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Rotem R, Carey MO, McCarthy CM, O'Reilly BA, Daykan Y, O'Sullivan OE. Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology. BJOG 2024. [PMID: 39358908 DOI: 10.1111/1471-0528.17974] [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: 08/18/2024] [Revised: 09/13/2024] [Accepted: 09/19/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES This study aimed to evaluate the training and self-assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision-making, the surgical techniques employed, the training received, and the management of complications. DESIGN A cross-sectional survey. SETTING An electronic questionnaire. POPULATION European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members. METHODS A total of 33 questions evaluating surgeon preference regarding vaginal surgeries. MAIN OUTCOME MEASURES Demographics, surgical selection, proficiency and technique, and training methods. RESULTS There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two-thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10-30 cases were needed to achieve and maintain proficiency. CONCLUSION Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine-sparing prolapse repairs, the decision-making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques.
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Affiliation(s)
- Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - Michael O Carey
- Department of Obstetrics and Gynaecology, University College Dublin, Dublin, Ireland
| | - Claire M McCarthy
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Yair Daykan
- The Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Tius V, Arcieri M, Taliento C, Pellecchia G, Capobianco G, Simoncini T, Panico G, Caramazza D, Campagna G, Driul L, Scambia G, Ercoli A, Restaino S, Vizzielli G. Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review. Int J Gynaecol Obstet 2024. [PMID: 39324500 DOI: 10.1002/ijgo.15891] [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: 07/03/2024] [Accepted: 08/22/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH). OBJECTIVE To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process. SEARCH STRATEGY We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar. SELECTION CRITERIA We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available. DATA COLLECTION AND ANALYSIS A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0. MAIN RESULTS We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I2 = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I2 = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I2 = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I2 = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I2 = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively). CONCLUSIONS LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation. PROSPERO REGISTRATION NUMBER CRD42024537270.
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Affiliation(s)
- Veronica Tius
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Cristina Taliento
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
- Department of Development and Regeneration-Woman and Child, KU Leuven, Leuven, Belgium
| | - Giulia Pellecchia
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Giampiero Capobianco
- Department of Clinical and Experimental Medicine, Gynecologic and Obstetric Clinic, University of Sassari, Sassari, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Panico
- Department of Woman and Child's Health and Public Health, Division of Urogynecology and Reconstructive Surgery of Pelvic Floor, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniela Caramazza
- Precision Gynecological Surgery Unit, Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina, Rome, Italy
| | - Giuseppe Campagna
- Precision Gynecological Surgery Unit, Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina, Rome, Italy
| | - Lorenza Driul
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giovanni Scambia
- Department of Woman and Child's Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Ercoli
- Department of Human Pathology in Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, Sassari, Italy
| | - Giuseppe Vizzielli
- Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
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Vinnikov Y, Barzilay E, Barel O, Levy G. A novel technique for the measurement of cervical length in non-pregnant women. Australas J Ultrasound Med 2024; 27:141-148. [PMID: 39328260 PMCID: PMC11423437 DOI: 10.1002/ajum.12383] [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: 09/28/2024] Open
Abstract
Introduction Cervical elongation is considered a risk factor for pelvic organ prolapse treatment failure in uterine preservation surgery. Consensus has not been reached regarding what is considered a normal cervical length, or how to measure it. Our primary aim was to test a new technique for measuring cervical length. Materials and Methods We enrolled women undergoing hysterectomy, with or without pelvic organ prolapse (for all indications except cervical tumours/history of cervical operations). Their cervical lengths were measured both by ultrasound and anatomical measurement. The external length of the cervix was measured using Doppler location of the uterine artery near the cervical-uterine junction as the proximal point and compared to the ultrasound measurement of the cervical canal. The uterine specimen was used to record anatomical cervical measurements as well as uterine corpus length. Baseline characteristics such as age, body mass index and pelvic organ prolapse quantification were also collected. Results Twenty women were eligible for evaluation. We found the average anatomical cervical canal length was (ccAN) 33.95 mm (range ± 9.23) and by external measurement (ceAN) 36.80 mm (range ± 7.54). We found a significant, high-powered correlation between our ultrasound and anatomical measurements in both techniques, as well as between the two ultrasound techniques. We also found a negative correlation between cervical length and women's age (rp = -0.443, P = 0.05). Conclusion Transvaginal ultrasound measurement of cervical length using the location of the uterine artery was found to have a strong correlation to the anatomical cervical length and can be used for the measurement of normal cervical length.
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Affiliation(s)
- Yana Vinnikov
- Department of Obstetrics and Gynecology Maynei Hayeshua Hospital Bnei Brak Israel
| | - Eran Barzilay
- Division of Women's Ultrasound, Department of Obstetrics and Gynecology Assuta Samson University Hospital Ashdod Israel
| | - Oshri Barel
- Division of Gynecology, Department of Obstetrics and Gynecology Assuta Samson University Hospital Ashdod Israel
| | - Gil Levy
- Division of Female Pelvic Medicine, Department of Obstetrics and Gynecology Assuta Samson University Hospital Ashdod Israel
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Mukwege A, Harlow SD, Hood MM, Reed BD, Dugan SA, Miller JM. Race/Ethnicity and Incidence of Pelvic Organ Prolapse in Midlife Women: The Study of Women's Health Across the Nation. J Womens Health (Larchmt) 2024; 33:1042-1051. [PMID: 38551169 DOI: 10.1089/jwh.2023.0804] [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] [Indexed: 07/24/2024] Open
Abstract
Background: Pelvic organ prolapse (POP) affects a considerable proportion of women. Limited information exists regarding the incidence of POP as women transition through menopause. Using data from the Study of Women's Health Across the Nation (SWAN), this diverse community-based longitudinal cohort study assessed the incidence of symptomatic POP and risk by race/ethnicity. Methods: Self-reported POP was ascertained by questionnaire at 11 approximately annual SWAN visits over a median of 13.3 years of follow-up. We estimated probabilities for reporting POP using interval-censored Kaplan-Meier survival plots. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using interval-censored Cox proportional hazards models. Results: The estimated cumulative probability of POP increased linearly from 2.1% at age 45 to 10.1% by age 65 (4.0% per decade). At age 65, the probability was 4.2%, 4.8%, 8.9%, 9.7%, and 33.9% for Japanese, Chinese, Black, White, and Hispanic women, respectively. Compared with White women, the unadjusted HR for POP was 3.09 (95% CI = 2.18-4.39), 0.96 (0.71-1.31), 0.43 (0.22-0.85), and 0.48 (0.26-0.88) for Hispanic, Black, Chinese, and Japanese women, respectively. After adjustment for financial strain and vaginal birth, the low hazards among Chinese and Japanese women and the high hazard for Hispanic women remained significant. Conclusion: Incidence of symptomatic POP increased as women aged through midlife. Risks varied by race and ethnicity and were not accounted for by population differences in socioeconomic life contexts or the probability of having had a vaginal birth. Although not associated with menopause, health providers should incorporate screening for and information about POP when treating menopausal symptoms and health needs of midlife women. Research on pathophysiological factors associated with increasing POP in midlife is warranted.
