1
|
Ashmore S, Geller EJ, Bretschneider CE. Minimally Invasive Sacrocolpopexy: Impact on Sexual Function. Int Urogynecol J 2024:10.1007/s00192-024-05834-z. [PMID: 39101957 DOI: 10.1007/s00192-024-05834-z] [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: 03/08/2024] [Accepted: 05/10/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy (SCP) is the gold standard surgical management of apical pelvic organ prolapse (POP), and increasingly, minimally invasive SCP is being adopted as a primary treatment for advanced uterovaginal prolapse. Patients undergoing surgery for POP consider postoperative improvement in sexual function to be a highly important outcome, and sexual dysfunction and dyspareunia severe adverse events. Therefore, it is crucial to understand the impact of minimally invasive SCP on postoperative sexual function. We aimed to analyze the current literature available to discuss the impact of minimally invasive SCP on postoperative sexual function. METHODS We performed a narrative review of minimally invasive SCP and its impact on sexual function. PubMed and EMBASE were searched from inception through 28 January 2024 for studies that reported sexual function following surgery for POP. Baseline and postoperative sexual activity, dyspareunia, and validated questionnaire scores for sexual function were documented. RESULTS Minimally invasive SCP is associated with improved postoperative sexual function, increased rates of postoperative sexual activity, and low rates of dyspareunia. Dyspareunia was not associated with mesh related complications. Patients with baseline dyspareunia or pain were more likely to experience persistent dyspareunia after surgery. CONCLUSION The rates of POP are increasing in our aging population, and sexual function is very important to patients undergoing surgery for POP. Clinicians should consider all factors related to sexual function when planning surgery for POP and address dyspareunia prior to surgery. Sexual function appears to improve overall after minimally invasive SCP and de novo dyspareunia rates are low.
Collapse
Affiliation(s)
- Sarah Ashmore
- Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL, USA
| | - Elizabeth J Geller
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - C Emi Bretschneider
- Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
2
|
Rusavy Z, Kovarova V, Tvarozek S, Smazinka M, Havir M, Kalis V. A Comprehensive Evaluation of Sexual Life in Women After Laparoscopic Sacrocolpopexy using PISQ-IR. Int Urogynecol J 2024; 35:873-880. [PMID: 38485810 DOI: 10.1007/s00192-024-05765-9] [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: 01/04/2024] [Accepted: 02/17/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy. METHODS This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05). RESULTS Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12 months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively. CONCLUSIONS Although the overall rate of sexually active women and sexual desire declined 12 months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased.
Collapse
Affiliation(s)
- Zdenek Rusavy
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| | - Veronika Kovarova
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Samuel Tvarozek
- Department of Gynecology and Obstetrics. Faculty of Medicine, Masaryk University in Brno, Brno, Czech Republic
| | - Martin Smazinka
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Havir
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimir Kalis
- Department of Gynecology and Obstetrics. Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| |
Collapse
|
3
|
Chang OH, Shepherd JP, St Martin B, Sokol ER, Wallace S. Surgical correction of the genital hiatus at the time of sacrocolpopexy - a 7-year Markov analysis: a cost-effectiveness analysis. Int Urogynecol J 2023; 34:2969-2975. [PMID: 37650903 DOI: 10.1007/s00192-023-05628-9] [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: 04/25/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To perform a cost-effectiveness analysis of concurrent posterior repair performed at the time of laparoscopic hysterectomy with sacrocolpopexy over a 7-year time period. We hypothesize it is not cost-effective to perform a posterior colporrhaphy. METHODS We used TreeAge Pro® to construct a decision model with Markov modeling to compare sacrocolpopexy with and without concurrent posterior repair (SCP and SCP+PR) over a time horizon of 7 years. Outcomes included probability and costs associated with prolapse recurrence, prolapse retreatment, and complications including rectal injury, rectovaginal hematoma requiring reoperation, and postoperative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) calculated as ∆ costs /∆ effectiveness and the willingness to pay (WTP) was set at $100,000/QALY. RESULTS Our model showed that SCP was the dominant strategy, with lower costs (-$ 2681.06) and higher effectiveness (+0.10) compared to SCP+PR over the 7-year period. In two-way sensitivity analyses, we varied the probability of prolapse recurrence after both strategies. Our conclusions would only change if the probability of recurrence after SCP was at least 29.7% higher than after SCP+PR. When varying the probabilities of dyspareunia for both strategies, SCP+PR only became the dominant strategy if the probability of dyspareunia for SCP+PR was lower than the rate of SCP alone. CONCLUSIONS In this 7-year Markov cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy. SCP+PR costs more with lower effectiveness than SCP alone, due to higher surgical cost of SCP+PR and higher probability of dyspareunia after SCP+PR.
Collapse
Affiliation(s)
- Olivia H Chang
- Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology, University of California Irvine, 3800 W. Chapman St, Suite 7200, Orange, CA, 92868, USA.
| | - Jonathan P Shepherd
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Brad St Martin
- Urogynecology and Reconstructive Pelvic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Eric R Sokol
- Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Shannon Wallace
- Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
4
|
Casas-Puig V, Yao M, Propst KA, Ferrando CA. Is there an association between 6-month genital hiatus size and 24-month composite prolapse recurrence following minimally invasive sacrocolpopexy? Int Urogynecol J 2023; 34:2593-2601. [PMID: 37401961 DOI: 10.1007/s00192-023-05578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Although an enlarged postoperative genital hiatus (GH) size has been identified as a predictor of recurrence following pelvic organ prolapse (POP) surgery, the protective role of concurrent level III support procedures to reduce the GH size at the time of minimally invasive sacrocolpopexy (MI-SCP) remains unclear. The objective of this study was to compare 24-month composite prolapse recurrence following MI-SCP between patients with a 6-month postoperative GH measurement of <3 cm versus ≥3 cm; and to explore the impact of concurrent level III support procedures on prolapse recurrence, bowel, and sexual function. METHODS This was a secondary analysis of two randomized controlled trials of women who underwent MI-SCP from 2014 to 2020. Our primary outcome was composite prolapse recurrence defined as retreatment with either pessary or surgery, and/or subjective bothersome vaginal bulge. A receiver operating characteristic (ROC) curve was generated to identify a 6-month GH cutoff point associated with 24-month composite recurrence. RESULTS Of the 108 women who met the inclusion criteria, 13 (12%) had composite prolapse recurrence at 24 months: 12 patients (11.1%) reported a bothersome vaginal bulge, and 3 patients (2.8%) underwent retreatment with surgery. A ROC curve demonstrated that a 6-month postoperative GH size of 3 cm had 84.6% sensitivity to predict vaginal bulge and/or retreatment at 24 months (area under curve = 0.52). There was no difference in the composite prolapse recurrence between the groups; however, only patients with a 6-month GH >3 cm underwent retreatment. CONCLUSIONS Twenty-four-month composite prolapse recurrence does not differ based on 6-month GH size; however, surgical failure may be more common in those with a GH size greater than 3 cm.
Collapse
Affiliation(s)
- Viviana Casas-Puig
- Division of Female Pelvic Medicine and Reconstructive Surgery, Advent Health, 960 Rinehart Road, Lake Mary, FL, USA.
| | - Meng Yao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Katie A Propst
- Urogynecology & Reconstructive Pelvic Surgery, Obstetrics & Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Cecile A Ferrando
- Center for Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
5
|
Impact of laparoscopic sacrocolpopexy (LSC) on sexual function in women with advanced stages of pelvic organ prolapse (POP): A five-year prospective study. Eur J Obstet Gynecol Reprod Biol 2023; 284:12-15. [PMID: 36907055 DOI: 10.1016/j.ejogrb.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To compare patients undergoing laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP), in terms of sexual function and surgical anatomical outcomes more than 5-years follow up period. STUDY DESIGN This is a cohort study of prospectively collected data that includes all women who underwent LSC between July 2005 and December 2021 at a tertiary care center. A total of 228 women were enrolled in this study. Patients completed a validated quality of life questionnaires and were evaluated using the POP-Q, the PFDI-20, PFIQ-7 and the PISQ-12 scores. Patients were divided preoperatively if they are sexually active or not and postoperatively according to the sexual improvement after POP surgery. RESULTS There was a statistically significant improvement in the PFDI, PFIQ and POPQ score. There was no significant improvement in the PISQ-12 score with more than 5 years follow-up. 76.1 % of patients who were not sexually active preoperatively resumed their sexual activity after the surgery. CONCLUSION The anatomical correction of a pelvic organ prolapse and pelvic floor disorders by laparoscopic sacrocolpopexy allowed a significant proportion (over ¾) of the women to resume sexual activity whom had not previously been sexually active. However, PISQ 12 scores did not alter significantly in those who were sexually active prior to surgery. Sexual function is a very complex issue affected by multitude of factors among which prolapse seems to be less important.
