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Harvey MA, Chih HJ, Geoffrion R, Amir B, Bhide A, Miotla P, Rosier PFWM, Offiah I, Pal M, Alas AN. International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain. Int Urogynecol J 2021; 32:2575-2594. [PMID: 34338825 DOI: 10.1007/s00192-021-04941-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP. METHODS An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category. RESULTS The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies. CONCLUSIONS The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.
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Affiliation(s)
- Marie-Andrée Harvey
- Department of Obstetrics and Gynecology Queen's University, Victory 4, Kingston Health Science Centre, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.
| | - Hui Ju Chih
- Department of Obstetrics and Gynecology Queen's University, Victory 4, Kingston Health Science Centre, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Baharak Amir
- Department of Obstetrics & Gynecology, Division of Urogynecology and Pelvic Floor Surgery, Dalhousie University, Halifax, Canada
| | - Alka Bhide
- Department of Obstetrics and Gynecology, Imperial College Healthcare NHS Trust, London, UK
| | - Pawel Miotla
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ifeoma Offiah
- Department Obstetrics and Gynecology, Derriford Hospital Healthcare, NHS Trust, Plymouth, UK
| | - Manidip Pal
- Department of Obstetrics and Gynecology College of Medicine & JNM Hospital, WBUHS, Kalyani, India
| | - Alexandriah Nicole Alas
- Department of Obstetrics and Gynecology, University of Texas Health Sciences, San Antonio, TX, USA
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Shkarupa D, Zaytseva A, Kubin N, Kovalev G, Shapovalova E. Native tissue repair of cardinal/uterosacral ligaments cures overactive bladder and prolapse, but only in pre-menopausal women. Cent European J Urol 2021; 74:372-378. [PMID: 34729228 PMCID: PMC8552928 DOI: 10.5173/ceju.2021.285.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/02/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this article was to study the effect of native tissue cardinal/uterosacral ligament repair on overactive bladder (OAB) and pelvic organ prolapse (POP). MATERIAL AND METHODS Inclusion criteria included decrease of urge symptoms following insertion of a gauze tampon in the posterior fornix of vagina ('simulated operation'). Exclusion criteria included SUI, POP grades 3-4. The surgery consisted of plication of cardinal/uterosacral ligaments. Post-operative assessment was performed at3, 6, 12 and 18 months after surgery and included evaluation by stage of prolapse, Urinary Distress Inventory Short Form 6 (UDI-6), Overactive Bladder Questionnaire (OAB-q), Pelvic Floor Impact Questionnaire- Short Form 7 (PFIQ-7), and International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-SF) questionnaires and voiding diary. RESULTS At 3 months, cure rates for frequency, urgency, nocturia and prolapse were comparable. By the 6-month review, catastrophic failure commenced in the postmenopausal group, parallel for all pa-rameters, starkly contrasting with premenopausal group. At 18 months, % cure rates for pre-menopausal (post-menopausal in brackets) were 79.6 (15.4) for POP, 67.3 (20.5) for urgency, 87.7 (20.5) for nocturia and 59.2 (15.4) for frequency. CONCLUSIONS We hypothesize the stepwise parallel recurrence of POP and symptoms in the menopausal group was a consequence of collagen deficiency in the plicated ligaments. Nevertheless, plication of uterosacral-cardinal ligament complex is simple, inexpensive, effective, especially applicable pre-menopausally for POP and as an alternative treatment option in that difficult group of pre-menopausal women who have major OAB/nocturia symptoms but only minimal prolapse.
