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Aichner S, Studer A, Frey J, Brambs C, Krebs J, Christmann-Schmid C. Analysis of the Clinical Value of Laparoscopic Sacrocolpopexy to Support the Posterior Compartment in Women with Multicompartment Prolapse Including Rectocele. J Clin Med 2024; 13:5051. [PMID: 39274264 PMCID: PMC11396045 DOI: 10.3390/jcm13175051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/15/2024] [Accepted: 08/24/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Laparoscopic sacrocolpopexy is regarded as the gold standard treatment for apical or multicompartment prolapse, predominantly with anterior compartment descent. However, the optimal surgical approach for concurrent rectocele is still debated. The aim of this study was to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥stage II), analyzing the anatomical outcomes, the necessity for concomitant or subsequent posterior repair, and the impact on bowel function in women undergoing surgery. Methods: Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a standardized urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system, and completed the German-validated Australian Pelvic Floor Questionnaire before and after surgery (6-12 weeks). Preoperative anatomic support and bowel symptoms were compared with postoperative values. Results: In total, 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant (p < 0.001) objective improvement was seen for all compartments post- compared with preoperatively (Ba: 0 (-1/2) vs. -3 (-3/-2), C: -1 (-2/0) vs. -8 (-12/-7), Bp: 0 (-1/0) vs. -3 (-2/-2); (median (25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel-specific questions in the German-validated Australian Pelvic Floor Questionnaire showed significant improvement (p < 0.001). Conclusions: Nerve-sparing sacrocolpopexy alone appears to be a suitable surgical approach to correct multicompartment prolapse, including a rectocele ≥ stage II, and results in a reduction of objective signs and symptoms of pelvic organ prolapse.
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Affiliation(s)
- Simone Aichner
- Department of Urogynecology, Women's Hospital, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Andreas Studer
- Department of Urogynecology, Women's Hospital, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Janine Frey
- Department of Urogynecology, Women's Hospital, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Christine Brambs
- Department of Urogynecology, Women's Hospital, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Jörg Krebs
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland
| | - Corina Christmann-Schmid
- Department of Urogynecology, Women's Hospital, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
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Nowakowski Ł, Gałczyński K, Dybowski M, Typek R, Dawidowicz A, Miotła P, Olcha P, Rechberger T. Effects of topical dehydroepiandrosterone therapy in women after pelvic organ prolapse surgery. Menopause 2023; 30:629-634. [PMID: 37130371 DOI: 10.1097/gme.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) occurs predominantly in postmenopausal women. Restoration of the proper estrogenization of vaginal mucosa is important in preoperative and postoperative treatment, increasing the effectiveness of this approach. The objective of this study was the development of intravaginal vaginal suppositories containing DHEA and comparison of the clinical effects of vaginal topical therapy with DHEA, estradiol, or antibiotic after POP surgery. METHOD Nine types of vaginal suppositories containing 6.5 mg DHEA in different bases were prepared to find optimal formulation for the vaginal conditions. Ninety women referred for POP surgery were randomly assigned to one of three groups receiving topical treatment in the postoperative period (estradiol, DHEA, or antibiotic). On admission to hospital and during follow-up vaginal pH, vaginal maturation index and vaginal symptoms were assessed. RESULTS Vaginal suppositories with the base made from polyethylene glycol 1,000 without surfactants characterized the highest percentage of the released DHEA. In women treated with topical estradiol or DHEA a significant decrease in the number of parabasal cells, increase in superficial and intermediate cells in the vaginal smears, decrease in vaginal pH, and reduction of vaginal symptoms were observed. CONCLUSIONS The use of topical therapy with DHEA or the use of topical therapy with estradiol in the postoperative period were both shown to improve maturation index, vaginal pH, and vaginal symptoms. The benefits of topical therapy with DHEA after pelvic organ prolapse repair brings similar results as estradiol, without potential systemic exposure to increased concentrations of sex steroids above levels observed in postmenopausal women.
