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Vigna A, Barba M, Frigerio M. Long-Term Outcomes (10 Years) of Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Repair. Healthcare (Basel) 2024; 12:1611. [PMID: 39201168 PMCID: PMC11353278 DOI: 10.3390/healthcare12161611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/02/2024] Open
Abstract
Vaginal vault prolapse is one of the main reasons for reoperation in patients with pelvic organ prolapse. Effective correction of the vaginal apex is essential for lasting repair for these women. Apical suspension of the sacrospinous ligament is probably one of the main vaginal treatments still offered to patients today. We proposed an evaluation of the functional and anatomical results of long-term sacrospinous ligament fixation. OBJECTIVE The purpose of this study was to evaluate the 10-year results of sacrospinous ligament suspension as primary repair for apical prolapse and to evaluate long-term side effects. MATERIALS AND METHODS A retrospective study analyzed 10-year follow-up after prolapse repair using sacrospinous ligament suspension. A subjective recurrence was identified as the postoperative occurrence of swelling symptoms based on a particular item on the Italian Prolapse Quality of Life (P-QoL) questionnaire. An objective recurrence was defined as a postoperative decline to stage II or below in any compartment based on the POP-Q system or the requirement for additional surgery. The assessment of postoperative subjective satisfaction was conducted using the Patient Global Impression of Improvement (PGI-I) score. RESULTS In total, 40 patients underwent sacrospinous ligament fixation. Objective recurrence was remarkably high, as it was observed in 17 (56.7%) patients. Subjective recurrence was reported by ten (33.3%) women, and reintervention occurred in two (6.7%) of patients. From the point of view of quality of life, according to the PGI-I, twenty-three (76.7%) patients described some degree of improvement after surgery, four (13.3%) described their status as unmodified, and three (10%) reported some form of worsening after primary treatment. CONCLUSIONS Transvaginal repair with sacrospinous fixation is a long-lasting option for prolapse repair, with improvement in every POP-q parameter. Some degree of anterior recurrence, recurrence of symptoms with swelling, or an overall worsening of quality of life after surgery is possible.
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Affiliation(s)
- Annalisa Vigna
- Department of Gynecology, IRCCS Policlinico San Martino, University of Genova, 16126 Genova, Italy;
| | - Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy;
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Menefee SA, Richter HE, Myers D, Moalli P, Weidner AC, Harvie HS, Rahn DD, Meriwether KV, Paraiso MFR, Whitworth R, Mazloomdoost D, Thomas S. Apical Suspension Repair for Vaginal Vault Prolapse: A Randomized Clinical Trial. JAMA Surg 2024; 159:845-855. [PMID: 38776067 PMCID: PMC11112501 DOI: 10.1001/jamasurg.2024.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/01/2024] [Indexed: 05/25/2024]
Abstract
Importance The optimal surgical repair of vaginal vault prolapse after hysterectomy remains undetermined. Objective To compare the efficacy and safety of 3 surgical approaches for vaginal vault prolapse after hysterectomy. Design, Setting, and Participants This was a multisite, 3-arm, superiority and noninferiority randomized clinical trial. Outcomes were assessed biannually up to 60 months, until the last participant reached 36 months of follow-up. Settings included 9 clinical sites in the US National Institute of Child Health and Human Development (NICHD) Pelvic Floor Disorders Network. Between February 2016 and April 2019, women with symptomatic vaginal vault prolapse after hysterectomy who desired surgical correction were randomized. Data were analyzed from November 2022 to January 2023. Interventions Mesh-augmented (either abdominally [sacrocolpopexy] or through a vaginal incision [transvaginal mesh]) vs transvaginal native tissue repair. Main Outcomes and Measures The primary outcome was time until composite treatment failure (including retreatment for prolapse, prolapse beyond the hymen, or prolapse symptoms) evaluated with survival models. Secondary outcomes included patient-reported symptom-specific results, objective measures, and adverse events. Results Of 376 randomized participants (mean [SD] age, 66.1 [8.7] years), 360 (96%) had surgery, and 296 (82%) completed follow-up. Adjusted 36-month failure incidence was 28% (95% CI, 20%-37%) for sacrocolpopexy, 29% (95% CI, 21%-38%) for transvaginal mesh, and 43% (95% CI, 35%-53%) for native tissue repair. Sacrocolpopexy was found to be superior to native tissue repair (adjusted hazard ratio [aHR], 0.57; 99% CI, 0.33-0.98; P = .01). Transvaginal mesh was not statistically superior to native tissue after adjustment for multiple comparisons (aHR, 0.60; 99% CI, 0.34-1.03; P = .02) but was noninferior to sacrocolpopexy (aHR, 1.05; 97% CI, 0-1.65; P = .01). All 3 surgeries resulted in sustained benefits in subjective outcomes. Mesh exposure rates were low (4 of 120 [3%] for sacrocolpopexy and 6 of 115 [5%] for transvaginal mesh) as were the rates of dyspareunia. Conclusions and Relevance Among participants undergoing apical repair for vaginal vault prolapse, sacrocolpopexy and transvaginal mesh resulted in similar composite failure rates at study completion; both had lower failure rates than native tissue repair, although only sacrocolpopexy met a statistically significant difference. Low rates of mesh complications and adverse events corroborated the overall safety of each approach. Trial Registration ClinicalTrials.gov Identifier: NCT02676973.
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Affiliation(s)
- Shawn A. Menefee
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, California
| | - Holly E. Richter
- Division of Urogynecology and Pelvic Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham
| | - Deborah Myers
- The Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Pamela Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alison C. Weidner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Heidi S. Harvie
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David D. Rahn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Kate V. Meriwether
- The Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Marie Fidela R. Paraiso
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan Whitworth
- RTI International, Research Triangle Park, North Carolina
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Sonia Thomas
- RTI International, Research Triangle Park, North Carolina
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Kinouchi R, Yoshida K, Kawakita T, Yasui T, Iwasa T, Kato T. Improvement in Quality of Life after Laparoscopic or Robotic-assisted Sacrocolpopexy with a Single Anterior Mesh in Patients with Pelvic Organ Prolapse: A Retrospective Analysis from a Single Institution. Gynecol Minim Invasive Ther 2024; 13:168-173. [PMID: 39184259 PMCID: PMC11343358 DOI: 10.4103/gmit.gmit_19_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 10/24/2023] [Accepted: 11/10/2023] [Indexed: 08/27/2024] Open
Abstract
Objectives Pelvic organ prolapse (POP) is a significant health-care problem for older women. We have treated POP surgically using laparoscopic sacrocolpopexy (LSC) or robotic-assisted sacrocolpopexy (RSC). The original LSC and RSC procedures were done with anterior and posterior meshes; however, the use of the single mesh procedure is increasing because of its simplicity and safety. There have been few reports about the change in quality of life (QOL) using the single mesh procedure. Therefore, the present study aimed to retrospectively evaluate the change in QOL by LSC and RSC using a single anterior mesh for women without posterior compartment prolapse. Materials and Methods We performed LSC or RSC using a single anterior mesh in 52 patients who had POP without posterior vaginal wall prolapse between August 2018 and October 2022. We assessed the QOL before and after surgery using prolapse-QOL (P-QOL) questionnaires. Results All patients who received LSC or RSC with a single anterior mesh left the hospital as scheduled without severe perioperative complications. There were no instances of wound infection or vaginal mesh extrusion. The recovery rate of questionnaires was 63.5% (33/52). All QOL score domains improved significantly, and there were no questionnaire parameters that worsened. Conclusion LSC or RSC using only a single anterior mesh improves P-QOL with a low incidence of surgical complications for POP patients who did not have posterior vaginal wall prolapse. LSC or RSC with a single anterior mesh may be a prospective new procedure for POP.
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Affiliation(s)
- Riyo Kinouchi
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
| | - Kanako Yoshida
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
| | - Takako Kawakita
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
| | - Takeshi Kato
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima, Japan
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Deldar Pesikhani M, Ghanbari Z, Eftekhar T, Kazemi M, Nassiri S, Sabzi Shahrbabaki F, Ghaemi M. Long-term outcomes and quality of life after Manchester procedure for pelvic reconstructive surgery in women with cervical elongation. Eur J Obstet Gynecol Reprod Biol 2023; 289:152-157. [PMID: 37678128 DOI: 10.1016/j.ejogrb.2023.08.371] [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: 02/09/2023] [Revised: 06/03/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Native-tissue techniques for Pelvic Organ Prolapse (POP) repairs, such as the Manchester Procedure (MP), have recently been revitalized. However, there are conflicting opinions regarding correcting cervical elongation support by the MP, and the risk of possible poor outcomes and postoperative complications. Therefore, this study aimed to investigate anatomical and patient-reported outcomes during one year after MP. DESIGN Prospective cohort study. SETTING This study was conducted on women who underwent the MP for cervical elongation between 2010 and 2020. PATIENTS Women with apical compartment prolapse up to stage 3 due to cervical elongation. INTERVENTIONS Manchester Procedure. MEASUREMENTS Pre and postoperative evaluations by POP Quantification (POP-Q) system were performed, and patients filled out the quality-of-life questionnaires including Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 12 months after the procedure. Anatomical outcomes were measured by POP-Q and the changes in POP-related symptoms were evaluated and reported. MAIN RESULTS 33 participants were recruited in the study. Significant anatomical improvements were obtained in all compartments after the surgery. After 12 months in POP-Q examination, the mean (±SD) of Ba was changed from +1.82 (±1.71) to -1.18 (±1.50), C was changed from -1.25 (±2.81) to -6 (±1.82), and D from -6.30 (±1.42) to -7.1 (±1.25) respectively (P < 0.001). POP-Q stage 0-1 was obtained inof7% in the apical compartment (C < -1), but only in 45.4% in the anterior compartment (Ba < -1). A significant reduction in symptom scores was obtained for PFDI-20 (P < 0.01) and PISQ-12 (P = 0.011). CONCLUSIONS Our findings suggest that the MP provides adequate apical support with improvement in anatomic and subjective findings for patients with cervical elongation.