Collapse
|
6
|
Bretschneider CE, Myers E, Geller EG, Kenton K, Henley B, Wu JM, Matthews CA. Long-Term Pain After Minimally Invasive Total Hysterectomy and Sacrocolpopexy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:144-150. [PMID: 36735427 DOI: 10.1097/spv.0000000000001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE There are limited long-term data on patient-reported pain after surgical treatment of uterovaginal prolapse. OBJECTIVE This study aimed to evaluate pain in women undergoing minimally invasive total hysterectomy and sacrocolpopexy with a lightweight polypropylene Y-mesh (Upsylon) >2 years after surgery. STUDY DESIGN This is a planned secondary analysis of a 5-site randomized trial comparing permanent versus absorbable suture for vaginal attachment of a lightweight polypropylene Y-mesh during total laparoscopic hysterectomy and sacrocolpopexy in women with stage ≥2 uterovaginal prolapse. Our primary outcome was patient-reported pain or dyspareunia at >2 years. RESULTS Of the 185 participants eligible for enrollment in the e-PACT study, 106 enrolled; 98 participants (96%) completed either in-person examinations or study questionnaires regarding pain and are included in this analysis. At >2 years, 28% reported any pain: 14% reported dyspareunia on questionnaires, 5% reported pelvic pain on questionnaires, and 14% of those who had an in-person examination reported pain. Of participants who reported pain or dyspareunia at baseline before surgery, 59% reported resolution of their symptoms >2 years. On multiple logistic regression controlling for age and baseline pain or dyspareunia, baseline pain or dyspareunia was associated with a nearly 3-fold increased risk of reporting any pain >2 years (adjusted odds ratio, 2.7; 95% confidence interval, 1.1-6.9). No women had repeat surgical intervention for pain. CONCLUSIONS Although 60% of women report pain resolution >2 years after surgery, de novo pain was present in 1 of 5 women. Baseline history of pain or dyspareunia is the only factor associated with an increased likelihood of experiencing pain >2 years after surgery.
Collapse
Affiliation(s)
| | | | | | - Kimberly Kenton
- From the Northwestern Feinstein School of Medicine, Chicago, IL
| | | | | | | |
Collapse
|
7
|
Chang OH, Yao M, Ferrando CA, Paraiso MFR, Propst K. Determining the Ideal Intraoperative Resting Genital Hiatus Size-Balancing Surgical and Functional Outcomes. Female Pelvic Med Reconstr Surg 2022; 28:649-657. [PMID: 35830588 DOI: 10.1097/spv.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE The intraoperative resting genital hiatus (GH) size can be surgically modified but its relationship to prolapse recurrence is unclear. OBJECTIVES The objective of this study was to identify the optimal intraoperative resting GH size as it relates to prolapse recurrence and functional outcomes at 1 year. STUDY DESIGN This prospective cohort study was conducted at 2 hospitals from 2019 to 2021. Intraoperative measurements of the resting GH, perineal body, and total vaginal length were collected. The composite primary outcome consisted of anatomic recurrence, subjective recurrence, and/or conservative or surgical retreatment at 1 year. Comparisons of anatomic, functional, and sexual outcomes were compared between patients stratified by the optimal intraoperative GH size identified by receiver operating characteristic curve analysis. RESULTS Sixty-eight patients (median age of 63 years) underwent surgery, with 59 (86.8%) presenting for follow-up at 1 year. Based on the 13 patients (22%) with composite recurrence, receiver operating characteristic curve analysis demonstrated an intraoperative resting GH size of 3 cm, had 76.9% sensitivity (confidence interval [CI], 54-99.8%), and 34.8% specificity (CI, 21.0-48.5%) for composite recurrence at 1 year (area under curve = 0.61). Nineteen patients had an intraoperative GH less than 3 cm (32.2%) and 40 had a GH of 3 cm or greater (67.8%). The intraoperative resting GH size was significantly larger in patients with prolapse beyond the hymen at 1 year (4 cm [3.0, 4.0]) compared with those with prolapse at or proximal to the hymen (3.0 cm [2.5, 3.5], P = 0.009). CONCLUSIONS Intraoperative GH size may not reliably predict composite prolapse recurrence at 1 year, although there was an association between intraoperative resting GH size with prolapse beyond the hymen.
Collapse
Affiliation(s)
- Olivia H Chang
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute
| | - Meng Yao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Cecile A Ferrando
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute
| | - Marie Fidela R Paraiso
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute
| | - Katie Propst
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute
| |
Collapse
|
8
|
Contemporary Use and Techniques of Laparoscopic Sacrocolpopexy With or Without Robotic Assistance for Pelvic Organ Prolapse. Obstet Gynecol 2022; 139:922-932. [PMID: 35576354 PMCID: PMC9015033 DOI: 10.1097/aog.0000000000004761] [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: 09/11/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Laparoscopic sacrocolpopexy with or without robotic assistance is an effective approach for the treatment of any pelvic organ prolapse when apical involvement is present. The past 4 years have been consequential in the world of surgery to correct pelvic organ prolapse. In 2018, results of a large, multicenter randomized trial demonstrated very disappointing cure rates of traditional native tissue repairs at 5 years or more. In 2019, a vaginal mesh hysteropexy kit was removed from the market by the U.S. Food and Drug Administration only to subsequently demonstrate it provided better cure rates and similar risk profile to vaginal hysterectomy plus native tissue repair in its own 5-year study published in 2021. Meanwhile, the use and techniques of laparoscopic sacrocolpopexy with or without robotic assistance have evolved such that it is commonly adapted to treat all support defects for patients with uterovaginal or posthysterectomy prolapse. This article is intended to provide an overview of the contemporary use and techniques of laparoscopic sacrocolpopexy based on the evidence and our clinical experience.
Collapse
|
9
|
Surgical Correction of the Genital Hiatus at the Time of Sacrocolpopexy—Are Concurrent Posterior Repairs Cost-Effective? Female Pelvic Med Reconstr Surg 2022; 28:325-331. [DOI: 10.1097/spv.0000000000001130] [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]
|
10
|
van der Vaart LR, Vollebregt A, Pruijssers B, Milani AL, Lagro-Janssen AL, Roovers JPWR, van der Vaart CH. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022; 19:270-279. [PMID: 34969614 DOI: 10.1016/j.jsxm.2021.11.008] [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: 08/28/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Female pelvic organ prolapse (POP) has a negative effect on female sexual functioning and with an increasing life expectancy female sexual dysfunction caused by POP will be an arising global issue. AIM Improvement in female sexual functioning, measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), 24-months after pessary or surgery, for both sexually active (SA) and sexually inactive women (NSA) presenting with POP. METHODS A multicenter prospective comparative cohort study was conducted in 22 Dutch hospitals. Women referred with moderate to severe POP symptoms and POP stage ≥ 2 were included and chose either pessary therapy or surgical intervention. The PISQ-IR was filled in at baseline and 24-months, the delta of change was calculated and compared between both groups. Multivariate linear regression was performed to adjust for potential confounding factors in the association between the summary score of the PISQ-IR and therapy. OUTCOMES Change in PISQ-IR between pessary and surgical intervention. RESULTS The delta of change at 24-months was calculated for 198 women in the pessary group and 129 women in the surgery group. SA women in the surgery group reported statistically significant more improvement on the condition-specific (-0.19 95%CI -0.35; -0.03, P = .02), and condition-impact (-0.48 95%CI -0.69; -0.28, P < .001) domains as well as on the summary score (-0.15 95%CI -0.23; -0.08, P < .001) as compared to the pessary group. No significant differences between pessary and surgery were found on the domains for NSA women. After controlling for potential baseline confounders, surgery still had a statistically significant effect on the summary score (B = 0.08; 95%CI interval 0.007-0.15, P = .03). Women having surgery had 2.62 times higher odds of changing from NSA to SA than pessary therapy. CLINICAL IMPLICATIONS SA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement. STRENGTHS & LIMITATIONS Our strengths include the large sample size, long-term follow-up, the use of the PISQ-IR as a validated outcome tool evaluating both SA and NSA women, and this study reflects real-life clinical practice that enhances the external validity of the findings. A limitation of our study is the considerable proportion of non-responders at 24-months follow-up. CONCLUSION Sexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy. van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022;19:270-279.
