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Dabica A, Balint O, Olaru F, Secosan C, Balulescu L, Brasoveanu S, Pirtea M, Popin D, Bacila IF, Pirtea L. Complications of Pelvic Prolapse Surgery Using Mesh: A Systematic Review. J Pers Med 2024; 14:622. [PMID: 38929843 PMCID: PMC11205245 DOI: 10.3390/jpm14060622] [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: 05/01/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair. METHODS Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included. RESULTS Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications. CONCLUSIONS Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience.
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Affiliation(s)
- Alexandru Dabica
- Doctoral School, Victor Babes, University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.D.); (L.B.); (M.P.); (D.P.); (I.F.B.)
| | - Oana Balint
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.O.); (C.S.); (S.B.); (L.P.)
| | - Flavius Olaru
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.O.); (C.S.); (S.B.); (L.P.)
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.O.); (C.S.); (S.B.); (L.P.)
| | - Ligia Balulescu
- Doctoral School, Victor Babes, University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.D.); (L.B.); (M.P.); (D.P.); (I.F.B.)
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.O.); (C.S.); (S.B.); (L.P.)
| | - Marilena Pirtea
- Doctoral School, Victor Babes, University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.D.); (L.B.); (M.P.); (D.P.); (I.F.B.)
| | - Diana Popin
- Doctoral School, Victor Babes, University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.D.); (L.B.); (M.P.); (D.P.); (I.F.B.)
| | - Ioana Flavia Bacila
- Doctoral School, Victor Babes, University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.D.); (L.B.); (M.P.); (D.P.); (I.F.B.)
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (F.O.); (C.S.); (S.B.); (L.P.)
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Wang W, Liang H, Yu H, Rong C, Dong Y, Xue M, Liu X, Liang J, Ling B. Mesh-less laparoscopic extraperitoneal linear suspension treatment of vaginal vault prolapse. Eur J Obstet Gynecol Reprod Biol 2024; 296:275-279. [PMID: 38493551 DOI: 10.1016/j.ejogrb.2024.02.043] [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: 09/03/2023] [Revised: 11/28/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To report the results of a mesh-less laparoscopic extraperitoneal linear suspension technique for the treatment of post-hysterectomy vaginal vault prolapse (PHVP). STUDY DESIGN A retrospective observational study was conducted collecting medical records of 41 patients with symptomatic PHVP treated between November 2017 to November 2019 in Gynecologic department of China-Japan Friendship Hospital. All patients had Pelvic Organ Prolapse Quantification (POP-Q) scores indicating stage 3-4 PHVP and underwent mesh-less laparoscopic extraperitoneal linear suspension.The primary outcome was the subjective satisfaction rate based on responses to validated questionnaires. The secondary outcomes were the objective anatomical cure rate based on POP-Q scores and complication rates. All listed parameters were determined before the surgery and at control examinations in 1 year and 3 years after the treatment. RESULTS The operation was completed successfully without serious complications in all patients. Mean operation time was 53.8 mins. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.The subjective satisfaction rates were 100 % (41/41) and 95 % (38/40) at 1 year and 3 years after surgery. The objective cure rates were 100 % (41/41) and 97.5 % (39/40) at 1 year and 3 years after surgery, respectively. During the follow-up, none of the patients experienced suture exposure, infection, chronic pelvic pain, or other related complications. CONCLUSION The mesh-less laparoscopic extraperitoneal linear suspension technique avoids the use of implantable synthetic mesh. It has been shown to lead to favorable postoperative outcomes, considerable patient contentment, and low complication rates. It offers a new, cost-effective treatment option for PHVP patients.
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Affiliation(s)
- Wenhui Wang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Haiyan Liang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Huan Yu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chunhong Rong
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuxiao Dong
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ming Xue
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaodie Liu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jing Liang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Bin Ling
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China.
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Lin FC, Gilleran JP, Powell CR, Atiemo HO. To mesh or not mesh "apical prolapse," that is the question! Neurourol Urodyn 2024. [PMID: 38623999 DOI: 10.1002/nau.25469] [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: 01/10/2024] [Revised: 03/16/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
Surgical approaches for pelvic organ prolapse have evolved over the last 30 years and is a popular topic for debate, particularly when discussing apical prolapse. Transvaginal native tissue repairs remain the mainstay of POP surgeries, however, transabdominal approaches continue to evolve. Use of interposition material, such as synthetic polypropylene mesh, is the standard when performing an abdominal sacrocolpopexy, however, use of autologous fascia can be considered. This debate article provides an overview of this subject and highlights the value of different approaches to apical prolapse. The authors were asked to support their approach in various scenarios including:extremes of age, prior hysterectomy and intact uterus, desire to avoid mesh, sexual activity, and presence of comorbidities. In discussing common patient scenarios, ultimate decision making on specific POP surgeries is determined by patient preference and goals.