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Affiliation(s)
- Łukasz Nowakowski
- From the 1 Military Clinical Hospital with Polyclinic in Lublin, Poland
| | - Krzysztof Gałczyński
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Michał Dybowski
- Department of Chromatography Institute of Chemical Sciences Faculty of Chemistry, Maria Curie Skłodowska University in Lublin, Lublin, Poland
| | - Rafał Typek
- Department of Chromatography Institute of Chemical Sciences Faculty of Chemistry, Maria Curie Skłodowska University in Lublin, Lublin, Poland
| | - Andrzej Dawidowicz
- Department of Chromatography Institute of Chemical Sciences Faculty of Chemistry, Maria Curie Skłodowska University in Lublin, Lublin, Poland
| | - Paweł Miotła
- Second Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Olcha
- Department of Gynaecology and Gynaecological Endocrinology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Rechberger
- Second Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Sato H, Otsuka S, Abe H, Miyagawa T. Medium-term risk of recurrent pelvic organ prolapse within 2-year follow-up after laparoscopic sacrocolpopexy. Gynecol Minim Invasive Ther 2023; 12:38-43. [PMID: 37025445 PMCID: PMC10071876 DOI: 10.4103/gmit.gmit_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 02/11/2023] Open
Abstract
Objective The present study was performed to determine the risk of recurrent pelvic organ prolapse (POP) within 2 years after laparoscopic sacrocolpopexy (LSC) in patients with uterovaginal prolapse. Materials and Methods A retrospective comparative study was performed in a population of 204 patients over a 2-year follow-up period following LSC with concomitant supracervical hysterectomy or uterine preservation at a single urological clinic between 2015 and 2019. The primary outcome was surgical failure following LSC in cases of POP, focusing on failures occurring before the 2ndyear of follow-up. Logistic regression analysis was used to determine the odds ratios (ORs) for surgical failure. Results The primary outcome, surgical failure in cases of POP, occurred 2 years after the initial surgery in 19 of the 204 patients (9.3%) (95% confidence interval [CI], 5.7% - 14.2%). Surgical failure was most common in the anterior compartment (n = 10, 4.9%), and further surgery was performed in seven of the patients with surgical failure (3.4%). The poor primary outcome was predicted by lysis of adhesions (OR, 7.5, 95% CI, 1.6-33.8, P = 0.008) and preoperative POP stage IV (OR, 3.5; 95% CI, 1.1-10.8, P = 0.03) on multivariable logistic regression analysis. Conclusion The overall rate of surgical failure following LSC in our cohort was 9.3% over the 2-year follow-up period after surgery, and preoperative prolapse stage IV was associated with a higher risk of recurrence.
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van Oudheusden AMJ, Eissing J, Terink IM, Vink MDH, van Kuijk SMJ, Bongers MY, Coolen ALWM. Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial. Int Urogynecol J 2023; 34:93-104. [PMID: 36112182 PMCID: PMC9483545 DOI: 10.1007/s00192-022-05350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). METHODS Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC (n=37) or ASC (n=37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment. RESULTS We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0-17; ASC: IQR 0-0) on the "genital prolapse" domain of the Urogenital Distress Inventory in both groups (p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% (n = 11) in the LSC group and 84.6% (n = 11) in the ASC group (p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729). CONCLUSIONS At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. TRIAL REGISTRATION Dutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynecology and Obstetrics, Jeroen Bosch Hospital, P.O. Box 90153, 5200, ME, 's-Hertogenbosch, The Netherlands.
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Josephine Eissing
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130, MB, Sittard-Geleen, The Netherlands
| | - Ivon M Terink
- Utrecht General Practice Training Institute, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maarten D H Vink
- Department of Gynecology and Obstetrics, Isala Medical Centre, P.O. Box 10400, 8000, GK, Zwolle, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology, Bergman Clinics, Marathon 1, 1213, PA, Hilversum, The Netherlands
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Lallemant M, Clermont-Hama Y, Giraudet G, Rubod C, Delplanque S, Kerbage Y, Cosson M. Long-Term Outcomes after Pelvic Organ Prolapse Repair in Young Women. J Clin Med 2022; 11:jcm11206112. [PMID: 36294437 PMCID: PMC9605202 DOI: 10.3390/jcm11206112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to describe the long-term outcomes of Pelvis Organ Prolapse (POP) repair in women under 40 years old. A retrospective chart review of all POP repairs performed in women ≤40 years old between January 1997 and December 2015 in the Gynecologic Surgery Department of Lille University Hospital was performed. Inclusion criteria were all women ≤40 years old who underwent a POP repair with a stage ≥2 POP according to the Baden and Walker classification. The study population was separated into three groups: a sacrohysteropexy group, a vaginal native tissue repair (NTR) group, and a transvaginal mesh surgery (VMS) group. The primary outcome was reoperation procedures for a symptomatic recurrent POP. Secondary outcomes were other complications. During the study period, 43 women ≤ 40 years old who underwent a POP repair were included and separated into three groups: 28 patients (68%), 8 patients (19%), and 7 patients (16%) in the sacrohysteropexy, VMS, and NTR groups respectively. The mean followup time was 83 ± 52 months. POP recurrence, reoperated or not, was essentially diagnosed in the VMS group (87.5%) and the NTR group (50%). POP recurrence repairs were performed for nine patients (21%): 7%, 62.5%, and 25% in the sacrohysteropexy, VMS, and NTR groups, respectively. Global reoperation concerned 10 patients (23%) whatever the type of POP surgery, mainly patients from the VMS group (75%) and from the NTR group (25%). It occurred in only 7% of patients from the sacrohysteropexy group. Two patients (4%) presented a vaginal exposure of the mesh (in the VMS group). De novo stress urinary incontinence was encountered by nine patients (21%): 29% and 12.5% in the sacrohysteropexy and NTR groups, respectively. Despite the risk of recurrence, POP repair should be proposed to young women in order to restore their quality of life. Vaginal native tissue repair or sacrohysteropexy should be performed after explaining to women the advantages and disadvantages of each procedure.
