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Protsepko O, Voisard P, Kuhn C, Maccagno A, Dannecker C, Jeschke U, Pauli F, Garrido F. Induction of a different immune response in non-titanized compared to titanized polypropylene meshes. Acta Biomater 2023; 169:363-371. [PMID: 37579913 DOI: 10.1016/j.actbio.2023.08.018] [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: 02/27/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
It is well known that pelvic organ prolapse (POP) significantly reduces the quality of life of affected women and in many cases requires corrective surgery. Aim of the study was to compare the immune response against titanized versus non-titanized meshes, especially macrophage polarization and immune checkpoint association. For this, we analyzed 644 POP surgeries, which were performed between 2017 and 2022, in our department. Four of them needed revision surgery caused by erosion. We analyzed the influx of CD68 & CD163 positive macrophages and the expression of immune checkpoint molecules PD-L1 and PD1 in these 4 patients. We identified a large number of CD68 and CD163 positive macrophages and additionally a PD-L1 expression of these cells. Based on the in-vivo results, we isolated monocytes and co-cultivated monocytes with different mesh material covered with or without fibroblasts. We identified a significantly enhanced macrophage activation and PD-L1 expression in macrophages surrounding non-titanized polypropylene mesh material. Encapsulation of the material by fibroblasts was crucial for that. Specifically, CD68-positive macrophages are upregulated (p < 0.001), co-expressing PD-L1 (p < 0.001) in monocytes co-cultivated with non-titanized polypropylene meshes. Monocytes co-cultivated with titanized polypropylene meshes showed significantly lower expression of CD163 (p = 0.027) and PD-L1 (p = 0.022). In conclusion, our in vitro data suggest that the titanium coating leads to a decreased polarization of macrophages and to a decreased immune response compared to non-titanized meshes. This could be an indication for the increased incidence of erosion of the non-titanized meshes, which is a severe complication of this procedure and requires revision surgery. STATEMENT OF SIGNIFICANCE: Pelvic organ prolapse is a well-known problem for women and often requires corrective surgery. Polypropylene meshes are often used, which differ in their coating (titanized vs. non-titanized). A severe side effect of these surgeries is mesh erosion, due to onset of inflammation, which requires revision surgery. We examined all erosion cases (4 of 644 patients) with implanted nontitanium-coated meshes by immunohistochemistry and found upregulation of macrophage polarization (as markers CD68 and CD163) and increased expression of the immune checkpoint molecules PD-L1 and PD1. This suggests inflammatory processes and an enhanced immune response. In addition, we set up an in vitro experiment to investigate whether coating plays a role. Here, we demonstrated that the non-titanized meshes elicited a significantly higher immune response in comparison to titanized meshes, which could lead to the higher erosion rate of the non-titanized meshes. Our results highlight the benefit of titanized meshes, which should lead to a lower revision surgery rate and thus improved patient outcome.
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Affiliation(s)
- Oleksii Protsepko
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Philipp Voisard
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Christina Kuhn
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Andrea Maccagno
- Department of Pathology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany.
| | - Friedrich Pauli
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Fabian Garrido
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
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Tvarozek S, Huser M, Dostalova M, Szypulova M, Horvath I. Evaluating sexual function among women after recurrent pelvic organ prolapse transvaginal mesh repair. J OBSTET GYNAECOL 2022; 42:3666-3671. [PMID: 36476069 DOI: 10.1080/01443615.2022.2153023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We aimed to evaluate women's sexual function before and after pelvic organ prolapse (POP) surgery utilising light transvaginal mesh after a prior hysterectomy. Only sexually active women with recurrent cystocele stage 3-4 according to POP-Q, who had previously undergone vaginal hysterectomy with anterior native tissue repair without apical fixation, were enrolled in the study. Women with previous mesh implant POP surgery, persistent vaginal infection or pelvic inflammatory disease were excluded. All patients were surgically treated between 2012 and 2015 using single-incision transvaginal mesh Calistar A. Sexual function was evaluated before a surgery and two years postoperatively. The assessment was accomplished via the standardised validated Czech translation of PISQ-12SF questionnaire. For each patient, age, BMI and parity were monitored. Out of all (89) eligible patients, 48 patients met inclusion criteria and were subsequently enrolled in our study. Two years postoperatively, 31 women (79.5%) improved their PISQ-12 score; five (12.8%) had equivalent scores, and three patients (7.7%) reported lower scores. Overall PISQ-12 score was 37.1 ± 2.6 postoperatively with a 2.9 ± 2.3 statistically significant positive difference compared to the score preceding surgery. The majority of patients undergoing surgery using Calistar A experienced a significant improvement in sexual function.IMPACT STATEMENTWhat is already known on this subject? Pelvic organ prolapse has a significant impact on women's sexual functioning in an adverse manner. Mesh implant repair is associated with lower rates of prolapse awareness and prolapse re-operation; however, it is linked with safety concerns. One of these concerns is the negative impact on women's sexual function. Evaluative study results following sexual function among women with mesh implant transvaginal repair are contradictory.What do the results of this study add? The results showed, that contrary to finding some of the previous studies, transvaginal mesh implant use could benefit patients with previous native tissue POP surgery failure with a low risk of sexual function deterioration.What are the implications of these findings for clinical practice and/or further research? The study provides clinical data for vaginal mesh implants on women's sexual function in the mid-term outcome. These data can be crucial for selecting the right POP surgical technique and evaluating its benefits and risks.