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Affiliation(s)
- Alain Mukwege
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle M Hood
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Barbara D Reed
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation, Rush University System for Health, Chicago, Illinois, USA
| | - Janis M Miller
- Department of Health Behavior and Biological Science, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Lange S, Carlin G, Zängle R, Heinzl F, Umek W, Bodner-Adler B. Subjective Long-Term Outcomes After Vaginal Native Tissue Hysteropexy: Cohort Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:714-720. [PMID: 38289022 DOI: 10.1097/spv.0000000000001449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
IMPORTANCE There are still doubts about long-term satisfaction rates of native tissue uterine preserving surgical techniques for pelvic organ prolapse. OBJECTIVE The objective of this study was to compare long-term subjective success rates and satisfaction rates between vaginal sacrospinous hysteropexy (SSHP) and vaginal hysterectomy with uterosacral ligament suspension (VH-USLS). STUDY DESIGN This was a retrospective single-center, observational matched cohort study in women receiving either SSHP or VH-USLS between 2004 and 2021. Primary outcome was overall subjective success (combined outcome of absence of bulge nor retreatment, and satisfaction with operation) at least 12 months after surgery. Satisfaction with the operation was defined as a combined Patient Global Impression of Improvement rating ≤ 2 and a patient satisfaction score ≥7. RESULTS Of 583 patients, 192 patients could be matched (SSHP, 96; VH-USLS, 96), with 55% (SSHP, 60; VH-USLS, 45) participating at the telephone interview. Mean follow-up time was 77 months for VH-USLS, and 36 months for SSHP, respectively. No difference in overall subjective success rates was found between the groups (45% VH-USLS and 51% SSHP; P = 0.54). Overall satisfaction was similar between both groups (70% vs 71%, P = 0.90). Logistic regression found no influence of duration of follow-up and the overall subjective success rate. Both procedures would be recommended to a relative or friend by a large majority of patients (88% vs 85%, P = 0.761). Operative time and hospitalization time were significantly shorter in the SSHP group. No serious complications were reported. CONCLUSIONS Overall success rates did not differ between both procedures after at least 1 year of follow-up with relatively high satisfaction rates. Sacrospinous hysteropexy had shorter operative time and shorter duration of hospitalization.
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Dou Y, Deng L, Liang X, Cao F, Chen B, Tang S, Wang Y. A Retrospective Cohort Study of vNOTES Extraperitoneal Versus Laparoscopic Sacral Hysteropexy With Uterine Preserving Regarding Surgical Outcomes and Two-Year Follow-Up Results. J Minim Invasive Gynecol 2024; 31:584-591. [PMID: 38642887 DOI: 10.1016/j.jmig.2024.04.013] [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: 01/18/2024] [Revised: 04/06/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
STUDY OBJECTIVE To explore the effectiveness of transvaginal natural orifice transluminal endoscopic surgery extraperitoneal sacral hysteropexy (vNOTES-ESH) in women with symptomatic uterine prolapse over a 2 year follow-up. DESIGN Retrospective cohort study. SETTING Gynecological minimally invasive center. PATIENTS Women undergoing sacral hysteropexy either by vNOTES (n = 25) or laparoscopic (n = 74) between November 2016 and December 2020. INTERVENTIONS Both vNOTES-ESH and laparoscopic sacral hysteropexy (LAP-SH) were used for uterine prolapse. Demographic data, operative characteristics, perioperative outcomes, and follow-up information 2 years postsurgery in the 2 groups were retrospectively evaluated. RESULTS Both procedures showed similar operation time, estimated blood loss, hospital stays, and pain scores (p >0.05). During a median follow-up of 59 (24-72) months, the surgical success rate was 96% for vNOTES-ESH and 97.3% for LAP-SH (p >0.05), with no differences in anatomical position or pelvic organ function after the operation. Women in the LAP-SH group experienced more bothersome symptoms of constipation compared to those in the vNOTES-ESH group (5.41% vs 0, p <0.05). Lastly, 1 case in the vNOTES-ESH group had a mesh exposed area of less than 1 cm2, and 1 patient in the LAP-SH group experienced stress incontinence. CONCLUSIONS In this retrospective study, vNOTES-ESH met our patients' preference for uterine preservation and was a successful and effective treatment for uterine prolapse, providing good functional improvement in our follow-up. This procedure should be considered as an option for patients with pelvic organ prolapse.
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Affiliation(s)
- Yuya Dou
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Li Deng
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Xiaolong Liang
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Feng Cao
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Bingyu Chen
- The First Clinical College (Chen), Chongqing Medical University, Chongqing, China
| | - Shuai Tang
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China.
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Porcari I, Zorzato PC, Bosco M, Garzon S, Magni F, Salvatore S, Franchi MP, Uccella S. Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 166:173-189. [PMID: 38269852 DOI: 10.1002/ijgo.15343] [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: 09/09/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned. OBJECTIVES To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair. SEARCH STRATEGY MEDLINE and Embase databases were searched from inception to January 2023. SELECTION CRITERIA We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded. DATA COLLECTION AND ANALYSIS A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI). MAIN RESULTS Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups. CONCLUSIONS No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors.
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Affiliation(s)
- Irene Porcari
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Francesca Magni
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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de Tayrac R, Cosson M. Vaginal Hysterectomy and Pelvic Organ Prolapse: History and Recent Developments. Int Urogynecol J 2024; 35:1363-1373. [PMID: 38691125 DOI: 10.1007/s00192-024-05783-7] [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: 11/13/2023] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable. METHODS Literature review to provide an overview of current evidence and experts' opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use. RESULTS Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery. CONCLUSIONS Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care.
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Affiliation(s)
- Renaud de Tayrac
- Department of Obstetrics and Gynecology, Caremeau University Hospital, Nimes, France.