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Sato H, Otsuka S, Abe H, Tsukada S. Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan. J OBSTET GYNAECOL 2022; 42:3336-3341. [PMID: 36149283 DOI: 10.1080/01443615.2022.2125293] [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: 01/06/2023]
Abstract
This study was performed to investigate medium-term outcomes and reoperation rates after laparoscopic sacrocolpopexy (LSC). We examined 119 patients undergoing LSC for symptomatic pelvic organ prolapse (POP). The primary outcomes were subjective failure and anatomical failure at 2 years; a score ≥ 2 on question 3 of the PFDI-20 was considered to indicate subjective failure. POP-Q stage 2 or higher in any compartment was considered to indicate anatomical failure. Secondary outcomes were reoperations for POP recurrence, mesh-related complications, and stress urinary incontinence (SUI). The rates of subjective failure and anatomical failure were 4.2% (n = 5) and 9.2% (n = 11), respectively. Reoperations were needed in 13.4% (n = 16) of patients, including SUI with tape procedure in 7.5% (n = 9), POP recurrence in 4.2% (n = 5), and mesh-related complications in 1.6% (n = 2). The subjective failure rate at 2 years after LSC was acceptably low.Impact StatementWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) has clinical efficacy equivalent to open sacrocolpopexy, and there is evidence that LSC involves less blood loss and shorter length of hospital stay. However, there is still insufficient evidence to assess medium-term outcomes after LSC in Japan.What the results of this study revealed? The findings of this study showed excellent medium-term rates of subjective failure (4.2%) and anatomical failure (8.4%) after LSC. We demonstrated that patients with persistent postoperative vaginal bulge (subjective failure) also had no improvement in postoperative urinary and colorectal symptoms. Our cohort had low rates of reoperation (13.4%) after LSC. The most common reoperations were for stress urinary incontinence (SUI) (7.5%), followed by pelvic organ prolapse (POP) recurrence (4.2%) and mesh-related complications (1.6%).What are the implications of these findings in clinical practice and/or further research? This study showed that LSC is a safe and effective treatment for POP. Comparative evaluation of anatomical outcomes and the patient's condition is required to understand the extent to which LSC positively impacts a woman's pelvic floor-related quality of life.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Shota Otsuka
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Sawada Y, Kitagawa Y, Hayashi T, Tokiwa S, Nagae M, Cortes AR, Nomura M. Clinical outcomes after laparoscopic sacrocolpopexy for pelvic organ prolapse: A 3-year follow-up study. Int J Urol 2021; 28:216-219. [PMID: 33432712 DOI: 10.1111/iju.14436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the mid-range subjective and objective success rate of laparoscopic sacrocolpopexy. METHODS Of the 317 women with pelvic organ prolapse who underwent laparoscopic sacrocolpopexy surgery at the same center between January 2013 and March 2015, we assessed 233 patients who were followed up for >3 years. We carried out urogynecological examinations and used questionnaires for the postoperative assessment of the patients. Scoring 0 points on question 3 of the Pelvic Floor Distress Inventory-20 was considered to show subjective success. Objective success was defined as stage 0 or 1 on the Pelvic Organ Prolapse Quantification. RESULTS The subjective and objective success rates in the third year after surgery were 89.7% (209/233) and 90.6% (211/233), respectively, and those in the first year were 90.6% (211/233) and 91.0% (212/233), respectively. Perioperative complications included bladder injury (0.4%) in one case and vaginal wall injury (0.4%) in one case. Postoperative complications included the incidence of chronic pain (mesh retraction) in one case, which was the only case requiring re-operation due to complications (0.4%); vaginal suture exposure (0.4%) in one case; port-site hernia (0.4%) in one case; and subileus (0.4%) in one case. The complications associated with voiding function included de novo stress urinary incontinence (20.6%) in 48 cases, out of which there were 12 cases of de novo overactive bladder (5.2%) and eight cases required midurethral sling procedures. CONCLUSIONS Laparoscopic sacrocolpopexy provides a good outcome with a low rate of subjective and objective recurrence and surgical complications.