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Affiliation(s)
- Samuel Tvarozek
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Martin Huser
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
- Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Dostalova
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Martina Szypulova
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Ivan Horvath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Todd J, Aspell JE, Lee MC, Thiruchelvam N. How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools. BMC Womens Health 2022; 22:396. [PMID: 36180841 PMCID: PMC9523957 DOI: 10.1186/s12905-022-01977-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. METHODS First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. RESULTS Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. CONCLUSIONS We recommend further qualitative research regarding women's experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.
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Affiliation(s)
- Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, Cambridgeshire, CB1 1PT, UK.
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia.
| | - Jane E Aspell
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, Cambridgeshire, CB1 1PT, UK
| | - Michael C Lee
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Torres-Lacomba M, Navarro-Brazález B, Yuste-Sánchez MJ, Sánchez-Sánchez B, Prieto-Gómez V, Vergara-Pérez F. Women’s Experiences with Compliance with Pelvic Floor Home Exercise Therapy and Lifestyle Changes for Pelvic Organ Prolapse Symptoms: A Qualitative Study. J Pers Med 2022; 12:jpm12030498. [PMID: 35330497 PMCID: PMC8950721 DOI: 10.3390/jpm12030498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/01/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
In this study, we aimed to investigate women’s experiences with compliance with prescribed pelvic floor muscle exercises (PFMEs) and lifestyle changes 6–12 months after completing an individual pelvic floor physiotherapy program. This study was targeted to understanding factors affecting adherence to PFMEs and lifestyle changes to deal with pelvic organ prolapse (POP) symptoms. We designed this research as a descriptive qualitative study. We conducted this study from December 2016 to September 2017 in Madrid, Spain. Twenty-six women with symptomatic POP selected using a purposive sampling method participated in six focus groups and three one-to-one semi-structured interviews. Three authors coded and inductively analyzed transcript contents with iterative theme development. A thematic analysis revealed three main themes: (1) symptoms change; (2) PFMEs and lifestyle changes performance; and (3) a health practitioner–patient relationship. Women identified as adherent reported improvement in physical symptoms and emotional and general state as a result of the new knowledge achieved. Fear also promoted compliance with performing PFMEs and adopting lifestyle changes. Likewise, PFMEs preference and routine, integration of PFMEs and lifestyle changes into activities of daily living, support guides, therapeutic alliance, individual supervision, follow-up, and feedback were also identified as adherence facilitators. One of the biggest barriers that we identified was responsibility. Compliance with prescribed PFMEs and lifestyle changes can be improved with effective individual, women-centered, and supervised physiotherapy programs reducing symptoms, including exercises aligned with women’s preferences that are easy to integrate in daily living, promoting knowledge and awareness of their condition, providing written or electronic guidelines, with routine follow-up visits offering both positive feedback and clear and consistent messages, and enhancing therapeutic alliance.
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Harvey MA, Chih HJ, Geoffrion R, Amir B, Bhide A, Miotla P, Rosier PFWM, Offiah I, Pal M, Alas AN. International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain. Int Urogynecol J 2021; 32:2575-2594. [PMID: 34338825 DOI: 10.1007/s00192-021-04941-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP. METHODS An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category. RESULTS The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies. CONCLUSIONS The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.
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Affiliation(s)
- Marie-Andrée Harvey
- Department of Obstetrics and Gynecology Queen's University, Victory 4, Kingston Health Science Centre, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.
| | - Hui Ju Chih
- Department of Obstetrics and Gynecology Queen's University, Victory 4, Kingston Health Science Centre, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Baharak Amir
- Department of Obstetrics & Gynecology, Division of Urogynecology and Pelvic Floor Surgery, Dalhousie University, Halifax, Canada
| | - Alka Bhide
- Department of Obstetrics and Gynecology, Imperial College Healthcare NHS Trust, London, UK
| | - Pawel Miotla
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ifeoma Offiah
- Department Obstetrics and Gynecology, Derriford Hospital Healthcare, NHS Trust, Plymouth, UK
| | - Manidip Pal
- Department of Obstetrics and Gynecology College of Medicine & JNM Hospital, WBUHS, Kalyani, India
| | - Alexandriah Nicole Alas
- Department of Obstetrics and Gynecology, University of Texas Health Sciences, San Antonio, TX, USA
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Kayondo M, Kaye DK, Migisha R, Tugume R, Kato PK, Lugobe HM, Geissbüehler V. Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study. BMC WOMENS HEALTH 2021; 21:258. [PMID: 34172043 PMCID: PMC8228931 DOI: 10.1186/s12905-021-01397-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022]
Abstract
Background Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life. Methods We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery. Results Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p < 0.001). The overall QOL improved by 38.9% after surgery (p < 0.001). Conclusions The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.
