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Gee AD, Lee SK, Ban K, Paraiso MFR. The Current Evidence and How-To on Combined Sacrocolpopexy and Rectopexy. Int Urogynecol J 2024:10.1007/s00192-024-05869-2. [PMID: 39090473 DOI: 10.1007/s00192-024-05869-2] [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: 04/01/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Multicompartment prolapse is a complex pelvic floor condition that can involve coordination of both urogynecologists and colorectal surgeons. METHODS Concomitant sacrocolpopexy and ventral rectopexy is a safe and effective approach to treating this condition. RESULTS The combined procedure has high rates of patient satisfaction and symptom improvement, including defecatory dysfunction, sexual health, and overall increased quality of life. CONCLUSION Concomitant sacrocolpopexy with ventral rectopexy is safe and improves overall outcomes.
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Affiliation(s)
- Amy D Gee
- Department of Urogynecology, Cleveland Clinic, 9500 Euclid Ave, A81, Cleveland, OH, 44195, USA.
| | - Sunny Kairi Lee
- Department of Urogynecology, Cleveland Clinic, 9500 Euclid Ave, A81, Cleveland, OH, 44195, USA
| | - Kristen Ban
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marie Fidela R Paraiso
- Department of Urogynecology, Cleveland Clinic, 9500 Euclid Ave, A81, Cleveland, OH, 44195, USA
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Lua-Mailland LL, Stanley EE, Yao M, Paraiso MFR, Wallace SL, Ferrando CA. Healthcare Resource Utilization Following Minimally Invasive Sacrocolpopexy: Impact of Concomitant Rectopexy. Int Urogynecol J 2024; 35:1001-1010. [PMID: 38416154 DOI: 10.1007/s00192-024-05748-w] [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: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Combined surgical procedures with sacrocolpopexy (SCP) and rectopexy (RP) are more commonly being performed for treatment of multicompartment pelvic organ prolapse. This study aimed to compare healthcare resource utilization (HRU) within 6 weeks following combined surgery (SCP-RP) versus SCP alone (SCP-only). We hypothesized that concomitant RP does not impact HRU. METHODS A retrospective cohort study of patients who underwent minimally invasive SCP from 2017 to 2022 was conducted at a tertiary referral center. Patients were grouped based on the performance of concomitant RP. HRU was defined as a composite of unscheduled office visits, emergency department visits, and readmissions before the 6-week postoperative visit. HRU was compared in the SCP-RP and SCP-only groups. Multivariable regression analysis was performed to identify factors associated with HRU. RESULTS There were 144 patients in the SCP-RP group and 405 patients in the SCP-only group. Patient characteristics were similar between the two groups, with the following exceptions: the SCP-RP group was older, more likely to have comorbid conditions, and live >60 miles from the hospital. Of the 549 patients, 183 (33.3%) had ≥1 HRU encounter within 6 weeks after surgery. However, there was no difference between the SCP-RP and SCP-only groups in composite HRU (34.0% vs 33.1%, p = 0.84). The most common reasons for HRU were pain, urinary tract infection symptoms, and wound issues. Concomitant mid-urethral sling was associated with a two-fold increased risk of HRU after surgery. CONCLUSIONS One in 3 patients undergoing minimally invasive SCP had at least one unanticipated encounter within 6 weeks after surgery. Concomitant RP was not associated with increased postoperative HRU.
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Affiliation(s)
- Lannah L Lua-Mailland
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics and Gynecology Institute, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA.
