anterior and posterior mesh extension is a safe, effective and durable surgery with a positive long-term effect on quality of life. Although the surgical success gradually decreases, LSH remains a surgical success in most women.
Collapse
Affiliation(s)
- Zdenek Rusavy
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
| | - Ehud Grinstein
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yara Abdelkhalek
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| |
Collapse
|
6
|
Baird CE, Chughtai B, Bradley CS, Kobashi K, Jung M, Sedrakyan A, Andrews S, Ferriter A, Cornelison T, Marinac-Dabic D. Development of a coordinated registry network for pelvic organ prolapse technologies. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000076. [PMID: 36393893 PMCID: PMC9660621 DOI: 10.1136/bmjsit-2020-000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The accumulation of data through a prospective, multicenter Coordinated Registry Network (CRN) could be a robust and cost-effective way to gather real-world evidence on the performance of pelvic organ prolapse (POP) technologies for device-based and intervention-based studies. To develop the CRN, a group of POP experts consisting of representatives from professional societies, the Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements important to assess POP technologies. Design A Delphi method approach was employed to achieve consensus on a core minimum dataset for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by the study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via conference call. This process was repeated twice over a 6-month time period during which consensus was achieved. Results Twenty-one experts participated in the effort and proposed 120 data elements. Participation rates in the first and second round of the Delphi survey were 95.2% and 71.4%, respectively. The working group reached final consensus among responders on 90 data elements capturing relevant general medical and surgical history, procedure and discharge, short-term and long-term follow-up, device factors, and surgery and surgeon factors. Conclusions The CRN successfully developed a set of core data elements to support the study of POP technologies through convening an expert panel on POP technologies and using the Delphi method. These standardized data elements have the potential to influence patient and provider decisions about treatments and include important outcomes related to efficacy and safety.
Collapse
Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Kathleen Kobashi
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Mary Jung
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ann Ferriter
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Terri Cornelison
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
7
|
Diniz MB, Ribeiro MF, Dias LAM, Monteiro MVDC. Use of Urodynamics by Gynecologists and Urologists in Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:654-659. [PMID: 35940172 PMCID: PMC9948106 DOI: 10.1055/s-0042-1744460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Urodynamic studies (UDSs) are a set of tests that assess the storage and emptying of urine, and they are widely used by gynecologists and urologists in the management of urinary incontinence (UI), despite the discussion about its indications. The objectives of the present study were to verify whether UDSs are routinely used in the conservative and surgical approaches to female UI, their other clinical indications, and to compare the responses of Brazilian gynecologists and urologists. METHODS The present is an opinion survey applied from August 2020 to January 2021 through a semistructured questionnaire about the clinical practice sent by e-mail to all participants. The responses were compared through statistical analyses. RESULTS Of the 329 participants, 238 were gynecologists (72.3%) and 91, urologists (27.7%). Most gynecologists (73.5%) and urologists (86.6%) do not request UDSs before the conservative treatment of UI; but UDSs are indicated in the preoperative period of anti-incontinence surgeries. Most participants request UDSs in the initial approach to overactive bladder (gynecologists: 88.2%; urologists: 96.7%), and the urologist has greater chance to request this study (odds ratio [OR] = 3.9). For most participants, it is necessary to request uroculture before the UDSs. CONCLUSION Most Brazilian gynecologists and urologists who participated in the present study do not request UDSs before the conservative treatment of UI, according to national and internacional guidelines, and often request it before the surgical treatment for female UI. The indication of this exam in the initial approach of idiopathic overactive bladder should be reviewed by the participants.
Collapse
Affiliation(s)
- Mucio Barata Diniz
- Department of Gynecology and Obstetrics of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | |
Collapse
|
8
|
Munch A, Greisen S, Axelsen SM, Bek KM, Glavind-Kristensen M. Treatment of apical vaginal prolapse with minimal mesh repair (Uphold): patient-reported long-term outcomes and mesh-related complications. Acta Obstet Gynecol Scand 2022; 101:589-596. [PMID: 35150002 DOI: 10.1111/aogs.14322] [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: 10/29/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To evaluate patient-reported outcomes and clinical findings after surgery for apical prolapse with the transvaginal Uphold mesh technique. Moreover, to evaluate the rate of mesh-related complications. MATERIAL AND METHODS A historical cohort study of patients who underwent surgery from January 1, 2012 to April 30, 2019, at Aarhus University Hospital, Denmark. Pelvic examination and patient completion of questionnaires were performed in 2018-2019. Information on adverse events and reoperations was obtained from medical records. RESULTS A total of 240 patients were operated on using the Uphold mesh, 89% due to recurrent prolapse. Follow-up was attended by 192 patients (80%). Median follow-up time was 30 months, interquartile range 19-52. During follow-up, 29 patients (15%) underwent reoperation due to prolapse and are considered failures. Among the remaining, patient satisfaction was high. Thus, average score for pelvic symptoms affecting daily life was 2, on a scale of 0-10, where 0 represents no symptoms. The Patient Global Impression of Improvement (PGI-I) had an average score of 6.4 (1: very much worse; 7 very much better). Preoperatively, 89.5% of the women had grade 2 or more apical prolapse, whereas at follow-up, this was only 6.1%. Perioperative heavy bleeding needing embolization was observed in one patient (0.5%). Two patients had serious constriction of the ureter and needed re-operation. Postoperative complications, primarily temporary voiding problems, were observed in 15 patients (8%). Complications during the follow-up period were registered in 23 patients (12%); eight of these were mesh erosions. Due to complications, 11 patients (6%) needed re-operation. CONCLUSIONS The study confirms that the Uphold procedure in a centralized set-up is a procedure with high patient-reported satisfaction even in a population characterized by a high proportion of recurrent prolapse. Moreover, the procedure seems safe with acceptable complication rates.
Collapse
Affiliation(s)
- Anne Munch
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Greisen
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Aarhus, Denmark
| | | | - Karl Møller Bek
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
9
|
Rusavy Z, Najib B, Abdelkhalek Y, Grinstein E, Gluck O, Deval B. Outcomes of sacrocolpopexy/sacrohysteropexy with mesh placement targeted to affected compartment. Eur J Obstet Gynecol Reprod Biol 2022; 272:188-192. [PMID: 35364554 DOI: 10.1016/j.ejogrb.2022.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE No recommendation regarding the number of meshes to be implanted in laparoscopic genital prolapse surgery exists. Is it necessary to implant a mesh into a compartment that is not affected to prevent its prolapse in the follow-up? Our objective was to compare the long-term outcomes of laparoscopic sacrocolpopexy according to compartments where mesh was implanted. STUDY DESIGN This is a retrospective cohort study of 328 patients after laparoscopic sacrocolpopexy at our centre in 7/2005 - 3/2021. 294 patients with perioperative data and POP-Q and/or prolapse symptoms in mean follow-up of 42.8 months was available for the outcome analysis. Surgical failure was defined as prolapse beyond hymen, subjective recurrence or retreatment. The women were divided into four groups depending on compartments, where the mesh was implanted. Group A - anterior, group P - posterior, Group AP - compound of patients with anterior or posterior single arm mesh placement and (B), with anterior and posterior arm placement. Groups AP and B were compared for feasibility of single compartment mesh implantation. Comparison of groups A and P allowed assessment of non-inferiority of single anterior vs. posterior compartment placement. The data were compared using Wilcoxon Two Sample test, Chi-square test or Fisheŕs Exact test, p-value < 0.05 was considered statistically significant. RESULTS A single compartment mesh implantation was associated with shorter operating time and hospital stay and comparable incidence of complications. A statistically significant difference in all POP-Q points in favour of group B was observed, however, with comparable rate of prolapse beyond hymen(6.3%AP vs. 7.8%B). Similar frequency of surgical failure (17.5%AP vs. 13.8%B) and incidence of de novo pelvic floor disorders or pain was observed. Comparison of groups A and P showed higher suspension of point C in group P(-2.6 vs. -4.0, p < 0.05) with no difference in points Ba, Bp, surgical failure rate and de novo pelvic floor disorders. CONCLUSION Implantation of a single sheet of mesh was not associated with inferior outcome to implantation of mesh to both compartments. Laparoscopic sacrocolpopexy with a single mesh arm placed into the affected compartment along with apical suspension does not induce a de novo prolapse in unoperated compartment.
Collapse
Affiliation(s)
- Zdenek Rusavy
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
| | - Bernard Najib
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Yara Abdelkhalek
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Ehud Grinstein
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| |
Collapse
|
10
|
Li Marzi V, Morselli S, Di Maida F, Musco S, Gemma L, Bracco F, Tellini R, Vittori G, Mari A, Campi R, Carini M, Serni S, Minervini A. Robot-assisted sacro(hystero)colpopexy with anterior and posterior mesh placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up. Ther Adv Urol 2022; 14:17562872221090884. [PMID: 35493316 PMCID: PMC9039451 DOI: 10.1177/17562872221090884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Robotic sacrocolpopexy (RSCP) is an established option for the treatment of apical, anterior, and proximal posterior compartment pelvic organ prolapses (POP). However, there is lack of evidence investigating how lower bowel tract symptoms (LBTS) may change after RSCP. Methods: Data from consecutive patients treated with RSCP for stage 3 or higher POP from 2012 to 2019 at a single tertiary referral center with at least 1 year of follow-up were prospectively collected and retrospectively analyzed. RSCP was performed following a standardized technique which always employed both anterior and posterior hand-shaped meshes. Outcomes were collected at follow-up and analyzed. LBTS were evaluated through the Wexner questionnaire. Results: Overall, 114 women underwent RSCP. Eleven were excluded for missing data, whereas 12 had insufficient follow-up. Thus, 91 (79.8%) patients were included in this cohort. Median follow-up was 42 [interquartile range (IQR), 19–62] months. Mean age was 65 ± 10 years. In our series, RSCP was mainly performed for anterior and apical/medium stage 3 POP (in 95.6% of patients). Anatomic success rate of RSCP was 97.8%, with 89 patients with POP stage 0–1 at 12-month follow-up. Two patients (2.2%) experienced POP recurrence and were treated with redo-SCP. No patient experienced clinically significant posterior vaginal wall prolapse after RSCP. When analyzing LBTS, there was no significant change in postoperative total Wexner’s score as compared to the preoperative value ( p > 0.05). However, the manual assistance subscore was statistically significantly lower within the first-year follow-up ( p = 0.04), but it spontaneously improved during the follow-up ( p = 0.12). Conclusion: RSCP with simultaneous placement of both anterior and posterior mesh is safe and successful to treat high-stage POP in carefully selected patients. Of note, LBTS appear unaffected by posterior mesh placement, supporting its routine use to prevent posterior POP recurrence. Larger prospective studies are needed to confirm our results.