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Affiliation(s)
- Musa Kayondo
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda. .,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda.
| | - Dan Kabonge Kaye
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Rodgers Tugume
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
| | - Paul Kalyebara Kato
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
| | - Henry Mark Lugobe
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
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Sleiman Z, Bitar R, Christoforou C, Török P, Fichera M, Panella MM, Biondi A, Laganà AS, Garzon S, Radwan G. Is there proof of transferability of laparoscopic psychomotor skills from the simulator laboratory to the operating room? Results from a systematic review. J OBSTET GYNAECOL 2021; 42:181-187. [PMID: 34027781 DOI: 10.1080/01443615.2021.1904216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This systematic review aims to understand better the translation of laparoscopic psychomotor skills, acquired in dry lab training, into a direct patient benefit in actual clinical practice in the operating room. The review was performed according to PRISMA guidance, searching database-specific filters for controlled trials: 'laparoscopy', 'simulator', 'surgical training', 'dry lab', 'psychomotor skills'. We included only RCTs in which the study population was the surgical trainee or novice surgeon with no prior simulation training, and the intervention was simulation training in laparoscopic surgery, regardless of subspecialty. Ten studies were included in this systematic review. The mean performance score was higher compared to the control groups. Fewer errors were noted in the intervention groups. No clinical patient outcomes (mortality, morbidity, quality of life) were addressed in these studies. All the trials were at high risk of bias. Training outside the operating room may lead to better surgical performance and less operative time. Nevertheless, additional studies with better designs are needed to provide more robust evidence.
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Affiliation(s)
- Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
| | - Roger Bitar
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
| | | | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, Debrecen, Hungary
| | - Michele Fichera
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Marzio Panella
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Ghida Radwan
- Obstetrics and Gynecology Department, Clemenceau Medical Center, Beirut, Lebanon
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Abrar S, Mohsin R, Saleem H. Surgery for pelvic organ prolapse and stress urinary incontinence and female sexual functions: A quasi-experimental study. Pak J Med Sci 2021; 37:1099-1103. [PMID: 34290790 PMCID: PMC8281190 DOI: 10.12669/pjms.37.4.3892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To assess the effect of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) on various domains of female sexual functions in patients before and after reconstructive surgery for these pelvic floor disorders. Methods: We conducted a quasi-experimental study of 126 women aged 25-65 years, presenting with POP / SUI, from January 1st 2019 to December 31st 2019 at Aga Khan University Hospital. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 18 months after surgery. Results: Mean age of the participants was 51.6, with a mean parity of four. Out of 126 patients, 31 patients underwent vaginal hysterectomy, pelvic floor repair and mid-urethral sling (MUS), 55 had vaginal hysterectomy with pelvic floor repair, 12 women had only pelvic floor repair and 10 patients had uterine suspension surgery for prolapse, while 18 patients underwent MUS operation alone for SUI. There was a statistically significant difference in female sexual functions after surgery for POP and/or SUI (p<0.01). This improvement was observed in both total and individual scores of each domain of FSFI with an overall improvement in sexual function from a mean of 18.5 pre-surgery to 20.8 post-surgery. Conclusions: This study reveals that women sexual functions are affected by POP and SUI and improve remarkably after reconstructive surgeries for these pelvic floor disorders.
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Affiliation(s)
- Saida Abrar
- Dr. Saida Abrar, Clinical Fellow Urogynecology and pelvic reconstructive surgery, Department of Gynecology/Obstetrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Raheela Mohsin
- Dr. Raheela Mohsin Rizvi, Clinical Fellowship Urogynecology Sydney, Australia Associate Professor, OBGYN, section of Urogynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Huda Saleem
- Dr. Huda Saleem, Resident Obstetrics/Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
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Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Gjerde JL, Ayele TA. Pelvic organ prolapse surgery and health-related quality of life: a follow-up study. BMC WOMENS HEALTH 2021; 21:4. [PMID: 33388056 PMCID: PMC7778798 DOI: 10.1186/s12905-020-01146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL. METHODS A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores. RESULTS In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant's mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores. CONCLUSIONS Surgical repair for prolapse effectively improves patient's HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.
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Affiliation(s)
- Tadesse Belayneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abebaw Gebeyehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Guri Rortveit
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway
| | - Janne Lillelid Gjerde
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tadesse Awoke Ayele
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Aydın S, Sönmez FC, Karasu AFG, Gül B, Arıoğlu Ç. Search for the G spot: microvessel and nerve mapping of the paraurethral anterior vaginal wall. Int Urogynecol J 2020; 31:2565-2572. [PMID: 32577788 DOI: 10.1007/s00192-020-04379-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Orgasm and other sexual responses such as pain, arousal and lubrication may be mediated by nerve fibers and vessels in the lamina propria and muscularis of the vaginal wall, in which case the number of nerve fibers and vessels would be associated with sexual functions. The aim of the study is to map the distribution of nerves and vessels in the anterior vaginal wall along the paraurethral region in a systematic fashion. METHODS Specimens were taken from women with anterior vaginal wall prolapse undergoing colporrhaphy anterior repair. All specimens were mapped in a standard way starting 15 mm proximal to the external urethral orifice. Selected blocks of samples were immunohistochemically stained: actin, smooth muscle Ab-1 and S100 Protein Ab-1. The numbers of microvessels and nerves in the lamina propria and muscularis were counted in five consecutive high-power fields of a light microscope. Pairwise comparisons of proximal, distal, right and left paravaginal microvessel and nerve fiber density were analyzed with paired-sample t-test or Wilcoxon signed-rank test. RESULTS Vaginal nerve fibers in the lamina propria and muscularis have a fairly even distribution in the anterior vaginal wall. Vaginal small vessel vascularization and microvascularization are also evenly distributed, with no concentrated site along the paraurethral region of the anterior vaginal wall. CONCLUSIONS Nerve fiber, nerve bundle, microvessel and small vessel densities in the lamina propria and muscularis were fairly regular, with no concentrated site on the paraurethral region of the anterior vaginal wall.