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Affiliation(s)
- Yugo Sawada
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yasuhide Kitagawa
- Department of Urology, Komatsu Municipal Hospital, Komatsu, Ishikawa, Japan
| | - Tokumasa Hayashi
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Shino Tokiwa
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Mika Nagae
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | | | - Masayoshi Nomura
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
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Noé GK, Schiermeier S, Papathemelis T, Fuellers U, Khudyakov A, Altmann HH, Borowski S, Morawski PP, Gantert M, De Vree B, Tkacz Z, Ugarteburu RG, Anapolski M. Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair. J Clin Med 2021; 10:jcm10020217. [PMID: 33435323 PMCID: PMC7827325 DOI: 10.3390/jcm10020217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.
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Affiliation(s)
- Günter K. Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Rheinlandclinics Dormagen, 41540 Dormagen, Germany;
- Correspondence:
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, 258452 Witten, Germany;
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, St. Marien Hospital Amberg, 92224 Amberg, Germany;
| | - Ulrich Fuellers
- Private Department of Surgical Gynecology, Krefeld (GTK) Germany, 47800 Krefeld, Germany; (U.F.); (A.K.)
| | - Alexander Khudyakov
- Private Department of Surgical Gynecology, Krefeld (GTK) Germany, 47800 Krefeld, Germany; (U.F.); (A.K.)
| | - Harald-Hans Altmann
- Department of Obstetrics and Gynecology, Regiomed Clinics Coburg, 96450 Coburg, Germany;
| | - Stefan Borowski
- Department of Obstetrics and Gynecology, Clinic Links der Weser, 28277 Bremen, Germany;
| | - Pawel P. Morawski
- Department of Obstetrics and Gynecology, Helios Clinic Bad Sarow, 15526 Bad Saarow, Germany;
| | - Markus Gantert
- Department of Obstetrics and Gynecology, St. Franziskus Hospital Ahlen, 59227 Ahlen, Germany;
| | - Bart De Vree
- Department of Obstetrics and Gynecology, ZNA Middelheim Antwerp, 2020 Antwerpen, Belgium;
| | - Zbigniew Tkacz
- Department of Obstetrics and Gynecology, NHS Tayside Dundee, Dundee DD1 9SY, UK;
| | - Rodrigo Gil Ugarteburu
- Department of Obstetrics and Gynecology, University Hospital de Cabueñes, 33394 Gijon, Spain;
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Rheinlandclinics Dormagen, 41540 Dormagen, Germany;
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Chattot C, Deffieux X, Lucot JP, Fritel X, Fauconnier A. Preoperative predictors and a prediction score for perception of improvement after mesh prolapse surgery. Int Urogynecol J 2019; 31:1393-1400. [PMID: 31115611 DOI: 10.1007/s00192-019-03953-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) surgery using a mesh has a complication rate of 26%, and an estimated 10% of those operated on do not consider it brings improvement. The objective of this study was to identify preoperative predictors of improvement after POP repair with mesh to develop a predictive score. METHODS This is a secondary analysis of the randomized multicenter trial PROSPERE, which compared morbidity after prolapse repair with mesh according to the vaginal or laparoscopic approach. Improved women [PGI-I score at 1-year follow-up = 1 (much better) or 2 (better)] were compared with unimproved women. Two hundred fifty-five women were included to derive the prediction score based on multiple logistic regression. An internal validation by bootstrapping estimated the unbiased performance of the model. RESULTS Criteria independently related to improvement were: (1) cystocele stage > II [OR: 2.93 95% CI (1.22-7.04), p = 0.015]; (2) preoperative expectation related to bulge symptom improvement [OR: 2.57 95% CI (1.07-6.04), p = 0.031] and (3) absence of chronic pelvic pain [OR: 4.55 95% CI (1.77-11.46), p = 0.001]. A score (scored from 0 to 11) was constructed from the aOR of the predictive model: the ROC-AUC of the score was 0.75, and a score ≥ 9 predicted a 97% chance of improvement (95% CI 92-99), with a specificity of 85% (95% CI 68-94). The ROC-AUC corrected for optimism by the bootstrap procedure was 0.70. CONCLUSIONS This score could be used by surgeons in preoperative counseling of women.
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Affiliation(s)
- Chloé Chattot
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France.
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France.
| | - Xavier Deffieux
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics and Reproductive Medicine, APHP, Hôpital Antoine Béclère, 92140, Clamart, France
| | - Jean-Philippe Lucot
- Gynecological Surgery Unit, Centre Hospitalier Universitaire Jeanne de Flandre, 59 000, Lille, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Centre Hospitalier Universitaire de Poitiers, 86021, Poitier, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France
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