Collapse
Affiliation(s)
- Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Ospedale Careggi, Largo Brambilla 3, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simone Morselli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Stefania Musco
- Unit of Neuro-Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Gemma
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Bracco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Gianni Vittori
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| |
Collapse
|
11
|
Nüssler E, Granåsen G, Bixo M, Löfgren M. Long-term outcome after routine surgery for pelvic organ prolapse-A national register-based cohort study. Int Urogynecol J 2022; 33:1863-1873. [PMID: 35312802 PMCID: PMC9270303 DOI: 10.1007/s00192-022-05156-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/20/2022] [Indexed: 10/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is common, and women have an estimated 12-19% lifetime risk for needing POP surgery. Aims were to measure re-operation rates up to 10 years after POP surgery and patient-reported outcomes (PROMs) 5 years after a first-time operation for POP. METHODS This is a cohort study using the Swedish National Quality Register for Gynaecological Surgery (GynOp). We retrieved information from 32,086 POP-operated women up to 10 years later. After validation, a web-based PROM questionnaire was sent to 4380 women who 5 years previously had standard POP surgery. Main outcome measures were reoperations due to a relapse of prolapse and PROMs 5 years after the primary operation. RESULTS Among women operated for all types of POP, 11% had re-operations 5 years later and an additional 4% 10 years later, with similar frequencies for various compartments/types of surgery. PROMs yielded a 75% response rate after 5 years. Cure rate was 68% for anterior, 70% for posterior, and 74% for combined anterior-posterior native repairs. Patient satisfaction exceeded 70%, and symptom reduction was still significant after 5 years (p < 0.0001). CONCLUSIONS Following primary prolapse surgery, re-operation rates are low, even after 10 years. A web-based survey for follow-up of PROMs after POP surgery is feasible and yields a high response rate after 5 years. The subjective cure rate after primary POP operations is high, with reduced symptoms and satisfied patients regardless of compartment. Standard prolapse surgery with native tissue repair produces satisfactory long-term results.
Collapse
Affiliation(s)
- Emil Nüssler
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, 901 85, Umeå, Sweden.
| | - Gabriel Granåsen
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, 901 85, Umeå, Sweden
| | - Marie Bixo
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, 901 85, Umeå, Sweden
| | - Mats Löfgren
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, 901 85, Umeå, Sweden
| |
Collapse
|
12
|
Sacrospinous ligament fixation (SSLF): an old method with new horizons. Arch Gynecol Obstet 2022; 305:1379-1382. [DOI: 10.1007/s00404-022-06508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
13
|
Sato H, Abe H, Ikeda A, Miyagawa T, Sato K, Tsukada S. Laparoscopic sacrocolpopexy for pelvic organ prolapse in the elderly: safety and outcomes. J OBSTET GYNAECOL 2022; 42:110-115. [PMID: 33890540 DOI: 10.1080/01443615.2020.1867968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Due to its low postoperative complication rate, vaginal surgery is the preferred intervention for pelvic organ prolapse (POP) in elderly patients. We aimed to assess outcomes and perioperative complication rates associated with laparoscopic sacrocolpopexy (LSC) in elderly women. We retrospectively reviewed the medical records of 74 consecutive patients [52 (70.3%) aged <75 years; 22 (29.7%) aged ≥75 years] with POP who underwent LSC between August 2015 and December 2017. We evaluated preoperative risks using the Charlson Comorbidity Index (CCI) and complications, using the Clavien-Dindo grading (CDG). No between-group differences were observed in CCI. CDG indicated fewer perioperative complications in patients aged >75 years. Anatomical success rates at 15 months were 95.5% and 90.4% in patients aged ≥75 and <75 years, respectively. LSC has a high anatomical correction rate and few perioperative complications regardless of age. Thus, the appropriate surgical intervention method would depend on the patient's health and comorbidities.IMPACT STATEMENTWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) is a superior method to vaginal surgery because of its anatomical and functional outcomes, particularly regarding sexual activity.What do the results of this study add? In this single-center study with a 15-month follow-up, we demonstrated that LSC has a high anatomical correction rate and few perioperative complications regardless of age at the time of surgery. Furthermore, there was no significant difference in the rate of complications between the ≥75 and <75 years groups. Thus, LSC may be considered for women aged >75 years. However, in these elderly patients, the surgical method should be determined according to their health status and medical comorbidities.What the implications are of these findings for clinical practice and/or further research? Age should not be the basis for exclusion from laparoscopic procedures. Moreover, LSC is a suitable and valid option for elderly women with POP. As the study population consisted of a homogenous group of Japanese women, it lacks generalisability. Studies evaluating these outcomes are required in other populations.
Collapse
Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi, Medical University Saitama Medical Center, Saitama, Japan
| | - Katsuhiko Sato
- Department of Urology, Eastern Oomiya Medical Center, Saitama, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| |
Collapse
|
14
|
Mardina Z, Venezuela J, Maher C, Shi Z, Dargusch M, Atrens A. Design, mechanical and degradation requirements of biodegradable metal mesh for pelvic floor reconstruction. Biomater Sci 2022; 10:3371-3392. [DOI: 10.1039/d2bm00179a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic organ prolapse (POP) is the herniation of surrounding tissue and organs into the vagina and or rectum, and is a result of weakening of pelvic floor muscles, connective tissue,...
Collapse
|
15
|
Diallo MN, Mayeur O, Lecomte-Grosbras P, Patrouix L, Witz JF, Lesaffre F, Rubod C, Cosson M, Brieu M. Simulation of the mobility of the pelvic system: influence of fascia between organs. Comput Methods Biomech Biomed Engin 2021; 25:1073-1087. [PMID: 34783611 DOI: 10.1080/10255842.2021.2001460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The mobility of pelvic organs is the result of an equilibrium called Pelvic Static characterizing the balance between the properties and geometries of organs, suspensions and support system. Any imbalance in this complex system can cause of pelvic static disorder. Genital prolapse is a common hypermobility pathology which is complex, multi factorial and its surgical management has high rate of complications. The use of 3 D numerical models and simulation enables the role of the various suspension structures to be objectively studied and quantified. Fascias are connective tissues located between organs. Although their role are described as important in various descriptions of pelvic statics, their influence and role has never been quantitatively objectified. This article presents a refine Finite Element (FE) model for a better understanding of biomechanical contribution of inter-organ fascia. The model is built from MRI images of a young volunteer, the mechanical properties derived from literature data to take into account the age of the patient and new experimental results have enabled an order of magnitude of the mechanical properties of the fascias to be defined. The FE results allows to quantify the biomechanical role of the fascia on pelvic mobility quantified by an analysis of dynamic MRI images and a local mapping of the gap between calculated and measured displacements. This improved numerical model integrating the fascias makes it possible to describe pelvic mobilities with a gap of 1 mm between numerical simulations and measurements, whereas without taking them into account this gap locally reaches 20 mm.