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
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Schiavi MC, Passarello A, Grossi G, Calcagno M, Contadini A, Ferro G, DI Pasquale F, Zullo MA, Morciano A, Valensise H, Palazzetti PL, Cervigni M, Caiazzo N. Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention. Minerva Obstet Gynecol 2024; 76:272-278. [PMID: 38088742 DOI: 10.23736/s2724-606x.23.05399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND The aim of this study was to evaluate effectiveness and safety of laparoscopic lateral suspension in women affected by high grade uterine prolapse associated to anterior defect. The secondary endpoint is to evaluate mid-term impact on Quality of Life and sexual function. METHODS A multicenter retrospective study on women undergoing laparoscopic lateral suspension for uterine prolapse ≥III stage was performed. We included 174 women, but due to exclusion criteria, 134 patients were enrolled for this study. Preoperative evaluation consisted of an urogynecological interview, clinical exam, 3-day voiding diary and urodynamic testing; the prolapse Quality of Life Questionnaire was used to quantify the impact of prolapse symptoms on Quality of Life and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form, the Female Sexual Function Index and the Female Sexual Distress Scale were administered to evaluate sexual function before surgical intervention and at median follow-up of 3.8 years. RESULTS We included 134 women with uterine prolapse ≥III stage. All patients underwent laparoscopic lateral suspension, 8 also posterior colporrhaphy and 5 also transobturator tape insertion. POP-Q classification score for anterior and apical compartment showed a significant average decrease. The surveys administered to patients showed an improvement in Quality of Life, an increase in the number of monthly intercourses and a significant improvement in sexual life after surgery. CONCLUSIONS Laparoscopic lateral suspension for pelvic organ prolapse correction is a safe and effective technique for uterine and anterior associated defect. Quality of Life and sexual function significantly improved after surgery.
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Affiliation(s)
- Michele C Schiavi
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | | | - Giovanni Grossi
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Marco Calcagno
- Department of Obstetrics and Gynecology, Santo Spirito Hospital, Rome, Italy
| | - Alessia Contadini
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy -
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Gabriella Ferro
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Federica DI Pasquale
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Marzio A Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione Card. G. Panico, Tricase, Lecce, Italy
| | - Herbert Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Casilino Hospital, Rome, Italy
| | - Pier L Palazzetti
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | | | - Nicola Caiazzo
- Department of Urology, Sapienza University, ICOT-Latina, Latina, Italy
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Pecorella G, Morciano A, Sparic R, Tinelli A. Literature review, surgical decision making algorithm, and AGREE II-S comparison of national and international recommendations and guidelines in pelvic organ prolapse surgery. Int J Gynaecol Obstet 2024. [PMID: 38760975 DOI: 10.1002/ijgo.15614] [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: 03/13/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II-S (AGREE II-S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German-speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous-hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
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Deffieux X, Perrouin-Verbe MA, Campagne-Loiseau S, Donon L, Levesque A, Rigaud J, Stivalet N, Venara A, Thubert T, Vidart A, Bosset PO, Revel-Delhom C, Lucot JP, Hermieu JF. Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 2024; 294:170-179. [PMID: 38280271 DOI: 10.1016/j.ejogrb.2024.01.015] [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: 12/22/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
Complications associated with pelvic organ prolapse (POP) surgery using a synthetic non-absorbable mesh are uncommon (<5%) but may be severe and may hugely diminish the quality of life of some women. In drawing up these multidisciplinary clinical practice recommendations, the French National Authority for Health (Haute Autorité de santé, HAS) conducted an exhaustive review of the literature concerning the diagnosis, prevention, and management of complications associated with POP surgery using a synthetic mesh. Each recommendation for practice was allocated a grade (A,B or C; or expert opinion (EO)), which depends on the level of evidence (clinical practice guidelines). PREOPERATIVE PATIENTS' INFORMATION Each patient must be informed concerning the risks associated with POP surgery (EO). HEMORRHAGE, HEMATOMA Vaginal infiltration using a vasoconstrictive solution is not recommended during POP surgery by the vaginal route (grade C). The placement of vaginal packing is not recommended following POP surgery by the vaginal route (grade C). During laparoscopic sacral colpopexy, when the promontory seems highly dangerous or when severe adhesions prevent access to the anterior vertebral ligament, alternative surgical techniques should be discussed per operatively, including colpopexy by lateral mesh laparoscopic suspension, uterosacral ligament suspension, open abdominal mesh surgery, or surgery by the vaginal route (EO). BLADDER INJURY When a bladder injury is diagnosed, bladder repair by suturing is recommended, using a slow resorption suture thread, plus monitoring of the permeability of the ureters (before and after bladder repair) when the injury is located at the level of the trigone (EO). When a bladder injury is diagnosed, after bladder repair, a prosthetic mesh (polypropylene or polyester material) can be placed between the repaired bladder and the vagina, if the quality of the suturing is good. The recommended duration of bladder catheterization following bladder repair in this context of POP mesh surgery is from 5 to 10 days (EO). URETER INJURY After ureteral repair, it is possible to continue sacral colpopexy and place the mesh if it is located away from the ureteral repair (EO). RECTAL INJURY Regardless of the approach, when a rectal injury occurs, a posterior mesh should not be placed between the rectum and the vagina wall (EO). Concerning the anterior mesh, it is recommended to use a macroporous monofilament polypropylene mesh (EO). A polyester mesh is not recommended in this situation (EO). VAGINAL WALL INJURY After vaginal wall repair, an anterior or a posterior microporous polypropylene mesh can be placed, if the quality of the repair is found to be satisfactory (EO). A polyester mesh should not be used after vaginal wall repair (EO). MESH INFECTION (ABSCESS, CELLULITIS, SPONDYLODISCITIS) Regardless of the surgical approach, intravenous antibiotic prophylaxis is recommended (aminopenicillin + beta-lactamase inhibitor: 30 min before skin incision +/- repeated after 2 h if surgery lasts longer) (EO). When spondylodiscitis is diagnosed following sacral colpopexy, treatment should be discussed by a multidisciplinary group, including especially spine specialists (rheumatologists, orthopedists, neurosurgeons) and infectious disease specialists (EO). When a pelvic abscess occurs following synthetic mesh sacral colpopexy, it is recommended to carry out complete mesh removal as soon as possible, combined with collection of intraoperative bacteriological samples, drainage of the collection and targeted antibiotic therapy (EO). Non-surgical conservative management with antibiotic therapy may be an option (EO) in certain conditions (absence of signs of sepsis, macroporous monofilament polypropylene type 1 mesh, prior microbiological documentation and multidisciplinary consultation for the choice of type and duration of antibiotic therapy), associated with close monitoring of the patient. BOWEL OCCLUSION RELATED TO NON-CLOSURE OF THE PERITONEUM Peritoneal closure is recommended after placement of a synthetic mesh by the abdominal approach (EO). URINARY RETENTION Preoperative urodynamics is recommended in women presenting with urinary symptoms (bladder outlet obstruction symptoms, overactive bladder syndrome or incontinence) (EO). It is recommended to remove the bladder catheter at the end of the procedure or within 48 h after POP surgery (grade B). Bladder emptying and post-void residual should be checked following