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Vidoman M, Kalis V, Smazinka M, Havir M, Rusavy Z, Ismail KM. Pilsner Modification of Mesh Sacrohysterocolpopexy (PiMMS): An Initial Report on Safety and Efficacy. Int Urogynecol J 2024; 35:1155-1162. [PMID: 38691124 DOI: 10.1007/s00192-024-05780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/04/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS It is reported that up to 60% of women would prefer to spare their uterus during pelvic organ prolapse (POP) repair surgery. A reliable hysteropexy technique is therefore crucial. We aimed to describe the safety profile and initial core patient-reported and clinical outcomes of the Pilsner modification of laparoscopic mesh sacrohysterocolpopexy (PiMMS) in comparison with the laparoscopic sacrohysterocolpopexy technique (standard laparoscopic sacrohysterocolpopexy [sLSH]) previously used in our unit. METHODS This was a retrospective cohort study conducted in a single tertiary referral urogynecological center. All patients who underwent laparoscopic mesh sacrohysterocolpopexy between 1 January 2015, and 31 January 2022 were included in the study. Follow-up clinical, patient-reported, and imaging outcomes at the 12-month follow-up time point are presented. RESULTS A total of 87 patients were included. Of these, 49 (56.3%) and 38 (43.7%) underwent sLSH and PiMMS respectively. Low numbers of perioperative complications were found in both groups with no mesh-related complications reported following PiMMS up to 12 months postoperatively. There were no apical compartment failures in either group. There were 8 (17.0%) vs 1 (2.7%) anterior compartment failures (Ba ≤ -1) in the sLSH and PiMMS groups respectively (p = 0.07) at 12 months. At the 1-year follow-up, 42 (89.4%) patients reported a Patient Global Impression of Improvement score of ≤ 2 in the sLSH groups compared with 35 (94.6%) patients following PiMMS. CONCLUSIONS The PiMMS technique seems to have comparable safety profile and patient-reported outcomes with the sLSH technique. However, there is a trend toward reduced anterior compartment failures with this modification. The findings of this preliminary report need to be re-evaluated in a well-powered prospective study.
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Affiliation(s)
- Matej Vidoman
- Department of Gynecology and Obstetrics, Faculty Hospital, Trenčín, Slovakia
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
| | - Vladimir Kalis
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Martin Smazinka
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Martin Havir
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Zdenek Rusavy
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Khaled M Ismail
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia.
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czechia.
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Rusavy Z, Kovarova V, Tvarozek S, Smazinka M, Havir M, Kalis V. A Comprehensive Evaluation of Sexual Life in Women After Laparoscopic Sacrocolpopexy using PISQ-IR. Int Urogynecol J 2024; 35:873-880. [PMID: 38485810 DOI: 10.1007/s00192-024-05765-9] [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: 01/04/2024] [Accepted: 02/17/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy. METHODS This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05). RESULTS Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12 months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively. CONCLUSIONS Although the overall rate of sexually active women and sexual desire declined 12 months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased.
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Affiliation(s)
- Zdenek Rusavy
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| | - Veronika Kovarova
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Samuel Tvarozek
- Department of Gynecology and Obstetrics. Faculty of Medicine, Masaryk University in Brno, Brno, Czech Republic
| | - Martin Smazinka
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Havir
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimir Kalis
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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Sato H, Otsuka S, Abe H, Tsukada S. Comparison of outcomes of laparoscopic sacrocolpopexy with concomitant supracervical hysterectomy or uterine preservation. Int Urogynecol J 2023; 34:2217-2224. [PMID: 37052646 PMCID: PMC10506926 DOI: 10.1007/s00192-023-05534-0] [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: 01/12/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy was traditionally performed for post-hysterectomy prolapse or during concurrent hysterectomy. Sacrocolpopexy outcome with uterine preservation is poorly investigated. This study compared outcomes of laparoscopic sacrocolpopexy with concurrent supracervical hysterectomy or uterine preservation. METHODS This retrospective study compared data of patients with pelvic organ prolapse who underwent laparoscopic sacrocolpopexy with uterine preservation with the data of controls who underwent laparoscopic sacrocolpopexy with supracervical hysterectomy. We analyzed composite failure in uterine preservation versus concurrent supracervical hysterectomy (primary objective) and evaluated factors associated with the primary outcome of composite failure after laparoscopic sacrocolpopexy with preservation or supracervical hysterectomy (secondary objective). Composite failure was defined as subjective bulge symptoms, reoperation, or anatomical prolapse. Cox models indicated time to composite failure as an endpoint. RESULTS Of 274 patients, 232 underwent laparoscopic sacrocolpopexy with supracervical hysterectomy and 42 underwent laparoscopic uterine preservation. After propensity score matching (ratio: 2, for the laparoscopic sacrocolpopexy with supracervical hysterectomy group), 56 patients (24.1%) were in the supracervical hysterectomy group and 28 (66.7%) in the uterine preservation group. All patients underwent 24 months of follow-up. The composite failure rates were 10.7% for supracervical hysterectomy and 3.6% for preservation (p=0.87). The mean estimated blood loss was 10 ml (preservation, 10.0 ml [5.0-10.0] versus supracervical hysterectomy, 10.0 ml [10.0-15.0]; p=0.007). In the Cox proportional hazards model, higher preoperative body mass index and the point Ba increased composite failure risk. CONCLUSIONS Although not statistically significant, composite failure in the two techniques is likely clinically meaningful.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan.