Collapse
Affiliation(s)
- Mouhamadou Nassirou Diallo
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Olivier Mayeur
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Pauline Lecomte-Grosbras
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Laurent Patrouix
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Jean François Witz
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - François Lesaffre
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Chrystle Rubod
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Michel Cosson
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Mathias Brieu
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Department of Mechanical Engineering, College Engineering, Computer Science and Technology, California State University, Los Angeles, Long Angeles, CA, USA
| |
Collapse
|
16
|
Readmission and emergency department visits after minimally invasive sacrocolpopexy and vaginal apical pelvic organ prolapse surgery. Am J Obstet Gynecol 2021; 225:552.e1-552.e7. [PMID: 34437864 DOI: 10.1016/j.ajog.2021.08.017] [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: 01/04/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Minimally invasive pelvic reconstructive surgery is becoming increasingly common; however, data on readmission and emergency department visits within 30 days of surgery are limited. OBJECTIVE Our objective was to report the risk factors for 30-day readmission and emergency department visits after minimally invasive pelvic organ prolapse surgery. STUDY DESIGN This retrospective cohort study included all minimally invasive urogynecologic prolapse procedures with and without concomitant hysterectomy performed within a large managed healthcare organization of 4.5 million members from 2008 to 2018. We queried the system-wide medical record for current procedural terminology and International Classification of Diseases, Ninth or Tenth Revision codes for all included procedures and patient demographic and perioperative data. Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department visits. Risk factors including demographics, surgical approach, and characteristics for 30-day outcomes were examined using odds ratios and chi-square tests for categorical variables and Wilcoxon rank sum tests for continuous variables. RESULTS Of the 13,445 patients undergoing prolapse surgery, 6171 patients underwent concomitant hysterectomy whereas 7274 did not. Readmission within 30 days was 2.1% for those with and 1.5% for those without a concomitant hysterectomy. Emergency department visit within 30 days was 9.5% in those with and 9.2% in those without a concomitant hysterectomy. Concomitant hysterectomy (adjusted odds ratio, 1.41; 95% confidence interval, 1.07-1.81) was associated with an increased risk of 30-day readmission. There was no difference in risk of 30-day readmission when comparing the various approaches to hysterectomy. When compared with patients who underwent sacrocolpopexy, undergoing a sacrospinous ligament suspension increased the risk (adjusted odds ratio, 2.43; 95% confidence interval, 1.22-4.70) of 30-day readmission, while undergoing uterosacral ligament suspension (adjusted odds ratio, 0.99; 95% confidence interval, 0.57-1.63) or colpocleisis (adjusted odds ratio, 1.79; 95% confidence interval, 0.50-5.24) did not in the concomitant hysterectomy subgroup, when compared with patients who underwent sacrocolpopexy, there was no difference in the risk of 30-day readmission for sacrospinous ligament suspension (adjusted odds ratio, 1.09; 95% confidence interval, 0.61-3.34), uterosacral ligament suspension (adjusted odds ratio, 1.39; 95% confidence interval, 0.61-3.34) or colpocleisis (adjusted odds ratio, 1.88; 95% confidence interval, 0.71-4.02). Similarly, sacrocolpopexy was not associated with an increased risk of emergency department visits in either subgroup. For those who had a concomitant hysterectomy, the patient factors that were associated with an increased 30-day readmission risk were hypertension (odds ratio, 1.54; 95% confidence interval, 1.03-2.31; P=.03) and chronic obstructive pulmonary disease (odds ratio, 2.52; 95% confidence interval, 1.32-4.81; P<.01). For those whose prolapse procedure did not include concomitant hysterectomy, the patient factors that were associated with an increased 30-day readmission risk were age (odds ratio, 1.05; 95% confidence interval, 1.02-1.07; P<.01) and heart failure (odds ratio, 3.26; 95% confidence interval, 1.68-6.33; P<.01). CONCLUSION In women undergoing minimally invasive pelvic organ prolapse surgery, sacrocolpopexy was not associated with an increased risk of 30-day readmission and emergency department visits. Clinicians may consider surgical approach and other factors when counseling patients about their risks after minimally invasive pelvic organ prolapse surgery.
Collapse
|
17
|
Laparoscopic versus vaginal native tissue repair in combination with pectopexy. Sub-analysis from an international, prospective, and multi-centre study: short term results. MINIM INVASIV THER 2021; 31:782-788. [PMID: 34278938 DOI: 10.1080/13645706.2021.1941118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of mesh for vaginal repairs is currently problematic and as a consequence, there is increased interest in native tissue repair. We describe the follow-up data of a sub-analysis of a prospective and multi-center study focusing on the combination of pectopexy and native tissue repair. Patients were followed up for 12-18 months after surgery (+ SD: 15). Two-hundred and sixty-four patients attended the clinics for physical examination and were integrated into the follow-up. Cystocele repair was performed laparoscopically in 84 patients and vaginally in 52 patients. Posterior repair was performed vaginally in 40 patients and laparoscopically in 53 patients. Results: Clinical success rate, patient recommendations and patient satisfaction rates were similar in both groups. The laparoscopic anterior repair resulted in an 89% cure or anatomical improvement rate; this compared to 94.2% for the vaginal approach. In the posterior group, laparoscopy resulted in a 94.3% cure or improvement rate compared to 97.5% in the second group. Conclusions: The outcomes of both strategies showed satisfactory results in our study. Consequently, surgeons may choose between the two strategies according to their preference and skill. The two approaches only differed with regard to vaginal scarring. We suggest future research investigating the long-term impact of scarring.
Collapse
|
18
|
Aleksandrov A, Smith AV, Rabischong B, Botchorishvili R. Mesh-less laparoscopic treatment of apical prolapse. Facts Views Vis Obgyn 2021; 13:179-181. [PMID: 34184848 PMCID: PMC8291984 DOI: 10.52054/fvvo.13.2.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pelvic organ prolapse (POP) is a common gynaecological problem, affecting nearly 50% of women over 40. The sacrocolpopexy using a synthetic mesh is now considered the “gold standard” for management of women with apical prolapse. In April 2019 the FDA placed a ban on the production of transvaginal meshes for prolapse due to late complications. The meshes for abdominal repair of POP are still used, but in future they may also be prohibited. The goal of the following video is to present a mesh-less modification of two techniques used for apical organ prolapse, the sacrocolpopexy and the pectopexy.
Collapse
|
19
|
Keyhanvar N, Zarghami N, Bleisinger N, Hajipour H, Fattahi A, Nouri M, Dittrich R. Cell-based endometrial regeneration: current status and future perspectives. Cell Tissue Res 2021; 384:241-254. [PMID: 33650018 DOI: 10.1007/s00441-021-03419-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
Endometrial-related disorders including Asherman's syndrome, thin endometrium, pelvic organ prolapse, and cesarean scar pregnancies can be accompanied by different symptoms such as amenorrhea, infertility, abnormal placental implantation and recurrent miscarriage. Different methods have been introduced to overcome these problems such as surgery and hormonal therapy but none of them has shown promising outcomes. On the other hand, the development of novel regenerative therapeutic strategies has opened new avenues for the treatment of endometrial-related deficiencies. In this regard, different types of scaffolds, acellular matrices and also cell therapy with adult or stem cells have been investigated for the treatment of endometrial-related deficiencies. In this paper, we review the current status of cell-based endometrium regeneration using scaffold dependent and scaffold-free methods and future perspectives in this field. Moreover, we discuss the endometrial diseases that can be candidates for cell-based treatments. Also, the cells with the potential for endometrial regeneration are explained.
Collapse
Affiliation(s)
- Neda Keyhanvar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nathalie Bleisinger
- University Hospital Erlangen, OB/GYN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hamed Hajipour
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Nouri
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ralf Dittrich
- University Hospital Erlangen, OB/GYN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
20
|
Moalli PA, Bowen ST, Abramowitch SD, Lockhart ME, Ham M, Hahn M, Weidner AC, Richter HE, Rardin CR, Komesu YM, Harvie HS, Ridgeway BM, Mazloomdoost D, Shaffer A, Gantz MG. Methods for the defining mechanisms of anterior vaginal wall descent (DEMAND) study. Int Urogynecol J 2021; 32:809-818. [PMID: 32870340 PMCID: PMC7917148 DOI: 10.1007/s00192-020-04511-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The protocol and analysis methods for the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study are presented. DEMAND was designed to identify mechanisms and contributors of prolapse recurrence after two transvaginal apical suspension procedures for uterovaginal prolapse. METHODS DEMAND is a supplementary cohort study of a clinical trial in which women with uterovaginal prolapse randomized to (1) vaginal hysterectomy with uterosacral ligament suspension or (2) vaginal mesh hysteropexy underwent pelvic magnetic resonance imaging (MRI) at 30-42 months post-surgery. Standardized protocols have been developed to systematize MRI examinations across multiple sites and to improve reliability of MRI measurements. Anatomical failure, based on MRI, is defined as prolapse beyond the hymen. Anatomic measures from co-registered rest, maximal strain, and post-strain rest (recovery) sequences are obtained from the "true mid-sagittal" plane defined by a 3D pelvic coordinate system. The primary outcome is the mechanism of failure (apical descent versus anterior vaginal wall elongation). Secondary outcomes include displacement of the vaginal apex and perineal body and elongation of the anterior wall, posterior wall, perimeter, and introitus of the vagina between (1) rest and strain and (2) rest and recovery. RESULTS Recruitment and MRI trials of 94 participants were completed by May 2018. CONCLUSIONS Methods papers which detail studies designed to evaluate anatomic outcomes of prolapse surgeries are few. We describe a systematic, standardized approach to define and quantitatively assess mechanisms of anatomic failure following prolapse repair. This study will provide a better understanding of how apical prolapse repairs fail anatomically.
Collapse
Affiliation(s)
- Pamela A Moalli
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee Women's Research Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Division of Urogynecology and Reconstructive Pelvic Surgery, Magee Women's Research Institute, Magee Women's Hospital of the University of Pittsburgh, 204 Craft Avenue, A320, Pittsburgh, PA, 15213, USA.
| | - Shaniel T Bowen
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Ham
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, Durham, NC, USA
| | - Michael Hahn
- Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego Health, San Diego, CA, USA
| | | | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Heidi S Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Beri M Ridgeway
- Division of Urogynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Amanda Shaffer
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, Durham, NC, USA
| | - Marie G Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, Durham, NC, USA
| |
Collapse
|
21
|
Gagyor D, Kalis V, Smazinka M, Rusavy Z, Pilka R, Ismail KM. Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study). BMC WOMENS HEALTH 2021; 21:72. [PMID: 33596878 PMCID: PMC7890869 DOI: 10.1186/s12905-021-01208-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/03/2021] [Indexed: 12/04/2022]
Abstract
Background Abdominal and laparoscopic sacro-colpopexy (LSC) is considered the standard surgical option for the management of a symptomatic apical pelvic organ prolapse (POP). Women who have their uterus, and for whom an LSC is indicated, can have a laparoscopic sacro-hysteropexy (LSH), a laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH + LSC) or a total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH + LSC). The main aim of this study was to compare clinical and patient reported outcomes of uterine sparing versus concomitant hysterectomy LSC procedures. Methods A retrospective analysis of clinical, imaging and patient reported outcomes at baseline, 3 and 12 months after LSH versus either LSCH + LSC or TLH + LSC between January 2015 and January 2019 in a tertiary referral urogynecology center in Pilsen, the Czech Republic. Results In total, 294 women were included in this analysis (LSH n = 43, LSCH + LSC n = 208 and TLH + LSC n = 43). There were no differences in the incidence of perioperative injuries and complications. There were no statistically significant differences between the concomitant hysterectomy and the uterine sparing groups in any of the operative, clinical or patient reported outcomes except for a significantly lower anterior compartment failure rate (p = 0.017) and higher optimal mesh placement rate at 12 months in women who had concomitant hysterectomy procedures (p = 0.006). Conclusion LSH seems to be associated with higher incidence of anterior compartment failures and suboptimal mesh placement based on postoperative imaging techniques compared to LSC with concomitant hysterectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01208-5.