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Affiliation(s)
- Frank C Lin
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jason P Gilleran
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - C R Powell
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Lallemant M, Shimojyo AA, Mayeur O, Ramanah R, Rubod C, Kerbage Y, Cosson M. Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system. PLoS One 2024; 19:e0299012. [PMID: 38512958 PMCID: PMC10956756 DOI: 10.1371/journal.pone.0299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient's pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). METHODS Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix's or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. RESULTS Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. CONCLUSION According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04551859.
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Affiliation(s)
- Marine Lallemant
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Andres Arteaga Shimojyo
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Olivier Mayeur
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Rajeev Ramanah
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM E4 4662, Université de Franche-Comté, Besançon, France
| | - Chrystèle Rubod
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Yohan Kerbage
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Michel Cosson
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
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Barba M, Cola A, Melocchi T, De Vicari D, Costa C, Volontè S, Sandullo L, Frigerio M. High Uterosacral Ligaments Suspension for Post-Hysterectomy Vaginal Vault Prolapse Repair. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:320. [PMID: 38399607 PMCID: PMC10890601 DOI: 10.3390/medicina60020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault prolapse repair through high uterosacral ligaments suspension is limited. Consequently, with this study, we aimed to assess the efficiency, complications frequency, and functional results of native-tissue repair through USLs in vaginal vault prolapse. Materials and Methods: This was a retrospective study. Women with symptomatic vaginal vault prolapse (≥stage 2) who underwent surgery with transvaginal native-tissue repair by high uterosacral ligaments were included. Patient characteristics, preoperative assessment, operative data, postoperative follow-up visits, and re-interventions were collected from the hospital's record files. High uterosacral ligament suspension was performed according to the technique previously described by Shull. A transverse apical colpotomy at the level of the post-hysterectomy scar was performed in order to enter the peritoneal cavity. USLs were identified and transfixed from ventral to dorsal with three absorbable sutures. Sutures were then passed through the vaginal apex and tightened to close the transverse colpotomy and suspend the vaginal cuff. At the end of the surgical time, a diagnostic cystoscopy was performed in order to evaluate ureteral bilateral patency. Using the POP-Q classification system, we considered an objective recurrence as the descensus of at least one compartment ≥ II stage, or the need for a subsequent surgery for POP. The complaint of bulging symptoms was considered the item to define a subjective recurrence. We employed PGI-I scores to assess patients' satisfaction. Results: Forty-seven consecutive patients corresponding to the given period were analyzed. No intraoperative complications were observed. We observed one postoperative hematoma that required surgical evacuation. Thirty-three patients completed a minimum of one-year follow-up (mean follow-up 21.7 ± 14.6 months). Objective cure rate was observed in 25 patients (75.8%). No patients required reintervention. The most frequent site of recurrence was the anterior compartment (21.2%), while apical compartment prolapse relapsed only in 6% of patients. An improvement in all POP-Q parameters was recorded except TVL which resulted in a mean 0.5 cm shorter. Subjective recurrence was referred by 4 (12.1%) patients. The mean satisfaction assessed by PGI-I score was 1.6 ± 0.8. Conclusion: This analysis demonstrated that native-tissue repair through high USL suspension is an effective and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse. Objective, subjective, functional, and quality of life outcomes were satisfactory, with minimal complications.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Tomaso Melocchi
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Desirèe De Vicari
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Lucia Sandullo
- Department of Gynecology, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy;
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