POP surgery, before discharge (EO). When postoperative urine retention occurs after POP surgery, it is recommended to carry out indwelling catheterization and to prefer intermittent self-catheterization (EO). POSTOPERATIVE PAIN Before POP surgery, the patient should be asked about risk factors for prolonged and chronic postoperative pain (pain sensitization, allodynia, chronic pelvic or non-pelvic pain) (EO). Concerning the prevention of postoperative pain, it is recommended to carry out a pre-, per- and postoperative multimodal pain treatment (grade B). The use of ketamine intraoperatively is recommended for the prevention of chronic postoperative pelvic pain, especially for patients with risk factors (preoperative painful sensitization, allodynia, chronic pelvic or non-pelvic pain) (EO). Postoperative prescription of opioids should be limited in quantity and duration (grade C). When acute neuropathic pain (sciatalgia or pudendal neuralgia) resistant to level I and II analgesics occurs following sacrospinous fixation, a reintervention is recommended for suspension suture removal (EO). When chronic postoperative pain occurs after POP surgery, it is recommended to systematically seek arguments in favor of neuropathic pain with the DN4 questionnaire (EO). When chronic postoperative pelvic pain occurs after POP surgery, central sensitization should be identified since it requires a consultation in a chronic pain department (EO). Concerning myofascial pain syndrome (clinical pain condition associated with increased muscle tension caused by myofascial trigger points), when chronic postoperative pain occurs after POP surgery, it is recommended to examine the levator ani, piriformis and obturator internus muscles, so as to identify trigger points on the pathway of the synthetic mesh (EO). Pelvic floor muscle training with muscle relaxation is recommended when myofascial pain syndrome is associated with chronic postoperative pain following POP surgery (EO). After failure of pelvic floor muscle training (3 months), it is recommended to discuss surgical removal of the synthetic mesh, during a multidisciplinary discussion group meeting (EO). Partial removal of synthetic mesh is indicated when a trigger point is located on the pathway of the mesh (EO). Total removal of synthetic mesh should be discussed during a multidisciplinary discussion group meeting when diffuse (no trigger point) chronic postoperative pain occurs following POP surgery, with or without central sensitization or neuropathic pain syndromes (EO). POSTOPERATIVE DYSPAREUNIA When de novo postoperative dyspareunia occurs after POP surgery, surgical removal of the mesh should be discussed (EO). VAGINAL MESH EXPOSURE To reduce the risk of vaginal mesh exposure, when hysterectomy is required during sacral colpopexy, subtotal hysterectomy is recommended (grade C). When asymptomatic vaginal macroporous monofilament polypropylene mesh exposure occurs, systematic imaging is not recommended. When vaginal polyester mesh exposure occurs, pelvic +/- lumbar MRI (EO) should be used to look for an abscess or spondylodiscitis, given the greater risk of infection associated with this type of material. When asymptomatic vaginal mesh exposure of less than 1 cm2 occurs in a woman with no sexual intercourse, the patient should be offered observation (no treatment) or local estrogen therapy (EO). However, if the patient wishes, partial excision of the mesh can be offered. When asymptomatic vaginal mesh exposure of more than 1 cm2 occurs or if the woman has sexual intercourse, or if it is a polyester prosthesis, partial mesh excision, either immediately or after local estrogen therapy, should be offered (EO). When symptomatic vaginal mesh exposure occurs, but without infectious complications, surgical removal of the exposed part of the mesh by the vaginal route is recommended (EO), and not systematic complete excision of the mesh. Following sacral colpopexy, complete removal of the mesh (by laparoscopy or laparotomy) is only required in the presence of an abscess or spondylodiscitis (EO). When vaginal mesh exposure recurs after a first reoperation, the patient should be treated by an experienced team specialized in this type of complication (EO). SUTURE THREAD VAGINAL EXPOSURE For women presenting with vaginal exposure to non-absorbable suture thread following POP surgery with mesh reinforcement, the suture thread should be removed by the vaginal route (EO). Removal of the surrounding mesh is only recommended when vaginal mesh exposure or associated abscess is diagnosed. BLADDER AND URETERAL MESH EXPOSURE When bladder mesh exposure occurs, removal of the exposed part of the mesh is recommended (grade B). Both alternatives (total or partial mesh removal) should be discussed with the patient and should be debated during a multidisciplinary discussion group meeting (EO).
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Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Marie-Aimée Perrouin-Verbe
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes F-44000, France
| | - Sandrine Campagne-Loiseau
- Centre Hospitalier Universitaire de Clermont Ferrand, Service de gynécologie obstétrique, Clermont-Ferrand F-63000, France
| | | | - Amélie Levesque
- Centre Hospitalier Universitaire Nantes, Service d'urologie, Nantes F-44093, France
| | - Jérome Rigaud
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes F-44000, France
| | - Nadja Stivalet
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris F-75017, France
| | - Aurélien Venara
- Université d'Angers, Centre Hospitalier Universitaire d'Angers, Service de chirurgie digestive, Angers F-49000, France
| | - Thibault Thubert
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service de gynécologie-obstétrique, Nantes F-44000, France
| | - Adrien Vidart
- Hôpital Foch, Service d'urologie, Suresnes F-92150, France
| | | | | | - Jean-Philippe Lucot
- Université catholique de Lille, Service de gynécologie-obstétrique, Lille F-59000, France
| | - Jean François Hermieu
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris F-75017, France
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Arab W, Lukanović D, Matjašič M, Blaganje M, Deval B. Determinants of Dissatisfaction After Laparoscopic Cure of Vaginal and/or Rectal Prolapse using Mesh: a Comprehensive Retrospective Cohort Study. Int Urogynecol J 2024; 35:457-465. [PMID: 38206336 DOI: 10.1007/s00192-023-05701-3] [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: 07/18/2023] [Accepted: 11/15/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The primary objective is to identify determinants of dissatisfaction after surgical treatment of vaginal prolapse ± rectal prolapse, using laparoscopic mesh sacrohysteropexy (LSH) or sacrocolpopexy (LSC) ± ventral mesh rectopexy (VMR). The secondary objective is the evaluation of complications and objective/subjective recurrence rates. METHODS The study performed was a single-surgeon retrospective review of prospectively collected data. LSH/LSC ± VMR were performed between July 2005 and September 2022. Primary investigated outcome was patients' satisfaction, assessed using the Patient Global Impression of Improvement (PGI-I) score and the bother visual analog scale (VAS) obtained postoperatively (at a 1-month interval and on a 6-month/yearly basis thereafter). We looked for a correlation between the level of satisfaction (as reflected by the VAS) and potential determinants. RESULTS There were 355 patients with a mean age of 62 ±12 years. Nearly all the patients (94.3%) had a stage 3 or 4 prolapse according to the POP-Q classification. The mean postoperative bother VAS was 1.8, with only 12.7% of patients reporting a bother VAS score ≥ 3/10, indicating a dissatisfaction. PGI-I showed improvement in the vast majority of patients (96.4% scoring 1 to 3). Patients with anal incontinence preoperatively scored higher on the bother VAS postoperatively (r=0.175, p < 0.05). The use of a posterior arm mesh (for posterior vaginal prolapse) correlated with better satisfaction overall (r= -0.178, p = 0.001), whereas the performance of VMR was associated with a bothering sensation (r = 0.232, p < 0.001). A regression analysis confirmed the impact of posterior mesh and VMR on satisfaction levels, with odds of dissatisfaction being 2.18 higher when VMR was combined with LSH/LSC. CONCLUSIONS Posterior mesh use improves patient satisfaction when the posterior compartment is affected. In patients with concomitant vaginal and rectal prolapse, combining VMR with anterior LSC/LSH appears to negatively impact patients' satisfaction. Preoperative anal incontinence was demonstrated to be a risk factor for postoperative dissatisfaction.
