Changes in voiding function after laparoscopic sacrocolpopexy for advanced pelvic organ prolapse: a cohort study of 76 cases

Voiding function after sacrocolpopexy versus native tissue transvaginal repair for apical pelvic organ prolapse in an ERAS era: A retrospective cohort study

OBJECTIVE

The objectives of this study were to compare time to return of voiding function and associated complications in women undergoing minimally invasive sacrocolpopexy (SCP) versus transvaginal native tissue repair in patients with same-day or early discharge.

METHODS

This was a retrospective cohort study conducted at a tertiary care center. The electronic medical record system was queried for women who underwent native tissue vaginal repair or SCP for apical prolapse between March and December 2020 using CPT codes for sacrocolpopexy (57425), extraperitoneal (57282), and intraperitoneal colpopexy (57283). Voiding success was our primary outcome and was defined by a postvoid residual < 150 ml. Secondary outcomes included catheter days and urinary tract infections. The total number of participants was based on a power calculation using internal institutional rates. Participants were compared based on the surgical approach. A multivariate regression analysis was performed to assess for confounding factors.

RESULTS

We included 134 women: 63 SCP and 71 native tissue. The failure rate of the first postoperative voiding trial was 34 vs. 11% (odds ratio: 4.91; 95% CI 1.96-12.3, p < 0.01) in the vaginal and SCP groups, respectively. Both groups had a similar success rate of a second voiding trial (100% in SCP group vs. 95.7% in the vaginal repair group, p = 1). The total number of days (3.108 vs. 1.603 days, p < 0.01) to return of bladder function, postoperative urinary tract infections (23.9 vs. 6.35%, p < 0.01) and emergency department visits (15.5 vs. 1.59%, p < 0.01) were all higher in the vaginal repair group.

CONCLUSIONS

Vaginal apical native tissue repair had a fivefold greater risk of acute postoperative urinary retention compared to sacrocolpopexy in addition to increased rates of post-operative urinary tract infection and emergency department visits for urinary tract concerns.

Medium term anatomical and functional outcomes following modified laparoscopic sacrocolpopexy

INTRODUCTION AND HYPOTHESIS

We evaluated the anatomical and functional outcomes following modified laparoscopic sacrocolpopexy (LSC) utilizing deep dissection of the vaginal walls and distal mesh fixation at the anterior and posterior compartments. We hypothesized that anatomical and functional outcomes improve after this modified LSC technique.

METHODS

This was a retrospective study of all women (n = 240) who underwent LSC for pelvic organ prolapse (POP) from January to December 2017 in a tertiary center. POP-Q staging, validated questionnaires (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Pelvic Floor Distress Inventory Questionnaire-Short Form), and uroflowmetry were used to evaluate the anatomical and functional outcomes. Statistical analyses were performed using McNemar test and repeated measures analysis of variance with Fisher's least significant difference post hoc (p < 0.05).

RESULTS

The anatomical success rate is 96%, with a prolapse recurrence rate of 3.8% at 3-year follow-up. Bulge symptoms and anatomical compartments were significantly improved after LSC. Clinically, there were significant improvements after LSC in voiding dysfunction and bowel symptoms. Also, there was a significant increase in stress urinary incontinence and non-significant decrease in mixed urinary incontinence and urge urinary incontinence. ICIQ-SF and Colorectal-Anal Distress Inventory 8 scores were significantly lower after LSC, signifying improvement in incontinence and bowel symptoms.

CONCLUSION

Our modified LSC technique is safe and effective in restoring level 1 and level 2 supports, without adverse effects on urinary and bowel function. Bladder and bowel symptoms have also been found to keep improving over time.

Impact of sacrocolpopexy for the management of pelvic organ prolapse on voiding dysfunction and uroflowmetry parameters: a prospective cohort study

PURPOSE

Voiding difficulties in the context of pelvic organ prolapse are often neglected or underestimated. To date, there are heterogeneous data available on the outcome of a surgical correction of pelvic organ prolapse and the impact on concomitant voiding dysfunction. The primary aim of this study was to evaluate whether laparoscopic sacrocolpopexy would resolve preoperative voiding dysfunction and the impact on objective uroflowmetry parameters.

METHODS

Data from 103 women undergoing sacrocolpopexy for prolapse stage ≥ II with concurrent objective and/or subjective voiding dysfunction were prospectively evaluated. All women underwent full urogynecological examination, and completed a validated questionnaire pre- and postoperatively. Objective uroflowmetry parameters and subjective outcome data regarding voiding functions were compared pre- and postoperatively.

RESULTS

All points of the POP-Q system improved significantly pre- to postoperatively (p < 0.001). Preoperatively, 42 of 103 women showed a postvoid residual ≥ 100 ml, whereas only six women had a relevant postvoid residual postoperatively. In total, the postoperative postvoid residual in all women decreased significantly (p < 0.001). Voiding time decreased significantly postoperatively (p < 0.001) with no significant change in the voided volume (p = 0.352). The maximum flow rate increased postoperatively, reaching no statistically significant change (p = 0.132). Subjective outcome measurements (weak or prolonged stream, incomplete bladder emptying, and straining to void) improved significantly (p < 0.001 for all the questions).

CONCLUSION

Our prospective study demonstrates that sacrocolpopexy to correct pelvic organ prolapse can successfully resolve voiding dysfunction, as both objective and subjective parameters improved significantly after surgery.

[LSC (LAPAROSCOPIC SACROCOLPOPEXY) VERSUS UPHOLD TYPE TVM: A CASE CONTROL STUDY]

(Objective) The comparative analysis of post-surgery condition of lower urinary tract symptoms of LSC and Uphold-type TVM. (Methods) Since August 2015, our hospital introduced LSC and launched Uphold-type TVM in May 2017. 25 cases were examined by December 2017. In comparison with 37 cases of LSC conducted simultaneously, OABSS, IPSS, ICIQ-SF as well as uroflowmetry and residual urine measurement were performed with focus on perioperative complications and postoperative (3 months) lower urinary tract symptoms. As can be observed from the patient background, the average age of subject patients were close to 77 years old for TVM group, 70 years old for LSC group. LSC group showed a tendency to be observed among younger patients. (Result) In Stage II of Pelvic organ prolapse quantification (POP-Q) most of the mild cases (8 cases in TVM group and 3 cases in LSC group) existied. The type of pelvic organ prolapse (most protruding part) was bladder. Many cystoceles in the TVM group (15 cases in the TVM group and 10 cases in the LSC group) were observed. The average operation time was 115 minutes in the TVM group and 214 minutes in the LSC group which was longer. The average bleeding amount was 54 ml in the TVM group and 10 ml in the LSC group, which was quite small. For the intraoperative complication, in 2 cases bleeding volume 100 ml or more were observed in the TVM group. Bladder injury was found in 1 case. (Conclusion) Regarding postoperative complications, one case of vaginal erosion in TVM group, one case of port suture failure in LSC group, one case of de novo OAB were observed respectively. OABSS, total urinary urgency, IPSS, residual urine were improved in both groups. Both types of surgery are expected to improve lower urinary symptoms and considered to be a useful tool for treatment of pelvic organ prolapse.