Collapse
Affiliation(s)
- Lisa R van der Vaart
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Astrid Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Bente Pruijssers
- Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, the Netherlands
| | - Alfredo L Milani
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Antoine L Lagro-Janssen
- Department of General Practice/ Women's Studies Medicine, University Medical Centre Radboud, Nijmegen, the Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gynaecology, Bergman Clinics, Amsterdam, the Netherlands
| | - Carl H van der Vaart
- Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, the Netherlands; Department of Gynaecology, Bergman Clinics, Hilversum, the Netherlands
| |
Collapse
|
11
|
Caldwell L, White AB. Stress Urinary Incontinence: Slings, Single-Incision Slings, and Nonmesh Approaches. Obstet Gynecol Clin North Am 2021; 48:449-466. [PMID: 34416931 DOI: 10.1016/j.ogc.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Synthetic midurethral slings offer optimal cure rates for the minimally invasive treatment of stress urinary incontinence in women. Performed via a retropubic or transobturator technique, midurethral sling approaches demonstrate comparable efficacy, with unique adverse event profiles. Single incision slings were introduced to minimize the complication of groin pain with full-length transobturator slings and enhance operative recovery. The earliest therapies for stress urinary incontinence including urethral bulking, retropubic colposuspension, and autologous sling offer alternative methods of surgical management without using synthetic mesh. These methods boast satisfactory efficacy with low rates of complications, and may be ideal for appropriately selected patients.
Collapse
Affiliation(s)
- Lauren Caldwell
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA
| | - Amanda B White
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Geller EJ, Bretschneider CE, Wu JM, Kenton K, Matthews CA. Sexual Function after Minimally Invasive Total Hysterectomy and Sacrocolpopexy. J Minim Invasive Gynecol 2021; 28:1603-1609. [PMID: 33515745 DOI: 10.1016/j.jmig.2021.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To evaluate sexual function in women undergoing minimally invasive total hysterectomy and sacrocolpopexy (TLH + SCP) with a lightweight polypropylene Y-mesh 1 year after surgery. DESIGN This was a planned secondary analysis of a 5-site randomized trial comparing permanent (2-0 Gore-Tex; W. L. Gore & Associates, Inc., Newark, DE) vs absorbable suture (2-0 polydioxanone suture) for vaginal attachment of a Y-mesh (Upsylon; Boston Scientific Corporation, Natick, MA) graft during TLH + SCP. SETTING Multicenter trial at 5 study sites (4 academic and 1 community). The study sites were: (1) University of North Carolina at Chapel Hill, Chapel Hill, NC; (2) Wake Forest Baptist Hospital, Winston-Salem, NC; (3) Northwestern University, Evanston, IL; (4) Georgia Regents University, Augusta, GA; and (5) Atlantic Health Medical Group, Morristown, NJ. PATIENTS Women previously enrolled in an original study undergoing TLH + SCP. INTERVENTIONS Quality-of-life questionnaires and physical examination. MEASUREMENTS AND MAIN RESULTS The primary objective was to assess changes in sexual function at 1 year after surgery as measured by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised. The secondary objective was to assess the factors associated with postoperative sexual activity and dyspareunia. Of the 200 participants enrolled, 182 (92.8%) completed follow-up: n = 95/99 Gore-Tex and n = 87/101 polydioxanone suture. The mean age was 60 ± 10 years; body mass index was 27 ± 5 kg/m2; 78% were menopausal and 56% sexually active before surgery. At 1 year after surgery, 63% were sexually active: 93% of the sexually active women preoperatively remained so at 1 year, and 24% reported new sexual activity at 1 year (p <.001). Sexual function at 1 year showed marked improvement in activity, quality, and arousal/orgasm compared with baseline Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores. Dyspareunia rates decreased from 22% preoperatively to 16.5% at 1 year (p = .65). Women who were sexually active at 1 year were younger (56.8 ± 9.6 years vs 65.4 ± 9.2 years, p <.001), more likely to be premenopausal (31.6% vs 7.4%, p = .001), and less likely to undergo bilateral salpingo-oophorectomy (53.3% vs 78.9%, p <.001). CONCLUSION Women undergoing TLH + SCP with a lightweight mesh graft report increased rates of sexual activity, improved sexual quality and arousal/orgasm, and lower rates of dyspareunia at 1 year after surgery.
Collapse
Affiliation(s)
- Elizabeth J Geller
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill (Drs. Geller and Wu).
| | - C Emi Bretschneider
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Evanston, Illinois (Drs. Bretschneider and Kenton)
| | - Jennifer M Wu
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill (Drs. Geller and Wu)
| | - Kim Kenton
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Evanston, Illinois (Drs. Bretschneider and Kenton)
| | - Catherine A Matthews
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Wake Forest Baptist Hospital, Winston-Salem (Dr. Matthews), North Carolina; Department of Urology, Wake Forest Baptist Hospital, Winston-Salem (Dr. Matthews), North Carolina
| |
Collapse
|
14
|
|
15
|
Bretschneider CE, Kenton K, Geller EJ, Wu JM, Matthews CA. Pain after permanent versus delayed absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy. Int Urogynecol J 2020; 31:2035-2041. [PMID: 32845399 DOI: 10.1007/s00192-020-04471-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective was to evaluate pain and dyspareunia in women undergoing minimally invasive total hysterectomy and sacrocolpopexy (TLH + SCP) with a light-weight polypropylene mesh 1 year after surgery. METHODS This is a planned secondary analysis of a randomized trial comparing permanent (Gore-Tex) versus absorbable suture (PDS) for vaginal attachment of a y-mesh (Upsylon™) during TLH + SCP in women with stage ≥II prolapse. Patient data were collected at baseline and 1 year after surgery. Our primary outcome was patient-reported pain or dyspareunia at 1 year. RESULTS Two hundred subjects (Gore-Tex n = 99, PDS n = 101) were randomized and underwent surgery. Overall, the mean age ± SD was 60 ± 10 years, and BMI was 27 ± 5 kg/m2. The majority were white (89%), menopausal (77%), and had stage III/IV (63%) prolapse. 93% completed a 1-year follow-up and are included in this analysis (Gor-Tex n = 95, PDS n = 90). The overall rate of participants who reported pain at 1 year was 20%. Of those who did not report any pain at baseline, 23% reported de novo dyspareunia, 4% reported de novo pain, and 3% reported both at 1 year. Of participants who reported pain or dyspareunia at baseline prior to surgery, 66% reported resolution of their symptoms at 1 year. There were no differences in most characteristics, including mesh/suture exposure (7% vs 5%, p = 0.56) between patients who did and did not report any pain at 1 year. On multiple logistic regression controlling for age, baseline dyspareunia, and baseline pain, baseline dyspareunia was associated with a nearly 4-fold increased odds of reporting any pain at 1 year (OR 3.8, 95%CI 1.7-8.9). CONCLUSIONS The majority of women report resolution of pain 1 year following TLH + SCP with a low rate of de novo pain.
Collapse
Affiliation(s)
- C Emi Bretschneider
- Northwestern Feinstein School of Medicine, 250 E. Superior St. Suite 5-2370, Chicago, IL, 60611, USA.
| | - Kimberly Kenton
- Northwestern Feinstein School of Medicine, 250 E. Superior St. Suite 5-2370, Chicago, IL, 60611, USA
| | - Elizabeth J Geller
- Departments of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer M Wu
- Departments of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
16
|
Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol 2020; 17:373-390. [DOI: 10.1038/s41585-020-0334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/09/2022]
|
17
|
Yalcin Y, Demir Caltekin M, Eris Yalcin S. Quality of life and sexuality after bilateral sacrospinous fixation with vaginal hysterectomy for treatment of primary pelvic organ prolapse. Low Urin Tract Symptoms 2020; 12:206-210. [PMID: 32003546 DOI: 10.1111/luts.12303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/19/2019] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the quality of life (QoL) and sexuality in women affected by pelvic organ prolapse (POP) and treated by bilateral sacrospinous ligament fixation (SSLF) with vaginal hysterectomy. METHODS This is a prospective observational study carried out at Isparta City Hospital from July 2017 to December 2018. A total of 26 sexually active women with symptomatic uterine prolapse POP-Q (Pelvic Organ Prolapse Quantification) stage II or higher requiring surgery were included in the study. Short Form Health Survey (SF-36) was used preoperatively and at 6 months to examine the impacts of vaginal reconstruction on QoL. To assess sexual functioning, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) was used preoperatively and at 6 months. RESULTS A significant improvement of POP-Q landmarks was found between pre- and posttreatment at 6 months of follow-up. The patients reported QoL improvement at the follow-up for all the categories of physical functioning, bodily pain, physical health, general health, vitality, social activity, emotional state, and mental health with respect to the baseline values (P < .001). The results of PISQ-12 demonstrated a significant improvement for all the three fields: behavioral emotive factor, physical factor, and partner-related factor, and the total score at 6 months after surgery (P < .001). CONCLUSION This study clearly demonstrates that bilateral SSLF is able to significantly improve both QoL and sexual function in patients with POP. Improvement in sexuality and QoL after surgery may be explained by correction of avoidance of sexual intercourse due to prolapse and physical recovery.