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Affiliation(s)
- Maryam Deldar Pesikhani
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Ghanbari
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Tahereh Eftekhar
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kazemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saina Nassiri
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Sabzi Shahrbabaki
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ciortea R, Roman MP, Măluțan AM, Bucuri CE, Ormindean CM, Nati ID, Mihu D. Comparison of laparoscopic sacrocolpopexy with vaginal reconstructive procedures and abdominal sacrocolpopexy for the surgical management of vaginal vault prolapse: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1269214. [PMID: 37766917 PMCID: PMC10520704 DOI: 10.3389/fmed.2023.1269214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Vaginal vault prolapse, also known as apical prolapse, is a distressing condition that may affect women following hysterectomy, necessitating surgical intervention when conservative measures prove ineffective. The surgical management of apical compartment prolapse includes procedures such as laparoscopic sacrocolpopexy (LSCP), abdominal sacrocolpopexy (ASCP) or vaginal reconstructive procedures (VRP). This systematic review and meta-analysis aims to compare the outcomes of these interventions. Methods A comprehensive search of electronic databases was conducted to identify eligible studies. Fourteen studies comprising a total of 1,289 women were included. The selected studies were analyzed to evaluate outcomes such as duration of surgery, length of hospital stay, blood loss, complication rates, and patient satisfaction. Results LSCP did not demonstrate significant advantages over VRP in terms of perioperative or long-term outcomes. However, when compared to ASCP, LSCP showed shorter hospital stay, reduced blood loss, decreased postoperative pain, and lower rates of ileus. Discussion This systematic review contributes to evidence-based decision-making for the surgical treatment of vaginal vault prolapse. While LSCP did not exhibit substantial benefits over VRP, it emerged as a preferable option compared to ASCP due to shorter hospital stays and reduced postoperative complications. The findings from this study provide valuable insights for clinicians and patients in selecting the most appropriate surgical approach for vaginal vault prolapse. However, future research should focus on long-term follow-ups, standardizing outcomes, and outcome measures, and evaluating cost-effectiveness to further enhance clinical practice.
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Affiliation(s)
- Răzvan Ciortea
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Maria-Patricia Roman
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Andrei Mihai Măluțan
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Carmen Elena Bucuri
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Military Emergency Hospital “Dr. Constantin Papilian”, Cluj-Napoca, Romania
| | - Cristina Mihaela Ormindean
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Ionel Daniel Nati
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Dan Mihu
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
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Zargham M, Dehghani M, Gholipour F, Emami M, Daneshvari M, Aminsharifi A. Triple-compartment strategy for abdominal sacral colpopexy using PVDF mesh: one-year report of anatomical and subjective outcomes. Int Urogynecol J 2023; 34:1907-1914. [PMID: 36795111 DOI: 10.1007/s00192-023-05471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/08/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse. METHODS Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively. RESULTS Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation. CONCLUSIONS Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication.
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Affiliation(s)
- Mahtab Zargham
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran.
| | - Mehdi Dehghani
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran.
| | - Farshad Gholipour
- Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Emami
- Department of Urology, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Daneshvari
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran
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Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, Baessler K. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev 2023; 7:CD012376. [PMID: 37493538 PMCID: PMC10370901 DOI: 10.1002/14651858.cd012376.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Apical vaginal prolapse is the descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available, but there are no guidelines to recommend which is the best. OBJECTIVES To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings and ClinicalTrials.gov (searched 14 March 2022). SELECTION CRITERIA We included randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS We used Cochrane methods. Our primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse (any site). MAIN RESULTS We included 59 RCTs (6705 women) comparing surgical procedures for apical vaginal prolapse. Evidence certainty ranged from very low to moderate. Limitations included imprecision, poor methodology, and inconsistency. Vaginal procedures compared to sacral colpopexy for vault prolapse (seven RCTs, n=613; six months to f four-year review) Awareness of prolapse was more common after vaginal procedures (risk ratio (RR) 2.31, 95% confidence interval (CI) 1.27 to 4.21, 4 RCTs, n = 346, I2 = 0%, moderate-certainty evidence). If 8% of women are aware of prolapse after sacral colpopexy, 18% (10% to 32%) are likely to be aware after vaginal procedures. Surgery for recurrent prolapse was more common after vaginal procedures (RR 2.33, 95% CI 1.34 to 4.04; 6 RCTs, n = 497, I2 = 0%, moderate-certainty evidence). The confidence interval suggests that if 6% of women require repeat prolapse surgery after sacral colpopexy, 14% (8% to 25%) are likely to require it after vaginal procedures. Prolapse on examination is probably more common after vaginal procedures (RR 1.87, 95% CI 1.32 to 2.65; 5 RCTs, n = 422; I2 = 24%, moderate-certainty evidence). If 18% of women have recurrent prolapse after sacral colpopexy, between 23% and 47% are likely to do so after vaginal procedures. Other outcomes: Stress urinary incontinence (SUI) was more common after vaginal procedures (RR 1.86, 95% CI 1.17 to 2.94; 3 RCTs, n = 263; I2 = 0%, moderate-certainty evidence). The effect of vaginal procedures on dyspareunia was uncertain (RR 3.44, 95% CI 0.61 to 19.53; 3 RCTs, n = 106, I2 = 65%, low-certainty evidence). Vaginal hysterectomy compared to sacral hysteropexy/cervicopexy (six RCTS, 554 women, one to seven year review) Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.01 95% CI 0.10 to 9.98; 2 RCTs, n = 200, very low-certainty evidence). Surgery for recurrent prolapse - There may be little or no difference between the groups for this outcome (RR 0.85, 95% CI 0.47 to 1.54; 5 RCTs, n = 403; I2 = 9%, low-certainty evidence). Prolapse on examination- there was little or no difference between the groups for this outcome (RR 0.78, 95% CI 0.54 to 1.11; 2 RCTs n = 230; I2 = 9%, moderate-certainty evidence). Vaginal hysteropexy compared to sacral hysteropexy/cervicopexy (two RCTs, n = 388, 1-four-year review) Awareness of prolapse - No difference between the groups for this outcome (RR 0.55 95% CI 0.21 to 1.44; 1 RCT n = 257, low-certainty evidence). Surgery for recurrent prolapse - No difference between the groups for this outcome (RR 1.34, 95% CI 0.52 to 3.44; 2 RCTs, n = 345; I2 = 0%, moderate-certainty evidence). Prolapse on examination- There were little or no difference between the groups for this outcome (RR 0.99, 95% CI 0.83 to 1.19; 2 RCTs n =367; I2 =9%, moderate-certainty evidence). Vaginal hysterectomy compared to vaginal hysteropexy (four RCTs, n = 620, 6 months to five-year review) Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.0 95% CI 0.44 to 2.24; 2 RCTs, n = 365, I2 = 0% moderate-quality certainty evidence). Surgery for recurrent prolapse - There may be little or no difference between the groups for this outcome (RR 1.32, 95% CI 0.67 to 2.60; 3 RCTs, n = 443; I2 = 0%, moderate-certainty evidence). Prolapse on examination- There were little or no difference between the groups for this outcome (RR 1.44, 95% CI 0.79 to 2.61; 2 RCTs n =361; I2 =74%, low-certainty evidence). Other outcomes: Total vaginal length (TVL) was shorter after vaginal hysterectomy (mean difference (MD) 0.89cm 95% CI 0.49 to 1.28cm shorter; 3 RCTs, n=413, low-certainty evidence). There is probably little or no difference between the groups in terms of operating time, dyspareunia and stress urinary incontinence. Other analyses There were no differences identified for any of our primary review outcomes between different types of vaginal native tissue repair (4 RCTs), comparisons of graft materials for vaginal support (3 RCTs), pectopexy versus other apical suspensions (5 RCTs), continuous versus interrupted sutures at sacral colpopexy (2 RCTs), absorbable versus permanent sutures at apical suspensions (5 RCTs) or different routes of sacral colpopexy. Laparoscopic sacral colpopexy is associated with shorter admission time than open approach (3 RCTs) and quicker operating time than robotic approach (3 RCTs). Transvaginal mesh does not confer any advantage over native tissue repair, however is associated with a 17.5% rate of mesh exposure (7 RCTs). AUTHORS' CONCLUSIONS Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, and postoperative SUI than a variety of vaginal interventions. The limited evidence does not support the use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. There were no differences in primary outcomes for different routes of sacral colpopexy. However, the laparoscopic approach is associated with a shorter operating time than robotic approach, and shorter admission than open approach. There were no significant differences between vaginal hysteropexy and vaginal hysterectomy for uterine prolapse nor between vaginal hysteropexy and abdominal hysteropexy/cervicopexy. There were no differences detected between absorbable and non absorbable sutures however, the certainty of evidence for mesh exposure and dyspareunia was low.
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Affiliation(s)
- Christopher Maher
- Wesley and Royal Brisbane and Women's Hospitals, Brisbane, Australia
| | - Ellen Yeung
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nir Haya
- Rambam Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Alex Mowat
- Greenslopes Hospital, Brisbane, Australia
| | | | - Kaven Baessler
- Franziskus and St Joseph Hospitals Berlin, Berlin, Germany
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Chene G, Cerruto E, Moret S, Nohuz E. Long-Term Results after Bilateral Sacrospinous Colposuspension: A Prospective Study. J Clin Med 2023; 12:4691. [PMID: 37510805 PMCID: PMC10380842 DOI: 10.3390/jcm12144691] [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: 05/20/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The loss of apical support is usually present in patients with pelvic organ prolapse. An effective correction for the vaginal apex may be an essential part of a durable repair for these women. Apical suspension of the sacrospinous ligament is likely one of the best treatments by the vaginal route. We proposed the evaluation of the functional and anatomical long-term results of an ultralight and macroporous sling. In this prospective study, bilateral sacrospinous colposuspension was performed in 32 patients with a specific mesh. Functional assessment with several validated quality of life questionnaires and pelvic examination was performed at 1, 6, 12, and 24 months after surgery. Pelvic examination using the POP-Q classification showed a very good efficacy of the BSC mesh with only three prolapse recurrences at 24 months after surgery. All the following QoL scores were significantly improved by two years: PFIQ-7 (p < 0.0001), PFDI-20 (p < 0.0001), and SF-12 (p < 0.0001). No improvement was achieved by the PISQ12 questionnaire. This vaginal minimally invasive procedure is effective, quick, reproducible, and easy. It may be a relevant option for a vaginal vault or cervical or uterine prolapse.