Collapse
Affiliation(s)
- Daniel Gagyor
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University and Faculty Hospital, Olomouc, Czech Republic
| | - Vladimir Kalis
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Martin Smazinka
- Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Zdenek Rusavy
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Radovan Pilka
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University and Faculty Hospital, Olomouc, Czech Republic
| | - Khaled M Ismail
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic. .,Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| |
Collapse
|
22
|
Noé GK, Schiermeier S, Papathemelis T, Fuellers U, Khudyakov A, Altmann HH, Borowski S, Morawski PP, Gantert M, De Vree B, Tkacz Z, Ugarteburu RG, Anapolski M. Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair. J Clin Med 2021; 10:jcm10020217. [PMID: 33435323 PMCID: PMC7827325 DOI: 10.3390/jcm10020217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.
Collapse
Affiliation(s)
- Günter K. Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Rheinlandclinics Dormagen, 41540 Dormagen, Germany;
- Correspondence:
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, 258452 Witten, Germany;
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, St. Marien Hospital Amberg, 92224 Amberg, Germany;
| | - Ulrich Fuellers
- Private Department of Surgical Gynecology, Krefeld (GTK) Germany, 47800 Krefeld, Germany; (U.F.); (A.K.)
| | - Alexander Khudyakov
- Private Department of Surgical Gynecology, Krefeld (GTK) Germany, 47800 Krefeld, Germany; (U.F.); (A.K.)
| | - Harald-Hans Altmann
- Department of Obstetrics and Gynecology, Regiomed Clinics Coburg, 96450 Coburg, Germany;
| | - Stefan Borowski
- Department of Obstetrics and Gynecology, Clinic Links der Weser, 28277 Bremen, Germany;
| | - Pawel P. Morawski
- Department of Obstetrics and Gynecology, Helios Clinic Bad Sarow, 15526 Bad Saarow, Germany;
| | - Markus Gantert
- Department of Obstetrics and Gynecology, St. Franziskus Hospital Ahlen, 59227 Ahlen, Germany;
| | - Bart De Vree
- Department of Obstetrics and Gynecology, ZNA Middelheim Antwerp, 2020 Antwerpen, Belgium;
| | - Zbigniew Tkacz
- Department of Obstetrics and Gynecology, NHS Tayside Dundee, Dundee DD1 9SY, UK;
| | - Rodrigo Gil Ugarteburu
- Department of Obstetrics and Gynecology, University Hospital de Cabueñes, 33394 Gijon, Spain;
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Rheinlandclinics Dormagen, 41540 Dormagen, Germany;
| |
Collapse
|
23
|
Hegde's Modification of Fothergill Surgery for Cervical Elongation: A 7-Year Retrospective Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:300-305. [PMID: 33436347 DOI: 10.1016/j.jogc.2020.10.010] [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: 05/08/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of Hegde's modification of Fothergill surgery, an innovative procedure for cervical elongation (CE), and to report perioperative challenges and follow-up. METHODS This is a retrospective review of data from 12 patients who underwent successful repair of CE by Hegde's modification of Fothergill surgery from June 2012 to May 2019. Primary outcomes were cervical viability and stenosis. Secondary outcomes were perioperative complications, Pelvic Organ Prolapse Quantification system (POP-Q) measurement and staging, recurrence, conception rates, and World Health Organization Quality of Life (QOL) BREF (WHOQOL-BREF) scores. RESULTS All women had a viable, patent cervix at 1-month follow-up. Perioperative complications included total intraoperative blood loss (>50 mL) and febrile morbidity (both 16.7%) and urinary tract infections (8.3%). The mean reduction of point C was 5.78 cm (2.87 ± 0.13 cm to -2.91 ± 1.55 cm). Recurrence was noted in 1 patient (8.3%) who had POP-Q stage 2 prolapse at 6 and 12 months of follow-up. The conception rate was 8.3% at 12 months. All women conceived spontaneously. Mean preoperative WHOQOL-BREF scores improved in all 4 domains, with major improvement seen in the physical domain, from 24.66 ± 8.18 to 70.91 ± 11.01, 19.0 ± 6.48 to 54.92 ± 8.21, 9.33 ± 7.46 to 59.33 ± 14.33, and 19.0 ± 4.89 to 47.07 ± 7.14, for the physical, psychological, social, and environmental domains, respectively. CONCLUSION Hegde's modification of Fothergill surgery can be considered as a surgical option for the repair of isolated CE with a healthy cervix in women who desire uterine preservation with the major advantage of preventing cervical stenosis.
Collapse
|
24
|
Urdzík P, Kalis V, Blaganje M, Rusavy Z, Smazinka M, Havir M, Dudič R, Ismail KM. Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey). BMC WOMENS HEALTH 2020; 20:241. [PMID: 33109157 PMCID: PMC7590717 DOI: 10.1186/s12905-020-01105-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Background The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia. Results A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. Conclusions The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.
Collapse
Affiliation(s)
- Peter Urdzík
- Department of Gynecology and Obstetrics, Faculty of Medicine, Safarik's University and L. Pasteur Teaching Hospital in Kosice, SNP Street No. 1, 04001, Košice, Slovak Republic.
| | - Vladimir Kalis
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Mija Blaganje
- Division of Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, 1525, Ljubljana, Slovenia
| | - Zdenek Rusavy
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Martin Smazinka
- Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Martin Havir
- Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Rastislav Dudič
- Department of Gynecology and Obstetrics, Faculty of Medicine, Safarik's University and L. Pasteur Teaching Hospital in Kosice, SNP Street No. 1, 04001, Košice, Slovak Republic
| | - Khaled M Ismail
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic.,Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| |
Collapse
|
25
|
Pain Resolution and Recurrent Prolapse Rates Following Vaginal Mesh Removal. Urology 2020; 150:134-138. [PMID: 32673676 DOI: 10.1016/j.urology.2020.06.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate pain resolution and recurrent prolapse following removal of painful pelvic organ prolapse (POP) mesh. METHODS This was an IRB-approved retrospective review of patients who underwent POP mesh removal from 2009 to 2018 for the primary indication of pain and/or dyspareunia. Factors of interest included mesh type, complete versus partial removal, presenting symptom(s), and recurrent prolapse. Complete removal was defined as complete excision of all possible mesh, including arms, and partial removal was anything less. Postoperative symptom improvement was categorized as resolved, improved, or unresolved. RESULTS Ninety-two mesh removal patients were identified, 78 of whom underwent mesh removal for pain or dyspareunia, with mean follow-up of 17.25 months (range: 0.46-60.25). Overall, presenting symptoms resolved or improved in 85.9%. In the 45 complete removal patients, 46.7% resolved, 40.0% improved, and 11.1% unresolved compared to 51.5% resolved, 33.3% improved, and 12.1% unresolved in the 33 partial removal patients (P = .82). Recurrent symptomatic POP developed in 31.1% of patients after complete removal compared to 15.2% after partial removal (P = .12). Overall, 23 (30.3%) patients required additional reconstructive procedures. CONCLUSION Most patients experienced resolution or improvement in painful symptoms after any degree of mesh removal. Complete removal was not significantly associated with greater symptom improvement compared to partial removal. Complete removal was associated with a higher percentage of recurrent POP, but this association was not statistically significant. Less than one-third of patients required additional surgery.
Collapse
|
26
|
Evolution of patients with and without preoperative stress urinary incontinence after surgical cystocele repair by mesh implantation using a vaginal approach. Prog Urol 2020; 30:610-617. [PMID: 32536586 DOI: 10.1016/j.purol.2020.04.026] [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: 04/14/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. MATERIAL AND METHODS Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. RESULTS Thirty-six women were included (mean age: 72±7years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41±12min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n=6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR=2.0 [95% CI: 0.8175-4.8928]; P=0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. CONCLUSION Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. LEVEL OF EVIDENCE 4.