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Workineh ZA, Ayana BA, Gashaye KT, Wubneh SB, Kassie BA. Surgical management practice of pelvic organ prolapse among Ethiopian gynecologists, 2021: a descriptive study. BMC Womens Health 2023; 23:654. [PMID: 38066529 PMCID: PMC10704734 DOI: 10.1186/s12905-023-02818-x] [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: 06/04/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Pelvic Organ Prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina. Surgical intervention addresses both anatomical defect and associated symptoms. The landscape of prolapse surgery has been evolving constantly over years. Emerging evidences either support or challenge existing surgical treatment options, making urogynecology a dynamic field. In Ethiopia, the surgical management of pelvic organ prolapse has transitioned from abdominal to vaginal hysterectomy, supplemented later by McCall's culdoplasty. Disparities exist in the national uniformity of surgical approaches, linked to the establishment of Urogynecology centers in certain institutions. OBJECTIVES This study was done to assess the surgical management practice of Ethiopian gynecologists on pelvic organ prolapse. METHODS A cross-sectional study encompassing all Gynecologists in Ethiopia took place between January to June 2021. Information was gathered through online Google forms crafted in English. Subsequently, the collected data underwent verification, coding, and entry into Epi info 7 before being exported to SPSS version 22 software for descriptive statistical analysis. RESULTS We reached 280 gynecologists out of the 450 practicing in the Ethiopia making 62% response rate. Anterior colporrhaphy (98.6%), vaginal hysterectomy with McCall's cul-do-plasty (51.8%), and Posterior colporrhaphy (97.5%) were the most commonly performed surgical procedures for anterior vaginal wall prolapse, apical prolapse (uterine/cervical), and posterior vaginal wall prolapse respectively. Only 3.2% and 0.7% of the gynecologists conducted abdominal and vaginal paravaginal repair for anterior vaginal wall prolapse. Sacrospinous ligament fixation and sacrocolpopexy for apical prolapse were carried out by 32.9% and 9.3% of the gynecologists respectively. Site-specific posterior repair for posterior vaginal wall prolapse was performed only by 23.9% of the gynecologists. The main reasons mentioned not to perform paravaginal repair, sacrocolpopexy, sacrospinous ligament fixation, and site-specific posterior repair were lack of skill and lack of appropriate materials. CONCLUSION AND RECOMMENDATION Most gynecologists in Ethiopian continue to perform vaginal hysterectomy and colporrhaphy procedures for treatment of pelvic organ prolapse due primarily to lack of skill and appropriate materials to perform the alternative procedures. Implementing short term training on alternative surgical treatment options of pelvic organ prolapse with provision of suitable materials and increasing the number of urogynecologists in the country in the long run holds the potential to enhance the standard of care of women with the condition.
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Affiliation(s)
- Zelalem Ayichew Workineh
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Birhanu Abera Ayana
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kiros Terefe Gashaye
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Berhe Wubneh
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Ayanaw Kassie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rozycki SK, Rutledge EC, Nisar T, Yadav GS, Antosh DD. Healthcare disparities and pelvic organ prolapse operative complications: a nationwide analysis. Int Urogynecol J 2023; 34:2893-2899. [PMID: 37548744 DOI: 10.1007/s00192-023-05620-3] [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: 03/29/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate the differences in the incidence of peri-operative complications at the time of pelvic organ prolapse (POP) repair based on health care disparities such as race and socioeconomic status. METHODS The National Inpatient Sample (NIS) database was queried using ICD-9/-10 codes for patients aged >18 years undergoing POP repair in 2008-2018. Demographic information, Elixhauser Comorbidity Index (ECI), insurance status, and peri-operative complications were extracted. Multivariate weighted logistic regression using the discharge weights from NIS were constructed on binary outcomes. Complications with at least 1% incidence were included in the analysis. RESULTS A total of 172,483 POP repair patients were analyzed: 130,022 (75.4%) were white, 10,561 (6.1%) were Black, 21,915 (12.7%) were Hispanic, and 9,985 (5.8%) were of other races. Patients with Medicaid as well as Black, Hispanic, and other races had higher odds of developing postoperative complications such as urinary tract infections, sepsis, and acute renal failure (p value <0.001-0.02). These were also more common in smaller, rural hospitals and with patients with an annual income of $45,999 or less (p value <0.001-0.03). Black and Hispanic patients had lower odds of intraoperative complications such as hemorrhage (aOR 0.77, 95% CI 0.71-0.84; aOR 0.75, 95% CI 0.7-0.8 respectively) or abdominopelvic injury (aOR 0.86, 95% CI 0.81-0.92; aOR 0.93, 95% CI 0.79-0.88 respectively) compared with white patients. CONCLUSION Nonwhite patients with lower socioeconomic status had increased postoperative complications and fewer intraoperative complications from POP surgery, whereas white patients with higher socioeconomic status had more intraoperative complications.