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Affiliation(s)
- Serdar Aydın
- Department of Obstetric and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, Istanbul, Turkey.
| | | | - Ayşe Filiz Gökmen Karasu
- Department of Obstetric and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, Istanbul, Turkey
| | - Burcu Gül
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| | - Çağrı Arıoğlu
- Department of Obstetric and Gynecology, Medicalpark Goztepe Hospital, Istanbul, Turkey
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11
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Chen J, Yu J, Morse A, Fünfgeld C, Huang K, Gong J, Tao G, Wang B, Wang Y, Jiang X, Ababaikeli G, Liu P, Nisier H, Zhang X, Wang P, Sun X, Zhu L. Self-cut titanium-coated polypropylene mesh versus pre-cut mesh-kit for transvaginal treatment of severe pelvic organ prolapse: study protocol for a multicenter non-inferiority trial. Trials 2020; 21:226. [PMID: 32102687 PMCID: PMC7045611 DOI: 10.1186/s13063-019-3966-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 12/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is a common health problem and has significant negative effects on a woman's quality of life. The transvaginal mesh procedure is a durable reconstructive surgery, but the mesh kits are expensive for underdeveloped countries. Our previous case-series study showed that the use of self-cut mesh had a good success rate (91.8% at 1-year follow-up) and low complication rate. This trial is designed to compare a self-cut titanium-coated polypropylene mesh procedure with a mesh kit for the treatment of symptomatic stage III-IV anterior or apical prolapse in terms of efficacy, safety and cost-effectiveness. METHODS The trial is a randomized controlled multicenter non-inferiority trial. The primary outcome measure is the composite success rate at 1-year follow-up. The secondary outcomes are anatomic outcomes of each vaginal segment (anterior, posterior and apical) using the POP-Q score, subjective improvement of quality of life according to questionnaires, intraoperative parameters, complications and costs. Analysis will be performed according to the intention-to-treat principle. Based on a comparable success rate of 90% and 10% as the margin (β = 0.2 and one-sided α = 0.025), about 312 patients in total from 11 centers will be recruited including 10% dropout. The aims of the research are to demonstrate whether the self-cut mesh procedure is non-inferior to the mesh-kit procedure and to investigate the performance of titanium-coated mesh for vaginal prolapse repair. DISCUSSION This multicenter non-inferiority trial will evaluate whether the efficacy and safety of self-cut mesh is non-inferior to mesh kits in women with severe symptomatic stage III-IV anterior or apical prolapse. If we are able to show that the self-cut mesh procedure is non-inferior to the mesh-kit procedure in success rates, then the self-cut mesh procedure may be more cost-effective. TRIAL REGISTRATION ClinicalTrials.gov, NCT03283124. Registered on 17 January 2018.
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Affiliation(s)
- Juan Chen
- Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jiajie Yu
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Abraham Morse
- Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Christian Fünfgeld
- Center for surgery of Pelvic Prolapse and Incontinence, Tettnang Hospital (Klinik Tettnang GmbH), Tettnang, Germany
| | - Kuanhui Huang
- Department of Obstetrics and Gynecology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian China
| | - Jian Gong
- Department of Obstetrics/Gynecology, the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University Hospital, Wuxi, Jiangsu China
| | - Guangshi Tao
- Department of Obstetrics/Gynecology, The Second Xiangya Hospital of Central South University Changsha, Hunan, China
| | - Binan Wang
- Department of Obstetrics/Gynecology, Changsha Hospital for Maternal and Child Health Care, Changsha, Hunan China
| | - Yuling Wang
- Department of Obstetrics/Gynecology, Foshan Maternal and Child Health Care Hospital, Foshan, Guangdong China
| | - Xiangyang Jiang
- Department of Gynecology, Shaanxi Provincial People’s Hospital, Xi’an, Shanxi China
| | - Gulina Ababaikeli
- Department of Obstetrics/Gynecology, The First Affiliated Hospital of Xinjiang Medical University Ürümqi, Xinjiang, China
| | - Peishu Liu
- Department of Obstetrics/Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong China
| | - Hatiguli Nisier
- Department of Obstetrics/Gynecology, The People’s Hospital of Xinjiang Uygur Autonomous Region Ürümqi, Xinjiang, China
| | - Xiaowei Zhang
- Department of Obstetrics/Gynecology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Ping Wang
- Department of Obstetrics/Gynecology, Sichuan University West China Second University Hospital, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan China
| | - Lan Zhu
- Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
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La Rosa VL, Ciebiera M, Lin LT, Sleiman Z, Cerentini TM, Lordelo P, Kahramanoglu I, Bruni S, Garzon S, Fichera M. Multidisciplinary management of women with pelvic organ prolapse, urinary incontinence and lower urinary tract symptoms.A clinical and psychological overview. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2019; 18:184-190. [PMID: 31975987 PMCID: PMC6970416 DOI: 10.5114/pm.2019.89496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 08/24/2019] [Indexed: 02/05/2023]
Abstract
Although female sexual dysfunctions are common among women with urogynecological conditions, they have not been thoroughly studied and there are still many questions without an answer. The recent evidence on sexual disorders in women with urogynecological diseases shows a quite wide spectrum of therapeutic approaches, which require the physicians to take into account not only the primary symptoms, but also all the associated factors negatively affected. It has been widely underlined that gynecological diseases are often associated with high stress and have a negative impact on quality of life and psychological well-being of women affected. For this reason, a multidisciplinary approach for the management of these diseases is highly recommended. Also in the case of urogynecological disorders, it is important to take into account psychological outcomes throughout the diagnostic and therapeutic process. In the light of these considerations, the aim of this short review is to evaluate the impact of the main urogynecological diseases and the currently available therapeutic options in order to improve quality of life and sexuality of these patients and to stress the need for a multidisciplinary approach in order to minimize the negative consequences of these diseases for the sexual well-being of women and their partners.