Collapse
|
27
|
Lo TS, Ng KL, Huang TX, Chen YP, Lin YH, Hsieh WC. Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year. J Minim Invasive Gynecol 2020; 28:107-116. [PMID: 32416263 DOI: 10.1016/j.jmig.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. DESIGN Retrospective cohort study. SETTING Tertiary-care university hospital. PATIENTS Patients with symptomatic anterior or apical POP stage III and above. INTERVENTIONS All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. MEASUREMENTS AND MAIN RESULTS Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre- and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. CONCLUSION A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh); Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Taiwan (Drs. Lo and Chen); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei (Dr. Lo), Taiwan.
| | - Kai Lyn Ng
- Department of Obstetrics and Gynaecology, National University Hospital of Singapore (Dr. Ng), Singapore
| | - Ting-Xuan Huang
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh)
| | - Yi-Pin Chen
- Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Taiwan (Drs. Lo and Chen)
| | - Yi-Hao Lin
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh); Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin)
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh)
| |
Collapse
|
28
|
Giugale LE, Carter-Brooks CM, Ross JH, Shepherd JP, Zyczynski HM. Outcomes of a Staged Midurethral Sling Strategy for Stress Incontinence and Pelvic Organ Prolapse. Obstet Gynecol 2020; 134:736-744. [PMID: 31503149 DOI: 10.1097/aog.0000000000003448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the proportion of women who experienced resolution of stress urinary incontinence (SUI) symptoms after surgery for pelvic organ prolapse (POP) without a concomitant incontinence procedure. METHODS We conducted a retrospective observational study of women with preoperative subjective and objective SUI who underwent minimally invasive sacrocolpopexy or uterosacral ligament suspension from 2009 to 2015. We excluded cases with incontinence procedures. The primary outcome was the proportion of women with subjective resolution of SUI postoperatively, defined as the absence of patient reported SUI symptoms during follow-up. Secondary outcomes included the proportion of women who underwent a subsequent staged midurethral sling (MUS) procedure and factors associated with resolution of SUI and staged MUS placement. RESULTS Of 93 women, most were white (n=90, 98%) with stage III POP (n=55, 59%). Mean age was 59.5±8.9 years and body mass index 28.7±4.7. Seventy-three patients (78%) underwent minimally invasive sacrocolpopexy, and 20 (22%) underwent uterosacral ligament suspension. Median follow-up was 8.3 months (interquartile range 3.4-26.7). Postoperatively, 28 (30%) patients reported resolution of SUI, and 65 (70%) reported persistent SUI. Of the 93 patients, 47 (51%) were treated for persistent SUI and 34 (37%) underwent a staged MUS procedure. Among the staged MUS procedures, 27 (79%) were placed within 12 months. Median time to staged MUS procedure was 5.5 months (interquartile range 4.2-9.9). After controlling for degree of preoperative SUI bother, obese women were less likely to experience resolution of SUI after prolapse repair (odds ratio 0.28, 95% CI 0.08-0.95). We did not identify any factors that were significantly associated with undergoing a staged MUS procedure on univariate analyses (P>.05). CONCLUSION Preoperative SUI resolved in nearly a third of women after prolapse surgery without a concomitant incontinence procedure. In a population typically offered a concomitant MUS procedure at the time of prolapse repair, a staged approach may result in nearly two-thirds fewer patients undergoing MUS procedures. This information may be helpful during preoperative shared decision making.
Collapse
Affiliation(s)
- Lauren E Giugale
- UPMC Magee-Womens Hospital, and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Department of Obstetrics and Gynecology, Trinity Health Of New England, Hartford, Connecticut
| | | | | | | | | |
Collapse
|
29
|
Perioperative Outcomes for Combined Ventral Rectopexy With Sacrocolpopexy Compared to Perineal Rectopexy With Vaginal Apical Suspension. Female Pelvic Med Reconstr Surg 2020; 26:376-381. [PMID: 32217912 DOI: 10.1097/spv.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe and compare perioperative complications in women undergoing combined ventral rectopexy with sacrocolpopexy compared with perineal rectopexy with vaginal apical suspension. METHODS Current Procedural Terminology codes were used to identify women in the National Surgical Quality Improvement Program database who underwent ventral rectopexy with sacrocolpopexy or perineal rectopexy with vaginal apical suspension from 2006 to 2015. Perioperative complication was defined as any of the following within 30 days of surgery: death, return to the operating room, transfusion, or vascular, wound, respiratory, infectious, or renal morbidity. Secondary outcomes included length of hospital stay, operative time, blood loss, readmission, and rate of urinary tract infections. Modified Poisson regression was used to estimate the adjusted relative risks of complication associated with surgical approach, abdominal versus perineal. RESULTS Of the 273 women included, 240 (88%) underwent surgery with an abdominal approach, and 33 (12%) underwent surgery with a perineal approach. Perioperative complications occurred in 24 (9%) patients; 19 (8%) in the abdominal group and 5 (15%) in the perineal group. The age-adjusted risk of perioperative complications was not significantly different between those with a perineal approach compared with those with an abdominal approach (adjusted relative risk, 1.78; 95% confidence interval, 0.73-4.33). CONCLUSIONS Patients in this database who underwent surgery with a vaginal/perineal approach were not more likely to have a postoperative complication after adjusting for age compared with those undergoing an abdominal approach. Larger studies are needed to determine a more precise estimate of the impact of surgical approach on rates of perioperative complications.
Collapse
|
30
|
Li C, Dai Z, Shu H. Laparoscopic inguinal ligament suspension combined with hysterectomy for the treatment of uterovaginal prolapse. J Obstet Gynaecol Res 2019; 45:1918-1924. [PMID: 31264339 DOI: 10.1111/jog.14035] [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: 12/18/2018] [Accepted: 05/25/2019] [Indexed: 11/28/2022]
Abstract
AIM To demonstrate the efficacy and safety of a modified technique of laparoscopic inguinal ligament suspension (LILS) with hysterectomy for the treatment of uterovaginal prolapse. METHODS A total of 57 patients were treated by LILS combined with hysterectomy between Jan 2014 and Feb 2016. The perioperative parameters, such as operative time, estimated blood loss, length of stay and intra- and postoperative complications were recorded. The Pelvic Organ Prolapse questionnaire classification was applied to evaluate the Pelvic Organ Prolapse stage, and Patient Global Impression of Improvement scale was used to determine the patients' satisfaction. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire were used to evaluate the functional improvement. All data were collected preoperatively and then at 12 months postoperatively. RESULTS The mean surgical time was 130.4 (82-190) min, the average blood loss was 50.4 (10-300) mL and the mean hospitalization was 5.3 (4-8) days. The rates of intra- and postoperative complications were low. After a minimal of 12 months follow-up, the anatomical success rate was 85.5%, and the subjective satisfaction rate was 92.7%. The functional measures also presented a significant improvement with no recurrence of prolapse. CONCLUSION LILS combined with hysterectomy was a safe and effective technique and might be considered as an alternative treatment for patients with uterovaginal prolapse.
Collapse
Affiliation(s)
- Chunbo Li
- 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
| | - Huimin Shu
- Department of Gynaecology and Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
31
|
Efficacy and safety of the Calistar and Elevate anterior vaginal mesh procedures. Eur J Obstet Gynecol Reprod Biol 2019; 239:30-34. [PMID: 31163354 DOI: 10.1016/j.ejogrb.2019.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/05/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The pelvic organ prolapse (POP) surgery with implantation of anterior transvaginal mesh (e.g. Elevate or Calistar) may provide objective and subjective improvement as compared to traditional POP repair without mesh. Given differences between the Elevate and the Calistar mesh and their different placement methods, some variation inlong-term clinical outcomes of these anterior vaginal mesh procedures can be expected. STUDY DESIGN The purpose of the study was to compare the 18-month operative success in patients who had undergone anterior POP surgery with either the Calistar (n = 54) or Elevate mesh (n = 50). RESULTS There were no between-group differences in objective measures of operative efficacy, including POP-Q anterior stage 0 or I (94% for Calistar, 92% for Elevate) and "no descent beyond the hymen" (98% for Calistar, 94% for Elevate). The proportion of patients with subjective measure of operative efficacy (no vaginal bulge symptoms) did not differ between the groups (91% for Calistar, 78% for Elevate). There were no between-group differences in the proportion of women suffering from vaginal exposure, de novo stress urinary incontinence (SUI), de novo overactive bladder (OAB) symptoms, pelvic floor pain or dyspareunia. The operative cure of OAB symptoms was similar in the groups. The proportion of patients with the operative cure of SUI symptoms was significantly higher in the Calistar as compared to the Elevate group. CONCLUSIONS The results suggestthat the Calistar system offers similar efficacy in the treatment of anterior and both anterior and apical POP as compared to the Elevate. The use of anterior Calistar is associated with some additional benefits, i.e. SUI treatment in patients with concomitant anterior and both anterior and apical POP and SUI symptoms.
Collapse
|
32
|
A systematic review of the psychometric properties of the cross-cultural adaptations and translations of the Prolapse Quality of Life (P-QoL) questionnaire. Int Urogynecol J 2019; 30:1989-2000. [PMID: 31028420 DOI: 10.1007/s00192-019-03920-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Due to linguistic and cultural differences, there is a need to test the psychometrics of the translated versions of any patient-reported outcome measures. We investigated the psychometric properties of the Prolapse Quality of Life (P-QoL) questionnaire for non-English-speaking populations by conducting a systematic review of studies that examined the psychometric properties of non-English versions. METHODS We searched PubMed, Latin American and Caribbean Health Science Information Center (LILACS), and Science Direct databases for articles published in English up to February 2018. Methodological quality and quality of psychometric properties were assessed by two independent reviewers using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and validated quality assessment criteria. The two assessments were combined to produce the best level of evidence per language/translation. RESULTS Sixteen articles in 13 languages were retrieved. Most (n = 9; 56.3%) were not rigorously translated or reported, and there was poor evidence for structural validity. Internal consistency was reported in all studies, and all studies had good methodological quality. There was fair evidence for construct and good to fair for criterion validity. Evidence for responsiveness was good, although this was evaluated only in three studies. CONCLUSIONS There is limited evidence supporting the psychometric robustness of the original validation and translated versions of P-QoL. Cross-cultural adaptations are insufficient. Given this variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error, and cutoff values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions.