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Affiliation(s)
- Sarah K Rozycki
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA.
| | - Emily C Rutledge
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Tariq Nisar
- Houston Methodist Research Institute, Center for Outcomes Research, Houston, TX, 77030, USA
| | - Ghanshyam S Yadav
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA
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van Oudheusden AMJ, van IJsselmuiden MN, Menge LF, Coolen ALWM, Veen J, van Eijndhoven HWF, Dietz V, Kluivers KB, Spaans WA, Vollebregt A, van de Pol G, Radder CM, van der Ploeg JM, van Kuijk SMJ, Bongers MY. Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse: a randomised controlled trial and prospective cohort (SALTO-2 trial). BJOG 2023; 130:1542-1551. [PMID: 37132094 DOI: 10.1111/1471-0528.17525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP-Q stage ≥2 vaginal vault prolapse (VVP). DESIGN Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. SETTING Seven non-university teaching hospitals and two university hospitals in the Netherlands. POPULATION Patients with symptomatic post-hysterectomy vaginal vault prolapse, requiring surgical treatment. METHODS Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP-Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. MAIN OUTCOME MEASURES Primary outcome was disease-specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri-operative data, complications and sexual function. RESULTS A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease-specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). CONCLUSIONS LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow-up period of 12 months.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynaecology and Obstetrics, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Mèlanie N van IJsselmuiden
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Isala Medical Centre, Zwolle, The Netherlands
| | - Leah F Menge
- Department of Gynaecology and Obstetrics, Reinier de Graaf Guesthouse, Delft, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynaecology and Obstetrics, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Joggem Veen
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Viviane Dietz
- Department of Gynaecology and Obstetrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wilbert A Spaans
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Astrid Vollebregt
- Department of Gynaecology and Obstetrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Geerte van de Pol
- Department of Gynaecology and Obstetrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Celine M Radder
- Department of Gynaecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | | | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
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Bauters E, Page AS, Cattani L, Housmans S, Van der Aa F, D'Hoore A, Deprest J. Safety and medium-term outcome of redo laparoscopic sacrocolpopexy: a matched case-control study. Int Urogynecol J 2023; 34:2799-2807. [PMID: 37632537 DOI: 10.1007/s00192-023-05631-0] [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: 05/25/2023] [Accepted: 07/20/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In the case of recurrent apical prolapse following laparoscopic sacrocolpopexy (LSCP), one may consider a "redo" procedure. We hypothesized that redo LSCP may carry an increased complication risk and less favorable outcomes when compared with primary procedures. METHODS This is a single-center, matched case-control (1:4) study, comparing all 39 women who had a redo LSCP and 156 women who had a primary LSCP for symptomatic apical prolapse between 2002 and 2020 with a minimum follow-up of 12 months. Matching was based on proximity to the operation date. The primary outcome was the occurrence of intraoperative and early postoperative complications within 3 months. Secondary outcomes included subjective (Patient Global Impression of Change [PGIC] ≥4) and objective (Pelvic Organ Prolapse Quantification [POP-Q] stage <2) success rates, surgical variables, graft-related complications and reinterventions. RESULTS There was no difference in the rate of intraoperative and early postoperative complications (redo: 21.1% vs control: 29.8%, OR: 0.63, 95% CI 0.27-1.48). The conversion rate was higher in redo patients (redo: 10.3% vs control: 0.6, OR: 17.71, 95% CI 1.92-163.39). Early postoperative complications were comparable: they were mainly infectious and managed by antibiotics. At a comparable follow-up (redo: 81 months (IQR: 54) vs control: 71.5 months (IQR: 42); p=0.37), there were no differences in graft-related complications (redo: 17.9% vs control: 9.6%, p=0.14) and reinterventions for complications (redo: 12.8% vs control: 5.1%, p=0.14) or prolapse (redo: 15.4% vs control: 8.3%, p=0.18). Subjective (redo: 88.5% vs control: 80.2%, p=0.41) and objective (redo: 31.8% vs control: 24.7%, p=0.50) success rates were also comparable. CONCLUSIONS In our experience, redo LSCP is as safe and effective as a primary LSCP, but there is a higher risk of conversion.
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Affiliation(s)
- Emma Bauters
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ann-Sophie Page
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Laura Cattani
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Susanne Housmans
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
- Department of Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.