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Affiliation(s)
- Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy
- Corresponding author: Valentina Lucia La Rosa, Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy, e-mail:
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
| | - Tais Marques Cerentini
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Ilker Kahramanoglu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Simone Bruni
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Michele Fichera
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Changes in Sexual Function Following Uphold Transvaginal mesh Surgery for the Treatment of Urogenital Prolapse. Sci Rep 2019; 9:17047. [PMID: 31745119 PMCID: PMC6863913 DOI: 10.1038/s41598-019-52990-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 10/22/2019] [Indexed: 11/08/2022] Open
Abstract
Uphold transvaginal mesh implantation is an option for treating pelvic organ prolapse (POP). This prospective cohort study aims to evaluate the effect of Uphold transvaginal mesh implantation on female sexual function. 205 women with symptomatic POP were recruited and evaluated pre-operatively and re- evaluated six months post-operatively in terms of anatomical restoration, quality of life influenced by urinary incontinence and female sexual function. 30 women eventually completed the assessments and been statistically evaluated. The main outcome focused on sexual function. In our study, we found that Uphold transvaginal mesh surgery could achieve effective anatomical restoration of POP and better sexual function regardless of concomitant sling surgery.
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Bernays V, Schwartz AK, Geraedts K, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Eberhard M, Imthurn B, Fink D, Imesch P, Leeners B. Qualitative and quantitative aspects of sex life in the context of endometriosis: a multicentre case control study. Reprod Biomed Online 2019; 40:296-304. [PMID: 31954612 DOI: 10.1016/j.rbmo.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION What are the specific characteristics of sexual activity in women with endometriosis compared with women without endometriosis? DESIGN Multicentre case control study. Participants were recruited from university hospitals, district hospitals and doctor's offices in Germany, Switzerland and Austria. A total of 565 women with endometriosis were pair-matched to 565 control women by age and ethnic background. Diagnosis of endometriosis was confirmed by histology, and disease stage was classified according to American Society for Reproductive Medicine criteria. Data on sexuality were collected using selected questions from the Brief Index of Sexual Function and the Sexual History Form. RESULTS Altogether, 69.1% of women with endometriosis and 77.8% of control women engaged in sexual activity during the month before the study period (P < 0.001). Overall, 42.3% of endometriosis-affected women and 30.5% of the control women desired a higher frequency of sexual activity (P < 0.001). Petting, foreplay and vaginal sexual intercourse were reported to be practised less often by women with endometriosis. Frequencies for masturbation, reciprocal masturbation, oral and anal sex were similar in both groups. Dyspareunia was negatively associated with sexual activity (OR 2.42, 95% CI 1.26 to 4.63), whereas chronic pain showed no association with sexual activity (OR 1.35, 95% CI 0.93, 1.96). CONCLUSIONS Women with endometriosis have lower frequencies of petting, foreplay and vaginal sexual intercourse than control women; this difference has to be attributed, at least in part, to dyspareunia. Potentially pain-free sexual options are used to a limited degree. As endometriosis-affected women desire higher levels of sexual activity, sexual counselling should be included in medical support.
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Affiliation(s)
- Valerie Bernays
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland
| | - Alexandra Kohl Schwartz
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland; University Women's Hospital, Division of Gynecological Endocrinology and Reproductive Medicine, Bern, 3010 Bern, Switzerland
| | - Kirsten Geraedts
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland
| | - Martina Rauchfuss
- Charité Berlin, University Hospital, Department of Psychosomatics, 10117 Berlin, Germany
| | - Monika Maria Wölfler
- University Hospital Graz, Department of Gynecology and Obstetrics, 8036 Graz, Austria
| | - Felix Haeberlin
- Cantonal Hospital St. Gallen, Department of Gynecology and Obstetrics, 9007 St. Gallen, Switzerland
| | - Stephanie von Orelli
- Triemli Hospital Zürich, Department of Gynecology and Obstetrics, 8036 Zürich, Switzerland
| | - Markus Eberhard
- Canton Hospital Schaffhausen, Department of Gynecology and Obstetrics, 8208 Schaffhausen, Switzerland
| | - Bruno Imthurn
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland
| | - Daniel Fink
- University Hospital Zürich, Department of Gynecology, 8910 Zürich, Switzerland
| | - Patrick Imesch
- University Hospital Zürich, Department of Gynecology, 8910 Zürich, Switzerland
| | - Brigitte Leeners
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland.