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Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
- EMR 3738 CICLY, University Claude Bernard of Lyon 1, 69000 Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
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Huang LX, Guo M, Sha LX, Chen C, Lin XH, Dong XX. Clinical Effect of Uterosacral and Cardinal Ligament Fixation versus Sacrospinous Ligament Fixation of Vaginal Vault Prolapse: A Retrospective Analysis. Int J Clin Pract 2023; 2023:1489928. [PMID: 37305223 PMCID: PMC10257538 DOI: 10.1155/2023/1489928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study aimed at comparing sacrospinous ligament fixation (SSLF) with uterosacral and cardinal ligament fixation (USCLF) concerning complications and outcomes in patients with pelvic organ prolapse (POP). Methods A retrospective analysis was performed on the clinical data of patients with POP stage III or above uterine prolapse treated at Wenzhou People's Hospital from January 2013 to December 2019. Patients were divided into two groups: USCLF group and SSLF group. The perioperative indicators, postoperative complications, pelvic organ prolapse quantification (POP-Q), Pelvic Floor Distress Inventory-20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores of the groups were analyzed and compared. Results (1) The operative time and intraoperative blood loss in the USCLF group were lower than those in the SSLF group, with statistical significance (p < 0.05). (2) The incidence of postoperative buttock pain in the SSLF group was 10.7% (6/56), higher than that in the USCLF group (0/56) (Fisher's exact test, p = 0.027). (3) At one year of follow-up, significant improvement in Aa, Ba, C, Ap, and Bp values was observed in both groups (p < 0.05). The values of the Aa and Ba sites in the USCLF group were lower than those in the SSLF group one year after surgery (p < 0.05). (4) The PFDI-20 and PISQ-12 scores of the groups one year after surgery were lower than those before surgery (p < 0.05). Conclusion Uterosacral and cardinal ligament suture fixation leads to less bleeding and better postoperative quality of life than preoperative and may be better than SSLF at preventing the recurrence of anterior wall prolapse after surgery.
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Affiliation(s)
- Ling-xiao Huang
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Min Guo
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Li-xiao Sha
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Cong Chen
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Xiao-hua Lin
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Xiao-xia Dong
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
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Mao M, Fu H, Wang Q, Bai J, Zhang Y, Guo R. The effect of hysteropreservation versus hysterectomy on the outcome of laparoscopic uterosacral suspension in pelvic organ prolapse surgery. Maturitas 2023; 170:58-63. [PMID: 36773501 DOI: 10.1016/j.maturitas.2023.01.005] [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: 08/29/2022] [Revised: 11/14/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study compares the recurrence rate, complication rate and subjective satisfaction with laparoscopic uterosacral suspension with or without hysterectomy. STUDY DESIGN This retrospective cohort study included 105 patients between June 2014 and December 2019. Recurrent pelvic organ prolapse was defined as any prolapse to or beyond the hymen with straining or needing retreatment. Student's t-test, the Mann-Whitney U test, the chi square test or Fisher's exact test, multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used for the data analysis. MAIN OUTCOME MEASURES Whether the durability of laparoscopic uterosacral suspension surgery is affected by uterine preservation. RESULTS 60 patients underwent laparoscopic uterosacral suspension with concomitant hysterectomy (Hysterectomy group), and 45 underwent laparoscopic uterosacral hysteropexy (Hysteropexy group). The median (interquartile range) duration of follow-up for all 105 patients was 31 (22.5-47.5) months. The results of multivariate Cox proportional hazards regression showed that no difference was found in the risk of overall recurrence between the hysterectomy and hysteropexy groups (25 % vs. 22 %; HR, 0.37; 95 % CI, 0.14-1.00). Kaplan-Meier survival analysis also demonstrated that there were no significant differences in the overall rates of recurrent prolapse between the two groups (P = 0.30). In addition, the subjective success rates were high in both groups (82 %). CONCLUSIONS Our study demonstrated equally satisfactory objective and subjective long-term outcomes after laparoscopic uterosacral suspension with or without hysterectomy. Laparoscopic uterosacral hysteropexy can be safely and effectively offered to patients with pelvic organ prolapse who wish to preserve their uterus and do not have contraindications.
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Affiliation(s)
- Meng Mao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hanlin Fu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Bai
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ye Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Guo
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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11
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Elsibai Anter M, Elsayed Ellakwa H, Fouad Sanad Z, Abd-Elhameed Nasr-Eldin M, Ramzy Rashid M. Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial. Actas Urol Esp 2023:S2173-5786(23)00013-6. [PMID: 36750158 DOI: 10.1016/j.acuroe.2023.02.004] [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: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/07/2023]
Abstract
IMPORTANCE uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. OBJECTIVE compare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. STUDY DESIGN This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. RESULTS High statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). CONCLUSIONS Using Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.
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Affiliation(s)
| | | | - Z Fouad Sanad
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - M Ramzy Rashid
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
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12
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Kumbasar S, Salman S, Sogut O, Gencer FK, Bacak HB, Tezcan AD, Timur GY. Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse. J Obstet Gynaecol Res 2023; 49:341-349. [PMID: 36196844 DOI: 10.1111/jog.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. METHODS LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. RESULTS The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p ˂ 0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. CONCLUSION LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.
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Affiliation(s)
- Serkan Kumbasar
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Suleyman Salman
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ozlem Sogut
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Fatma K Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Havva B Bacak
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ayse D Tezcan
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Gözde Y Timur
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
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Isenlik BS, Aksoy O, Erol O, Mulayim B. Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial. Int Urogynecol J 2023; 34:231-238. [PMID: 35737006 DOI: 10.1007/s00192-022-05267-6] [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: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We compared the outcomes of women who underwent laparoscopic lateral suspension with concurrent total laparoscopic hysterectomy (LLS-TLH) with those of women who underwent laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy (LSC-TLH) for apical and/or anterior vaginal wall prolapse. METHODS Eighty women underwent LLS-TLH or LSC-TLH operations. According to the Pelvic Organ Prolapse Quantification System (POP-Q), women with symptomatic pelvic organ prolapse of stage 2 or higher apical and/or anterior compartment prolapse were enrolled in the study. The objective cure rate according to the POP-Q system was the primary (objective) outcome. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Impression of Improvement (PGI-I) questionnaire scores were the secondary (subjective) outcomes. The primary and secondary outcomes were evaluated at 1 year after surgery. RESULTS The primary and secondary outcomes indicated significant improvements in both groups (p < 0.05). The objective cure rate was 92.5% for apical and 78.6% for anterior compartment prolapse in the LLS-TLH group; the respective rates were 100% and 74.1% in the LSC-TLH group. The subjective cure rate was 87.5% for the LLS-TLH group and 90% for the LSC-TLH group. No statistically significant differences between groups were found in the objective cure rate, subjective cure rate, or ICIQ-VS, ICIQ-SF, or PGI-I scores at 1 year (p > 0.05). CONCLUSIONS LLS-TLH can serve as a safe, effective, and feasible alternative to LSC-TLH, with low complication rates and similar short-term objective and subjective outcomes.
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Affiliation(s)
- Bekir Sıtkı Isenlik
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Orhan Aksoy
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Barıs Mulayim
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey.
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14
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Cichowski S, Grzybowska ME, Halder GE, Jansen S, Gold D, Espuña M, Jha S, Al-Badr A, Abdelrahman A, Rogers RG. International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse. Int Urogynecol J 2022; 33:2603-2631. [PMID: 35980442 DOI: 10.1007/s00192-022-05315-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patient-reported outcome measure instruments include patient-reported outcomes (PROs) and patient-reported goals (PRGs), which allow practitioners to measure symptoms and determine outcomes of treatment that matter to patients. METHODS This is a structured review completed by the International Urogynecology Consultation (IUC), sponsored by the International Urogynecological Association (IUGA). The aim of this working group was to evaluate and synthesize the existing evidence for PROs and PRGs in the initial clinical work-up/evaluation and research arena for patients with pelvic organ prolapse (POP). RESULTS The initial search generated 3589 non-duplicated studies. After abstract review by 4 authors, 211 full texts were assessed for eligibility by 2 writing group members, and 199 studies were reviewed in detail. Any disagreements on abstract or full-text articles were resolved by a third reviewer or during video meetings as a group. The list of POP PROs and information on PRGs was developed from these articles. Tables were generated to describe the validation of each PRO and to provide currently available, validated translations. CONCLUSIONS All patients presenting for POP should be evaluated for vaginal, bladder, bowel and sexual symptoms including their goals for symptom treatment. This screening can be facilitated by a validated PRO; however, most PROs provide more information than needed to provide clinical care and were designed for research purposes.
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Affiliation(s)
| | - Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology Medical University of Gdansk, Gdansk, Poland
| | | | | | - Daniela Gold
- Department of Gynecology, Medical University Graz, Graz, Austria
| | | | - Swati Jha
- Sheffield Teaching Hospitals NHS trust, Sheffield, UK
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15
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Qin Z, Dong Z, Tang H, Zhang S, Wang H, Bao M, Wei W, Shi R, Chen J, Xia B. A preliminary clinical report of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse. Front Surg 2022; 9:931691. [PMID: 35965861 PMCID: PMC9372293 DOI: 10.3389/fsurg.2022.931691] [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: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To study the efficacy and safety of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse. Design Patients were selected into this study on a voluntary basis to evaluate the short-term efficacy of this surgery by comparing the OP-Q scores before the operation, three months after the operation, and six months after the operation. Setting and Patients Evaluate the clinical efficacy and safety by a retrospective analysis of the clinical data of the 18 patients with POP-Q grade III–IV pelvic organ prolapse treated by the Department of Gynecology of Nanjing Medical University Affiliated Changzhou No.2 People's Hospital from April 2020 to November 2020, and their post-operation follow-ups. Interventions Patients with postoperative follow-ups found no obvious relapse without intervention measures. Measurements and Main Results The transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation was performed successfully, and the anterior and posterior walls of vagina and/or trans-vaginal hysterectomy were repaired as appropriate. Except the total vaginal length (TVL), the P values of numerical analysis for all points before, three months after, and six months after the operation were all <0.05, being statistically significant. Conclusion This method is effective in the treatment of moderate and severe pelvic organ prolapse with few complications, but more cases and longer-term follow-up data are needed to determine the long-term effect of this procedure. For the selection of puncture sites, more anatomical data are needed to get more accurate result.