Collapse
|
33
|
Cameron AP. Systematic review of lower urinary tract symptoms occurring with pelvic organ prolapse. Arab J Urol 2019; 17:23-29. [PMID: 33110659 PMCID: PMC7567315 DOI: 10.1080/2090598x.2019.1589929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/23/2018] [Indexed: 10/31/2022] Open
Abstract
Objective: To review lower urinary tract symptoms (LUTS), which include a large variety of bladder complaints, in women with simultaneous pelvic organ prolapse (POP). Methods: This article is a systematic review of the current literature on LUTS occurring simultaneously with POP following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Results: The prevalence of both conditions is high, but they occur more frequently together than can be explained by chance. It appears that POP is in some women causative of overactive bladder (OAB) symptoms, as in many women correction of the POP resolves the bladder symptoms and small studies of women with detrusor underactivity also demonstrate resolution of symptoms. The most plausible explanation for the relationship is that POP causes bladder outlet obstruction, which results in excess bladder irritability or poor contractility. However, not all women have resolution of their OAB symptoms and some women develop them de novo after POP repair, so this explanation requires more in depth study. Conclusions: Women with both LUTS and symptomatic POP should probably have their POP targeted, as its reduction either via surgery or pessary can correct the LUTS. However, no studies have addressed asymptomatic POP, so it is unclear if treating POP in these instances is of benefit. Abbreviations: BOO: bladder outlet obstruction; DO: detrusor overactivity; DU: detrusor underactivity; OAB: overactive bladder; PdetQmax: detrusor pressure at maximum urinary flow; POP: pelvic organ prolapse; PVR: post-void residual urine volume; RR: relative risk; SUFU: Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction; UDS: urodynamic studies; (S)(U)UI: (stress) (urgency) urinary incontinence.
Collapse
Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
34
|
Abstract
OBJECTIVES This study aimed to evaluate surgical and clinical outcomes of laparoscopic mesh-less cervicosacropexy for the treatment of uterovaginal prolapse. METHODS This single institutional review board-approved prospective cohort study enrolled 46 consecutive, sexually active symptomatic women requiring surgical correction of uterovaginal prolapse, from July 2013 to March 2016. After supracervical laparoscopic hysterectomy, the cervix was suspended to the anterior longitudinal ligament of the sacral promontory through a continuous suture with plication and shortening of the right uterosacral ligament. Pelvic organs' function was evaluated through validated questionnaires during preoperative and postoperative follow-up evaluations. The anatomical recurrences of genital prolapse with a Pelvic Organ Prolapse Quantitative stage 2 or higher, in particular of central compartment (Pelvic Organ Prolapse Quantitative score C ≥-1), were recorded. RESULTS Mean ± SD age was 55.5 ± 10.9 years. Mean ± SD operating time was 97.4 ± 25.6 (range, 60-180) minutes. Mean ± SD hospitalization length was 3.6 ± 0.9 (range, 2-6) days. No intraoperative complications were recorded. Median length of follow-up was 24 (range, 12-38) months. During the follow-up period, the objective success rates for central compartment prolapse and for all compartments were 93.5% and 89.1%, respectively. No woman presented dyspareunia at follow-up. Thirty-nine women (84.8%) reported very high satisfaction related to surgery and 6 (13%) a moderate satisfaction. Overall Female Sexual Function Index, Knowles-Eccersley-Scott Symptom, and Bristol Female Lower Urinary Tract scores improved significantly after surgery, except for incontinence score domain. CONCLUSIONS Laparoscopic mesh-less cervicosacropexy represents an effective and feasible option for the surgical treatment of uterovaginal prolapse in sexually active women, avoiding postoperative complications due to the mesh use.
Collapse
|
35
|
Braun NM, Andraos W, Bettin S. Safety and efficacy of spider anchoring device for apical repair in laparoscopic sacrocolpopexy: Retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 235:88-92. [PMID: 30851636 DOI: 10.1016/j.ejogrb.2019.02.013] [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: 01/08/2019] [Revised: 01/27/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the study was to assess safety and efficacy of apical support when using the soft-tissue metal fasteners of EndoFast Reliant™ SCP during laparoscopic sacrocolpopexy (LSCP). STUDY DESIGN This is a single-center, retrospective cohort study including all patients which underwent LSCP between 2015 and 2017. Safety outcome included the procedure and the device related complications. Effectiveness outcomes included the anatomical success of apical repair and the functional results as were obtained from the clinic and from a Quality of life questionnaire (PFDI-20). RESULTS Eighty-four patients, 54% with grade III and IV prolapse were included in the study. Uterus was preserved in 68% of patients with uterus. Mean follow-up period for the clinic visit was 4.5 ± 4 months. Short term anatomical success was achieved for 98.8% of the patients. Marked improvement was observed in the related symptoms including urinary incontinence. Three intra-operative complications occurred: 1 case of bladder injury, 1 case of intra-abdominal bleeding, and 1 case of post-operative vaginal bleeding. Later complications included only two patients (2.3%) complained of chronic abdominal pain. There were no cases of mesh erosion or de-novo dyspareunia. The mean follow-up period for the PFDI-20 questionnaire was 15.6 months. 75% of patients had no bulge symptoms at all. Quarter of the patients had some bulge symptoms, bothers them between somewhat to moderately according to the questionnaire grading. CONCLUSIONS The use of Endofast SCP fasteners for laparoscopic promonto-fixation is a safe and effective surgery. Longer follow-up and larger studies should be performed to establish the results.
Collapse
Affiliation(s)
- Naama Marcus Braun
- Obstetrics and Gynecology Department, Ziv Medical Center, Safed, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Wael Andraos
- Obstetrics and Gynecology Department, Catholic Hospital Chain Weser-Egge, Sankt Ansgar Hospital, Höxter, Germany
| | - Stefan Bettin
- Obstetrics and Gynecology Department, Catholic Hospital Chain Weser-Egge, Sankt Ansgar Hospital, Höxter, Germany.
| |
Collapse
|
36
|
Ultrasonographic Assessment with Three-Dimensional Mode of the Urethral Compression Effect following Sling Surgery with and without Mesh Surgery. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8285351. [PMID: 30723744 PMCID: PMC6339735 DOI: 10.1155/2019/8285351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/14/2018] [Indexed: 11/18/2022]
Abstract
Background The aim of this study was to assess anatomical changes in the urethra at rest and during straining following sling surgery with and without transvaginal mesh surgery (TVM) in women with stress urinary incontinence (SUI) with or without pelvic organ prolapse (POP) using three-dimensional ultrasonography. Methods 76 women with SUI with or without pelvic organ prolapse after sling surgery. They underwent sling surgery alone (S group, n=36) or concomitant TVM (M group, n=40). All patients underwent urinalysis, pelvic examinations, urodynamic study, 3D perineal ultrasonography, and personal interviews before and 1 year after surgery. The urethral area was calculated from the axial plane of perineal ultrasonography by multiplying π by the long and short axes of the urethral lumen. Results The axial area of the middle and distal urethra during straining was significantly smaller than at rest in both groups (P<0.001). In addition, the length of the short axis of the proximal urethra was significantly shorter in those undergoing sling surgery alone during straining compared with those undergoing concomitant sling and mesh surgery (P<0.001). Conclusions There was a greater impact on the proximal urethra in women who underwent sling surgery alone than those who underwent sling and TVM surgery together.
Collapse
|
37
|
Israeli O, Weintraub AY. Surgery for Anterior Compartment Prolapse Synthetic Graft-Augmented Repair. Urol Clin North Am 2019; 46:71-78. [DOI: 10.1016/j.ucl.2018.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Zargham M, Saberi N, Khorrami MH, Mohamadi M, Nourimahdavi K, Izadpanahi MH. Stress Urinary Incontinence and Pelvic Organ Prolapse Correction by Single Incision and Using Monoprosthesis: Three-year Follow-up. Adv Biomed Res 2019; 7:159. [PMID: 30662888 PMCID: PMC6319033 DOI: 10.4103/abr.abr_57_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The aim was to study the effectiveness and safety of a modified technique that employs a four-arm polypropylene (PP) mesh (NAZCA-TC) to treat pelvic organ prolapse (POP) and concurrent stress urinary incontinence (SUI) simultaneously. Materials and Methods: This prospective follow-up study was conducted on fifty SUI women with concurrent high-grade (greater than Stage 2) anterior vaginal wall and/or uterine prolapse who were referred to Al-Zahra and Noor Hospitals in Isfahan and underwent surgery using the NAZCA-TC, Promedon, Argantina kit. The POP-Quantification system was employed for staging POP before and after surgery. To evaluate lower urinary tract symptoms (LUTS) and patients’ quality of life, a stress test and the short form of International Consultation on Incontinence Questionnaire of Female Lower Urinary Tract Symptom were used. Patients were followed up and assessed at 6 weeks, 6 months, and 1, 2, and 3 years after surgery. Results: The mean age of patients was 58.2 ± 10.2 years. There was a great reduction (88.6%) in POP staging after surgery. The success rate of SUI treatment was significantly high (83.5%). During 3 years of postoperative follow-up, mesh erosion occurred in 18%, 5 patients (10%) presented with mesh erosion in the first years after operation, 16% reported significant groin or pelvic pain, and 10% required sling release. Conclusion: A single vaginal incision and using two less percutaneous access sites with the PP meshes were effective for treating patients with concurrent POP and SUI but have a high rate of postsurgery erosion rate.