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Cadenbach-Blome T, Grebe M, Mengel M, Pauli F, Greser A, Fünfgeld C. Significant Improvement in Quality of Life, Positive Effect on Sexuality, Lasting Reconstructive Result and Low Rate of Complications Following Cystocele Correction Using a Lightweight, Large-Pore, Titanised Polypropylene Mesh: Final Results of a National, Multicentre Observational Study. Geburtshilfe Frauenheilkd 2019; 79:959-968. [PMID: 31523096 PMCID: PMC6739206 DOI: 10.1055/a-0984-6614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Patients who suffer from pelvic organ prolapse can experience severe limitations in their quality of life. To improve the quality of life of women affected and achieve a stable reconstruction, surgical therapy is often indispensable. In conventional prolapse surgery, the rate of recurrence is high. For this reason, alloplastic mesh has been implanted increasingly in recent years to reconstruct the anatomy of the pelvic floor organs. Even if the anatomical result can be significantly improved as a result, the mesh-induced complications have been the subject of controversial discussion. In this national, multicentre study, the quality of life, anatomical result as well as the rate of complications following the implantation of an alloplastic mesh for the correction of a cystocele were investigated. Method Fifty-four patients with symptomatic ≥ grade II were included in this prospective, national, multicentre study. The study participants were implanted with a titanised polypropylene mesh (TiLOOP ® PRO A, pfm medical ag). The follow-up observation period was 12 months. Primary as well as repeat procedures were taken into account. The anatomic result of the pelvic floor reconstruction was quantified using the POP-Q system. Data on quality of life and sexuality were collected using validated questionnaires. All complications which occurred were documented and evaluated by an independent committee. Results On average, the patients were in line with the census. An improvement in quality of life was able to be determined during the study in all domains investigated (p < 0.001, Wilcoxon test). Minus incorrect entries and incorrect reports, a total of 19 reports of adverse events in 15 patients were evaluated by the end of the study. The rate of recurrence in the anterior compartment was 4.3%. Conclusion In the reconstruction of the anatomical position of the pelvic floor organs given the presence of a symptomatic cystocele, the implantation of a third-generation alloplastic mesh achieves very good results. Affected patients benefit from the anatomical stability as well as a significant improvement in quality of life, whereby the risks are justifiable.
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Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev 2019; 8:3-17. [PMID: 30928249 DOI: 10.1016/j.sxmr.2018.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Dyspareunia has been traditionally divided into superficial (introital) dyspareunia and deep dyspareunia (pain with deep penetration). While deep dyspareunia can coexist with a variety of conditions, recent work in endometriosis has demonstrated that coexistence does not necessarily imply causation. Therefore, a reconsideration of the literature is required to clarify the pathophysiology of deep dyspareunia. AIMS To review the pathophysiology of deep dyspareunia, and to propose future research priorities. METHODS A narrative review after appraisal of published frameworks and literature search with the terms (dyspareunia AND endometriosis), (dyspareunia AND deep), (dyspareunia AND (pathophysiology OR etiology)). MAIN OUTCOME VARIABLE Deep dyspareunia (present/absent or along a pain severity scale). RESULTS The narrative review demonstrates potential etiologies for deep dyspareunia, including gynecologic-, urologic-, gastrointestinal-, nervous system-, psychological-, and musculoskeletal system-related disorders. These etiologies can be classified according to anatomic mechanism, such as contact with a tender pouch of Douglas, uterus-cervix, bladder, or pelvic floor, with deep penetration. Etiologies of deep dyspareunia can also be stratified into 4 categories, as previously proposed for endometriosis specifically, to personalize management: type I (primarily gynecologic), type II (nongynecologic comorbid conditions), type III (central sensitization and genito-pelvic pain/penetration disorder), and type IV (mixed). We also identified gaps in the literature, such as lack of a validated patient-reported questionnaire or an objective measurement tool for deep dyspareunia and clinical trials not powered for sexual outcomes. CONCLUSION We propose the following research priorities for deep dyspareunia: deep dyspareunia measurement tools, inclusion of the population avoiding intercourse due to deep dyspareunia, nongynecologic conditions in the generation of deep dyspareunia, exploration of sociocultural factors, clinical trials with adequate power for deep dyspareunia outcomes, partner variables, female sexual response, pathways between psychological factors and deep dyspareunia, and personalized approaches to deep dyspareunia. Orr N, Wahl K, Joannou A, et al. Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev 2020;8:3-17.