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Affiliation(s)
- Wissam Arab
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - David Lukanović
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Matjašič
- Department of Education Studies, Faculty of Education, University of Ljubljana, Ljubljana, Slovenia
| | - Mija Blaganje
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
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Cox KR, Ferzandi TR, Dancz CE, Mandelbaum RS, Klar M, Wright JD, Matsuo K. Nationwide assessment of practice variability in the utilization of hysteropexy at laparoscopic apical suspension for uterine prolapse. AJOG GLOBAL REPORTS 2024; 4:100322. [PMID: 38586613 PMCID: PMC10994978 DOI: 10.1016/j.xagr.2024.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Although hysteropexy has been used to preserve the uterus during uterine prolapse surgery for a long time, there is a scarcity of data that describe the nationwide patterns of use of this surgical procedure. OBJECTIVE This study aimed to examine the national-level use and characteristics of hysteropexy at the time of laparoscopic apical suspension surgery for uterine prolapse in the United States. STUDY DESIGN This cross-sectional study used data from the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample. The study population included 55,608 patients with a diagnosis of uterine prolapse who underwent laparoscopic apical suspension surgery from 2016 to 2019. Patients who had a hysterectomy were assigned to the hysterectomy group, and those who did not have a hysterectomy were assigned to the hysteropexy group. The main outcome was clinical characteristics associated with hysteropexy, assessed using a multivariable binary logistic regression model. A classification tree was further constructed to assess the use pattern of hysteropexy during laparoscopic apical suspension procedures. The secondary outcome was surgical morbidity, including urinary tract injury, intestinal injury, vascular injury, and hemorrhage. RESULTS A hysteropexy was performed in 6500 (11.7%) patients. In a multivariable analysis, characteristics associated with increased use of a hysteropexy included (1) patient factors, such as older age, Medicare coverage, private insurance, self-pay, and medical comorbidity; (2) pelvic floor dysfunction factor of complete uterine prolapse; and (3) hospital factors, including medium bed capacity center and location in the Southern United States (all P<.05). Conversely, (1) the patient factor of higher household income; (2) gynecologic factors such as uterine myoma, adenomyosis, and benign ovarian pathology; (3) pelvic floor dysfunction factor with stress urinary incontinence; and (4) hospital factors including Midwest and West United States regions and rural setting center were associated with decreased use of a hysteropexy (all P<.05). A classification tree identified a total of 14 use patterns for hysteropexies during laparoscopic apical suspension procedures. The strongest factor that dictated the use of a hysteropexy was the presence or absence of uterine myomas; the rate of hysteropexy use was decreased to 5.6% if myomas were present in comparison with 15% if there were no myomas (P<.001). Second layer factors were adenomyosis and hospital region. Patients who did not have uterine myomas or adenomyosis and who underwent surgery in the Southern United States had the highest rate of undergoing a hysteropexy (22.6%). Across the 14 use patterns, the percentage rate difference between the highest and lowest uptake patterns was 22.0%. Patients who underwent a hysteropexy were less likely to undergo anteroposterior colporrhaphy, posterior colporrhaphy, and sling procedures (all P<.05). Hysteropexy was associated with a decreased risk for measured surgical morbidity (3.0 vs 5.4 per 1000 procedures; adjusted odds ratio, 0.57; 95% confidence interval, 0.36-0.90). CONCLUSION The results of these current, real-world practice data suggest that hysteropexies are being performed at the time of ambulatory laparoscopic apical suspension surgery for uterine prolapse. There is substantial variability in the application of hysteropexy based on patient, gynecologic, pelvic floor dysfunction, and hospital factors. Developing clinical practice guidelines to address this emerging surgical practice may be of use.
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Affiliation(s)
- Kaily R. Cox
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Cox and Matsuo)
| | - Tanaz R. Ferzandi
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Ferzandi and Dancz)
| | - Christina E. Dancz
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Ferzandi and Dancz)
| | - Rachel S. Mandelbaum
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Mandelbaum)
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg Faculty of Medicine, Freiburg, Germany (Dr Klar)
| | - Jason D. Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY (Dr Wright)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Cox and Matsuo)
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Dr Matsuo)
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Wang J, Shang X, Huang J, Wang J. Effect of different surgical techniques on postoperative wound infection in patients with uterine prolapse: A meta-analysis. Int Wound J 2024; 21:e14588. [PMID: 38272813 PMCID: PMC10794079 DOI: 10.1111/iwj.14588] [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: 11/17/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
The assumption is that a number of controlled trials have been conducted to assess the impact of uterus retaining or hysterectomy on wound and haemorrhage, but there is no indication as to which method would be more beneficial for wound healing. This research is intended to provide a comprehensive overview of the availability of wound healing in case studies of both operative methods. From inception to October 2023, four databases were reviewed. The odds ratio (OR) and the mean difference (MD) for both groups were computed with a random effect model, as well as the corresponding 95% confidence intervals. A total of five studies were carried out in the overall design and enrolled 16 972 patients. No statistical significance was found in the rate of postoperative wound infection among the two treatments (OR,1.46; 95% CI,0.66,3.22 p = 0.35); The rates of bleeding after surgery did not differ significantly from one procedure to another (OR,1.41; 95% CI,0.91,2.17 p = 0.12); two studies demonstrated no statistical significance for the rate of incisional hernia after surgery (OR,2.58; 95% CI,0.37,18.05 p = 0.34). Our findings indicate that there is a similar risk between uterine preservation and hysterectomies for the incidence of wound infection, haemorrhage and protrusion of incision.
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Affiliation(s)
- Jinyun Wang
- People's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xianping Shang
- People's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jingjie Huang
- Community Health Service Center of Yangli StreetJinanChina
| | - Jing Wang
- Laiwu District Gaozhuang Street Community Health Service CentreJinanChina
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15
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Schreibmayer M, Bolovis DI, Brucker CVM. Apical prolapse correction by unilateral pectineal suspension. Arch Gynecol Obstet 2024; 309:315-316. [PMID: 37233808 PMCID: PMC10770223 DOI: 10.1007/s00404-023-07067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Michael Schreibmayer
- University Women's Hospital, Paracelsus Medical University, Nuremberg, Germany.
