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Rudroff C, Madukkakuzhy J, Hernandez AV, Otten J, Ulrici C, Karapanos L, Ludwig S. Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study. BMC Surg 2024; 24:185. [PMID: 38877450 PMCID: PMC11177501 DOI: 10.1186/s12893-024-02474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. AIM OF THE STUDY: This retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP. METHODS The study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM). RESULTS Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%). CONCLUSIONS The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study's retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials. TRIAL REGISTRATION Retrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.
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Affiliation(s)
- Claudia Rudroff
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany.
| | - Joshy Madukkakuzhy
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
| | - Alberto Vega Hernandez
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of General, Visceral and Minimally Invasive Surgery, Park-Klinik Weissensee Berlin, Berlin, Germany
| | - Jakob Otten
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Christoph Ulrici
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of General and Visceral Surgery, St.Josef Hospital Bonn-Beuel, GFO Kliniken Bonn, Bonn, Germany
| | - Leonidas Karapanos
- Department of Urology, Division of Neurourology, University Hospital of Cologne and Medical Faculty Cologne, 50931, Cologne, Germany
- Department of Urology, Municipal Hospital of Leverkusen, Leverkusen, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital of Cologne and Medical Faculty Cologne, 50931, Cologne, Germany
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Koenig JB, Burnett LA. Understanding the Role of Obesity and Metabolism in Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:389-393. [PMID: 38564623 DOI: 10.1097/spv.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jenny B Koenig
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences
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Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:80-87. [PMID: 36548108 DOI: 10.1097/spv.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Polypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population. OBJECTIVES The objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction. STUDY DESIGN This is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics. Baseline demographics and clinical characteristics were obtained from the electronic medical record. Validated surveys were administered to determine severity of lower urinary tract symptoms (Overactive Bladder Validated 8-Question Screener, Urogenital Distress Inventory-6), pelvic floor dysfunction (Pelvic Organ Prolapse Distress Inventory-6, Colorectal-Anal Distress Inventory-8), and sexual dysfunction (6-item Female Sexual Function Index). Standard statistical techniques were used. RESULTS One hundred ninety-seven women with mean age 58.8 years (SD, 13.4 years) were included, and most were of minority race/ethnicity (Black, 34.0%; Hispanic, 21.8%). The majority of participants met criteria for polypharmacy (58.4%) and multimorbidity (85.8%), with a mean prescription number of 6.5 (SD, ± 4.9) and mean number of medical comorbidities of 4.9 (SD, ± 3.3). Polypharmacy and multimorbidity were significantly associated with higher CRADI-8 scores. Specifically, polypharmacy was associated with straining with bowel movements and painful stools, whereas multimorbidity was associated with incomplete emptying and fecal urgency. There was no significant association between polypharmacy and multimorbidity with urinary symptoms, prolapse, or sexual dysfunction. CONCLUSIONS Polypharmacy and multimorbidity are common in the urogynecologic population. There is a relationship between greater defecatory distress and polypharmacy and multimorbidity.
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Cheng W, Chen L, Thibault MD, DeLancey JO, Swenson CW. Age, parity, and prolapse: interaction and influence on levator bowl volume. Int Urogynecol J 2022; 33:3415-3422. [PMID: 35503121 PMCID: PMC9650769 DOI: 10.1007/s00192-022-05203-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to test the hypotheses that a linear relationship exists between age and levator bowl volume (LBV); and that age, parity, and prolapse are independently associated with LBV. METHODS We conducted a secondary analysis of data from nulliparous women, parous controls, and prolapse (Pelvic Organ Prolapse Quantification (POP-Q) Ba ≥ 1 cm) cases from each of three age groups: young (≤40), mid-age (50-60), and older (≥70). LBV was measured using MRI at rest and Valsalva as the 3D space contained above the levator ani muscles and below the sacrococcygeal junction-to-inferior pubic point reference plane. Linear regression models were used to examine the effects of age, parity, prolapse, and their interactions (age*parity and age*prolapse) on LBV. RESULTS Each group consisted of 9-12 women. LBVRest increased with age in a nonlinear fashion. For nulliparous women, the median value increased 4.7% per decade from the young to mid-age group and 84% per decade from the mid-age to older group; for parous controls, the corresponding increases were 38% and -0.5%; and for women with prolapse, they were 46% and 11%. Age and prolapse status (both p<0.001) were found to be significant independent predictors of LBVRest. Interactions between age*prolapse (p=0.003) and age*parity (p=0.045) were also independently associated with LBVRest. CONCLUSIONS Parity and prolapse influence how age affects LBVRest. In nulliparous women, age had little effect on LBVRest until after mid-age. For women with prolapse, LBVRest increased at a much earlier age, with the biggest difference occurring between young and mid-age women.
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Affiliation(s)
- Wenjin Cheng
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
- Department of Obstetrics and Gynecology, Beaumont Dearborn, 18101 Oakwood Blvd, Dearborn, MI, USA.
| | - Luyun Chen
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mary Duarte Thibault
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Carolyn W Swenson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- University of Utah Health, Salt Lake City, UT, USA
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Lucia O, Alice B, Marques SJA, Branco BCGDAC, Conde BM, da Silva BNC. Physiologic and Radiographic Testing in Patients with Pelvic Floor Disorders and Pelvic Organ Prolapse. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Alperin M, Abramowitch S, Alarab M, Bortolini M, Brown B, Burnett LA, Connell KA, Damaser M, de Vita R, Gargett CE, Guess MK, Guler Z, Jorge RN, Kelley RS, Kibschull M, Miller K, Moalli PA, Mysorekar IU, Routzong MR, Shynlova O, Swenson CW, Therriault MA, Northington GM. Foundational science and mechanistic insights for a shared disease model: an expert consensus. Int Urogynecol J 2022; 33:1387-1392. [DOI: 10.1007/s00192-022-05253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/24/2022]
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