Collapse
Affiliation(s)
- Yakup Yalcin
- Department of Obstetrics and Gynecology, Istinye University, School of Medicine, Istanbul, Turkey.,Department of Gynecologic Oncology, Medical Park Hospital, Antalya, Turkey
| | - Melike Demir Caltekin
- Department of Obstetrics and Gynecology, Bozok University, School of Medicine, Yozgat, Turkey
| | - Serenat Eris Yalcin
- Department of Obstetrics and Gynecology, Suleyman Demirel University, School of Medicine, Isparta, Turkey
| |
Collapse
|
18
|
Enikeev ME, Enikeev DV, Korolev DO, Snurnitsyna OV, Lobanov MV, Nikitin AN, Rapoport LM, Glybochko PV. Repair of cystocele and apical genital prolapse using 6-strap mesh implant. Urologia 2019; 87:130-136. [PMID: 31841395 DOI: 10.1177/0391560319890999] [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: 11/15/2022]
Abstract
OBJECTIVE To assess the outcomes of surgical repair of anterior apical prolapse using the 6-strap mesh implant. STUDY DESIGN The prospective study included 100 patients with genitourinary prolapse. We used advanced 6-strap mesh implant. The results were assessed at 1 (n = 100) and 12 (n = 93) months after surgery. Maximum follow-up was over 4 years. The anatomical outcomes according to the Pelvic Organ Prolapse Quantification system and intraoperative and postoperative complications were assessed. Stage II and higher prolapse was considered to be a recurrence. The quality of life and sexual function were assessed using Pelvic Organ Prolapse Distress Inventory 20, Pelvic Floor Impact Questionnaire 7, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire 12. RESULTS Median age was 57 years (34-78 years (95% confidence interval)). All patients had stage III cystocele. The anterior vaginal wall descent in all the patients was associated with uterine descent: 37 (37%), stage II; 60 (60%), stage III; in 3 (3%), stage IV. In eight cases, postoperative de novo stress urinary incontinence developed. The quality of life improved in 93 (93%) women as judged by the Pelvic Floor Distress Inventory 20 data and in 87 (87%) women, according to the Pelvic Floor Impact Questionnaire 7 data. The desirable anatomical result (⩽stage I according to the Pelvic Organ Prolapse Quantification system) was achieved in 97 (97%) patients. With the exception of mesh fragment excision due to erosion (grade 3a), all the complications were classified as grade I according to the Clavien-Dindo classification. CONCLUSION Genitourinary prolapse repair using 6-strap mesh is efficacious and relatively safe. The method demonstrates good anatomical results in relation to both anterior and apical prolapses with relatively short-term complications.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Petr Vitalievich Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Russian Academy of Sciences, Sechenov University, Moscow, Russia
| |
Collapse
|
19
|
Joueidi Y, Gueudry P, Cardaillac C, Vaucel E, Lopes P, Winer N, Dochez V, Thubert T. [Uterine preservation or not during prolapse surgery: Review of the literature]. Prog Urol 2019; 29:1021-1034. [PMID: 31130408 DOI: 10.1016/j.purol.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of hysterectomy in case of genital prolapse on the anatomical and functional results, and on per and post operative complications compared with uterine preservation. MATERIAL AND METHODS We conducted a review of the Pubmed, Medline, Embase and Cochrane literature using the following terms and MeSH (Medical Subject Headings of the National Library of Medicine): uterine prolapse; genital prolapse; prolapse surgery; vaginal prolapse surgery; abdominal prolapse surgery; hysterectomy; hysteropexy; sacrocolpopexy; surgical meshes; complications; sexuality; neoplasia; urinary; incontinence; cancer. RESULTS Among the 168 abstracts studied, 63 publications were retained. Whatever performance of hysterectomy or not, anatomical and functional results were similar in abdominal surgery (sacrocolpopexy) (OR=2.21 [95% CI: 0.33-14.67]) or vaginal surgery (OR=1.07 [95% CI: 0.38-2.99]). There was no difference in terms of urinary symptoms or sexuality after surgery. Hysterectomy was associated to a higher morbidity (bleeding, prolonged operating time, longer hospital stay), to an increased risk of mesh exposure particularly in case of total hysterectomy (8.6%; 95% CI: 6.3-11). CONCLUSION In the absence of evidence of superiority in terms of anatomical and functional outcomes, with an increased rate of complications, concomitant hysterectomy with prolapse surgery should probably not be performed routinely.
Collapse
Affiliation(s)
- Y Joueidi
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - P Gueudry
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - C Cardaillac
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - E Vaucel
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - P Lopes
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - N Winer
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - V Dochez
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - T Thubert
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France.
| |
Collapse
|
20
|
Walter JE. A comparison of the use of mesh to native tissue in the management of vaginal vault prolapse. Best Pract Res Clin Obstet Gynaecol 2018; 54:73-88. [PMID: 30580956 DOI: 10.1016/j.bpobgyn.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 01/04/2023]
Abstract
Vaginal vault prolapse afflicts millions of women and evokes significant psychosocial and pelvic floor dysfunction. The risk factors and modalities of conservative management are discussed in this study. There remains controversy in the optimal surgical management. This review serves to study the clinical conundrum of the decision-making process to utilize the mesh and the approach. In-depth evaluation of mesh-related postsurgical complications as compared to those associated with the native tissue is explored.
Collapse
Affiliation(s)
- Jens-Erik Walter
- McGill University, Fellowship in Female Pelvic Medicine & Reconstructive Surgery, D05.2541, 1001 Decarie Boulevard Montreal, QC, H4A 3J1, Canada.
| |
Collapse
|
21
|
Recovering sexual satisfaction after prolapse surgery: a secondary analysis of surgical recovery. Int Urogynecol J 2018; 29:1675-1680. [PMID: 29961109 DOI: 10.1007/s00192-018-3690-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/11/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We compared pre- and postoperative sexual function scores in sexually active women undergoing pelvic organ prolapse (POP) surgery. METHODS Planned secondary analysis of women enrolled in the Restricted Convalescence: Outcomes Following Urogynecologic Procedures study, a randomized trial of postoperative activity after POP surgery. All participants could return to sexual activity at 6 weeks. Participants completed the Pelvic Floor Distress Inventory (PFDI), the Patient-Reported Outcomes Measurement Information System (PROMIS) profile, and the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaires at baseline and 3 months. GRISS is a validated 28-item survey for heterosexual couples that contains seven subscales to assess sexual function. Higher scores represent worse sexual function. RESULTS Thirty-seven sexually active women were assessed. Mean age ± standard deviation (SD) was 56 ± 11, most of whom (92%) were Caucasian; 78% had undergone minimally invasive sacrocolpopexy, and the remainder had native tissue vaginal repairs. GRISS scores improved 3 months after surgery [4.5 ± 2.6 to 3.6 ± 2.2, p < 0.001; mean decrease of 0.9, 95% confidence interval (CI) 0.36-1.36]. PFDI scores improved from 122 ± 53 at baseline to 28 ± 31 at 3 months (p < 0.001). Higher GRISS scores were correlated with higher PFDI scores (Spearman's rho = 0.35, p = 0.03) at baseline and 3 months (Spearman's rho = 0.31, p = 0.03). Several GRISS subscales improved after surgery: partner avoidance (p = 0.01), vaginismus (p = 0.02), noncommunication (p = 0.01), dissatisfaction (p = 0.03), and anorgasmia (p = 0.001). However, sexual infrequency (p = 0.08) and nonsensuality (p = 0.4) did not change. Fifty-one percent had sexual dysfunction before surgery, which decreased to 32% after surgery (p = 0.04). CONCLUSION Sexual function and satisfaction are significantly improved 3 months following POP surgery. Improved sexual function is correlated with improved pelvic floor symptoms.