- Department of Obstetrics and Gynecology, Krankenhaus Barmherzige Brüder St.Veit/Glan, St. Veit an der Glan, Austria.
- Paracelsus Medical University, Salzburg, Austria.
| | - Dimitrios I Bolovis
- University Women's Hospital, Paracelsus Medical University, Nuremberg, Germany
- Paracelsus Medical University, Salzburg, Austria
- Georg Simon Ohm Technical University, Nuremberg, Germany
| | - Cosima V M Brucker
- University Women's Hospital, Paracelsus Medical University, Nuremberg, Germany
- Paracelsus Medical University, Salzburg, Austria
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16
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Thubert T, Degez M. Routine uterine preservation during sacrocolpopexy for apical prolapse - pro. Prog Urol 2023; 33:1044-1046. [PMID: 37996210 DOI: 10.1016/j.purol.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
- T Thubert
- Department of Gynecology Obstetric, University Hospital Hotel Dieu Nantes, Nantes, France.
| | - M Degez
- Department of Gynecology Obstetric, University Hospital Hotel Dieu Nantes, Nantes, France
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17
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Ryu SM, Cho JS, Kong MK, Bai SW. The incidence and risk factors of occult malignancy in patients receiving vaginal hysterectomy for pelvic organ prolapse. Int Urogynecol J 2023; 34:2719-2724. [PMID: 37401960 DOI: 10.1007/s00192-023-05576-4] [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: 03/16/2023] [Accepted: 05/13/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess the incidence and risk factors for premalignant and malignant pathology in patients receiving vaginal hysterectomy (VH) and pelvic floor repair (PFR) for pelvic organ prolapse (POP). METHODS We performed a retrospective cohort study of pathological results after VH and PFR of 569 women at our institution from January 2011 through December 2020. Age, body mass index (BMI), POP-Q stage, and preoperative ultrasound results were evaluated as risk factors for occult malignancy. RESULTS Six of the 569 patients (1.1%) had unanticipated premalignant uterine pathology and 2 (0.4%) had unanticipated malignant uterine pathology (endometrial cancer). There was no significant difference in the incidence of premalignant or malignant uterine pathology according to age, BMI, and POP-Q stage. However, if endometrial pathology is confirmed on preoperative ultrasonography, the probability of confirming malignant pathology increases (OR 4.63; 95% CI 1.84-51.4; p=0.016). CONCLUSION The incidence of occult malignancy during VH for POP was significantly lower than that found in hysterectomy owing to benign disease. In the case of POP patients, for whom uterine-conserving surgery is not absolutely contraindicated, it can be performed. However, if endometrial pathology is confirmed by preoperative ultrasonography, uterine-conserving surgery is not recommended.
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Affiliation(s)
- Soo Min Ryu
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jeong Soo Cho
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Mi Kyung Kong
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sang Wook Bai
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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18
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Li Z, Zheng Y, Shen F, Liu M, Zhou Y. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques. Open Med (Wars) 2023; 18:20230833. [PMID: 37900959 PMCID: PMC10612525 DOI: 10.1515/med-2023-0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 08/20/2023] [Accepted: 10/08/2023] [Indexed: 10/31/2023] Open
Abstract
Contemporary understanding of the dynamic anatomy of pelvic floor support has led us to new conservative surgery for uterine prolapse (UP). In this study, we comprehensively evaluate the safety and feasibility of a new technique for uterine-preserving pelvic organ prolapse surgery: laparoscopic rectus abdominis hysteropexy for uterine prolapse (LRAHUP). A retrospective study was conducted between 2006 and 2016. Sixty-five women diagnosed with advanced prolapsed uterus were eligible and grouped into traditional vaginal surgery (TVS, n = 30) group and new laparoscopic surgery (NLS, n = 35) group. Evaluated items of 65 cases included surgery-related parameters and postoperative outcomes. Surgical safety evaluating indicators, including operation time, blood loss, postoperative hospitalized day, and operation complications, also showed great significant difference between two groups (P < 0.05). The subjective index of post-operative Pelvic Floor Distress Inventory-short form 20 scores and some objective anatomic outcomes all showed great difference between pre- and post-operation (P < 0.05). Although the TVL showed no difference between pre- and post-operation in the same group, the TVL displayed a remarkable elongation. And a remarkable tendency was a higher cumulative recurrence ratio in the TVS group and a shorter follow-up period in the NLS group. LRAHUP may be a good procedure to manage women with advanced prolapsed uterus.
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Affiliation(s)
- Zijun Li
- Department of Gynecology, The People’s Hospital of LongQuan, LongQuan, China
| | - Yaqin Zheng
- Clinical Laboratory Centre, The People’s Hospital of LongQuan, LongQuan, Zhejiang, China
| | - Fangrong Shen
- Department of Gynecology, Soochow University Affiliated First Hospital, Suzhou, China
| | - Ming Liu
- Department of Gynecology, Zhejiang Quhua Hospital, Quzhou, Zhejiang, China
| | - Ying Zhou
- Imagning Diagnosis Center, Zhejiang Quhua Hospital, Quzhou, Zhejiang, China
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Schroeder MN, Wu JM, Margulies SL, Willis-Gray MG. PROMIS pain intensity and interference after pelvic organ prolapse surgery. Int Urogynecol J 2023; 34:2415-2420. [PMID: 37145124 DOI: 10.1007/s00192-023-05547-9] [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: 01/05/2023] [Accepted: 04/08/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires provide valid comparisons across disciplines. Pain measures can be used to track functional outcomes. Limited PROMIS pain data exist in gynecological surgery. We sought to use pain intensity and pain interference short forms to assess pain and recovery after pelvic organ prolapse surgery. METHODS The PROMIS pain intensity and pain interference questionnaires were given to patients undergoing uterosacral ligament suspension (USLS), sacrospinous ligament fixation (SSLF) or minimally invasive sacrocolpopexy (MISC) at baseline, 1 week, and 6 weeks postoperatively. Clinical minimally important change was defined as a difference of 2-6 T-score points. Mean pain intensity and pain interference T-scores were compared at baseline, 1 week and 6 weeks with ANOVA. Multiple linear regression assessed 1-week scores adjusted for apical suspension type, advanced prolapse, concurrent hysterectomy, concurrent anterior or posterior repair, and concurrent sling. RESULTS At 1 week, all apical suspension groups showed minimally important change in pain intensity and pain interference T-scores. Between groups at 1 week, pain interference was higher in USLS (66.3±6.6) and MISC (65.5±5.9) than in SSLF (59.2±9.8), p=0.01. Multiple linear regression showed an association of hysterectomy with increases in pain intensity and pain interference. USLS had a higher proportion of concurrent hysterectomy (100%) than SSLF (0%) and MISC (30.8%), p<0.01. No difference was found based on apical suspension type alone. CONCLUSIONS No differences were found in PROMIS pain intensity and pain at 1 week postoperatively after apical suspension procedures.
