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Prolapse repair in the elderly patient: contemporary trends and 30-day perioperative complications. Int Urogynecol J 2020; 31:2095-2100. [DOI: 10.1007/s00192-020-04365-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
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Joukhadar R, Radosa J, Paulus V, Hamza A, Solomayer EF, Herr D, Wöckel A, Baum S. Influence of Patient's Age on the Outcome of Vaginal and Laparoscopic Procedures in Urogynaecology. Geburtshilfe Frauenheilkd 2019; 79:949-958. [PMID: 31523095 PMCID: PMC6739203 DOI: 10.1055/a-0854-5916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction
In the treatment of prolapse and incontinence, the choice of surgical procedure often depends not only on the clinical findings but also on the age of the patient. Uncertainty exists at present regarding the effect of patient age on treatment outcomes for both vaginal and laparoscopic procedures. The aim of this study is therefore to compare both the anatomical outcome after prolapse surgery and the functional outcome after incontinence surgery in the context of the treatment of stress urinary incontinence in older and younger patients.
Patients/Methods
This is a retrospective single-centre study conducted at a university site. Over the study period, a total of 407 women underwent surgery, 278 of whom were < 70 and 129 ≥ 70 years of age. They were assigned to one of three treatment groups (prolapse surgery, incontinence surgery or a combination of both types of surgery) and were then subjected to statistical analysis after assessment of the anatomical and functional outcome after 3 – 6 months.
Results
The most common form of prolapse among the 407 evaluated patients was in the anterior and middle compartment, with a higher degree of severity being diagnosed in the older patients. Grade 4 prolapse according to the Baden–Walker system was thus present in the anterior compartment in 15.6 vs. 28.8% (p = 0.033) and in the middle compartment in 5.7 vs. 23.7% (p < 0.001) of cases. Younger women underwent vaginal mesh implantation less frequently and laparoscopic sacropexy more frequently for this overall. The proportion of cases of combined prolapse and incontinence surgery was the same in both groups. Overall, high success rates were observed in both younger and older patients following prolapse and incontinence surgery. These rates were 93.5 vs. 84.8% (p = 0.204) after prolapse surgery and 92.8 vs. 84.2% (p = 0.261) after incontinence surgery. A significant disadvantage for the older patients was the persistence of stress urinary incontinence after prolapse surgery alone (19.6 vs. 50%, p = 0.030) and the rate of occult (de novo) stress urinary incontinence (7.4 vs. 20%, p = 0.030).
Conclusion
Our data show that both pelvic organ prolapse and stress urinary incontinence can be treated with surgery with good results in women aged ≥ 70 years. It was thus possible to show for the first time in a large patient population that older women should not be denied appropriate surgery but can be offered the same range of surgical options as younger patients.
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Affiliation(s)
- Ralf Joukhadar
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany.,Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Saar, Germany
| | - Julia Radosa
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Saar, Germany
| | - Viola Paulus
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Saar, Germany
| | - Amr Hamza
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Saar, Germany
| | - Erich Franz Solomayer
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Saar, Germany
| | - Daniel Herr
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Sascha Baum
- Department of Obstetrics and Gynaecology, Lübeck University Medical Centre, Lübeck, Germany.,Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Saar, Germany
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Marcu D, Diaconu C, Iorga L, Bratu O, Mischianu D. Mesh colposacropexy in the management of anterior vaginal compartment prolapse. J Med Life 2019; 12:65-70. [PMID: 31123527 PMCID: PMC6527416 DOI: 10.25122/jml-2019-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pelvic organ prolapse is a frequent female pathology, often causing a negative impact on the patient’s quality of life. The purpose of this paper is to present the results that we have achieved in 32 patients with anterior vaginal compartment prolapse, managed using the transvaginal mesh approach. Over a period of twelve months, we have performed 32 transvaginal reconstructive procedures using a four arms polypropylene mesh. The superior arms of the mesh have been passed through the obturator foramen while the inferior arms have been passed through the sacrospinous ligament. The surgery has lead to a significant improvement in the quality of life in this group of patients, this being assessed using self-administered questionnaires that evaluated the quality of life, the sexual function, and urinary continence. Anatomical success was achieved in 96.87% of the cases. In terms of postoperative complications, we mention one case of vaginal erosion, one case of de novo dyspareunia and three cases of pelvic discomfort. So far we have not encountered any mesh exposure cases nor prolapse recurrence. Considering the results that we have achieved in our study, we can conclude that the transvaginal polypropylene mesh approach can prove itself to be a viable solution for the management of genital prolapse, especially if we consider the high postoperative rates of anatomical success and low rates of postoperative complications, as well as improving the patient’s quality of life. In spite of these encouraging results, the fact that in recent years FDA has emitted several warnings in terms of postoperative complications following such procedures, as well as the fact that our study was conducted on a small group of patients, limits the strength of our research, its only purpose being to present our experience for this surgical approach over a limited period of time.