Collapse
|
22
|
van Zanten F, Brem C, Lenters E, Broeders IAMJ, Schraffordt Koops SE. Sexual function after robot-assisted prolapse surgery: a prospective study. Int Urogynecol J 2018; 29:905-912. [PMID: 29687171 PMCID: PMC5948283 DOI: 10.1007/s00192-018-3645-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/23/2018] [Indexed: 11/23/2022]
Abstract
Introduction and hypothesis Female pelvic organ prolapse (POP) can severely influence sexual function. Robot-assisted surgery is increasingly used to treat POP, but studies describing its effect on sexual function are limited. The objective of this study was to evaluate sexual function after robot-assisted POP surgery. Methods This prospective cohort study included all patients who underwent a robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS). Exclusion criteria were unknown preoperative sexual activity status or concomitant surgery. In sexually active women, sexual function was measured with the translated validated version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual activity were scored. Prolapse stages were described using the simplified Pelvic Organ Prolapse Quantification (S-POP) system. Results A total of 107 women were included (median follow-up 15.3 months). No difference was found in the total number of sexually active women before and after surgery [63 (58.9%) vs. 61 (63.5%), p = 0.999]. Significantly fewer women avoided sexual intercourse postoperatively compared with preoperatively. Preoperatively, sexual intercourse was avoided due to vaginal bulging (2% vs. 24%, respectively, p = 0.021). Total mean PISQ-12 scores improved significantly 1 year after prolapse correction (33.5 vs. 37.1; p = 0.004), mainly due to improved scores on the physical and behavioral–emotive domain. No significant difference in pre- and postoperative complains of dyspareunia was found. Conclusion Robot-assisted middle-compartment surgery improved sexual function 1 year after surgery according to enhanced physical and emotional scores. The total number of sexually active women and complains of dyspareunia before and after surgery did not differ.
Collapse
Affiliation(s)
- Femke van Zanten
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands. .,Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands.
| | - Cherèl Brem
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Egbert Lenters
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Ivo A M J Broeders
- Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands.,Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | |
Collapse
|
23
|
Meili G, Christmann C, Schneider J. [Long-term Outcome after Prolapse Surgery in a General Gynecological Teaching Hospital]. PRAXIS 2018; 107:497-504. [PMID: 29690850 DOI: 10.1024/1661-8157/a002960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Untersucht wurden objektive und subjektive Langzeitergebnisse vaginaler und laparoskopischer Prolapsoperationen in einem allgemeinen gynäkologischen Lehrkrankenhaus. Es handelt sich um eine retrospektive Studie mit 269 Frauen. Das subjektive Ergebnis wurde anhand des P-QOL-Fragebogens und Befragungen beurteilt, die objektiven Ergebnisdaten wurden prä- und postoperativ nach drei bis neun Monaten beurteilt. Die Krankengeschichte wurde bezüglich Anamnese sowie intra- und postoperativen Komplikationen analysiert. Wir führten 87 laparoskopische Sakrokolpopexien, 100 Kolpofixationen nach Richter, 164 anteriore oder/und posteriore vaginale Plastiken, oft in Kombination mit anderen Eingriffen, sowie weitere Eingriffe durch. 80 % (185/206) der behandelten Frauen waren mit dem postoperativen Ergebnis zufrieden. Kenntnisse der Anamnese und der Symptome der Patientin sind sehr wichtig, um die Frauen über chirurgische Optionen und Erwartungen hinsichtlich des objektiven postoperativen Ergebnisses orientieren zu können.
Collapse
|
24
|
Cundiff GW, Quinlan DJ, van Rensburg JA, Slack M. Foundation for an evidence-informed algorithm for treating pelvic floor mesh complications: a review. BJOG 2018; 125:1026-1037. [DOI: 10.1111/1471-0528.15148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- GW Cundiff
- Department of Obstetrics and Gynaecology; University of British Columbia; Vancouver BC Canada
| | - DJ Quinlan
- Department of Obstetrics and Gynaecology; University of British Columbia; Vancouver BC Canada
| | - JA van Rensburg
- Department of Obstetrics and Gynaecology; University of Stellenbosch and Tygerberg Hospital; Cape Town South Africa
| | - M Slack
- Department of Obstetrics and Gynaecology; Addenbrooke's Hospital; University of Cambridge; Cambridge UK
| |
Collapse
|
25
|
Yune JJ, Cheng JW, Wagner H, Kim J, Hardesty JS, Siddighi S. Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach. Neurourol Urodyn 2018; 37:1794-1800. [PMID: 29572921 DOI: 10.1002/nau.23526] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/13/2018] [Indexed: 11/10/2022]
Abstract
AIMS Postoperative urinary retention has been reported in 13-32% of patients that undergo pelvic organ prolapse (POP) repair. The purpose of our study was to compare rates of urinary retention between transvaginal and robotic transabdominal approaches and identify risk factors for postoperative urinary retention following POP repair. METHODS Medical records of patients that underwent POP repair were reviewed. Surgeries included transvaginal high uterosacral ligament suspension (HUSLS) and robotic-assisted sacral colpopexy (RASCP). All patients underwent a retrograde fill voiding trial (RGVT) postoperatively. Demographics, comorbidities, preoperative urodynamic findings, and surgical procedures were compared between women that passed their RGVT and those that did not. RESULTS Out of 484 patients reviewed, 333 underwent POP repair with a transvaginal HUSLS and 151 underwent RASCP. Postoperative urinary retention was identified in 128 (26.4%) patients where 113 underwent transvaginal HUSLS and 15 underwent RASCP. The odds ratio (OR) of postoperative urinary retention following transvaginal HUSLS was 3.26 (CI 1.72-6.18; P < 0.001) compared to RASCP. Older age was also a risk factor for postoperative urinary retention (OR 1.03, CI 1.01-1.05; P = 0.012). While parity, preoperative post-void residual (PVR), and rates of concomitant transvaginal anterior/posterior repair were significantly higher in patients that developed postoperative urinary retention on univariate analysis, these factors did not demonstrate significance on multivariate analysis. CONCLUSIONS Transvaginal HUSLS demonstrates a 3.26 OR for postoperative urinary retention compared to the robotic transabdominal approach. Older age is also a significant risk factor whereas parity, preoperative PVR, and rates of concomitant transvaginal anterior/posterior repair were not significant risk factors on multivariate analysis.
Collapse
Affiliation(s)
- Junchan J Yune
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Julie W Cheng
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Hillary Wagner
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Joo Kim
- Department of Urology, Loma Linda University, Loma Linda, California
| | - Jeffrey S Hardesty
- Department of Obstetrics and Gynecology, Loma Linda University, Loma Linda, California
| | - Sam Siddighi
- Department of Obstetrics and Gynecology, Loma Linda University, Loma Linda, California
| |
Collapse
|
26
|
Kurdoglu M, Unlu S, Antonetti-Elford M, Kurdoglu Z, Kilic GS. Short-term results of changes in existing and de novo lower urinary tract symptoms after robot-assisted laparoscopic uterosacral ligament suspension and sacrocolpopexy. Low Urin Tract Symptoms 2018; 11:O71-O77. [PMID: 29508556 DOI: 10.1111/luts.12219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/26/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study presents short-term outcomes related to changes in existing and de novo lower urinary tract symptoms (LUTS), pelvic pain, and bowel function following robot-assisted laparoscopic uterosacral ligament suspension (RALUSLS) and sacrocolpopexy (RALSC). METHODS Observational data for RALUSLS (n = 23) and RALSC (n = 25) collected between August 2014 and March 2016 from a single institute (The University of Texas Medical Branch) were evaluated retrospectively. Patient characteristics, concomitant procedures, and the occurrence of lower urinary tract, pelvic pain, and bowel symptoms were compared between patients undergoing RALUSLS and RALSC. RESULTS There was no significant difference in background characteristics between the 2 groups, except for parity, which was high in the RALUSLS group. In the RALUSLS group, patients experienced significant resolution of urinary urgency (P < .001) and frequency, urge and mixed incontinence, and pelvic pain (P < .05). In the RALSC group, there was significant resolution of nocturia, mixed incontinence, pelvic pain, and dyspareunia (P < .05). There was no significant difference in the occurrence of de novo symptoms in the RALUSLS and RALSC groups (P > .05), although newly appearing urinary urgency or frequency and stress or urge incontinence were more common after RALSC. CONCLUSION Mixed incontinence and pelvic pain improved significantly in patients after RALUSLS or RALSC. In RALUSLS patients, urgency, frequency, and urge incontinence also improved, whereas additional improvement in nocturia and dyspareunia was evident only in RALSC patients. De novo LUTS developing after these procedures, especially after RALSC, necessitate careful patient consultation prior to surgery.