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Affiliation(s)
- Michelle N Schroeder
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jennifer M Wu
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samantha L Margulies
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marcella G Willis-Gray
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chen CC, Peng IT, Wu MP. The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery. Gynecol Minim Invasive Ther 2023; 12:203-210. [PMID: 38034113 PMCID: PMC10683956 DOI: 10.4103/gmit.gmit_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 12/02/2023] Open
Abstract
In the "boat at the dock" theory, pelvic organ prolapse (POP) may happen when the ropes (uterine supportive ligaments) break and/or the water level drops (pelvic floor muscles). Thus, it causes the boat (uterus and other pelvic organs) to slip from normal position and protrude out of the vagina. Surgical intervention with or without hysterectomy (hystero-preservation) is the most effective treatment for POP. Both hysterectomy and hystero-preservation for POP had a high anatomic and clinical cure rate. There is an increasing trend of hystero-preservation for POP during the past decades. The choices of either hysterectomy or hystero-preservation depend on the surgical factors, psychosocial factors, self-esteem and sexuality factors, and surgeon factors. Pelvic reconstructive surgery, either hysterectomy or hystero-preservation, can be performed via different approaches, including abdominal, laparoscopic, and vaginal routes, with native tissue or with mesh. This review will elucidate their related pros and cons, with further discussion and comparison of hystero-preservation via different routes.
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Affiliation(s)
- Chin-Chiu Chen
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Ting Peng
- Division of Obstetrics, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Sato H, Otsuka S, Abe H, Tsukada S. Comparison of outcomes of laparoscopic sacrocolpopexy with concomitant supracervical hysterectomy or uterine preservation. Int Urogynecol J 2023; 34:2217-2224. [PMID: 37052646 PMCID: PMC10506926 DOI: 10.1007/s00192-023-05534-0] [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: 01/12/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy was traditionally performed for post-hysterectomy prolapse or during concurrent hysterectomy. Sacrocolpopexy outcome with uterine preservation is poorly investigated. This study compared outcomes of laparoscopic sacrocolpopexy with concurrent supracervical hysterectomy or uterine preservation. METHODS This retrospective study compared data of patients with pelvic organ prolapse who underwent laparoscopic sacrocolpopexy with uterine preservation with the data of controls who underwent laparoscopic sacrocolpopexy with supracervical hysterectomy. We analyzed composite failure in uterine preservation versus concurrent supracervical hysterectomy (primary objective) and evaluated factors associated with the primary outcome of composite failure after laparoscopic sacrocolpopexy with preservation or supracervical hysterectomy (secondary objective). Composite failure was defined as subjective bulge symptoms, reoperation, or anatomical prolapse. Cox models indicated time to composite failure as an endpoint. RESULTS Of 274 patients, 232 underwent laparoscopic sacrocolpopexy with supracervical hysterectomy and 42 underwent laparoscopic uterine preservation. After propensity score matching (ratio: 2, for the laparoscopic sacrocolpopexy with supracervical hysterectomy group), 56 patients (24.1%) were in the supracervical hysterectomy group and 28 (66.7%) in the uterine preservation group. All patients underwent 24 months of follow-up. The composite failure rates were 10.7% for supracervical hysterectomy and 3.6% for preservation (p=0.87). The mean estimated blood loss was 10 ml (preservation, 10.0 ml [5.0-10.0] versus supracervical hysterectomy, 10.0 ml [10.0-15.0]; p=0.007). In the Cox proportional hazards model, higher preoperative body mass index and the point Ba increased composite failure risk. CONCLUSIONS Although not statistically significant, composite failure in the two techniques is likely clinically meaningful.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan.
| | - Shota Otsuka
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sachiyuki Tsukada
- Department of Orthopedics, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Enklaar RA, Schulten SFM, van Eijndhoven HWF, Weemhoff M, van Leijsen SAL, van der Weide MC, van Bavel J, Verkleij-Hagoort AC, Adang EMM, Kluivers KB. Manchester Procedure vs Sacrospinous Hysteropexy for Treatment of Uterine Descent: A Randomized Clinical Trial. JAMA 2023; 330:626-635. [PMID: 37581670 PMCID: PMC10427949 DOI: 10.1001/jama.2023.13140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
Importance In many countries, sacrospinous hysteropexy is the most commonly practiced uterus-preserving technique in women undergoing a first operation for pelvic organ prolapse. However, there are no direct comparisons of outcomes after sacrospinous hysteropexy vs an older technique, the Manchester procedure. Objective To compare success of sacrospinous hysteropexy vs the Manchester procedure for the surgical treatment of uterine descent. Design, Setting, and Participants Multicenter, noninferiority randomized clinical trial conducted in 26 hospitals in the Netherlands among 434 adult patients undergoing a first surgical treatment for uterine descent that did not protrude beyond the hymen. Interventions Participants were randomly assigned to undergo sacrospinous hysteropexy (n = 217) or Manchester procedure (n = 217). Main Outcomes and Measures The primary outcome was a composite outcome of success, defined as absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by a standardized vaginal support quantification system, absence of bothersome bulge symptoms, and absence of prolapse retreatment (pessary or surgery) within 2 years after the operation. The predefined noninferiority margin was 9%. Secondary outcomes were anatomical and patient-reported outcomes, perioperative parameters, and surgery-related complications. Results Among 393 participants included in the as-randomized analysis (mean age, 61.7 years [SD, 9.1 years]), 151 of 196 (77.0%) in the sacrospinous hysteropexy group and 172 of 197 (87.3%) in the Manchester procedure group achieved the composite outcome of success. Sacrospinous hysteropexy did not meet the noninferiority criterion of -9% for the lower limit of the CI (risk difference, -10.3%; 95% CI, -17.8% to -2.8%; P = .63 for noninferiority). At 2-year follow-up, perioperative outcomes and patient-reported outcomes did not differ between the 2 groups. Conclusions Based on the composite outcome of surgical success 2 years after primary uterus-sparing pelvic organ prolapse surgery for uterine descent, these results support a finding that sacrospinous hysteropexy is inferior to the Manchester procedure. Trial Registration TrialRegister.nl Identifier: NTR 6978.