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Affiliation(s)
- Dmitry Shkarupa
- Saint Petersburg State University Hospital, Department of Urology, Saint-Petersburg, Russian Federation
| | - Anastasiya Zaytseva
- Saint Petersburg State University Hospital, Department of Urology, Saint-Petersburg, Russian Federation
| | - Nikita Kubin
- Saint Petersburg State University Hospital, Department of Urology, Saint-Petersburg, Russian Federation
| | - Gleb Kovalev
- Saint Petersburg State University Hospital, Department of Urology, Saint-Petersburg, Russian Federation
| | - Ekaterina Shapovalova
- Saint Petersburg State University Hospital, Department of Gynecology, Saint-Petersburg, Russian Federation
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Petros P. A watershed paper for surgical cure of overactive bladder and nocturia. Cent European J Urol 2021; 74:379-381. [PMID: 34729229 PMCID: PMC8552949 DOI: 10.5173/ceju.2021.ed2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Peter Petros
- University of Western Australia School of Mechanical and Mathematical Engineering, Perth, Australia
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Piñango-Luna S, Level-Córdova L, Petros PE, Yassouridis A. A low cost artisan tension-free tape technique cures pelvic organ prolapse and stress urinary incontinence - proof of concept. Cent European J Urol 2020; 73:490-497. [PMID: 33552575 PMCID: PMC7848829 DOI: 10.5173/ceju.0202.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The primary cause of pelvic organ prolapse (POP) is weak cardinal/uterosacral (CL/USL) ligaments and for stress urinary incontinence, weak pubourethral ligaments (PUL). MATERIAL AND METHODS A 1 cm wide tape cut from a mesh sheet was applied tension-free to reinforce already plicated CL/USLs for cure of prolapse and directly to PUL for cure of stress urinary incontinence (SUI). 40 tapes were inserted, 10 midurethrally for SUI and 30 for 2nd/3rd degree prolapse: 15 to uterosacral ligaments and 15 to cardinal ligaments. RESULTS At 12 months follow-up there was 72% cure for POP, 70% for SUI and improvement in urge/nocturia symptoms in 82% of patients.At 36 months 8/15 patients were evaluated. Anatomic cure for POP III was 2/4, for POP I-II 6/6. CONCLUSIONS Though a 'proof of concept' study, our results may be sufficient to provide, in time, an alternative individual pathway for surgeons wishing to provide more certainty to a prolapse repair than 'native tissue' for an individual patient. The method questions whether expensive mesh kits are really necessary: our data though small, actually part of a learning curve, was within 15 percentage points of more sophisticated, more expensive tensioned slings. Intraoperative complications were low with no tape erosions seen at 12 months. Further validation with larger prospective and comparative trials is required.
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Affiliation(s)
- Silvia Piñango-Luna
- Department of Surgery, Dr. Miguel Pérez Carreño Hospital, Universidad Central de Venezuela, Caracas, Venezuela
| | - Luis Level-Córdova
- Department of Surgery, Dr. Miguel Pérez Carreño Hospital, Universidad Central de Venezuela, Caracas, Venezuela
| | - Peter Emanuel Petros
- University of NSW Professorial Department of Surgery, St Vincent's Hospital, Sydney, Australia
- School of Mechanical and Chemical Engineering, University of Western Australia, Perth, Australia
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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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Shkarupa D, Kubin N, Shapovalova E, Zaytseva A. The resurrection of sacrospinous fixation: unilateral apical sling hysteropexy. Int Urogynecol J 2019; 31:351-357. [PMID: 31183536 DOI: 10.1007/s00192-019-03964-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/18/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The apical compartment is a keystone in POP treatment. Sacrospinous fixation, suggested half a century ago, today is still one of the most popular and efficient methods of colpo-hysteropexy. However, it has specific side effects: chronic pain syndrome, dyspareunia and а high rate of cystocele de novo. We aimed to evaluate the efficacy and safety of unilateral sacrospinous hysteropexy with a synthetic apical sling combined with anterior subfascial colporrhaphy. METHODS Following the suggested technique, 174 women with anterior-apical prolapse underwent surgery. The follow-up period took 12 months. Pre- and postoperative examination included: urogynecological examination (POP-Q), uroflowmetry, ultrasound of the bladder and filling in of validated questionnaires (PFDI-20, PISQ-12). RESULTS The mean surgery time was 26 ± 7.84 min. No cases of damage of the bladder or rectum or of intraoperative clinically significant bleeding were noted. At the 12-month follow-up, the recurrence rate in the apical compartment was 0.7% (1/147) and in the anterior compartment 7.4% (11/147). The efficacy of the surgery reached 96.5%. During 12 months of follow-up, no cases of mesh exposure or chronic pelvic pain syndrome were detected. The incidence of dyspareunia de novo was observed in just one patient. CONCLUSIONS A unilateral sacrospinous fixation with a synthetic mesh (apical sling) combined with anterior subfascial colporrhaphy enhances the anatomical efficacy of surgery. It also helps to avoid specific side effects of traditional sacrospinous fixation.
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Affiliation(s)
- Dmitry Shkarupa
- Department of Urology, Saint Petersburg State University Clinic of Advanced Medical Technologies, n.a. Nikolay I. Pirogov. 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia
| | - Nikita Kubin
- Department of Urology, Saint Petersburg State University Clinic of Advanced Medical Technologies, n.a. Nikolay I. Pirogov. 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia.
| | - Ekaterina Shapovalova
- Gynecology Department, Saint Petersburg State University Clinic of Advanced Medical Technologies, n.a. Nikolay I. Pirogov. 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia
| | - Anastasya Zaytseva
- Department of Urology, Saint Petersburg State University Clinic of Advanced Medical Technologies, n.a. Nikolay I. Pirogov. 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia
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Should surgeons continue to implant mesh sheets behind the vagina? Int Urogynecol J 2018; 29:777-779. [PMID: 29556675 DOI: 10.1007/s00192-018-3612-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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