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Affiliation(s)
| | - Zhiyong Dong
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | | | | | | | - Weiwei Wei
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Ruxia Shi
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Correspondence: Jiming Chen Bairong Xia
| | - Bairong Xia
- Department of Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Correspondence: Jiming Chen Bairong Xia
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16
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Donaldson K, Thomas J, Zhu Y, Clark-Deener S, Alperin M, De Vita R. In-plane and out-of-plane deformations of gilt utero-sacral ligaments. J Mech Behav Biomed Mater 2022; 131:105249. [PMID: 35526346 DOI: 10.1016/j.jmbbm.2022.105249] [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: 01/13/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 11/27/2022]
Abstract
The uterosacral ligaments (USLs) are supportive structures of the uterus and apical vagina. The mechanical function of these ligaments within the pelvic floor is crucial not only in normal physiological conditions but also in reconstructive surgeries for pelvic organ prolapse. Discrepancies in their anatomical and histological description exist in the literature, but such discrepancies are likely due to large variations of these structures. This makes mechanical testing very challenging, requiring the development of advanced methods for characterizing their mechanical properties. This study proposes the use of planar biaxial testing, digital image correlation (DIC), and optical coherence tomography (OCT) to quantify the deformations of the USLs, both in-plane and out-of-plane. Using the gilts as an animal model, the USLs were found to deform significantly less in their main direction (MD) of in vivo loading than in the direction perpendicular to it (PD) at increasing equibiaxial stresses. Under constant equibiaxial loading, the USLs deform over time equally, at comparable rates in both the MD and PD. The thickness of the USLs decreases as the equibiaxial loading increases but, under constant equibiaxial loading, the thickness increases in some specimens and decreases in others. These findings could contribute to the design of new mesh materials that augment the support function of USLs as well as noninvasive diagnostic tools for evaluating the integrity of the USLs.
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Affiliation(s)
- Kandace Donaldson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 330A Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Joseph Thomas
- Department of Electrical and Computer Engineering, Virginia Tech, 460 Turner Street, Suite 303, Blacksburg, VA, 24061, USA
| | - Yizheng Zhu
- Department of Electrical and Computer Engineering, Virginia Tech, 460 Turner Street, Suite 303, Blacksburg, VA, 24061, USA
| | - Sherrie Clark-Deener
- Department of Large Animal Clinical Sciences, Virginia Tech, 215 Duckpond Drive, Blacksburg, VA, 24061, USA
| | - Marianna Alperin
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Female Medicine and Reconstructive Surgery, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Raffaella De Vita
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 330A Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
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Chen Y, Banie L, Breyer BN, Tan Y, Wang Z, Zhou F, Wang G, Lin G, Liu J, Qi LS, Lue TF. Enhanced Myogenesis by Silencing Myostatin with Nonviral Delivery of dCas9 Ribonucleoprotein Complex. CRISPR J 2022; 5:598-608. [PMID: 35758824 DOI: 10.1089/crispr.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stress urinary incontinence (SUI) and pelvic floor disorder (PFD) are common conditions with limited treatment options in women worldwide. Regenerative therapy to restore urethral striated and pelvic floor muscles represents a valuable therapeutic approach. We aim to determine the CRISPR interference-mediated gene silencing effect of the nonviral delivery of nuclease-deactivated dCas9 ribonucleoprotein (RNP) complex on muscle regeneration at the cellular and molecular level. We designed four myostatin (MSTN)-targeting sgRNAs and transfected them into rat myoblast L6 cells together with the dCas9 protein. Myogenesis assay and immunofluorescence staining were performed to evaluate muscle differentiation, while CCK8 assay, cell cycle assay, and 5-ethynyl-2'-deoxyuridine staining were used to measure muscle proliferation. Reverse transcription-polymerase chain reaction and Western blotting were also performed to examine cellular signaling. Myogenic factors (including myosin heavy chain, MSTN, myocardin, and serum response factor) increased significantly after day 5 during myogenesis. MSTN was efficiently silenced after transfecting the dCas9 RNP complex, which significantly promoted more myotube formation and a higher fusion index for L6 cells. In cellular signaling, MSTN repression enhanced the expression of MyoG and MyoD, phosphorylation of Smad2, and the activity of Wnt1/GSK-3β/β-catenin pathway. Moreover, MSTN repression accelerated L6 cell growth with a higher cell proliferation index as well as a higher expression of cyclin D1 and cyclin E. Nonviral delivery of the dCas9 RNP complex significantly promoted myoblast differentiation and proliferation, providing a promising approach to improve muscle regeneration for SUI and PFD. Further characterization and validation of this approach in vivo are needed.
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Affiliation(s)
- Yinwei Chen
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lia Banie
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Yan Tan
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Zhao Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Feng Zhou
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Guifang Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei S Qi
- Department of Bioengineering, Stanford University, Stanford, California, USA.,ChEM-H, Stanford University, Stanford, California, USA
| | - Tom F Lue
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Vargas Maldonado D, Chen AH, Gebhart JB. Transvaginal Approach to Surgery for Pelvic Organ Prolapse. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Darlene Vargas Maldonado
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anita H. Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - John B. Gebhart
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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19
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Vargas Maldonado D, Yi J, Madsen AM. Laparoscopic Approach to Surgical Treatment of Pelvic Organ Prolapse. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Darlene Vargas Maldonado
- Department of Obstetrics and Gynecology, Division of Urogynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Johnny Yi
- Department of Medical and Surgical Gynecology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Annetta M. Madsen
- Department of Obstetrics and Gynecology, Division of Urogynecology, Mayo Clinic, Rochester, Minnesota, USA
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20
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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.
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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
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21
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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]
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22
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Fuschi A, Martoccia A, Al Salhi Y, Maggi M, Capone L, Suraci PP, Antonioni A, Bozzini G, Illiano E, Costantini E, Zucchi A, Cervigni M, Carbone A, Pastore AL. Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension. Langenbecks Arch Surg 2022; 407:1693-1700. [PMID: 35113228 DOI: 10.1007/s00423-022-02458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement. MATERIALS AND METHODS Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6 months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR). RESULTS At 6 months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001). CONCLUSIONS Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Martina Maggi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Capone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Alice Antonioni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Alessandro Zucchi
- Department of Translationals Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mauro Cervigni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy.
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23
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Ben Zvi M, Weintraub AY, Friedman T, Neuman M, Tsivian A. Minimally invasive meshless and minimal dissection ligament fixation system for apical organ prolapse procedures: A 4-year prospective follow up study. Int J Gynaecol Obstet 2021; 158:657-662. [PMID: 34850393 DOI: 10.1002/ijgo.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE EnPlace™ (formerly named NeuGuide™) is a minimally invasive meshless anchoring system for pelvic organ prolapse (POP) repair designed to provide centro-apical pelvic floor support. We present a 4-year prospective follow up evaluation of this repair system. METHODS This was a single-center longitudinal prospective study of women with advanced POP who underwent pelvic floor apical repair using EnPlace™ with at least 4 years of follow-up. The primary outcome was surgical success defined as anatomical success, no symptoms of vaginal bulging and no need for re-treatment. A standardized validated questionnaire to assess symptom burden was used. RESULTS Fifteen women were enrolled in the study. Two patients were lost to follow-up. The median follow-up was 51 months (range 42-57) with a surgical success rate of 92.3%. One patient (7.7%) reported symptoms of vaginal vault prolapse and underwent a repeated prolapse surgery. Using the UDI-6 questionnaire, an improvement in all domains was seen. CONCLUSION The 4-year prospective follow up suggests that apical repair using the EnPlace™ device may be considered safe and effective for sacrospinous ligament fixation with a sustainable long-term success. This procedure is a minimally invasive meshless addition to pelvic surgeon's armamentarium.
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Affiliation(s)
- Masha Ben Zvi
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Talia Friedman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menahem Neuman
- Urogynecology & Pelvic Floor Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Schwarzman P, Samueli B, Shaco-Levy R, Baumfeld Y, Leron E, Weintraub AY. The role of hydrodissection in native tissue repair of anterior vaginal wall defects. Aust N Z J Obstet Gynaecol 2021; 62:98-103. [PMID: 34580858 DOI: 10.1111/ajo.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/24/2021] [Accepted: 08/31/2021] [Indexed: 12/01/2022]
Abstract
AIMS A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). MATERIALS Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ2 and Fisher's exact tests. RESULTS Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). CONCLUSIONS After hydrodissection, less bleeding was noted without compromise the surgical planes.
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Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benzion Samueli
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruth Shaco-Levy
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Donaldson K, Huntington A, De Vita R. Mechanics of Uterosacral Ligaments: Current Knowledge, Existing Gaps, and Future Directions. Ann Biomed Eng 2021; 49:1788-1804. [PMID: 33754254 DOI: 10.1007/s10439-021-02755-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
The uterosacral ligaments (USLs) are important anatomical structures that support the uterus and apical vagina within the pelvis. As these structures are over-stretched, become weak, and exhibit laxity, pelvic floor disorders such as pelvic organ prolapse occur. Although several surgical procedures to treat pelvic floor disorders are directed toward the USLs, there is still a lot that is unknown about their function. This manuscript presents a review of the current knowledge on the mechanical properties of the USLs. The anatomy, microstructure, and clinical significance of the USLs are first reviewed. Then, the results of published experimental studies on the in vivo and ex vivo, uniaxial and biaxial tensile tests are compiled. Based on the existing findings, research gaps are identified and future research directions are discussed. The purpose of this exhaustive review is to help new researchers navigate scientific literature on the mechanical properties of the USLs. The use of these structures remains very popular in reconstructive surgeries that restore and augment the support of pelvic organs, especially as synthetic surgical mesh implants continue to be highly controversial.