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van Oudheusden AMJ, Weemhoff M, Menge LF, Essers BAB. Gynecologists' perspectives on surgical treatment for apical prolapse: a qualitative study. Int Urogynecol J 2023; 34:2705-2712. [PMID: 37392227 PMCID: PMC10682281 DOI: 10.1007/s00192-023-05587-1] [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: 03/31/2023] [Accepted: 05/21/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal sacrospinous fixation (VSF) without mesh and sacrocolpopexy (SCP) with mesh are the most frequently performed surgical procedures for apical prolapse in the Netherlands. There is no long-term evidence suggesting the optimal technique, however. The aim was to identify which factors play a role in the choice between these surgical treatment options. METHODS A qualitative study using semi-structured interviews amongst Dutch gynecologists was carried out. An inductive content analysis was performed with Atlas.ti. RESULTS Ten interviews were analyzed. All gynecologists performed vaginal surgeries for apical prolapse, six gynecologists perform SCP themselves. Six gynecologists would perform VSF for a primary vaginal vault prolapse (VVP); three gynecologists preferred a SCP. All participants prefer a SCP for recurrent VVP. All participants have stated that multiple comorbidities could be a reason for choosing VSF, as this procedure is considered less invasive. Most participants choose a VSF in the case of older age (6 out of 10) or higher body mass index (7 out of 10). All treat primary uterine prolapse with vaginal, uterine-preserving surgery. CONCLUSIONS Recurrent apical prolapse is the most important factor in advising patients which treatment they should undergo for VVP or uterine descent. Also, the patient's health status and the patient's own preference are important factors. Gynecologists who do not perform the SCP in their own clinic are more likely to perform a VSF and find more reasons not to advise a SCP. All participants prefer a vaginal surgery for a primary uterine prolapse.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynecology and Obstetrics, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Mirjam Weemhoff
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Leah F Menge
- Department of Gynecology and Obstetrics, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA, Delft, The Netherlands
| | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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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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Padoa A, Braga A, Fligelman T, Athanasiou S, Phillips C, Salvatore S, Serati M. European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:703-716. [PMID: 37490710 DOI: 10.1097/spv.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
| | | | | | - Stavros Athanasiou
- Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Urogynaecology, Basingstoke, Hampshire, United Kingdom
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Milan, Italy
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13
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Komon W, Saraluck A, Viseshsindh W, Chinthakanan O. The Surgical Management of Large Bladder Calculi and Irreducible Uterine Prolapse: A Case Report and Review of Literature. Urol Int 2023; 107:835-838. [PMID: 37487475 DOI: 10.1159/000531523] [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: 03/13/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Bladder calculi are rare in women. We report a case of bladder calculi complicating irreducible uterovaginal prolapse. It provides diagnostic and operative challenges to the management team. A 77-year-old woman presented with irreducible complete uterovaginal prolapse. Bladder stones were appreciated on examination and confirmed with imaging. The patient was managed surgically with transabdominal hysterectomy with bilateral uterosacral colpopexy followed by cystolithotomy. The patient's postoperative course was uncomplicated, and she had an uneventful recovery at her 3-month postoperative visit without a recurrence of prolapse and gained good continence. The presence of bladder calculi should be considered in the setting of irreducible pelvic organ prolapse. The abdominal approach of cystolithotomy with a concomitant hysterectomy and vaginal apical suspension is safe and effective.