| | - Shota Otsuka
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sachiyuki Tsukada
- Department of Orthopedics, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database. Female Pelvic Med Reconstr Surg 2022; 28:391-396. [PMID: 35234179 DOI: 10.1097/spv.0000000000001146] [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
IMPORTANCE Overweight and obese women represent a growing share of pelvic floor reconstruction surgeons' practices. Determining perioperative risk specific to this population is essential to inform decision making regarding operative approach in this population. OBJECTIVE The aim of the study was to compare surgical complications among overweight and obese women undergoing apical compartment prolapse surgery by either minimally invasive abdominal or vaginal approach. STUDY DESIGN The American College of Surgeons National Surgical Quality Improvement Database was used to identify overweight and obese patients (body mass index ≥ 25) undergoing either minimally invasive sacrocolpopexy (MISC) or vaginal vault suspension (VVS) in the form of a sacrospinous vault fixation or uterosacral ligament fixation for pelvic organ prolapse from 2012 to 2019. Odds ratios for surgical complications, readmission, and reoperation were estimated using multivariable logistic regression. RESULTS Of 8,990 eligible patients, 5,851 underwent a VVS and 3,139 patients underwent MISC. There was a greater odds of any complication in the first 30 days following VVS (n = 608 [10.4%]) compared with MISC (n = 247 [7.9%]; odds ratio, 1.27; 95% confidence interval, 1.08-1.48) on multivariable analysis. Urinary tract infections (UTIs) were the most common complication and were more likely following VVS (112 (3.6%) versus 350 (6.0%), P < 0.001). When UTIs were excluded, there was no difference in complications between approaches (1.00; 95% CI, 0.82-1.22). There were no statistically significant odds of readmission, reoperation, or serious complications between approaches. CONCLUSIONS Vaginal vault suspension may be associated with a higher odds of any complication compared with MISC in overweight and obese women, but the rate of serious complications, readmission, and reoperation are low, and approaches were comparable when considering complications other than UTI.
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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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Wen Q, Zhao Z, Wen J, Yang Y, Wang L, Wu J, Miao Y. Impact of obesity on operative complications and outcome after sacrocolpopexy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 258:309-316. [PMID: 33498005 DOI: 10.1016/j.ejogrb.2021.01.032] [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: 07/16/2020] [Revised: 11/15/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Surgery is required by many obese women with pelvic organ prolapse, and sacrocolpopexy is considered to be an effective method to correct apical prolapse. However, to the authors' knowledge, epidemiological studies have not been summarized formally. STUDY DESIGN A systematic literature search of Pubmed, Medline (Ovid) and Embase databases was undertaken for articles written in English. Statistical analysis was performed using Revman 5.3. RESULTS In total, 7315 patients in 12 studies were included in this meta-analysis. No significant differences were found between obese women and non-obese women in terms of re-operation rate [risk ratio (RR) 1.19, 95 % confidence interval (CI) 0.88-1.59; p = 0.25], postoperative Pelvic Organ Prolapse Quantification System stage ≥2 (RR 0.86, 95 % CI 0.64-1.16; p = 0.33), transfusion rate (RR 0.91, 95 % CI 0.57-1.44; p = 0.68), mesh erosion rate (RR 1.62, 95 % CI 0.74-3.51; p = 0.23), overall rate of surgical complications (RR 1.17, 95 % CI 0.91-1.50; p = 0.23) and length of hospital stay [mean difference (MD) 0.13 days, 95 % CI -0.05 to 0.31; p = 0.15). Additionally, no differences were found in the rates of bladder injury, ileus and urinary incontinence between obese women and non-obese women. However, obese women were associated with a higher laparoconversion rate (RR 3.00, 95 % CI 1.71-5.31; p = 0.0002), higher rate of infection (RR 1.65, 95 % CI 1.25-2.20; p = 0.0005), longer operative duration (MD 14.93 min, 95 % CI 10.14-19.73; p < 0.00001) and higher estimated blood loss (MD 18.01 ml, 95 % CI 8.22-27.80; p = 0.0003) compared with non-obese women. CONCLUSIONS The complications and curative effects of sacrocolpopexy for obese women are similar to those of non-obese women, except for the higher laparoconversion rate, higher rate of infection, longer operative duration and higher estimated blood loss in obese women. Obesity increases the operational difficulty of sacrocolpopexy to a certain extent, although it does not increase the mesh erosion rate or prolapse recurrence rate. Gynaecologists need to be aware of the possibility of the abovementioned risks when choosing sacrocolpopexy for obese patients with middle pelvic defects.