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Campagna G, Vacca L, Panico G, Caramazza D, Lombisani A, Scambia G, Ercoli A. Laparoscopic lateral suspension for pelvic organ prolapse: A systematic literature review. Eur J Obstet Gynecol Reprod Biol 2021; 264:318-329. [PMID: 34364019 DOI: 10.1016/j.ejogrb.2021.07.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex. OBJECTIVES The aim of this study was to summarize literature data regarding the anatomical and functional outcomes, and intra- and postoperative complications of this technique with minimally invasive approach (laparoscopic/robotic). SEARCH STRATEGY Systematic literature search using MEDLINE/PubMed, SCOPUS, Web of Science. DATA COLLECTION AND ANALYSIS Two authors extracted data on baseline characteristics (age, BMI, prior pelvic reconstructive surgery, preoperative POP stage), perioperative outcomes (operative time, estimated blood loss, intraoperative and postoperative complications, admission time), objective and subjective success rate, surgical failure, time of follow-up. Data were presented descriptively. MAIN RESULTS Thirteen studies were included in the review. The overall number of patients for our analysis was 1066. Patients referred for laparoscopic/robotic lateral suspension were most frequently postmenopausal, aged 50 to 65 years, BMI ≥ 25 kg/m2; 22.2% were already hysterectomized, while 17% had already a previous POP surgery. Operative time ranged from 78.4 ± 29.7 to 254 ± 45 min. The overall anatomic success was more than 90% in the apical compartment and more than 88% in the anterior compartment. Subjective cure rate varies from 78.4% to 100% in medium-term follow-up. Post-operative complication grade >= 3 according to Claiven-Dindo Scale was 1.03%. Mesh erosion rate varied between 0% and 13%. CONCLUSIONS Results coming from our systematic review suggest safety, efficacy and feasibility of minimally invasive lateral suspension with optimal anatomical and functional outcomes. Well-designed, randomized, controlled trials are required to confirm this data.
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Affiliation(s)
- Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
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Kayondo M, Kaye DK, Migisha R, Tugume R, Kato PK, Lugobe HM, Geissbüehler V. Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study. BMC WOMENS HEALTH 2021; 21:258. [PMID: 34172043 PMCID: PMC8228931 DOI: 10.1186/s12905-021-01397-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022]
Abstract
Background Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life. Methods We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery. Results Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p < 0.001). The overall QOL improved by 38.9% after surgery (p < 0.001). Conclusions The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.
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Affiliation(s)
- Musa Kayondo
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda. .,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda.
| | - Dan Kabonge Kaye
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Rodgers Tugume
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
| | - Paul Kalyebara Kato
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
| | - Henry Mark Lugobe
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
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Hu P, Zhong C, Lu S, Lei L, Wang Y, Liu L. Safety and efficiency of modified sacrospinous ligament fixation for apical prolapse: Long-term studies and outcomes. Int J Gynaecol Obstet 2021; 156:566-572. [PMID: 34117780 DOI: 10.1002/ijgo.13786] [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: 04/01/2021] [Revised: 05/23/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the safety and efficiency of modified sacrospinous ligament fixation (MSSF) for apical prolapse. METHODS A retrospective cohort study. Patients diagnosed with apical prolapse from 2014 to 2019 were recruited and divided into three groups: sacrospinous ligament fixation (SSF), MSSF, and laparoscopic sacral hysteropexy (LSH). All surgical characteristics were obtained and information concerning complications was collected and compared among these three groups. RESULTS A total of 710 patients were included: 108 in the SSF group, 260 in the LSH group, and 342 in the MSSF group. The MSSF and SSF groups took less surgical time (P < 0.001) and had shorter hospital stays (P < 0.001). All three methods can significantly change prolapses to point C on the POP quantification score (P < 0.001). Prevalence of vaginal and pelvic pain after surgery was higher in the SSF group (8/108; 7.41%) (P = 0.028), and urinary incontinence was higher in the LSH group (22/260; 8.46%) (P = 0.010). In the LSH group more patients experienced constipation and dyschezia after surgery (prevalence 18/260; 6.92%; P = 0.048). Recurrence of pelvic organ prolapse in the MSSF group (15/324; 4.39%) and LSH group (12/260; 4.62%) was much lower than in the SSF group (16/108; 14.81%) (P < 0.001). CONCLUSION The efficacy of MSSF is commendable with low recurrence of POP and few complications in long-term follow up.
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Affiliation(s)
- Pan Hu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Chongqing, China
| | - ChunYan Zhong
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
| | - Shentao Lu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Li Lei
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ying Wang
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Chongqing, China
| | - LuBin Liu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Chongqing, China
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Current use of the pelvic organ prolapse quantification system in clinical practice among Korean obstetrician-gynecologists. BMC WOMENS HEALTH 2021; 21:207. [PMID: 34006265 PMCID: PMC8130334 DOI: 10.1186/s12905-021-01354-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022]
Abstract
Background To assess current use of the Pelvic Organ Prolapse Quantification (POP-Q) system in clinical practice among Korean obstetrician-gynecologists. Methods A web-based questionnaire was sent to 780 Korean Society of Obstetrics and Gynecology members. The items evaluated in the questionnaire were demographic characteristics and current use of the POP-Q system in the evaluation of pelvic organ prolapse (POP) and surgical decision-making. Differences between POP-Q users and nonusers were analyzed by using the two-sample t-test and chi-squared test. Results One hundred twenty-six members (16%) responded to the survey. Of the respondents, 48% reported using the POP-Q system in the evaluation of POP. Members who were female, urogynecologists, or performed a high volume of prolapse surgery were more likely to use the POP-Q system (p < 0.05). All but one of the POP-Q users reported using the specific criteria to determine whether each compartmental prolapse should be corrected during prolapse surgery. Most respondents used stage 2 or the hymen as a threshold for prolapse to be corrected for all compartments. Conclusions Less than half of Korean obstetrician-gynecologists use the POP-Q system in the evaluation of POP. Almost all of POP-Q users make a surgical decision based on the results of the POP-Q examination. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01354-w.
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Greisen S, Axelsen SM, Bek KM, Guldberg R, Glavind-Kristensen M. Fast track sacrospinous ligament fixation: subjective and objective outcomes at 6 months. BMC Womens Health 2021; 21:154. [PMID: 33863314 PMCID: PMC8051023 DOI: 10.1186/s12905-021-01309-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sacrospinous ligament fixation (SSLF) is a widely used vaginal procedure for correction of apical vaginal prolapse. The objective of this study was to evaluate subjective and objective outcomes of SSLF performed in a fast-track setting. METHODS This was a prospective cohort study of sacrospinous ligament fixation performed using local anesthesia and light sedation in a fast-track setting at Aarhus University Hospital between April 2016 and December 2017. Objective signs of prolapse were assessed by gynecological examination preoperatively and at 6 months after the operation. Subjective symptoms were evaluated by questionnaires (the Pelvic Floor Distress Inventory (PFDI 20), and the Patient Global Impression of Improvement (PGI-I) supplemented with individual questions from the ICIQ-vaginal Symptoms (ICIQ-VS) and Sexual Questionnaire-IR (PISQ-12) questionnaires). RESULTS One hundred and three women with a median age of 65 (36-84) years were included. Previous hysterectomy had been performed in 40% of the women, and 43% had a history of previous prolapse operations. At follow-up, 75% of the women had apical descent less than stage 2. However, 18% had anterior vaginal wall prolapse beyond the hymen, and 25% had recurrence of the apical prolapse stage 2 or more and were offered reoperation. Bladder and anal symptoms improved in most women after the operation, and the number of women reporting dyspareunia was halved. In the overall assessment by Patient Global Impression of Improvement (PGI-I) questionnaire, 76% reported improvement. No serious operative complications were reported, and 81% of the patients were discharged on the day of the surgery. CONCLUSION In this cohort with a high rate of previous prolapse surgery, sacrospinous ligament fixation performed in a fast-track setting showed subjective and objective results comparable to the results of apical native tissue repair reported in the literature. Furthermore, the complication rate was low. Trial registration This study was notified to The Central Denmark Region Committees on Health Research Ethics on July 7, 2015, and was approved by The Danish Data Protection Agency (1-16-02-442-15). All methods were performed in accordance with the relevant guidelines and regulations. An informed consent for participation in the study and acceptance of using data for scientific purposes and publication was signed by all patients.
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Affiliation(s)
- Susanne Greisen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
- Regionshospitalet Horsens, Sundvej 30, 8700, Horsens, Denmark.
| | | | - Karl Møller Bek
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Guldberg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Panico G, Vacca L, Campagna G, Lombisani A, Caramazza D, Caporale N, Scambia G, Ercoli A. Quality of life recovery after laparoscopic high uterosacral ligament suspension: a single centre observational study. Eur J Obstet Gynecol Reprod Biol 2021; 260:212-217. [PMID: 33862432 DOI: 10.1016/j.ejogrb.2021.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Laparoscopic high uterosacral ligament suspension (l-HUSLS) is a laparoscopic-transposed vaginal technique for the treatment of pelvic organ prolapse. Nowadays data regarding quality of life and sexual functions in patients who underwent l-HUSLS for pelvic organ prolapse are few and generic with most of the study investigating the anatomical outcome. For these reasons, the aim of our study is to evaluate these subjective outcomes in women undergoing this surgical procedure with the support of validated questionnaires. STUDY DESIGN This is a retrospective study with the primary aim of analysing the quality of life, sexual function, patient satisfaction rates and anatomical outcome among patients who underwent l-HUSLS in our institution. The SPSS Version 26.0 for Windows (Statistical package for the social studies, Chicago, IL, USA) was used for the statistical analysis. RESULTS A total of 60 patients underwent l-HUSLS between 2016 and 2018. All patients had a high grade of apical prolapse. No intraoperative and major postoperative complications were registered. The median follow-up was 24 months (24-48). PGI-I score was 1-2 in 55 (91.6 %) women. We observed a significant improvement of EQ-5D index and VAS scores from the baseline to the 2 years follow-up: from 0.72 (0.67-1) to 0.91 (0.79-1) and from 50 (30-90) to 70 (50-100) respectively (p = 0.000). All women showed a statistically significant amelioration of FSDS and ICIQ-SF scores. Anatomical success rate after 24 months was 83.7 %. CONCLUSIONS l-HUSLS appears to be a safe, feasible and effective treatment for advanced pelvic organ prolapse with high rates of patient self-reported cure.
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Affiliation(s)
- Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Nicola Caporale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
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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.
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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.