| | - Elizabeth E Stanley
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics and Gynecology Institute, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
| | - Meng Yao
- Department of Quantitative Health Sciences, Section of Biostatistics, Cleveland Clinic, Cleveland, OH, USA
| | - Marie Fidela R Paraiso
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics and Gynecology Institute, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
| | - Shannon L Wallace
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics and Gynecology Institute, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
| | - Cecile A Ferrando
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics and Gynecology Institute, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
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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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Hainsworth A, Ferrari L, Malde S, Berry L. Building a Multidisciplinary Pelvic Floor Clinic: Why Bother? SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Contemporary Use and Techniques of Laparoscopic Sacrocolpopexy With or Without Robotic Assistance for Pelvic Organ Prolapse. Obstet Gynecol 2022; 139:922-932. [PMID: 35576354 PMCID: PMC9015033 DOI: 10.1097/aog.0000000000004761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Laparoscopic sacrocolpopexy with or without robotic assistance is an effective approach for the treatment of any pelvic organ prolapse when apical involvement is present. The past 4 years have been consequential in the world of surgery to correct pelvic organ prolapse. In 2018, results of a large, multicenter randomized trial demonstrated very disappointing cure rates of traditional native tissue repairs at 5 years or more. In 2019, a vaginal mesh hysteropexy kit was removed from the market by the U.S. Food and Drug Administration only to subsequently demonstrate it provided better cure rates and similar risk profile to vaginal hysterectomy plus native tissue repair in its own 5-year study published in 2021. Meanwhile, the use and techniques of laparoscopic sacrocolpopexy with or without robotic assistance have evolved such that it is commonly adapted to treat all support defects for patients with uterovaginal or posthysterectomy prolapse. This article is intended to provide an overview of the contemporary use and techniques of laparoscopic sacrocolpopexy based on the evidence and our clinical experience.
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Wallace SL, Enemchukwu EA, Mishra K, Neshatian L, Chen B, Rogo-Gupta L, Sokol ER, Gurland BH. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J 2021; 32:2401-2411. [PMID: 33864476 DOI: 10.1007/s00192-021-04778-y] [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: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence. METHODS A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination. RESULTS Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1). CONCLUSION Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.
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Affiliation(s)
- Shannon L Wallace
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA.
| | - Ekene A Enemchukwu
- Department of Urology, Division of Female Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kavita Mishra
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA
| | - Leila Neshatian
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Rogo-Gupta
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Brooke H Gurland
- Department of Surgery, Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Laparoscopic lateral suspension for anterior and apical prolapse: a prospective cohort with standardized technique. Int Urogynecol J 2021; 33:319-325. [PMID: 33835212 PMCID: PMC8803665 DOI: 10.1007/s00192-021-04784-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/24/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic lateral suspension (LLS) for anterior and apical pelvic organ prolapse (POP) repair is a recent approach. Previous studies used various meshes or sutures. The purpose of this study was to evaluate outcomes of a standardized LLS technique. METHODS From January 2010 until December 2014, we performed POP repair by LLS with mesh on 88 women with anterior and apical POP ≥ stage 2. We used a polypropylene titanized mesh fixed to the vesico-vaginal fascia with absorbable sutures and treated posterior compartment defect by vaginal approach with native tissue repair if required. Between July 2013 and December 2018, all women were assessed by gynecological examination including the pelvic organ prolapse quantification (POP-Q) system. Subjective outcome was evaluated by the patient global impression of improvement (PGI-I) questionnaire. RESULTS Seventy-nine women (89.8%) were available for follow-up. The mean duration of follow-up was 3.4 years (SD 1.6). Mean age was 59.6 (SD 11.1) years and mean BMI 25.8 (SD 4.0) kg/m2. Ten patients (12.7%) had previous POP surgery. Fifty-two women (65.8%) required posterior colporraphy for associated posterior defect and 21 (26.6%) had associated urinary incontinence (UI) surgery. There were no perioperative complications. The objective cure rate (no prolapse beyond the hymen and no reoperation for POP recurrence) was 87.3%. The reoperation rate for recurrence was 5.1%. The subjective success rate (PGI ≤ 2) was 96.2%. There were no mesh exposures or extrusions. CONCLUSIONS This standardized LLS is safe and effective with no mesh complications after 3-year follow-up.
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Shaw JS, Wilson LR, Wilson MZ, Ivatury SJ, Strohbehn K. Autologous Fascia Lata for Combined Sacrocolpopexy and Rectopexy. Female Pelvic Med Reconstr Surg 2021; 27:e484-e486. [PMID: 33620908 DOI: 10.1097/spv.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We present a case series and video of our technique using autologous fascia lata for combined sacrocolpopexy and rectopexy, with or without resection.