Collapse
Affiliation(s)
- Mertihan Kurdoglu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Serdar Unlu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Megan Antonetti-Elford
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Zehra Kurdoglu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Gokhan S Kilic
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
27
|
Tahaoglu AE, Bakir MS, Peker N, Bagli İ, Tayyar AT. Modified laparoscopic pectopexy: short-term follow-up and its effects on sexual function and quality of life. Int Urogynecol J 2018; 29:1155-1160. [PMID: 29500516 DOI: 10.1007/s00192-018-3565-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/13/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study examined the early outcomes of laparoscopic (LS) pectopexy and evaluated its effects on female sexual function and quality of life (QoL). METHODS Twenty-two patients with apical prolapse who underwent LS pectopexy were included. Outcomes of the procedure were noted; the Female Sexual Function (FSFI) and Prolapse Quality of Life (P-QOL) questionnaires were completed preoperatively and 6 months postoperatively. RESULTS There was no evidence of recurrent prolapse or constipation; the percentages of exacerbation of cystocele, rectocele, de novo stress urinary incontinence (SUI), and de novo urgency (UUI) were 4.5%, 9.0%, 4.5%, and 4.5%, respectively (mean follow-up 10.41 months). FSFI and P-QOL scores improved significantly (p < 0.05) postoperatively. CONCLUSIONS LS pectopexy shows promising results for pelvic organ prolapse (POP) surgery with comparable outcomes. It also improved the FSFI and P-QOL scores in POP patients.
Collapse
Affiliation(s)
- Ali Emre Tahaoglu
- Obstetrics and Gynecology Department, Health Sciences University Gazi Yasargil Research and Training Hospital, Talaytepe Mahallesi, Urfa Yolu, 21090 Merkez, Baglar, Diyarbakır, Turkey.
| | - Mehmet Sait Bakir
- Obstetrics and Gynecology Department, Health Sciences University Gazi Yasargil Research and Training Hospital, Talaytepe Mahallesi, Urfa Yolu, 21090 Merkez, Baglar, Diyarbakır, Turkey
| | - Nurullah Peker
- Obstetrics and Gynecology Department, Health Sciences University Gazi Yasargil Research and Training Hospital, Talaytepe Mahallesi, Urfa Yolu, 21090 Merkez, Baglar, Diyarbakır, Turkey
| | - İhsan Bagli
- Obstetrics and Gynecology Department, Health Sciences University Gazi Yasargil Research and Training Hospital, Talaytepe Mahallesi, Urfa Yolu, 21090 Merkez, Baglar, Diyarbakır, Turkey
| | - Ahter Tanay Tayyar
- Obstetrics and Gynecology Department, Zeynep Kamil Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
28
|
Comparison of sexual function between sacrocolpopexy and sacrocervicopexy. Obstet Gynecol Sci 2017; 60:207-212. [PMID: 28344963 PMCID: PMC5364104 DOI: 10.5468/ogs.2017.60.2.207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To compare sexual function before and 12 months after between sacrocolpopexy and sacrocervicopexy. Methods This retrospective study examined a cohort of 55 sexually active women who underwent either supracervical hysterectomy with sacrocervicopexy (n=28) or total abdominal hysterectomy with sacrocolpopexy (n=27) for stage II to IV pelvic organ prolapse. Pelvic floor support was measured with Pelvic Organ Prolapse-Quantification examination. Pelvic floor function was measured with the Pelvic Floor Distress Inventory-Short Form 20 and sexual function was measured with Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-Short Form 12 (PISQ-12). Results Baseline pelvic floor symptoms, demographics and PISQ-12 questionnaire scores were similar between the two groups. Overall improvements in sexual function were seen based on PISQ-12 scores in both groups, but were not statistically significant. No differences were seen in PISQ-12 scores regardless of sparing the cervix or surgical route. Responses to the PISQ-12 question of avoiding sexual intercourse because of vaginal bulging showed significant improvement in both group. No recurrences of prolapse occurred. Conclusion In women with pelvic organ prolapse, sexual function after either sacrocolpopexy or sacrocervicopexy was not different. Sexual dysfunction in terms of avoidance of sexual activity because of vaginal bulging was greatly improved in both groups with statistical significance.
Collapse
|
29
|
Is Pelvic Floor Dysfunction an Independent Threat to Sexual Function? A Cross-Sectional Study in Women With Pelvic Floor Dysfunction. J Sex Med 2017; 14:226-237. [DOI: 10.1016/j.jsxm.2016.11.323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/02/2016] [Accepted: 11/21/2016] [Indexed: 11/21/2022]
|
30
|
Klapdor R, Grosse J, Hertel B, Hillemanns P, Hertel H. Postoperative anatomic and quality-of-life outcomes after vaginal sacrocolporectopexy for vaginal vault prolapse. Int J Gynaecol Obstet 2017; 137:86-91. [PMID: 28099751 DOI: 10.1002/ijgo.12095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/25/2016] [Accepted: 01/04/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess anatomic outcome and quality of life (QOL) after vaginal sacrocolporectopexy among patients with pelvic organ prolapse. METHODS A noncomparative observational study was conducted at Hanover Medical School, Germany, among patients who underwent vaginal sacrocolporectopexy for uterine or vaginal vault prolapse between May 1, 2006, and October 31, 2012. A validated German version of the Prolapse QOL (P-QOL) questionnaire was sent to eligible patients; respondents were invited for follow-up examination. RESULTS Overall, 128 patients were enrolled. Concomitant hysterectomy was performed among 82 (64.1%) patients, anterior colporrhaphy among 105 (82.0%), and posterior colporrhaphy among 58 (45.3%). After a mean interval of 26.5 months (range 1.0-81.3 months), seven patients exhibited recurrent vaginal vault prolapse of at least stage 2, giving a success rate of 92.3% (95% confidence interval 85.9%-96.5%). The P-QOL scores were either low (<40) or very low (<20), indicating high QOL. Regarding symptoms related to pelvic organ prolapse, patients reported little or no impact on QOL after vaginal sacrocolporectopexy. CONCLUSION Vaginal sacrocolporectopexy seemed safe and feasible, leading to anatomically correct fixation of the vaginal apex, high anatomic success rates, and good QOL. This procedure might be considered as an alternative to laparoscopic or abdominal sacrocolpopexy.
Collapse
Affiliation(s)
- Rüdiger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Jolanda Grosse
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Bettina Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
31
|
Lamont J. Directive clinique de consensus sur la santé sexuelle de la femme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S79-S142. [DOI: 10.1016/j.jogc.2016.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Guyomard A, Delorme E. Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh. Int J Gynaecol Obstet 2016; 133:365-9. [DOI: 10.1016/j.ijgo.2015.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/02/2015] [Accepted: 02/03/2016] [Indexed: 12/21/2022]
|
33
|
The Impact of Sacrospinous Hysteropexy and Vaginal Hysterectomy With Suspension of the Uterosacral Ligaments on Sexual Function in Women With Uterine Prolapse: A Secondary Analysis of a Randomized Comparative Study. J Sex Med 2016; 13:213-9. [PMID: 26805940 DOI: 10.1016/j.jsxm.2015.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/16/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. AIMS The aim of this secondary analysis was to evaluate and compare sexual function after sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse. METHODS This is a secondary analysis of the SAVE U trial data, a multicenter trial in 4 nonuniversity hospitals in the Netherlands comparing sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in primary surgery of uterine prolapse stage II or higher. Primary outcome of the original study was recurrent prolapse stage II or higher of the uterus or vaginal vault (apical compartment) evaluated by POP-Q examination in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months follow-up. Secondary outcomes were overall anatomical recurrences, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning. Data from patients who had completed the POP/urinary incontinence sexual questionnaire (PISQ-12) at baseline and 24 months after surgery were used in the present trial. Total, subscale, and individual question analyses were performed. The SAVE U trial is registered in the Dutch trial registry, number NTR1866. MAIN OUTCOME MEASURES Differences and changes in sexual function 24 months after surgery, measured by the PISQ-12 questionnaire. RESULTS Between November 2009 and March 2012, 208 women were randomized between sacrospinous hysteropexy (n = 103) and vaginal hysterectomy with suspension of the uterosacral ligaments (n = 105). Of these, 99 women completed questionnaires at baseline and after 24 months follow-up and were included in the present study. During a follow-up period of 24 months, no significant differences in total PISQ-12 scores were observed between the groups. After both interventions the item "avoidance of intercourse due to prolapse" significantly improved, as did the physical subscale of the PISQ-12 questionnaire. CONCLUSION There was no statistically significant difference in overall sexual functioning (total PISQ-12 scores) between uterus-preserving sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments after a follow-up period of 24 months.