Collapse
Affiliation(s)
- Mahtab Zargham
- Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narjes Saberi
- Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hatef Khorrami
- Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Mohamadi
- Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kia Nourimahdavi
- Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hosein Izadpanahi
- Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
39
|
Effect of Er:YAG Laser for Women with Stress Urinary Incontinence. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7915813. [PMID: 30766886 PMCID: PMC6350556 DOI: 10.1155/2019/7915813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/25/2018] [Accepted: 01/01/2019] [Indexed: 01/24/2023]
Abstract
Purpose The aim of our study is to assess efficacy of noninvasive erbium-doped yttrium aluminium garnet laser (Er:YAG laser) for female stress urinary incontinence (SUI). Materials and Methods Forty-one women with SUI were included in the study and scheduled for vaginal Er:YAG laser treatment. The procedure was performed with a 2940 nm, Er:YAG laser (Fotona Smooth ™ XS, Fotona, Ljubljana, Slovenia), designed to heat up the vaginal mucosa to around 60°C. All subjects had a baseline and 6 months' posttreatment assessment that included perineal sonography and lower urinary tract symptoms. Results Significant improvements in both urinary frequency and incontinence were found 6 months after Er:YAG laser treatment when compared to the baseline results (p<0.001). The battery of questionnaires administered to patients, including the UDI-6, IIQ-7, OABSS, and POPDI-6, all showed significant improvement posttreatment (P < 0.001). The treatment efficacy for the vaginal Er:YAG laser for SUI at 6 months posttreatment was 75.5% (31/41). Bladder neck mobility by perineal ultrasonography decreased significantly (16.1 ± 6.4 mm to 10.5 ± 4.6 mm) after treatment (p=0.039). No permanent adverse events were found. Conclusions The Er:YAG vaginal laser seems to be a safe and efficacious treatment for women with mild to moderate SUI, this being partly related to the decrease of bladder neck mobility following laser treatment.
Collapse
|
40
|
Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Genet T. Translation, transcultural adaptation, reliability and validation of the pelvic organ prolapse quality of life (P-QoL) in Amharic. Health Qual Life Outcomes 2019; 17:12. [PMID: 30642346 PMCID: PMC6332683 DOI: 10.1186/s12955-019-1079-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/03/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Prolapse Quality of Life (P-QoL) is a disease-specific instrument designed to measure the health-related quality of life in women with prolapse; however, there is no Amharic version of the instrument. The aim of this study were to translate the P-QoL into Amharic and evaluate its psychometric properties among adult women. METHODS We followed an intercultural adaptation procedure to translate and adapt the P-QoL. A forward-backward translation, face validity interviews with experts and cognitive debriefing of the translated version with ten adults from the target group were performed. The Amharic version was then completed by 230 adult women with and without POP symptoms. All women were examined using a simplified Pelvic Organ Prolapse Quantification (SPOP-Q) system. We examined internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient = ICC). Confirmatory factor analysis (CFA) was conducted and model fit was discussed. We extracted a new factor structure by exploratory factor analysis (EFA). Criterion validity was also assessed against the SPOP-Q stage. RESULTS The translated measure was found acceptable by the experts and target group, with only minor adaptations required for the Amharic context. It had high internal consistency (α = 0.96) and test-retest reliability (ICC = 0.87; p < 0.001). In CFA results, the model fit indices were unacceptable (CFI = 0.69, RMSEA = 0.17, SRMR = 0.43, TLI = 0.65, and PCLOSE = 0.00). EFA extracted three-factor with satisfactory convergent and discriminant validity. The P-QoL median scores were significantly higher in symptomatic women (Mann-Whitney U Test; p < 0.001). The score was also significantly correlated with stage of prolapse (Spearman's correlation coefficient = 0.42 to 0.64, p < 0.001). CONCLUSIONS The P-QoL scale was successfully translated to Amharic and appears feasible, reliable and valid for Amharic-speaking women. Factor analysis confirmed a three-factor structure, inconsistent with the original English version. Further studies are needed to evaluate responsiveness of the Amharic P-QoL score.
Collapse
Affiliation(s)
- Tadesse Belayneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box –196, Gondar, Ethiopia
| | - Abebaw Gebeyehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box –196, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Obstetrics and Gynecology, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Guri Rortveit
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Tinsae Genet
- Department of Obstetrics and Gynecology, School of Medicine, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
41
|
Abstract
Sexual dysfunction in women with prolapse and incontinence is well documented in the literature, but the impact of treatment, particularly surgical correction, remains very limited and confusing. Age, on the other hand, has been shown to be an independent risk factor for deteriorating sexual function, with all aspects of the sexual function (i.e. desire, arousal, penetration, and orgasm) being affected. When combined with surgical correction of prolapse or incontinence there is potential for further worsening of sexual function, and hence this should be assessed before any pelvic floor surgery and patient expectations established. In this article the current evidence will be reviewed looking at the impact of pelvic floor dysfunction on sexual function and the effect of commonly performed surgery for these problems. Ways and means of preserving sexual function in women undergoing corrective surgery will also be investigated.
Collapse
Affiliation(s)
- S Jha
- a Department of Urogynaecology , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
| |
Collapse
|
42
|
Affiliation(s)
- Youn-Jee Chung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
- Seoul St. Mary's Fibroid Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
- Seoul St. Mary's Fibroid Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
43
|
Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Genet T. Validation of the Amharic version of the Pelvic Organ Prolapse Symptom Score (POP-SS). Int Urogynecol J 2018; 30:149-156. [PMID: 30465061 DOI: 10.1007/s00192-018-3825-x] [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: 08/27/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to translate and culturally adapt the Pelvic Organ Prolapse Symptom Score (POP-SS) into Amharic and evaluate its psychometric properties. METHODS We followed an intercultural adaptation procedure to translate and adapt the POP-SS. One hundred and eighty-six women with POP symptoms completed the Amharic POP-SS and Prolapse Quality of Life (P-QoL) questionnaires. All women were examined using a simplified Pelvic Organ Prolapse Quantification (SPOP-Q) system and were divided into four groups based on the POP-Q scores as stage 1, 2, 3, and 4. Internal consistency and test-retest reliability were determined using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. Criterion validity was assessed against the SPOP-Q stage and the P-QoL scale. Furthermore, we tested construct validity using exploratory factor analysis. RESULTS The POP-SS score was successfully translated and achieved good content validity. It had high internal consistency (Cronbach's alpha = 0.86) and test-retest reliability (ICC = 0.81; p < 0.001). There was a statistically significant difference among four groups of stages in POP-SS score. and women with stage 3 had the highest median score (Kruskal-Wallis test; p < 0.05). The POP-SS score was also significantly correlated with the P-QoL score (Spearman's correlation coefficient = 0.28, p < 0.001). The exploratory factor analysis identified two factors, namely, physical symptoms and evacuation symptoms. CONCLUSIONS The POP-SS scale was successfully translated to Amharic and appears reliable and valid for women with symptoms of POP. However, further studies are needed to evaluate its responsiveness.
Collapse
Affiliation(s)
- Tadesse Belayneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abebaw Gebeyehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Guri Rortveit
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, Uni Health, Uni Research, Bergen, Norway
| | - Tinsae Genet
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
44
|
SEAPI Incontinence Classification System: 1-Year Postoperative Results Following Midurethral Sling Placement. Female Pelvic Med Reconstr Surg 2018; 26:671-676. [PMID: 30418297 DOI: 10.1097/spv.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are limited long-term data that has examined postoperative quality-of-life measures following placement of midurethral sling (MUS) for stress urinary incontinence (SUI). The SEAPI incontinence questionnaire includes 5 data points that rate severity of specific urinary symptoms. Our aim was to describe changes in SEAPI questionnaire outcomes 1 year following sling placement. METHODS We retrospectively reviewed women who underwent MUS for SUI from 2005 to 2012. We included those women who had completed preoperative and postoperative (>12 months) SEAPI scores. Individual S, E, A, P, I score cure was defined as postoperative score of 0 (>0 preoperative). Logistic regression analysis was used to model the effects of patient characteristics on incontinence cure and S, E, A, P, I scores. RESULTS A total of 584 women were included. Median follow-up was 25.4 months (12-126.8 months). Follow-up duration and baseline S, P, and I scores were associated with significantly lower odds of overall incontinence cure, whereas rectocele grade has positive association (odds ratio, 1.31; P = 0.040). Type of sling did not impact overall incontinence cure or cure of individual SEAPI scores. CONCLUSIONS Preoperative S, P, and I scores had negative association with stress incontinence cure. Cure of individual S, E, A, P, I scores was impacted differently by various patient factors. The SEAPI questionnaire provides a unique profile of patient-reported and functional measures in women with SUI and may be helpful in those who undergo MUS.