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17
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Vaginal Mesh for Urinary Incontinence and Prolapse: Impact on Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duport C, Duperron C, Delorme E. Anterior and middle pelvic organ prolapse repair using a six tension-free strap low weight transvaginal mesh: long-term retrospective monocentric study of 311 patients. J Gynecol Obstet Hum Reprod 2018; 48:143-149. [PMID: 30508648 DOI: 10.1016/j.jogoh.2018.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/11/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatment of pelvic organ prolapse is an important public health issue due to the ageing population. The Food and Drug Administration, in 2011, issued a warning on complications after transvaginal insertion of high weight mesh. We evaluated a 6 tension-free straps, light prosthesis made from polypropylene monofilaments. MATERIALS AND METHODS This monocentric, retrospective study included patients undergoing anterior or apical prolapse repair surgery by placement of a six tension-free strap low weight vaginal mesh between 2008 and 2017. The surgical history, concomitant surgery, clinical examination results, pre and postoperative results of the Urinary Symptom Profile questionnaire, and intraoperative and postoperative complications were collected from patients' medical records. RESULTS 311 patients were included (median follow-up: 33 months). The majority (93%) had stage ≥ III cystocele and 26% had stage ≥ III hysterocele. Postoperatively, there were nine cases (2.9%) of asymptomatic cystocele recurrence and 11 (3.5%) cases of hysterocele recurrence, among them six underwent reoperation. Vaginal comfort was significantly improved in 92% vs. 17% before surgery (p < 0,0001); two (1,76%) patients had de novo dyspareunia. Preoperatively, 104 patients had stress urinary incontinence (SUI), 45,2% of them were cured postoperatively. There were 62 (30%) cases of de novo SUI. A significant improvement of dysuria (p < 0,0001) and overactive bladder (OAB) was found for all severity stages (p < 0,0001). Severe complications included haematoma (7,4%), mesh exposure (1.3%), retraction (0.6%), bladder injury (0.6%) and chronic pain (0.6%). CONCLUSION Treatment of anterior and/or mid-segment prolapse by transvaginal insertion of a six-strap low-weight mesh is long-term effective, with acceptable morbidity.
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Affiliation(s)
- Camille Duport
- Centre Hospitalier Universitaire de Dijon, Dijon, France.
| | | | - Emmanuel Delorme
- Hôpital Privé Sainte Marie, Groupe Ramsay General de Sante, Chalon sur Saône, France.
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Monti M, Schiavi MC, Colagiovanni V, Sciuga V, D'oria O, Cerone G, Scudo M, Zullo MA, Muzii L, Benedetti Panici P. Effectiveness, quality of life and sexual functions in women with anterior compartment prolapse treated by native tissue repair. ACTA ACUST UNITED AC 2018; 71:18-24. [PMID: 30291702 DOI: 10.23736/s0026-4784.18.04305-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Anterior compartment defect is the most common pelvic organ prolapse. It is defined as the descent of the bladder into the anterior vaginal wall. The etiology is multifactorial and the main risk factors are vaginal delivery and conditions associated with increased abdominal strain. Aging is significantly associated with the prevalence and severity of pelvic organ prolapse. Treatment may be conservative or surgical according to symptoms, prolapse degree and not forgetting both patient and doctor preferences. The aim of this work is to identify the most efficient surgical treatment of cystocele and its recurrences. There are two different surgical approaches for the treatment of cystocele: traditional repair and mesh repair. Prosthetic treatment gives higher anatomical success rate but traditional anterior repair has less complication demonstrating a lower risk of reoperation. Surgical treatment in general improves both the quality of life (QoL) and the sexual function. We carried out a research on the impact of the anterior defect before and after native tissue surgery on QoL and sexual function. The efficacy and complications of the treatment were also assessed.
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Affiliation(s)
- Marco Monti
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy -
| | - Michele C Schiavi
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Vanessa Colagiovanni
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Valentina Sciuga
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ottavia D'oria
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Gennaro Cerone
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Maria Scudo
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Marzio A Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Laganà AS, La Rosa VL, Rapisarda AMC, Vitale SG. Pelvic organ prolapse: the impact on quality of life and psychological well-being. J Psychosom Obstet Gynaecol 2018; 39:164-166. [PMID: 28589780 DOI: 10.1080/0167482x.2017.1294155] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The aim of this work is to propose a brief comment about the impact of pelvic organ prolapse on the quality of life and the psychological well-being of the affected women.
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Affiliation(s)
- Antonio Simone Laganà
- a Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| | - Valentina Lucia La Rosa
- b Unit of Psychodiagnostics and Clinical Psychology , University of Catania , Catania , Italy
| | | | - Salvatore Giovanni Vitale
- a Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
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A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2018; 26:327-348. [PMID: 29509647 DOI: 10.1097/spv.0000000000000578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research. METHOD Electronic databases PsycINFO, PubMed, EMBASE, and CINAHL were searched through November 1, 2017. RESULTS Of 524 titles reviewed, 103 articles met all inclusion criteria. Articles were grouped by the disease period (ie, prediagnosis, diagnosis/preintervention, intervention, follow-up, and mixed) and psychosocial factors. Most articles (n = 73) focused on women undergoing intervention. Articles focusing on the preintervention period was the next largest category (n = 14). Follow-up after intervention (n = 8) and samples of mixed disease periods (n = 7) were less common. One article focused on women before diagnosis. Articles focused on quality of life (QOL; n = 79), sexual function (n = 51), satisfaction (n = 16), body image (n = 13), psychological distress (n = 4), and knowledge (n = 3). CONCLUSIONS Research on the psychosocial experience of POP has largely focused on changes in QOL and sexual function. Future research should target emotional experience of women with POP; relationships among QOL, psychological distress, body image, and sexual function; and psychosocial factors related to treatment outcomes.