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Affiliation(s)
- Wanchat Komon
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Apisith Saraluck
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Wit Viseshsindh
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Orawee Chinthakanan
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
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Gaultier V, Martel C, Boisramé T, Faller E, Lecointre L, Akladios C. Bilateral posterior Richter sacrospinous fixation with native tissue: anatomical and functional results and quality of life assessment over 10 years. J Gynecol Obstet Hum Reprod 2023; 52:102575. [PMID: 36972736 DOI: 10.1016/j.jogoh.2023.102575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/09/2023] [Indexed: 03/28/2023]
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is a common condition that affects 50% of women who have given birth in their lifetime. With stop of vaginal mesh sale in 2019, the sacrospinous fixation technique according to Richter with native tissue has seen its incidence tripled in 15 years. Classically, sacrospinous fixation according to Richter is performed unilaterally, however its unilateral or bilateral character is controversial. Objective of this work is to evaluate the efficacy and safety of bilateral sacrospinous fixation according to Richter by the posterior approach with native tissue (SSB). METHODS We performed a retrospective single-center study. From March 12, 2010 to March 23, 2020, all first-time operated patients who underwent SSB in CHU Strasbourg gynecological surgery unit for symptomatic POP management were included. The main endpoint of our work is the anatomical and functional success rate at 12 and 24 months. The secondary judgment criteria of our work were based on the postoperative evaluation of patient's quality of life according to the PFDI-20 score as well as the rate of postoperative complications. RESULTS 77 patients were included in our work. The anatomical success rate at 12 months is 94% and 81% at 24 months regardless of the compartment affected. The functional success rate is 94% at 12 months and 82% at 24 months. Quality of life evaluation through the PFDI-20 scale revealed a clear improvement in the symptomatology related to POP: 127/300 +/- 27.3. preoperatively and 59.8 ± 14.7 postoperatively. CONCLUSION Bilateral sacrospinous fixation according to Richter by posterior approach with native tissue is a safe and effective surgical technique allowing a clear improvement in patients quality of life.
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15
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Baki Erin K, Taştan AŞ, Katırcı Y, Özdemir AZ, Güven D, Önem K, Önal M, Erin R, Kulaksiz D. Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study. Arch Gynecol Obstet 2023; 307:1859-1865. [PMID: 36808287 DOI: 10.1007/s00404-023-06958-1] [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: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). METHODS This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. RESULTS In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). CONCLUSIONS This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.
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Affiliation(s)
- Kübra Baki Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey.
| | - Ayşe Şeyma Taştan
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Yunus Katırcı
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayşe Zehra Özdemir
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Davut Güven
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Kadir Önem
- Department of Urology, Medicine Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Mesut Önal
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Recep Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Deniz Kulaksiz
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
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Hamdy MA, Ahmed WAS, Abolill ZM, Elshahat AM, Taha OT. Female sexual function after repair of uterovaginal prolapse. J Obstet Gynaecol Res 2022; 48:3286-3291. [PMID: 36065788 DOI: 10.1111/jog.15414] [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: 04/06/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy on female sexual function. METHODS A cross-sectional study was conducted at the Urogynecology Clinic of the Suez Canal University Hospital from May 2014 to April 2019. Twenty-seven women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri were recruited. Sacrospinous ligament fixation was done. Sexual symptoms were assessed using the female sexual function index (FSFI) questionnaire just before and 6 months after the operation. RESULTS The mean age of the participants was 36.5 ± 4 years. Sacrospinous hysteropexy only was performed for three women. Additional procedures included anterior colporrhaphy (12), posterior colporrhaphy (9), and perineorrhaphy (15). There was a significant improvement in pre- and postoperative patients' orgasm (3.1 ± [0.8] vs. 3.7 ± [1.1]; p value = 0.03) and satisfaction (3.4 ± [0.6] vs. 4.2 ± [0.8]; p value < 0.001) while there was worsening of pain (4.3 ± [1.5] vs. 3.2 ± [1.6]; p value = 0.017). There was insignificant improvement in the other three domains as well as total score of FSFI, with all patients having sexual dysfunction. CONCLUSION Sacrospinous hysteropexy was associated with significant improvement orgasm and satisfaction domains of FSFI and significant worsening of pain.
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Affiliation(s)
- Mostafa A Hamdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Waleed A S Ahmed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Zakia M Abolill
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Amal M Elshahat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Omima T Taha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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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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Letter to the editor: Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis. Int Urogynecol J 2022; 33:2065-2066. [PMID: 35445810 DOI: 10.1007/s00192-022-05201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II-IV Apical Prolapse. J Clin Med 2022; 11:jcm11082215. [PMID: 35456313 PMCID: PMC9029245 DOI: 10.3390/jcm11082215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Abstract
The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)—61; laparoscopic pectopexy (LP)—53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP.
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20
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Outcomes of the anterior approach versus posterior sacrospinous ligament fixation for pelvic organ prolapse. Int Urogynecol J 2022; 33:1857-1862. [DOI: 10.1007/s00192-022-05171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
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21
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Sharifiaghdas F. Autologous rectus fascia graft in the treatment of high-stage apical vaginal prolapse: preliminary results of a new surgical approach with native tissue. Int Urol Nephrol 2022; 54:1017-1022. [DOI: 10.1007/s11255-022-03167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
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