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Shi C, Zhao Y, Hu Q, Gong R, Yin Y, Xia Z. Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse. BMC Womens Health 2021; 21:46. [PMID: 33516228 PMCID: PMC7847570 DOI: 10.1186/s12905-021-01192-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain. METHODS A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed. RESULTS A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868-2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952-3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. CONCLUSIONS Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.
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Affiliation(s)
- Chang Shi
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Ying Zhao
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Qing Hu
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Runqi Gong
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yitong Yin
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Zhijun Xia
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
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Wang W, Zhang Y, Shen W, Niu K, Lu Y. Long-term efficacy of transvaginal high uterosacral ligament suspension for middle-compartment defect-based pelvic organ prolapse. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1645. [PMID: 33490157 PMCID: PMC7812174 DOI: 10.21037/atm-20-7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background We aim to assess the long-term efficacy of transvaginal high uterosacral ligament suspension (HUS) procedure for middle compartment defect-based pelvic organ prolapse (POP). Methods We performed a retrospective review of 84 women with middle-compartment defect-based POP who underwent transvaginal HUS as the primary surgical treatment without mesh augmentation from January 2007 to January 2019. All 84 patients manifested ≥ grade-II middle-compartment defect-based POP. Follow-up visits were performed 2, 6 and 12 months after surgery and then annually, including questionnaires and clinical examination using pelvic organ prolapse quantitation system (POP-Q). Surgical success required to fulfill all three of these criteria: (I) anterior or posterior vaginal wall prolapsed the leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (II) the absence of POP symptoms as reported on the PFDI-20 question No. 3 (“do you usually have a bulge or something falling out that you can see or feel in your vaginal area?”); and (III) no prolapse re-operations or pessary use during the study period. Results Of 84 women, 56 cases (66.7%, 56/84) were evaluated at a ≥5-year follow-up. The 5-year recurrence rates for patients with prolapse of either the anterior vaginal wall, vaginal vault, or posterior vaginal wall, or prolapses in multiple sites, were 7.1% (4/56), 0, 1.8% (1/56), and 3.6% (2/56), respectively. The surgery success rate was 87.5% (49/56). None of the recurrent women underwent retreatment. The satisfaction rate was 91.1% (51/56). Conclusions Transvaginal HUS without mesh augmentation is a safe and effective procedure in the surgical treatment of patients with middle-compartment defects. Anatomical, functional, and subjective outcomes were very satisfactory.
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Affiliation(s)
- Wenying Wang
- Department of Obstetrics and Gynecology, Fourth Medical Center, General Hospital of People's Liberation Army, Beijing, China
| | - Yinghui Zhang
- Department of Obstetrics and Gynecology, Fourth Medical Center, General Hospital of People's Liberation Army, Beijing, China
| | - Wenjie Shen
- Department of Obstetrics and Gynecology, Fourth Medical Center, General Hospital of People's Liberation Army, Beijing, China
| | - Ke Niu
- Department of Obstetrics and Gynecology, Fourth Medical Center, General Hospital of People's Liberation Army, Beijing, China
| | - Yongxian Lu
- Department of Obstetrics and Gynecology, Fourth Medical Center, General Hospital of People's Liberation Army, Beijing, China
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Ulrich D, Preyer O, Bjelic-Radisic V, Roithmeier F, Kropshofer S, Huemer H, Umek W, Angleitner-Flotzinger J, Reinstadler E, Tamussino K, Mazanek A, Nemeth Z, Strobl M, Aigmüller T. The Austrian Sacrocolpopexy Registry: Surgical Techniques, Perioperative Safety, and Complications. J Minim Invasive Gynecol 2020; 28:909-912. [PMID: 33144240 DOI: 10.1016/j.jmig.2020.10.020] [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: 07/13/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Sacrocolpopexy (SCP) has become the standard procedure to correct uterovaginal prolapse in women, but techniques and approaches are not standardized. We report the results of the Austrian Sacrocolpopexy Registry, which aimed to collect data on surgical techniques and perioperative outcomes. DESIGN The Austrian Urogynecology Working Group initiated a registry to assess surgical variability and perioperative safety of SCP. The study was performed at 14 centers (13 in Austria,1 in Switzerland). Institutional review board approvals were obtained. PATIENTS Consecutive patients with symptomatic pelvic organ prolapse (POP). INTERVENTIONS SCP in the course of routine POP treatment. MEASUREMENTS AND MAIN RESULTS Preoperative assessment included demographic data, clinical data on bladder, and bowel functions and POP-Q status. Surgical data included surgical approach (open, laparoscopic, robotic), type of mesh, depth of dissection, nerve sparing techniques, suture materials, uterus or cervix-sparing techniques, peritoneal closure, and concomitant surgeries. A total of 401 patients were recruited into the study. The mean age was 57 years (range: 26-84) and mean body mass index was 34. A total of 137 (34%) patients had undergone previous surgery for prolapse and in 264 cases SCP was the primary procedure. A total of 170 (42%) patients had undergone previous hysterectomy; For patients with uterus, SCP was performed with subtotal (n = 148) or total (n = 3) hysterectomy. A total of 285 (71%) SCPs were done laparoscopically, 102 (25%) robotically and 10 (3%) per laparotomy. The conversion rate from laparoscopy to abdominal surgery was 4.5%. Various meshes and suture materials were used and fixation techniques also varied widely. Four patients underwent reoperation within 30 days (2 trocar herniations, and 1 bowel obstruction, 1 compartment syndrome). One patient died of aortic dissection 7 days after SCP. CONCLUSIONS Most SCPs in this registry were performed laparoscopically, but there was considerable variation in surgical techniques. Perioperative morbidity appears modest.
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Affiliation(s)
- Daniela Ulrich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller).
| | - Oliver Preyer
- Department of Obstetrics and Gynecology, Landeskrankenhaus Villach, Villach, (Dr. Preyer)
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller)
| | - Franz Roithmeier
- Department of Obstetrics and Gynecology, Ordensklinikum Linz, Linz, (Dr. Roithmeier)
| | - Stephan Kropshofer
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, (Dr. Kropshofer)
| | - Hansjörg Huemer
- Austria, and Department of Obstetrics and Gynecology, Bethesda Krankenhaus, Basel, Switzerland (Dr. Huemer)
| | - Wolfgang Umek
- Department of Obstetrics and Gynecology, Medical University of Vienna, (Dr. Umek)
| | - Johannes Angleitner-Flotzinger
- Department of Obstetrics and Gynecology Krankenhaus der Barmherzigen Schwestern Ried, Ried im Innkreis, (Dr. Angleitner-Flotzinger)
| | - Evi Reinstadler
- Department of Obstetrics and Gynecology, Krankenhaus Dornbirn, Dornbirn, (Dr. Reinstadler)
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller)
| | - Andrea Mazanek
- Department of Obstetrics and Gynecology, Krankenhaus Hietzing, (Dr. Mazanek)
| | - Zoltan Nemeth
- Department of Gynecology, Krankenhaus der Barmherzigen Brüder Vienna, Vienna, (Dr. Nemeth)
| | | | - Thomas Aigmüller
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, (Drs. Ulrich, Bjelic-Radisic, Tamussino, and Aigmüller); Department of Obstetrics and Gynecology, Landeskrankenhaus Leoben, Leoben (Dr. Aigmüller)
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Hall B, Goh J, Islam M, Rawat A. Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes. Int Urogynecol J 2020; 32:1031-1036. [PMID: 33052437 PMCID: PMC8009774 DOI: 10.1007/s00192-020-04562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022]
Abstract
Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were:Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm
Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.
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Affiliation(s)
| | - Judith Goh
- Greenslopes Private Hospital, Brisbane, Australia.,Gold Coast University Hospital, Gold Coast, Australia.,Griffith University School of Medicine, Gold Coast, Australia.,QE2 Hospital, Brisbane, Australia.,Griffith University, Gold Coast, Australia
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Topdagi Yilmaz EP, Yapca OE, Topdagi YE, Atakan Al R, Kumtepe Y. Comparison of two natural tissue repair-based surgical techniques; sacrospinous fixation and uterosacral ligament suspension for pelvic organ prolapse treatment. J Gynecol Obstet Hum Reprod 2020; 50:101905. [PMID: 32916370 DOI: 10.1016/j.jogoh.2020.101905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND PURPOSE The present study aims to compare the effectiveness and perioperative results of the natural tissue repair-based treatments sacrospinous fixation (SSF) and uterosacral ligament suspension (USLS) based on the preoperative Pelvic Organ Prolapse Quantification system (POP-Q). MATERIALS AND METHODS Medical records of patients with stage ≥2 uterine prolapse between January 2011 and December 2016 were retrospectively examined. Preoperative POP-Q stages, demographic characteristics, perioperative results, and recurrence ratios in mid-term follow-up for patients were compared. RESULTS Overall, 235 patients were determined according to our study's inclusion criteria. A total of 155 patients underwent vaginal hysterectomy and USLS (VH/USLS), whereas 80 patients underwent vaginal hysterectomy and SSF (VH/SSF). There were no significant differences between groups in terms of body mass index (BMI), age, and parity as well as cardiovascular disease and diabetes mellitus. There was no significant difference in terms of anatomical success and clinical success rates in the postoperative follow-up period between both groups. (p = 0.588 and 0.692, respectively). However, the assessment of results based on preoperative stages of patients revealed that recurrence and anatomical failure were higher in the stage 4 group (p < 0.001). CONCLUSION Our findings indicate that the main determinant factor in evaluating recurrence rates is preoperative POP-Q staging of the patient. Recurrence rates significantly increase with disease stage. Consistent with studies that do not report a clear superiority for USLS or SSF, we observed no significant differences between both procedures in terms of recurrence. The effectiveness of these procedures is similar. We believe that prospective, long-term follow-up studies with larger populations are required to accurately identify preoperative risk factors and compare them with mesh techniques.
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Affiliation(s)
| | - Omer Erkan Yapca
- Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey.
| | - Yunus Emre Topdagi
- Department of Gynecology and Obstetrics, Sanko University School of Medicine, Gazinatep, Turkey.
| | - Ragıp Atakan Al
- Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey.
| | - Yakup Kumtepe
- Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey.