Collapse
|
34
|
Kokanalı MK, Cavkaytar S, Aksakal O, Doğanay M. McCall Culdoplasty vs. Sacrospinous Ligament Fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2015; 194:218-22. [PMID: 26448134 DOI: 10.1016/j.ejogrb.2015.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/13/2015] [Accepted: 09/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare preoperative and postoperative vaginal length in sexually active postmenopausal women who underwent vaginal hysterectomy with McCall Culdoplasty or Sacrospinous Ligament Fixation and investigate whether these findings are correlated with sexual function. STUDY DESIGN Fifty-eight sexually active postmenopausal women planned to undergo vaginal hysterectomy during the reconstructive surgical treatment of stage 2 or 3 uterine prolapse were included. They were classified into two groups according to their self-selections. Twenty-nine women underwent McCall Culdoplasty adjunct to hysterectomy while 29 women had Sacrospinous Ligament Fixation with hysterectomy. Vaginal length was measured before and after vaginal surgery at 6-week and 6-month follow-up. Sexual function were assessed by Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 form, preoperatively and 6 months postoperatively. RESULTS It was found that McCall Culdoplasty and Sacrospinous Ligament Fixation adjunct to vaginal hysterectomy shortened vaginal length significantly. And, the decrease in vaginal length was greater in McCall Culdoplasty group compared to Sacrospinous Ligament Fixation group. However, preoperative and postoperative sexual function questionnaire scores were not correlated with vaginal lengths. CONCLUSION McCall Culdoplasty or Sacrospinous Ligament Fixation adjunct to vaginal hysterectomy shortens vaginal length postoperatively. However these changes do not affect sexual function in postmenopausal women.
Collapse
Affiliation(s)
| | - Sabri Cavkaytar
- Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Orhan Aksakal
- Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| | - Melike Doğanay
- Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
35
|
de Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J 2014; 24:1859-72. [PMID: 24142061 DOI: 10.1007/s00192-013-2177-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim was to review complications associated with pelvic organ prolapse surgery. METHODS Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. RESULTS AND CONCLUSIONS Transvaginal mesh has a higher re-operation rate than native tissue vaginal repairs (grade A). If a synthetic mesh is placed via the vaginal route, it is recommended that a macroporous polypropylene monofilament mesh should be used. At sacral colpopexy mesh should not be introduced or sutured via the vaginal route and silicone-coated polyester, porcine dermis, fascia lata and polytetrafluoroethylene meshes are not recommended as grafts. Hysterectomy should also be avoided (grade B). There is no evidence to recommend routine local or systemic oestrogen therapy before or after prolapse surgery using mesh. The first cases should be undertaken with the guidance of an experienced surgeon in the relevant technique (grade C). Expert opinion suggests that by whatever the surgical route pre-operative urinary tract infections are treated, smoking is ceased and antibiotic prophylaxis is undertaken. It is recommended that a non-absorbable synthetic mesh should not be inserted into the rectovaginal septum when a rectal injury occurs. The placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after a bladder injury has been repaired, if the repair is considered to be satisfactory. It is possible to perform a hysterectomy in association with the introduction of a non-absorbable synthetic mesh inserted vaginally, but this is not recommended routinely.
Collapse
Affiliation(s)
- Renaud de Tayrac
- Department of Obstetrics and Gynecology, Caremeau University Hospital, Place du Prof Robert Debré, 30900, Nîmes, France,
| | | |
Collapse
|
36
|
Srikrishna S, Robinson D, Cardozo L. Measuring quality of life in urogenital prolapse. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
37
|
Daher A, Renouvel F, Lauratet B, Guillot E, Lefranc JP. Étude préliminaire sur la faisabilité de la double promontofixation robotique comparée à la voie cœlioscopique. ACTA ACUST UNITED AC 2013; 42:570-6. [DOI: 10.1016/j.jgyn.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 06/19/2013] [Accepted: 07/01/2013] [Indexed: 11/25/2022]
|
38
|
Lakeman MME, Laan E, Roovers JPWR. The effects of prolapse surgery on vaginal wall sensibility, vaginal vasocongestion, and sexual function: A prospective single centre study. Neurourol Urodyn 2013; 33:1217-24. [DOI: 10.1002/nau.22491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 08/15/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Marielle M. E. Lakeman
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| | - Ellen Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| | - Jan-Paul W. R. Roovers
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| |
Collapse
|
39
|
Thibault F, Costa P, Thanigasalam R, Seni G, Brouzyine M, Cayzergues L, De Tayrac R, Droupy S, Wagner L. Impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality: a medium-term analysis. BJU Int 2013; 112:1143-9. [DOI: 10.1111/bju.12286] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pierre Costa
- Department of Urology; University Hospital; Nîmes France
| | | | | | | | | | - Renaud De Tayrac
- Department of Obstetrics and Gynaecology; University Hospital; Nîmes France
| | | | - Laurent Wagner
- Department of Urology; University Hospital; Nîmes France
| |
Collapse
|
40
|
Two-year outcomes after vaginal prolapse reconstruction with mesh pelvic floor repair system. Female Pelvic Med Reconstr Surg 2013; 19:72-8. [PMID: 23442503 DOI: 10.1097/spv.0b013e3182841d4b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess anatomical and functional outcomes 2 years after prolapse repair using vaginal mesh repair system. METHODS Women enrolled in a 12-month observational study of outcomes after transvaginal mesh-augmented prolapse repair were invited to participate in an extended follow-up. Subjects completed questionnaires assessing pelvic symptoms, quality of life, global satisfaction, and a pelvic examination for anatomical support and mesh complications. RESULTS Of 118 eligible women, 85 enrolled, 82 provided subjective data at 24 months, and pelvic examination/Pelvic Organ Prolapse Quantification data are available from 79 women. Total, anterior, and posterior Prolift kits were used in 47 (55%), 25 (29%), and 13 (15%), respectively. At baseline, most of the women had stage III prolapse (75%), with the anterior compartment constituting the leading edge in 71% of subjects. At 24 months, Pelvic Organ Prolapse Quantification measures were significantly improved from baseline in all compartments, with 51 (65%) stage 0/I, 25 (31%) stage II, 3 (4%) and stage III (P < 0.001), as were quality of life scores (P < 0.001), with the exception of sexual function. Symptomatic prolapse was reported by 7 (8.5%) women, of which 4 demonstrated prolapse in the nonoperated compartment. Three subjects (4%) reported persistent pelvic pain. The 2-year mesh exposure incidence was at least 13% (11/85). The proportion reporting dyspareunia was 28.9% (13/45) and was unchanged from baseline. The median global satisfaction was 9.3 (range 2.0-10.0). CONCLUSIONS Anatomical support, symptom relief, and satisfaction are high 24 months after mesh-augmented vaginal prolapse repair, although mesh exposure and new onset prolapse of the nonoperated compartment are not uncommon.
Collapse
|
41
|
Costantini E, Porena M, Lazzeri M, Mearini L, Bini V, Zucchi A. Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy. Int Urogynecol J 2013; 24:1481-7. [PMID: 23361855 DOI: 10.1007/s00192-012-2041-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 12/29/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Incontinence and pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of hysterectomy on sexual function. We designed the present observational prospective longitudinal cohort study in order to evaluate the impact of uterus preservation after POP repair on sexual function. METHODS Between January 2006 and January 2011, 107 patients with POP, mean age 58 ± 8.9 years, underwent colposacropexy with or without hysterectomy. All the women without uterine disease were offered the chance to preserve the uterus. All patients gave written informed consent and completed the Female Sexual Function Index (FSFI) questionnaire, before and after surgery, provided detailed case history, underwent urogynaecological examination and urodynamic assessment and completed the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact on Quality of Life short form (IIQ-7) questionnaires, and the satisfaction Visual Analogue Scale (VAS). One year after surgery patients repeated the FSFI questionnaire and underwent a clinical check-up. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were objective anatomical and subjective success, defined respectively as no prolapse and no incontinence-related symptoms. RESULTS Sixty-eight patients were included: 32 underwent uterus-sparing surgery and 36 hysterectomy plus colposacropexy. After surgery both groups had significant improvements in the total FSFI score and in the domains of desire, arousal and orgasm. The median post-operative scores of desire, arousal, and orgasm domains showed significant improvements in the uterus-sparing group compared with the hysterectomy group. None of the women had a uterine or vault prolapse recurrence. CONCLUSIONS Our data demonstrate that POP plays a role in female sexual dysfunction and uterus sparing surgery is associated with a greater improvement in sexual function.