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Affiliation(s)
- Qiao Wen
- Department of Obstetrics and Gynaecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China; Deep Underground Space Medical Centre, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, China
| | - Zhiwei Zhao
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jirui Wen
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yanlin Yang
- West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Ling Wang
- Deep Underground Space Medical Centre, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, China
| | - Jiang Wu
- Deep Underground Space Medical Centre, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, China
| | - Yali Miao
- Department of Obstetrics and Gynaecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China.
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Urdzík P, Kalis V, Blaganje M, Rusavy Z, Smazinka M, Havir M, Dudič R, Ismail KM. Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey). BMC WOMENS HEALTH 2020; 20:241. [PMID: 33109157 PMCID: PMC7590717 DOI: 10.1186/s12905-020-01105-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Background The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia. Results A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. Conclusions The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.
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Affiliation(s)
- Peter Urdzík
- Department of Gynecology and Obstetrics, Faculty of Medicine, Safarik's University and L. Pasteur Teaching Hospital in Kosice, SNP Street No. 1, 04001, Košice, Slovak Republic.
| | - Vladimir Kalis
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Mija Blaganje
- Division of Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, 1525, Ljubljana, Slovenia
| | - Zdenek Rusavy
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Martin Smazinka
- Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Martin Havir
- Department of Obstetrics and Gynecology, University Hospital, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Rastislav Dudič
- Department of Gynecology and Obstetrics, Faculty of Medicine, Safarik's University and L. Pasteur Teaching Hospital in Kosice, SNP Street No. 1, 04001, Košice, Slovak Republic
| | - Khaled M Ismail
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic.,Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, alej Svobody 80, 304 60, Plzeň, Czech Republic
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Patnam R, Husk K, Sripad A, Barletta K, Dieter A, Geller EJ. Effect of BMI on clinical outcomes following minimally invasive sacrocolpopexy. J Robot Surg 2020; 15:63-68. [PMID: 32300933 DOI: 10.1007/s11701-020-01079-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2020] [Indexed: 02/04/2023]
Abstract
Our objective was to compare success and complication rates following minimally invasive sacrocolpopexy (SCP) based on body mass index (BMI). This is a retrospective cohort study of women who underwent laparoscopic or robotic SCP at one academic center from 2006 to 2016. Women were included if they had a postoperative pelvic organ prolapse quantification (POPQ) exam and subjective success documented. For our primary outcome, we compared composite success (POPQ stage ≤ I and report of no bulge symptoms) amongst three groups: normal weight (BMI ≤ 25), overweight (BMI 25-30) and obese (BMI ≥ 30) women. Secondary outcomes included intraoperative complications, 6 week postoperative complications, and sacrocolpopexy mesh exposure. Of the 431 women who met inclusion criteria, 140 (32%) had normal BMI (23 kg/m2; IQR 22, 24), 177 (41%) were overweight (27 kg/m2; IQR 26, 28), and 114 (26%) were obese (32 kg/m2; IQR 31, 36). Mean age was 60 ± 11 years, and most were Caucasian, with no differences in demographics or Charlson Comorbidity Index (CCI). Median length of follow-up was 49 weeks (IQR 9, 104), with similar follow-up for all groups. For our primary outcome, composite success was 72% overall, with no significant differences in composite success rates between groups. For secondary outcomes, there were no differences in the rates of perioperative complications but obese women had a 2.8 increased risk of mesh exposure (p = 0.02). Obesity was not associated with differences in the success or peri-operative complication rates for SCP in our population, but was associated with mesh exposure.
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Affiliation(s)
- Radhika Patnam
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Katherine Husk
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Abhishek Sripad
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Kathryn Barletta
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Alexis Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Elizabeth J Geller
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA. .,Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, CB#7570, Chapel Hill, NC, 27599-7570, USA.
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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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