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Kavvadias T, Schoenfisch B, Brucker SY, Reisenauer C. Anatomical and functional outcomes after hysterectomy and bilateral sacrospinous ligament fixation for stage IV uterovaginal prolapse: a prospective case series. BMC Urol 2020; 20:126. [PMID: 32814553 PMCID: PMC7439719 DOI: 10.1186/s12894-020-00694-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Aim of this study is to examine pelvic floor symptoms, anatomical results and patients’ satisfaction after sacrospinous vaginal fixation for stage 4 pelvic organ prolapse. Methods All patients with stage 4 pelvic organ prolapse were treated with vaginal hysterectomy, native tissue cystocele and rectocele repair and bilateral sacrospinous vaginal fixation. Anatomical and functional outcomes according to the POPq classification system and the German version of the Australian pelvic floor questionnaire were assessed. Changes between baseline, first follow-up and second follow-up were assessed by the paired Wilcoxon rank test using R, version 3.5.1. Results 20 patients were included in the study. Scores in all four domains of the pelvic floor symptom questionnaire (bladder, bowel, prolapse, sexual function) were significantly improved at 6 and 12-months follow-up. One patient presented with a symptomatic stage 3 cystocele that needed a second surgical intervention and two patients needed surgery due to a de novo stress urinary incontinence. There were no perioperative adverse events and all patients reported full satisfaction after surgery. Conclusions The vaginal approach with hysterectomy, native tissue repair and bilateral sacrospinous vaginal fixation seems to be a safe and effective method for the treatment of advanced stage POP, offering excellent relief in all pelvic floor symptoms. Trial registration ClinicalTrials.gov (NCT 02998216), December 20th, 2016. Prospectively registered.
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Affiliation(s)
- Tilemachos Kavvadias
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany. .,Department of Gynecology and Obstetrics, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Birgitt Schoenfisch
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Sara Yvonne Brucker
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
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Braga A, Serati M, Salvatore S, Torella M, Pasqualetti R, Papadia A, Caccia G. Update in native tissue vaginal vault prolapse repair. Int Urogynecol J 2020; 31:2003-2010. [PMID: 32556408 DOI: 10.1007/s00192-020-04368-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
The lifetime risk of women for undergoing surgery for pelvic organ prolapse (POP) is estimated to be 11-19%, and 30% of these women will require subsequent reoperation over time. Following hysterectomy, 3.6 per 1,000 person-years need surgical correction of prolapse, and in two-thirds of these cases multi-compartment prolapse is present. In the last decades, vaginally synthetic meshes were widely used in pelvic reconstructive surgery. However, after the decision of the Food and Drug Administration in 2019 to stop selling all surgical mesh devices for transvaginal prolapse repair, native tissue (NT) vaginal repair seems to regain an important role in pelvic reconstructive surgery. In the literature, various surgical techniques have been described for apical repair, but the best surgical approach is still to be proven. This paper analyzes the current evidence from recent literature on NT vaginal vault prolapse (VVP) repair, with special focus on the safety and efficacy of the various vaginal techniques.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland.
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, Naples, Italy
| | - Roberto Pasqualetti
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, EOC-Civico Hospital, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland
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Rechberger E, Skorupska K, Rechberger T, Kołodyńska A, Miotła P, Kulik-Rechberger B, Wróbel A. The Influence of Vaginal Native Tissue Repair (VNTR) on Various Aspects of Quality of Life in Women with Symptomatic Pelvic Organ Prolapse-A Prospective Cohort Study. J Clin Med 2020; 9:jcm9061634. [PMID: 32481614 PMCID: PMC7355538 DOI: 10.3390/jcm9061634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022] Open
Abstract
Pelvic organ prolapse (POP) and the associated functional disorders are a major epidemiological problem that compromises the quality of life (QoL). The aim of this study was to assess the impact of lower urinary tract symptoms (LUTS) related to POP and vaginal native tissue repair (VNTR) on QoL. Two hundred patients with symptomatic POP were stratified into four groups according to the dominant storage phase function disorders: Urgency; stress urinary incontinence (SUI); mixed urinary incontinence (MUI), and without clinically significant symptoms from lower urinary tract (LUT). They underwent VNTR from January 2018 to February 2019. After 12 months, the QoL was assessed by the Prolapse Quality of Life (P-QoL) and visual analogue scale (VAS) questionnaires. The data were analyzed with Statistica package version 12.0 (StatSoft, Krakow, Poland), using the Kalmogorow–Smirnoff, Shapiro–Wilk W and the one-way analysis of variance with post hoc Tukey tests. The results of P-QoL showed significant improvement (p < 0.05) in all the study groups in most domains assessed before surgery and 12 months after surgery. Significant improvements in all the symptoms assessed by the VAS scale results were found in groups Urgency and MUI. The LUTS questionnaire revealed significant improvement in all voiding and post voiding symptoms in these groups. VNTR effectively eliminated LUTS and significantly improved the patients’ QoL associated with POP.
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Affiliation(s)
- Ewa Rechberger
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Katarzyna Skorupska
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
- Correspondence: ; Tel.: +48-604418512
| | - Tomasz Rechberger
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Aleksandra Kołodyńska
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Paweł Miotła
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
| | - Beata Kulik-Rechberger
- Department of Paediatric Propedeutics, Medical University of Lublin, Gębali 6, 20-093 Lublin, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (E.R.); (T.R.); (A.K.); (P.M.); (A.W.)
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Chavez J, Finsterbusch C, Olson C, Zimmern PE. Vaginal cuff perforation during robotic-assisted mesh recto-sacrocolpopexy. IJU Case Rep 2020; 3:83-85. [PMID: 32743477 PMCID: PMC7292113 DOI: 10.1002/iju5.12138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/12/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION We report on the management of intraoperative vaginal cuff perforation during robotic-assisted mesh recto-sacrocolpopexy for vaginal vault prolapse with defecatory dysfunction. CASE PRESENTATION A 75-year-old woman with vaginal bulge and constipation was to undergo a joint robotic mesh recto-sacrocolpopexy. Intraoperatively, mesh was secured to the left posterior vaginal wall following dissection. Prior to contralateral suture placement, the vaginal cuff split open and exposed an end-to-end anastomotic sizer previously inserted in the vagina. Due to subsequent mesh erosion risk, we proceeded with vaginotomy closure with running and interrupted absorbable sutures, removal of mesh, direct suture rectopexy to the promontory, and enterocele defect correction by reapproximating the right and left wings of the peritoneum flaps over the rectum with running sutures. Patient reported satisfactory outcomes after 2 years. CONCLUSION We reviewed our experience with vaginal cuff perforation during robotic-assisted mesh recto-sacrocolpopexy prompting enterocele repair and rectopexy without mesh.
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Affiliation(s)
| | | | - Craig Olson
- UT Southwestern Medical CenterDallasTexasUSA
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Li C, Hua K. The current status of sacrocolpopexy in the management of apical prolapse. MINERVA GINECOLOGICA 2020; 72:165-170. [PMID: 32315126 DOI: 10.23736/s0026-4784.20.04477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pelvic organ prolapse (POP) is a prevalent condition that negatively affects women' s quality of life. There is growing recognition that adequate support for the vaginal apex is an important component of a durable surgical repair for women with advanced prolapse, including the anterior and posterior wall prolapse. Surgical treatment options include abdominal and vaginal approaches, the former of which can be performed open, laparoscopically, and robotically. Sacrocolpopexy is a common procedure designed for the treatment of prolapse including uterine or vaginal vault prolapse and multiple-compartment prolapse. Although traditionally performed as an open abdominal procedure, minimally invasive sacrocolpopexy, whether laparoscopic or robotic, has been successfully performed in the clinical practice by many pelvic reconstructive surgeons. In order to require an outstanding cosmetic result, transumbilical/transvaginal single-port sacrocolpopexy has been developed to achieve the goal and initial outcomes have demonstrated their efficacy, safety and feasibility. However, up to date, there are many variations to these procedures, with different levels of evidence to support each of them. Herein we reviewed the current literatures on current surgical choices for women with apical prolapse.
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Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Keqin Hua
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China -
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Ren C, Zhu L. Safety and efficacy of ischial spine fascia and sacrospinous ligament fixation for symptomatic stage 2 and 3 apical prolapse. Int J Gynaecol Obstet 2020; 149:292-297. [PMID: 32196660 DOI: 10.1002/ijgo.13145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/08/2019] [Accepted: 02/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare safety, efficacy, and impact on quality of life (QoL) between ischial spine fascia fixation (ISFF) and sacrospinous ligament fixation (SSLF) for stage 2-3 pelvic organ prolapse (POP). METHOD A prospective cohort study among women with POP attending a national referral university hospital in Beijing, China, between May 2007 and May 2015. Women underwent either ISFF or SSLF. Primary end point was objective success rates at 3 months after surgery. Exploratory outcomes included perioperative parameters, complications, subjective satisfaction rates and QoL at 1 year. RESULTS There was no difference in baseline characteristics between the groups (all P>0.05). After ISFF and SSLF, the objective success rate at 3 months was 100% and 98.1% (P>0.99), the recurrence rate at 1 year was 5.3% and 8.3% (P=0.266), and the subjective satisfaction rate at 1 year was 97.8% and 97.9%, respectively. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores improved significantly after ISFF. De novo urinary incontinence occurred for 5.3% and 6.3% of women, respectively, and de novo dyspareunia for approximately 14% of women in both groups. CONCLUSION ISFF was found to be a safe and effective alternative to SSLF for women with symptomatic stage 2 and 3 POP.
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Affiliation(s)
- Chang Ren
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy. Obstet Gynecol 2020; 134:323-332. [PMID: 31306334 DOI: 10.1097/aog.0000000000003380] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report long-term outcomes after laparoscopic sacrocolpopexy. METHODS We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥-1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management. RESULTS The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse. CONCLUSION More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).