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Nicita G, Villari D, Li Marzi V, Milanesi M, Saleh O, Jaeger T, Martini A. Long-term experience with a novel uterine-sparing transvaginal mesh procedure for uterovaginal prolapse. Eur J Obstet Gynecol Reprod Biol 2018; 222:57-63. [PMID: 29367167 DOI: 10.1016/j.ejogrb.2018.01.003] [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: 02/26/2017] [Revised: 11/03/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate outcomes and quality of life in patients operated transvaginally with an original mesh shape for uterus-sparing prolapse surgery and to demonstrate the safety and efficacy of the technique. STUDY DESIGN We prospectively evaluated 66 postmenopausal patients (POP-Q Stage III: 32, IV: 34) operated between May 2008 and December 2013. We used wide weave polypropylene monofilament mesh that functions as a hammock anchored posteriorly to sacrospinous ligaments, its anterior wings exit the pelvis through the obturatory membrane. Follow-up was scheduled at 3-, 12- months and in May 2016. Prolapse-Quality of Life Questionnaire (P-QoL) was administered preoperatively, at 12 months and in May 2016. The chi square and Wilcoxon test were used for statistical analysis. RESULTS Mean follow-up was 5.6 (SD: 1.6, Range: 1.1-8.1) years. The overall success rate (POP-Q ≤ 2) was 92.5% at 12 months and 84.4% at May 2016, these data remained stable over time (p > 0.05). Early complications occurred in 2 (3%) patients, late in 5 (7.8%) of which mesh extrusion in 4 (6.3%). Data from P-QoL showed significant improvement between preoperative and postoperative data (P < 0.01 for all domains) and they remained stable with time (p > 0.05). De-novo dyspareunia was 17.6% at 12 months and 10.3% at May 2016. CONCLUSIONS The low rate and grade of complications demonstrates the safety of the procedure, which offers stable anatomical correction with significant improvement in QoL.
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Affiliation(s)
- Giulio Nicita
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | - Donata Villari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Vincenzo Li Marzi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Martina Milanesi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Omar Saleh
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Tommaso Jaeger
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Alberto Martini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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Fünfgeld C, Stehle M, Henne B, Kaufhold J, Watermann D, Grebe M, Mengel M. Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months. Geburtshilfe Frauenheilkd 2017; 77:993-1001. [PMID: 28959063 PMCID: PMC5612771 DOI: 10.1055/s-0043-116857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/12/2017] [Accepted: 07/16/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Pelvic organ prolapse can significantly reduce quality of life of affected women, with many cases requiring corrective surgery. The rate of recurrence is relatively high after conventional prolapse surgery. In recent years, alloplastic meshes have increasingly been implanted to stabilize the pelvic floor, which has led to considerable improvement of anatomical results. But the potential for mesh-induced risks has led to a controversial discussion on the use of surgical meshes in urogynecology. The impact of cystocele correction and implantation of an alloplastic mesh on patients' quality of life/sexuality and the long-term stability of this approach were investigated. METHOD In a large prospective multicenter study, 289 patients with symptomatic cystocele underwent surgery with implantation of a titanized polypropylene mesh (TiLOOP ® Total 6, pfm medical ag) and followed up for 36 months. Both primary procedures and procedures for recurrence were included in the study. Anatomical outcomes were quantified using the POP-Q system. Quality of life including sexuality were assessed using the German version of the validated P-QoL questionnaire. All adverse events were assessed by an independent clinical event committee. RESULTS Mean patient age was 67 ± 8 years. Quality of life improved significantly over the course of the study in all investigated areas, including sexuality and personal relationships (p < 0.001, Wilcoxon test). The number of adverse events which occurred in the period between 12 and 36 months after surgery was low, with just 22 events reported. The recurrence rate for the anterior compartment was 4.5%. Previous or concomitant hysterectomy increased the risk of recurrence in the posterior compartment 2.8-fold and increased the risk of erosion 2.25-fold. CONCLUSION Cystocele correction using a 2nd generation alloplastic mesh achieved good anatomical and functional results in cases requiring stabilization of the pelvic floor and in patients with recurrence. The rate of recurrence was low, the patients' quality of life improved significantly, and the risks were acceptable.
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Affiliation(s)
| | | | | | - Jan Kaufhold
- Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany
| | | | - Markus Grebe
- Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Germany
| | - Mathias Mengel
- Klinikum Oberlausitzer Bergland gemeinnützige GmbH, Zittau, Germany
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Schiavi MC, Perniola G, Di Donato V, Visentin VS, Vena F, Di Pinto A, Zullo MA, Monti M, Benedetti Panici P. Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients. Arch Gynecol Obstet 2017; 295:917-922. [DOI: 10.1007/s00404-017-4307-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/27/2017] [Indexed: 02/03/2023]
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