Collapse
|
45
|
Prophylactic midurethral sling insertion during transvaginal pelvic reconstructive surgery for advanced prolapse patients with high-risk predictors of postoperative de novo stress urinary incontinence. Int Urogynecol J 2018; 30:1541-1549. [DOI: 10.1007/s00192-018-3787-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
|
46
|
Alt CD, Benner L, Mokry T, Lenz F, Hallscheidt P, Sohn C, Kauczor HU, Brocker KA. Five-year outcome after pelvic floor reconstructive surgery: evaluation using dynamic magnetic resonance imaging compared to clinical examination and quality-of-life questionnaire. Acta Radiol 2018; 59:1264-1273. [PMID: 29409326 DOI: 10.1177/0284185118756459] [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] [Indexed: 11/16/2022]
Abstract
Background Dynamic magnetic resonance imaging (dMRI) captures the entire pelvis during Valsalva maneuver and helps diagnosing pelvic floor changes after reconstructive surgery. Purpose To evaluate therapeutic outcome five years after reconstructive surgery using clinical examination, dMRI, and quality-of-life (QOL) questionnaire. Material and Methods Clinical examination, dMRI, and QOL questionnaire were conducted before surgery and in the follow-ups at 12 weeks, one year, and five years in women with pelvic organ prolapse (POP) stage ≥2. dMRI was performed at 1.5-T using a predefined protocol including sagittal T2-weighted (T2W) sequence at rest and sagittal T2W true-FISP sequence at maximum strain for metric POP measurements (reference points = bladder, cervix, pouch, rectum). Pelvic organ mobility (POM) was defined as the difference of the metric measurement at maximum strain and at rest. Results Twenty-six women with 104 MRI examinations were available for analysis. dMRI results mostly differ to clinical examination regarding the overall five-year outcome and the posterior compartment in particular. dMRI diagnosed substantially more patients with recurrent or de novo POP in the posterior compartment (n = 17) compared to clinical examination (n = 4). POM after five years aligns to preoperative status except for the bladder. POM reflects best the QOL results regarding defecation disorders. Conclusion A tendency for recurrent and de novo POP was seen in all diagnostic modalities applied. dMRI objectively visualizes the interaction of the pelvic organs and the pelvic floor after reconstructive surgery and POM correlated best with the women's personal impression on pelvic floor complaints.
Collapse
Affiliation(s)
- Céline D Alt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Medical School, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Florian Lenz
- Department of Obstetrics and Gynecology, St. Marienkrankenhaus Ludwigshafen, Academic Teaching Hospital of the Faculty of Medicine Mannheim of the University of Heidelberg Medical Center, Ludwigshafen am Rhein, Germany
| | - Peter Hallscheidt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Medical School, Heidelberg, Germany
- Radiological Department Darmstadt, Academic Teaching Practice of the University of Heidelberg Medical Center, Darmstadt, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, St. Marienkrankenhaus Ludwigshafen, Academic Teaching Hospital of the Faculty of Medicine Mannheim of the University of Heidelberg Medical Center, Ludwigshafen am Rhein, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Kerstin A Brocker
- Department of Obstetrics and Gynecology, St. Marienkrankenhaus Ludwigshafen, Academic Teaching Hospital of the Faculty of Medicine Mannheim of the University of Heidelberg Medical Center, Ludwigshafen am Rhein, Germany
| |
Collapse
|
47
|
Noé GK, Alkatout I, Schiermeier S, Soltécz S, Anapolski M. Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach. MINIM INVASIV THER 2018; 28:241-246. [PMID: 30261775 DOI: 10.1080/13645706.2018.1510420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Traditionally, a cystocele caused by a midline defect of the pelvic fascia is treated by vaginal fascia duplication, also known as anterior colporraphy. The rectocele is managed by suturing the posterior fascia and, frequently, the levator ani muscles. We developed the approach of laparoscopic anterior and posterior fascia repair by native tissue. Material and methods: The methods were based on anterior and posterior exposure of pelvic fascia similar to the preparation of an extended sacral colpopexy. The fascia was compressed and narrowed by absorbable woven sutures, size 1. Twenty-seven patients were followed up for 6-13 months. All patients received additional apical fixation by pectopexy. Results: In the examination group, 13 patients underwent anterior laparoscopic fascia repair and 23 had posterior repair. We detected one apical and one posterior relapse, and also one in the anterior repair group. The patient with the apical relapse reported pain and de novo urgency. Anatomical reconstruction was achieved in all other patients. Summary: Laparoscopic anterior and posterior native tissue repair appears to be a feasible method for the treatment of midline cystocele and rectocele. No new risks were observed. The technique leaves no scar in the vagina and is well accepted. Abbreviations: POPQ: Pelvic Organ Prolapse Quantification System; FDA: Food and Drug Association; US: United States; Fig: Figure; ICIQ: International Consultation on Incontinence Questionnaire.
Collapse
Affiliation(s)
- Guenter Karl Noé
- a University of Witten Herdecke Medical Department , Witten , Germany.,b Department of OB/GYN , Communal Hospital Dormagen , Dormagen , Germany
| | | | - Sven Schiermeier
- d Department of OB/GYN , University of Witten Herdecke, Marien Hospital Witten , Witten , Germany
| | - Stephan Soltécz
- b Department of OB/GYN , Communal Hospital Dormagen , Dormagen , Germany
| | - Michael Anapolski
- a University of Witten Herdecke Medical Department , Witten , Germany.,b Department of OB/GYN , Communal Hospital Dormagen , Dormagen , Germany
| |
Collapse
|
48
|
Patient-Reported Impact of Pelvic Organ Prolapse on Continence and Sexual Function in Women With Exstrophy-Epispadias Complex. Female Pelvic Med Reconstr Surg 2018; 23:377-381. [PMID: 28277470 DOI: 10.1097/spv.0000000000000414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to characterize long-term urogynecologic issues of women with a history of bladder exstrophy and pelvic organ prolapse (POP) and to assess the impact of POP repair on continence and sexual function. DESIGN Patient demographics and surgical history related to exstrophy and POP were collected through chart review. Patient perceptions regarding sexual function, urinary continence, and quality of life were assessed through Web-based administration of validated questionnaires: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and POP-Urinary Incontinence Sexual Questionnaire. SETTING Maryland, United States. PARTICIPANTS Review of a single-institution exstrophy-epispadias complex database resulted in 25 adult female patients with a history of POP treated at the authors' institution. Eleven patients participated and were included in the analysis. MAIN OUTCOME MEASURES Urinary continence and sexual function. RESULTS All participants underwent surgical repair for prolapse, with 7 (63.6%) experiencing unsuccessful initial repair and subsequent recurrence. Median total number of POP repairs was 2.5 (1-4). After correction of POP, patients reported a median improvement in International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form scores of 11 (21 to -1) of 21 and in POP-Urinary Incontinence Sexual Questionnaire scores of 9.5 (6.5-33.0) of 48.0. With regard to urinary continence, 6 (54.5%) patients presently reported no incontinence, 3 (27.3%) reported mild incontinence, and 2 (18.2%) reported continuous incontinence. CONCLUSIONS Pelvic organ prolapse poses significant reductions in quality of life for women born with exstrophy, with effects on urinary continence and sexual function. Identification and correction of prolapse seems to result in notable improvements in the lives of these patients.
Collapse
|
49
|
Kurdoglu M, Unlu S, Antonetti-Elford M, Kurdoglu Z, Kilic GS. Short-term results of changes in existing and de novo lower urinary tract symptoms after robot-assisted laparoscopic uterosacral ligament suspension and sacrocolpopexy. Low Urin Tract Symptoms 2018; 11:O71-O77. [PMID: 29508556 DOI: 10.1111/luts.12219] [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: 10/17/2017] [Revised: 12/26/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study presents short-term outcomes related to changes in existing and de novo lower urinary tract symptoms (LUTS), pelvic pain, and bowel function following robot-assisted laparoscopic uterosacral ligament suspension (RALUSLS) and sacrocolpopexy (RALSC). METHODS Observational data for RALUSLS (n = 23) and RALSC (n = 25) collected between August 2014 and March 2016 from a single institute (The University of Texas Medical Branch) were evaluated retrospectively. Patient characteristics, concomitant procedures, and the occurrence of lower urinary tract, pelvic pain, and bowel symptoms were compared between patients undergoing RALUSLS and RALSC. RESULTS There was no significant difference in background characteristics between the 2 groups, except for parity, which was high in the RALUSLS group. In the RALUSLS group, patients experienced significant resolution of urinary urgency (P < .001) and frequency, urge and mixed incontinence, and pelvic pain (P < .05). In the RALSC group, there was significant resolution of nocturia, mixed incontinence, pelvic pain, and dyspareunia (P < .05). There was no significant difference in the occurrence of de novo symptoms in the RALUSLS and RALSC groups (P > .05), although newly appearing urinary urgency or frequency and stress or urge incontinence were more common after RALSC. CONCLUSION Mixed incontinence and pelvic pain improved significantly in patients after RALUSLS or RALSC. In RALUSLS patients, urgency, frequency, and urge incontinence also improved, whereas additional improvement in nocturia and dyspareunia was evident only in RALSC patients. De novo LUTS developing after these procedures, especially after RALSC, necessitate careful patient consultation prior to surgery.
Collapse
Affiliation(s)
- Mertihan Kurdoglu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Serdar Unlu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Megan Antonetti-Elford
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Zehra Kurdoglu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Gokhan S Kilic
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
50
|
Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5727165. [PMID: 29675427 PMCID: PMC5851336 DOI: 10.1155/2018/5727165] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/12/2018] [Indexed: 01/22/2023]
Abstract
Objective Our aim was to study the efficacy of transvaginal bilateral sacrospinous fixation (TBSF) and its impact on quality of life (QoL) and sexual functions in women affected by second recurrences of vaginal vault prolapse (VVP). Materials and Methods We performed a prospective observational study on 20 sexually active patients affected by second recurrence of VVP, previously treated with monolateral sacrospinous fixation. TBSF was performed in all the patients. They had been evaluated before the surgery and at 12-month follow-up through pelvic organ prolapse quantification (POP-Q) system, Short Form-36 (SF-36), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results At 12-month follow-up, 18 out of 20 (90%) patients were cured of their recurrent VVP. No major intra- and postoperative complications occurred. We found a significant improvement in 4/5 POP-Q landmarks (excluding total vaginal length), SF-36, and PISQ-12 scores. Conclusion According to our data analysis, TBSF appears to be safe, effective, and able to improve both QoL and sexual functions in patients affected by second recurrence of VVP after previous monolateral sacrospinous fixation.
Collapse
|