Collapse
Affiliation(s)
- Elisabetta Costantini
- Department of Urology and Andrology, University of Perugia, S.M. Misericordia Hospital, S. Andrea delle Fratte, 06100, Perugia, Italy
| | | | | | | | | | | |
Collapse
|
42
|
El Haddad R, Svabik K, Masata J, Koleska T, Hubka P, Martan A. Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion. Eur J Obstet Gynecol Reprod Biol 2012; 167:110-3. [PMID: 23265298 DOI: 10.1016/j.ejogrb.2012.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/26/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia. STUDY DESIGN 69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1. RESULTS A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively. CONCLUSIONS The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up.
Collapse
Affiliation(s)
- Rachid El Haddad
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
| | | | | | | | | | | |
Collapse
|
43
|
Deffieux X, Letouzey V, Savary D, Sentilhes L, Agostini A, Mares P, Pierre F. Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 2012; 165:170-80. [PMID: 22999444 DOI: 10.1016/j.ejogrb.2012.09.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 08/01/2012] [Accepted: 09/03/2012] [Indexed: 11/19/2022]
Abstract
The objective of the study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning adverse events related to surgical procedures involving the use of prosthetic meshes. French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh; pelvic organ prolapse; cystocele; rectocele; uterine prolapse; complications; adverse event; sacral colpopexy; extrusion; infection). As with any surgery, recommendations include perioperative smoking cessation (Expert opinion) and compliance with the prevention of nosocomial infections (regulatory recommendation). There is no evidence to recommend routine local or systemic estrogen therapy before or after prolapse surgery using mesh, regardless of the surgical approach (Grade C). Antibiotic prophylaxis is recommended, regardless of the approach (Expert opinion). It is recommended to check for pre-operative urinary tract infection and treat it (Expert opinion). The first procedure should be undertaken under the guidance of a surgeon experienced in the relevant technique (Grade C). It is recommended not to place a non-absorbable synthetic mesh into the rectovaginal septum when a rectal injury occurs (Expert opinion). Placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after suturing of a bladder injury if the suture is considered to be satisfactory (Expert opinion). If a synthetic mesh is placed by vaginal route, it is recommended to use a macroporous polypropylene monofilament mesh (Grade B). It is recommended not to use polyester mesh for vaginal surgery (Grade B). It is permissible to perform hysterectomy associated with the placement of a non-absorbable synthetic mesh placed by the vaginal route but this is not routinely recommended (Expert opinion). It is recommended to minimize the extent of the colpectomy (Expert opinion). The laparoscopic approach is recommended for sacral colpopexy (Expert opinion). It is recommended not to place and suture meshes by the vaginal route when a sacral colpopexy is performed (Grade B). It is recommended not to use silicone-coated polyester, porcine dermis, fascia lata, and polytetrafluoroethylene meshes (Grade B). It is recommended to use polyester (without silicone coating) or polypropylene meshes (Grade C). Suture of the meshes to the promontory can be performed using thread/needle or tacks (Grade C). Peritonization is recommended to cover the meshes (Grade C). If hysterectomy is required, it is recommended to perform a subtotal hysterectomy (Expert opinion). Implementation of this guideline should decrease the prevalence of complications related to surgical procedures involving the use of prosthetic meshes.
Collapse
Affiliation(s)
- Xavier Deffieux
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Clamart, F-92141, France.
| | | | | | | | | | | | | |
Collapse
|
44
|
Segal S, Arya LA, Smith AL. Functional Outcomes for Incontinence and Prolapse Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2012; 7:179-186. [PMID: 23066437 PMCID: PMC3468911 DOI: 10.1007/s11884-012-0136-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of women with pelvic organ prolapse and stress urinary incontinence report more than one symptom that affects urinary, bowel, or sexual function. Most research studies on outcomes following surgery for pelvic organ prolapse and stress incontinence focus on anatomic outcomes and relief of symptoms specific to prolapse and/or stress incontinence. Pelvic symptoms related to voiding function such as de novo urgency or incontinence, bowel function, and sexual function are clinically important outcomes but are infrequently reported. Deterioration of pelvic symptoms postoperatively is associated with decreased patient satisfaction, which underscores the importance of effectively assessing functional and anatomic treatment outcomes. Future studies of reconstructive pelvic surgery should routinely include multiple domain functional outcomes specifically addressing voiding, defecatory, and sexual function.
Collapse
Affiliation(s)
- Saya Segal
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lily A. Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ariana L. Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, 299 South 8th Street, Philadelphia, PA 19104, USA
| |
Collapse
|
45
|
Health Concerns That Affect Female Sexuality. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012. [DOI: 10.1016/s1701-2163(16)35357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Kent D, Pelosi MA. Vaginal Rejuvenation: An In-Depth Look at the History and Technical Procedure. ACTA ACUST UNITED AC 2012. [DOI: 10.5992/ajcs-d-12-00001.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article is a comprehensive review of the pelvic cosmetic procedure, vaginal rejuvenation. The review covers the inception, evolution, and challenges involved with the operation. Comparison with the classic procedures from which it was derived as well as similar current procedures designed for pelvic organ prolapse are covered. Indications, patient selection, expected outcomes, and technical aspects of the operation itself are addressed.
Collapse
|
47
|
Perez T, Crochet P, Descargues G, Tribondeau P, Soffray F, Gadonneix P, Loundou A, Baumstarck-Barrau K. Laparoscopic sacrocolpopexy for management of pelvic organ prolapse enhances quality of life at one year: a prospective observational study. J Minim Invasive Gynecol 2012; 18:747-54. [PMID: 22024261 DOI: 10.1016/j.jmig.2011.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/31/2011] [Accepted: 08/03/2011] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVE Assessment of 1-year quality of life outcome of patients treated with laparoscopic sacrocolpopexy. DESIGN A prospective multicenter observational study (Canadian Task Force classification II-3). SETTING Four French medical centers. PATIENTS A total of 94 women who underwent laparoscopic sacrocolpopexy for pelvic organ prolapse between June 2006 and May 2007 were included in the study. MEASUREMENTS AND MAIN RESULTS Women attended a research clinic where they completed validated quality of life questionnaires and were examined. Women were assessed before and 1 year after surgery for the degree and impact of vaginal, urinary, and bowel symptoms with validated quality of life questionnaires, evaluation of sexual function with a validated questionnaire, and pelvic organ support was assessed by a Pelvic Organ Prolapse Quantification score. Mean age of the women was 58.8 years. Anatomic success occurred in 94% of women. Concomitant urinary continence surgery was performed in 39% of cases. All the scores of quality of life and sexuality were significantly improved at 1 year. CONCLUSIONS Laparoscopic sacrocolpopexy for pelvic floor prolapse is a safe and effective treatment that has a positive impact on every aspect of quality of life (symptoms, social impact, sexual function) in the medium term.
Collapse
Affiliation(s)
- Thomas Perez
- Department of Gynecology, Clinique La Casamance, Aubagne, France
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Medium-term clinical outcomes following surgical repair for vaginal prolapse with tension-free mesh and vaginal support device. Int Urogynecol J 2011; 23:487-93. [PMID: 22143448 DOI: 10.1007/s00192-011-1600-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was designed to evaluate clinical outcomes ≥2 years following surgery with polypropylene mesh and vaginal support device (VSD) in women with vaginal prolapse, in a prospective, multi-center setting. METHODS Patients re-consented for this extended follow-up (n = 110), with anatomic evaluation using Pelvic Organ Prolapse Quantification (POP-Q) and validated questionnaires to assess pelvic symptoms and sexual function. Complications were recorded (safety set; n = 121). RESULTS Median length of follow-up was 29 months (range 24-34 months). The primary anatomic success, defined as POP-Q 0-I, was 69.1%; however, in 84.5% of the cases, the leading vaginal edge was above the hymen. Pelvic symptoms and sexual function improved significantly from baseline (p < 0.01). Mesh exposure rate was 9.1%. Five percent reported stress urinary incontinence and 3.3% required further prolapse surgery. CONCLUSION These results indicate this non-anchored mesh repair is a safe and effective treatment for women with symptomatic vaginal prolapse in the medium term.
Collapse
|
49
|
Deffieux X, Savary D, Letouzey V, Sentilhes L, Agostini A, Mares P, Pierre F. Prévenir les complications de la chirurgie prothétique du prolapsus : recommandations pour la pratique clinique – Revue de la littérature. ACTA ACUST UNITED AC 2011; 40:827-50. [PMID: 22056180 DOI: 10.1016/j.jgyn.2011.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
50
|
Milani AL, Withagen MI, The HS, Nedelcu‐van der Wijk I, Vierhout ME. Sexual Function Following Trocar‐guided Mesh or Vaginal Native Tissue Repair in Recurrent Prolapse: A Randomized Controlled Trial. J Sex Med 2011; 8:2944-53. [DOI: 10.1111/j.1743-6109.2011.02392.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|