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Affiliation(s)
- Jonathan S Shaw
- From the Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, NH
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Gurland B, Mishra K. A Collaborative Approach to Multicompartment Pelvic Organ Prolapse. Clin Colon Rectal Surg 2020; 34:69-76. [PMID: 33536852 DOI: 10.1055/s-0040-1714289] [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] [Indexed: 10/23/2022]
Abstract
Multicompartment pelvic organ prolapse is common yet frequently underreported and unrecognized. Although not life-threatening, the impact on quality of life and daily functioning can be significant. Multidisciplinary evaluation and treatment with specialists in colorectal and female pelvic medicine and reconstructive surgery (FPMRS) help to identify patients who will benefit from surgical treatment of vaginal and rectal prolapse. Both abdominal and perineal combined procedures can be offered to patients with a single operation and concurrent recovery period without increasing complications.
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Affiliation(s)
- Brooke Gurland
- Urogynecology and Pelvic Reconstruction Surgery, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
| | - Kavita Mishra
- Female Pelvic Medicine & Reconstructive Surgery (Urogynecology), Stanford University School of Medicine, Stanford, California
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Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study. Dis Colon Rectum 2020; 63:1293-1301. [PMID: 32618619 DOI: 10.1097/dcr.0000000000001696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term data on robot-assisted sacrocolporectopexy for the treatment of multicompartment pelvic organ prolapse are scarce. With the rising prevalence of prolapse and increasing surgical repair, it is essential to evaluate long-term results. OBJECTIVE This study aimed to evaluate long-term functional and anatomic outcomes after sacrocolporectopexy. DESIGN This is a prospective, observational cohort study. SETTINGS This study was conducted at a teaching hospital with tertiary referral function for patients with gynecological/rectal prolapse. PATIENTS All patients undergoing robot-assisted sacrocolporectopexy from 2011 to 2012 were included. INTERVENTION Robot-assisted sacrocolporectopexy was performed. MAIN OUTCOME MEASURES The primary outcome was the anatomic cure rate after 1 and 4 years, defined as simplified pelvic organ prolapse quantification stage 1 vaginal apical prolapse and no external rectal prolapse or internal rectal prolapse present. Kaplan-Meier curves were used for determination of recurrence-free intervals. Secondary outcomes were functional pelvic floor symptoms (symptoms of bulge, obstructed defecation, fecal incontinence, urogenital distress inventory) and quality of life (Pelvic Floor Impact Questionnaire). RESULTS Fifty-three patients were included. After 12 and 48 months, the recurrence-free intervals based on Kaplan-Meier estimates were 100% and 90%. In total, there were 10 recurrences: 2 apical and 8 internal rectal prolapses. Symptoms of bulge (94%-12%; p < 0.0005), fecal incontinence (62%-32%; p < 0.0005), obstructed defecation (59%-24%; p = 0.008), and median Pelvic Floor Impact Questionnaire scores (124-5; p = 0.022) improved significantly at final follow-up. Median urogenital distress inventory scores showed improvement after 1 year (30-13; p = 0.021). LIMITATIONS This was an observational, single-center study with selective postoperative imaging. CONCLUSIONS Ninety percent of patients were recurrence free 48 months after robot-assisted sacrocolporectopexy. Symptoms of vaginal bulge, quality of life, constipation, and fecal incontinence improved significantly. However, a subgroup of patients showed persistent bowel complaints that underlie the complexity of multicompartment prolapse. See Video Abstract at http://links.lww.com/DCR/B265. RESULTADOS ANATÓMICOS Y FUNCIONALES A LARGO PLAZO DE LA CIRUGÍA DE PISO PÉLVICO ASISTIDA POR ROBOT EN EL TRATAMIENTO DEL PROLAPSO MULTICOMPARTIMENTAL: UN ESTUDIO PROSPECTIVO: Los datos a largo plazo sobre la sacrocolporectopexia asistida por robot para el tratamiento del prolapso multicompartimental de órganos pélvicos son escasos. Con el aumento de la prevalencia del prolapso y el