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Affiliation(s)
- Dragos Marcu
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Diaconu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian Iorga
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania
| | - Ovidiu Bratu
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
| | - Dan Mischianu
- Clinic of Urology, "Dr. Carol Davila" Central Military Emergency University Hospital", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
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Narins H, Danforth TL. Management of pelvic organ prolapse in the elderly - is there a role for robotic-assisted sacrocolpopexy? ROBOTIC SURGERY : RESEARCH AND REVIEWS 2016; 3:65-73. [PMID: 30697557 PMCID: PMC6193441 DOI: 10.2147/rsrr.s81584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abdominal sacrocolpopexy is considered the gold standard treatment for symptomatic pelvic organ prolapse (POP). Since its introduction, robotic-assisted sacrocolpopexy has emerged as a popular minimally invasive alternative to open repair. Epidemiologic data suggest that the number of women seeking surgical treatment for POP will increase to ~50% by 2050, and many of these women will be elderly. Advanced age should not preclude elective POP surgery. Substantial data suggest that medical comorbidities and other preoperative markers may be more important than age in predicting adverse surgical outcomes. POP surgery in the elderly has been extensively studied and found to be safe, but there is a paucity of information regarding robotic-assisted sacrocolpopexy in this population. Data are only beginning to emerge regarding the safety and efficacy of robotic surgery in the elderly, with most studies focusing on oncologic procedures. Preliminary studies in this setting suggest that elderly patients may benefit from a minimally invasive approach, although given their limited physiologic reserves, appropriate patient selection is essential. The purpose of this review article is to evaluate the stepwise management of POP in the elderly female, with a focus on the safety and feasibility of a robotic approach.
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Affiliation(s)
- Hadley Narins
- Department of Urology, The State University of New York at Buffalo, Buffalo, NY, USA,
| | - Teresa L Danforth
- Department of Urology, The State University of New York at Buffalo, Buffalo, NY, USA,
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Pizarro-Berdichevsky J, Clifton MM, Goldman HB. Evaluation and Management of Pelvic Organ Prolapse in Elderly Women. Clin Geriatr Med 2015; 31:507-21. [DOI: 10.1016/j.cger.2015.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Töz E, Özcan A, Apaydın N, Uyar İ, Kocakaya B, Okay G. Outcomes of vaginal hysterectomy and constricting colporrhaphy with concurrent levator myorrhaphy and high perineorrhaphy in women older than 75 years of age. Clin Interv Aging 2015; 10:1009-15. [PMID: 26150705 PMCID: PMC4484673 DOI: 10.2147/cia.s85960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We performed constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy, and investigated the intraoperative complications, and short-term outcomes of these constricting procedures in patients aged 75 years or older. METHODS We searched our hospital database for cases, between January 2011 and January 2014, of women aged over 75 years who underwent surgery for pelvic organ prolapse of stage 2 or higher, via vaginal hysterectomy, constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy, with or without treatment of urinary incontinence. All volunteers were evaluated via pelvic examination using the pelvic organ prolapse quantification system, the modified Decision Regret Scale-Pelvic Floor Disorders form, the Satisfaction Decision Scale-Pelvic Floor Disorders form, and the Pelvic Floor Distress Inventory form. RESULTS Fifty-four patients were included in the study. The mean follow-up time was 24.4 months after constricting surgery (range: 8-44 months). There were four cases (7%) of de novo urge incontinence (the symptoms resolved upon prescription of anticholinergic medication). Two patients developed de novo stress urinary incontinence after the procedure and were treated via transobturator sling surgery using Safyre T(®) polypropylene monofilament slings. No anatomical or subjective recurrence of prolapse was noted during the follow-up period. No patient required additional surgery for recurrence of prolapse. CONCLUSION Constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy is a feasible, safe, and effective surgical option in elderly patients at low anesthesiological risk. The decision to perform an incontinence procedure should be individualized based on preoperative findings after prolapse reduction.
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Affiliation(s)
- Emrah Töz
- Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Aykut Özcan
- Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Nesin Apaydın
- Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey
| | - İbrahim Uyar
- Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Betül Kocakaya
- Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Gülin Okay
- Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey
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Tan YL, Lo TS, Khanuengkitkong S, Krishna Dass A. Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women. Taiwan J Obstet Gynecol 2015; 53:348-54. [PMID: 25286789 DOI: 10.1016/j.tjog.2013.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups. MATERIALS AND METHODS Vaginal sacrospinous ligament fixation with anterior mesh repair as primary prolapse surgery was performed on 225 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was determined according to feedback of POPDI-6 (Questions 2 and 3). Patients provided responses to UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and postsurgery. Outcome measures were observed in cohorts of two age groups (<75 years and ≥75 years). RESULTS Postoperative data of 217 patients were available. The cumulative objective cure rates were 93.0% and 92.5% for patients aged ≥75 years and <75 years, respectively, with mean follow-up of 33.93 ± 18.52 months and 36.44 ± 19.34 months respectively. The UDI-6, IIQ-7, POPDI-6, and PISQ-12 scores within each of the two age groups improved significantly after surgery. Comparatively, the POPDI-6 score was better whereas the PISQ-12 score was poorer among patients aged ≥75 years. Older women had significantly more preoperative comorbidities. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. The intraoperative blood loss was significantly less in the older group and neither group had mortality. CONCLUSION This study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.
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Affiliation(s)
- Yiap Loong Tan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Kuching Specialist Hospital, KPJ and Department of Obstetrics & Gynecology, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan; Chang Gung University, School of Medicine, Taoyuan, Taiwan.
| | - Siwatchaya Khanuengkitkong
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Anil Krishna Dass
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Urogynecology Unit, Department of Obstetrics and Gynecology, Penang Hospital, Penang, Malaysia
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Epidemiology, Evaluation, and Treatment of Urinary Incontinence in Octogenarian Women. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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