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Standardized terminology of apical structures in the female pelvis based on a structured medical literature review. Am J Obstet Gynecol 2020; 222:204-218. [PMID: 31805273 DOI: 10.1016/j.ajog.2019.11.1262] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 12/13/2022]
Abstract
The objectives of this study were to review the published literature and selected textbooks, to compare existing usage to that in Terminologia Anatomica, and to compile standardized anatomic nomenclature for the apical structures of the female pelvis. MEDLINE was searched from inception until May 30, 2017, based on 33 search terms generated by group consensus. Resulting abstracts were screened by 11 reviewers to identify pertinent studies reporting on apical female pelvic anatomy. Following additional focused screening for rarer terms and selective representative random sampling of the literature for common terms, accepted full-text manuscripts and relevant textbook chapters were extracted for anatomic terms related to apical structures. From an initial total of 55,448 abstracts, 193 eligible studies were identified for extraction, to which 14 chapters from 9 textbooks were added. In all, 293 separate structural terms were identified, of which 184 had Terminologia Anatomica-accepted terms. Inclusion of several widely used regional terms (vaginal apex, adnexa, cervico-vaginal junction, uretero-vesical junction, and apical segment), structural terms (vesicouterine ligament, paracolpium, mesoteres, mesoureter, ovarian venous plexus, and artery to the round ligament) and spaces (vesicocervical, vesicovaginal, presacral, and pararectal) not included in Terminologia Anatomica is proposed. Furthermore, 2 controversial terms (lower uterine segment and supravaginal septum) were identified that require additional research to support or refute continued use in medical communication. This study confirms and identifies inconsistencies and gaps in the nomenclature of apical structures of the female pelvis. Standardized terminology should be used when describing apical female pelvic structures to facilitate communication and to promote consistency among multiple academic, clinical, and surgical disciplines.
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Laparoscopic approach to pelvic organ prolapse - the way to go or a blind alley? Wideochir Inne Tech Maloinwazyjne 2020; 14:469-475. [PMID: 31908691 PMCID: PMC6939204 DOI: 10.5114/wiitm.2019.88749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/04/2019] [Indexed: 11/17/2022] Open
Abstract
Pelvic organ prolapse represents a relatively frequent diagnosis that requires attention due to its detrimental effect on quality of life. Not surprisingly, it is one of the commonest indications for surgery in premenopausal and postmenopausal women, often requiring a complex multidisciplinary approach. Traditional vaginal procedures are being gradually replaced by laparoscopic techniques, offering anticipated benefits in reduced recurrence and complication rates, while respecting the trend towards uterus sparing if desirable. Recently, questions about the safety of alloplastic materials used in pelvic organ prolapse surgery were raised, leading to official restrictions in their use, particularly for transvaginal application. As a result, laparoscopic procedures might appear slightly favored but caution must be taken to assure proper technique of mesh placement while maintaining high awareness of possible long-term mesh-related complications that require close surveillance. Therefore, adequate education and training becomes even more important to achieve optimal results and to avoid possible serious medico-legal charges.
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Design of a 3-Arm Randomized Trial for Posthysterectomy Vault Prolapse Involving Sacral Colpopexy, Transvaginal Mesh, and Native Tissue Apical Repair: The Apical Suspension Repair for Vault Prolapse in a Three-Arm Randomized Trial. Female Pelvic Med Reconstr Surg 2019; 26:415-424. [PMID: 31860566 PMCID: PMC7326314 DOI: 10.1097/spv.0000000000000803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to present the design of the Apical Suspension Repair for Vault Prolapse in a Three-Arm Randomized Trial (ASPIRe), which compares the efficacy and safety of 3 apical repairs: native tissue (NT) transvaginal repair, transvaginal mesh, and sacral colpopexy. METHODS Patient selection criteria, primary and secondary outcome measures including patient-reported outcome questionnaires, masking, surgeon certification, procedure standardization, adverse events collection and adjudication, and cost analysis will be described for this multi-centered randomized trial. Given the unique risks/benefits of each technique, a noninferiority design will be used to compare apical transvaginal mesh to mesh sacral colpopexy. A superiority design will be used to compare the 2 mesh repairs to NT transvaginal apical repair. Survival analysis will be used to assess a composite primary outcome for success composed of a subjective measure (no prolapse symptoms), objective measure (no prolapse beyond the hymen), and no prolapse retreatment, with a minimum follow-up of 36 months. Secondary outcome measures collected every 6 months include assessment of validated general and condition-specific quality of life measures, global impression of improvement, satisfaction and regret, body image, and sexual function. RESULTS Randomization and surgical treatment of 360 participants are complete, and the study is in the follow-up phase. CONCLUSIONS This report will provide valuable insight on the design of a novel 3-arm surgical trial using mesh versus NT to repair vaginal vault prolapse. This trial will provide level 1 evidence on the risks and benefits of mesh augmented versus NT apical repairs.
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Kalis V, Rusavy Z, Ismail KM. Laparoscopic sacrohysteropexy: the Pilsner modification. Int Urogynecol J 2019; 31:1277-1280. [PMID: 31802161 DOI: 10.1007/s00192-019-04150-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic sacrocolpopexy is the preferred contemporary procedure for the surgical management of a significant apical pelvic organ prolapse. In the presence of a uterus it is possible for the patient to have subtotal hysterectomy and cervicopexy, total hysterectomy with colpopexy or uterine conservation and hysteropexy. However, hysteropexy seems to be associated with a higher risk of anterior compartment failure compared with cervicopexy or colpopexy. It is not uncommon for an asymmetrically large anterior compartment defect to co-exist with a symptomatic apical pelvic organ prolapse. In a cervicopexy or colpopexy, this asymmetry can be balanced by creating a de novo vaginal apex from the superior part of the anterior vaginal wall. However in a hysteropexy the attachment of the base of the anterior mesh to the vagina and cervical isthmus limits the ability to do this. METHODS In this video we present a solution where the shape of the posterior mesh is modified to include two horizontal arms that are passed through openings in the broad ligament and attached to the cervical isthmus anteriorly. RESULTS This frees the anterior Y-shaped mesh to be fixed to the anterior vaginal wall only and hence provides the required tension to create the de novo apex. CONCLUSION Prior to wide adoption, this technique should be further investigated in the context of robustly designed comparative studies.
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Affiliation(s)
- Vladimir Kalis
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic
| | - Zdenek Rusavy
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic
| | - Khaled M Ismail
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic.
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Kalis V, Smazinka M, Rusavy Z, Blaganje M, Havir M, Havelkova L, Ismail K. Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study. Eur J Obstet Gynecol Reprod Biol 2019; 244:60-65. [PMID: 31747633 DOI: 10.1016/j.ejogrb.2019.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES The primary aim of this study was to assess the clinical feasibility of a policy where laparoscopic sacrocolpopexy (LSC) is the default procedure for the management of a significant apical pelvic organ prolapse (a-POP). As a secondary aim, we wanted to evaluate LSC outcomes in relation to women's preoperative assessment of their surgical fitness using the American Society of Anesthesiologists physical status (ASA-PS) categorization. DESIGN Retrospective cohort study. SETTING A university affiliated urogynecology center. METHODS All women with symptomatic a-POP (C ≥ -1) who attended the urogynecology clinic between the 1st of January and the 31st of December 2016 and had their surgery by the 31st of May 2017 were included in the study. In our unit, routine follow-up appointments are arranged at 3 and 12 months post LSC. INTERVENTIONS Perioperative and mesh-related complications were assessed based on the Dindo-Clavien and IUGA/ICS classifications respectively. The preoperative outcome measures included Pelvic Organ Prolapse Quantification (POP-Q) stage, Pelvic Floor Distress Inventory (PFDI) and ASA-PS score. At follow-up women were asked to complete a PFDI, Patient Global Impression of Improvement (PGI-I), had their POP-Q staging and ultrasonographic assessment of mesh position and placement. The above measures are routinely collected as part of our standard practice. A preoperative ASA-PS score of <3 was used as a cut-off to dichotomies participants into low and high risk. MAIN RESULTS A total of 220 women attended our center during the study period because of POP. Of these, 146 women were diagnosed with a significant a-POP and 142 (97.2 %) women opted for a surgical repair. Of the 142 women, 128 (90.1 %) were deemed suitable for a type of LSC and 121 had their surgery before the 31st of May 2017. There were no statistically significant differences in any of our collected perioperative, clinical, patient reported or ultrasonographic outcome measures when comparing women with ASA-PS scores of <3 or ≥3. CONCLUSION In a specialized urogynecology healthcare setting, it is feasible and safe to rely on LSC as the mainstay surgical procedure for the repair of a significant a-POP. However, it is imperative to ensure that technical skills and equipment requirements are fulfilled and maintained.
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Affiliation(s)
- Vladimir Kalis
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 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, Czech Republic; Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Mija Blaganje
- Divison of Gynecology, University Medical Centre Ljubljana, Slovenia
| | - Martin Havir
- Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Linda Havelkova
- New Technologies - Research Centre, University of West Bohemia, Czech Republic
| | - Khaled Ismail
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
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Mereu L, Tateo S, D'Alterio MN, Russo E, Giannini A, Mannella P, Pertile R, Cai T, Simoncini T. Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Eur J Obstet Gynecol Reprod Biol 2019; 244:16-20. [PMID: 31770687 DOI: 10.1016/j.ejogrb.2019.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). STUDY DESIGN A prospective cohort study on 125 patients with vaginal bulge and apical +/- anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa. The main outcome measure was anatomic and symptomatic POP outcome; the secondary outcomes measures were recurrence, reoperation rate, de novo posterior POP and complications. Percentage distribution of the pre- and postoperative POP-Q stages was compared at mean follow-up. Wilcoxon signed rank sum test was used to compare preoperative POP-Q stage and postoperative POP-Q stage ate mean follow up, for each patient (paired data) and for each type of prolapse. RESULTS 120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment. Concerning posterior compartment prolapse 2 (1.7 %) patients referred stage 3 de novo prolapse during follow-up. The complication rate of Clavien-Dindo >3 was 0,8 %. Repeat surgery for POP occurred in 6.4 % of cases. The appearance of POP-Q recurrences was concentrated at 6 months follow-up. BMI > 25 was correlated with de novo posterior compartment appearance during follow-up. CONCLUSIONS LLS for the treatment of apical and anterior POP is a technique with optimal results in term of safety and effectiveness after 2 years follow-up.
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Affiliation(s)
- Liliana Mereu
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy.
| | - Saverio Tateo
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy
| | - Maurizio Nicola D'Alterio
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy; University of Cagliari, Italy
| | - Eleonora Russo
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Andrea Giannini
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Paolo Mannella
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Department - Trento Health Service, Trento, Italy
| | - Tommaso Cai
- Department of Urology, S Chiara Hospital, Trento, Italy
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