aumento de la reparación quirúrgica, es esencial evaluar los resultados a largo plazo.Evaluar los resultados funcionales y anatómicos a largo plazo después de la sacrocolporectopexia.Estudio prospectivo observacional de cohorte.Hospital de enseñanza con función de referencia terciaria para pacientes con prolapso ginecológico/rectal.Todos los pacientes sometidos a sacrocolporectopexia asistida por robot en 2011-2012.Sacrocolporectopexia asistida por robot.El resultado primario fue la tasa de curación anatómica a uno y cuatro años, definida como etapa 1 de prolapso apical vaginal en la cuantificación del prolapso de órganos pélvicos simplificado, y sin prolapso rectal externo o prolapso rectal interno presentes. Se utilizaron curvas de Kaplan Meier para determinar los intervalos libres de recurrencia. Los resultados secundarios fueron síntomas funcionales del piso pélvico (síntomas de abultamiento, obstrucción defecatoria, incontinencia fecal, inventario de molestias urogenitales) y calidad de vida (cuestionario de impacto del piso pélvico).Se incluyeron 53 pacientes. Después de 12 y 48 meses, el intervalo libre de recurrencia basado en las estimaciones con método Kaplan Meier fue del 100% y 90%, respectivamente. En total hubo diez recurrencias: dos apicales y ocho prolapsos rectales internos. Los síntomas de abultamiento (94% a 12%; p <0.0005), incontinencia fecal (62% a 32%; p <0.0005), obstrucción defecatoria (59% a 24%; p = 0.008) y puntajes promedio del cuestionario de impacto del piso pélvico (124 a 5; p = 0.022) mejoraron significativamente en el seguimiento final. Las puntuaciones medias del inventario de molestias urogenitales mostraron una mejoría después de un año (30 a 13; p = 0.021).Estudio observacional de centro único con imagenología postoperatoria selectiva.Noventa por ciento de los pacientes estaban libres de recurrencia 48 meses después de la sacrocolporectopexia asistida por robot. Los síntomas de abultamiento vaginal, la calidad de vida, el estreñimiento y la incontinencia fecal mejoraron significativamente. Sin embargo, un subgrupo de pacientes mostró molestias intestinales persistentes que subrayan a la complejidad del prolapso multicompartimental. Consulte Video Resumen en http://links.lww.com/DCR/B265.
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Speed JM, Zhang CA, Gurland B, Enemchukwu E. Trends in the Diagnosis and Management of Combined Rectal and Vaginal Pelvic Organ Prolapse. Urology 2020; 150:188-193. [PMID: 32439552 DOI: 10.1016/j.urology.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the rates of surgical repair of comorbid rectal prolapse (RP) and pelvic organ prolapse (POP) over time in a large population-based cohort. MATERIALS AND METHODS We queried Optum, a national administrative claims database, from 2003 to 2017. We evaluated female patients age 18 or older with a diagnosis of POP and/or RP. Sociodemographic characteristics, comorbidities, and rates of procedures were collected. RESULTS We identified 481,051 women diagnosed with RP and/or POP. Only 2.0% of women in the cohort had comorbid POP and RP. While 29.9% of women with RP had dual prolapse, only 2.1% of women with POP had both diagnoses. Overall, 25.8% of women had one or more surgical repairs. Surgical repairs were done in 26.0% of women with POP, 15.0% of women with RP, and 48.2% of women with comorbid POP/RP, though only 19.8% of patients with dual diagnoses had both RP and POP repairs. Over the study period, the rate of multidisciplinary surgical repairs increased by 2.7-fold. CONCLUSION The prevalence of comorbid RP and POP among women in our cohort is low (2.0%). Rates of multidisciplinary surgery have increased possibly due to the increased use of imaging, laparoscopic surgery, and awareness of the shared pathophysiology of the disease.
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Affiliation(s)
- Jacqueline M Speed
- Department of Urology, Stanford University Medical Center, Stanford, CA.
| | - Chiyuan Amy Zhang
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Brooke Gurland
- Department of General Surgery, Division of Colorectal Surgery, Stanford University Medical Center, Stanford, CA
| | - Ekene Enemchukwu
- Department of Urology, Stanford University Medical Center, Stanford, CA
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