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Affiliation(s)
- Rosa A. Enklaar
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sascha F. M. Schulten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Mirjam Weemhoff
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Marijke C. van der Weide
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen van Bavel
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, the Netherlands
| | | | - Eddy M. M. Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Thanatsis N, Ben Zvi M, Kupelian AS, Vashisht A. Laparoscopic suture sacrohysteropexy: A meshless uterine- sparing technique for surgical management of uterine prolapse. Facts Views Vis Obgyn 2023; 15:171-173. [PMID: 37436056 PMCID: PMC10410661 DOI: 10.52054/fvvo.15.2.075] [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: 07/13/2023] Open
Abstract
BACKGROUND Laparoscopic mesh sacrohysteropexy has been established as an effective, safe, and popular technique to treat uterine prolapse. Nevertheless, recent controversies regarding the role of synthetic mesh in pelvic reconstructive surgery have triggered a trend towards meshless procedures. Other laparoscopic native tissue prolapses techniques such as uterosacral ligament plication and sacral suture hysteropexy have been previously described in literature. OBJECTIVES To describe a meshless minimally invasive technique with uterine preservation, which incorporates steps from the above-mentioned procedures. MATERIALS AND METHODS We present a case of a 41-year-old patient with stage II apical prolapse and stage III cystocele and rectocele, who was keen to proceed to surgical management preserving her uterus and avoiding the use of a mesh implant. The narrated video demonstrates the surgical steps of our technique of laparoscopic suture sacrohysteropexy. MAIN OUTCOME MEASURES Objective (i.e., anatomic) and subjective (i.e., functional) surgical success on follow-up assessment at least 3 months post-surgery, similarly to every prolapse procedure. RESULTS Excellent anatomical result and resolution of prolapse symptoms at follow-up appointments. CONCLUSIONS Our technique of laparoscopic suture sacrohysteropexy seems a logical progression in prolapse surgery, responding to patients' wishes for minimally invasive meshless procedures with uterine preservation while at the same time achieving excellent apical support. Its long-term efficacy and safety need to be carefully assessed before it becomes established in clinical practice. LEARNING OBJECTIVE To demonstrate a laparoscopic uterine-sparing technique to treat uterine prolapse without the use of a permanent mesh.
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Chan IS, Chen GY, Shih YC, Jiang LY, Chang YH, Wang TY, Chen YJ. Robot-assisted sacrohysteropexy vs robot-assisted sacrocolpopexy in women with primary advanced apical prolapse: A retrospective cohort study. J Chin Med Assoc 2023; 86:418-425. [PMID: 36859778 DOI: 10.1097/jcma.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the anatomic and clinical outcomes of robot-assisted sacrohysteropexy (RASH) against robot-assisted sacrocolpopexy (RASC) for the treatment of primary advanced apical prolapse. METHODS We conducted a retrospective cohort study of all robot-assisted pelvic organ prolapse surgeries for primary advanced apical prolapse (stage ≥II) between January 2011 and May 2021 at an academic tertiary hospital. Surgical outcomes and pelvic organ function were evaluated using the Pelvic Organ Prolapse Quantitative (POP-Q) stage and validated questionnaires (POPDI-6) during preoperative and postoperative 12-month follow-up evaluations. All data were obtained from electronic medical records. RESULTS A total of 2368 women underwent surgery for apical prolapse repair, and 18 women underwent either RASH (n = 11) or RASC (n = 7). Compared to the RASC group, the RASH group was significantly younger, premenopausal, and less parous. Preoperative prolapse stage, operative time, estimated blood loss, and hospitalization length was comparable between the groups. No intraoperative complications were observed. All women had a median follow-up duration of 24 months (range: 12-108 months). During the 12-month follow-up period, women in the RASH group reported higher satisfaction with the surgery than those in the RASC group (100% vs. 71.4%, p = 0.137). The mesh exposure rate was significantly higher in the RASC group (3/7, 42.9%) than in the RASH group (0/11, 0%) ( p = 0.043), which was found at 12 to 36 months postoperatively and was successfully managed with vaginal estrogen cream. In the RASH group, one woman required reoperation with anterior colporrhaphy for recurrent anterior prolapse at 60 months postoperatively. The apical success rate was 100% at one year postoperatively, without apical recurrence in either group during the follow-up period. CONCLUSION RASH represents an effective and feasible option for the surgical treatment of advanced primary apical prolapse in women who desire uterine preservation and have a significantly lower risk of mesh erosion than RASC.
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Affiliation(s)
- I-San Chan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Guan-Yeu Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Chu Shih
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Hou Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzu-Ya Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Alsary S, Alsahabi J, Al Baalharith M. Outcomes of Pregnancy and Recurrence of Pelvic Organ Prolapse After Laparoscopic Sacrocolpopexy With Uterine Preservation: A Retrospective Case-Series Study. Cureus 2023; 15:e37874. [PMID: 37091483 PMCID: PMC10116998 DOI: 10.7759/cureus.37874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION The objective is to study the pregnancy outcomes and the recurrence of pelvic organ prolapse (POP) following laparoscopic sacrocolpopexy (SCP) with uterine preservation in patients who are considering future fertility. METHODS This is a retrospective study in single teaching hospital. The study included six young women who conceived spontaneously, after laparoscopic SCP. Data were retrieved from the medical records of patients who underwent laparoscopic SCP and became pregnant after surgery. RESULTS A total of six women conceived spontaneously. Two of them got pregnant twice. The total number of pregnancies was considered to be eight. Two pregnancies ended in spontaneous miscarriages; one of them required dilatation and curettage. Five pregnancies were carried out to term, and one pregnancy ended by preterm delivery at 32 weeks. All the neonates were at appropriate weight as per their respective gestational ages except the one preterm delivery, which was small for gestational age. No intraoperative difficulties were reported during all cesarean sections. Follow-up was documented by objective assessment for more than four years post laparoscopic SCP. No recurrent apical prolapse was found. Only one patient had a recurrent, symptomatic, grade two cystocele that required reoperation. CONCLUSION Patients who desired fertility and presented with symptomatic high-grade POP were good candidates for laparoscopic SCP. Our findings demonstrate the visibility of laparoscopic SCP as an effective surgical intervention that not only levitates symptomatic POP but preserves fertility in young women.
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Affiliation(s)
- Saeed Alsary
- Department of Obstetrics and Gynecology, Urogynecology Division, Ministry of the National Guard - Health Affairs, Riyadh, SAU
- Department of Obstetrics and Gynecology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Jawaher Alsahabi
- Department of Obstetrics and Gynecology, Urogynecology Division, Ministry of the National Guard - Health Affairs, Riyadh, SAU
| | - Maha Al Baalharith
- Department of Obstetrics and Gynecology, Urogynecology Division, Ministry of the National Guard - Health Affairs, Riyadh, SAU
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Serati M, Salvatore S, Torella M, Scancarello C, De Rosa A, Ruffolo AF, Caccia G, Ghezzi F, Papadia A, Baruch Y, Braga A. Hysteropexy and Anterior Vaginal Native Tissue Repair in Women with Anterior and Central Compartment Prolapse: A Long Term Follow-Up. J Clin Med 2023; 12:jcm12072548. [PMID: 37048632 PMCID: PMC10095252 DOI: 10.3390/jcm12072548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Although it is known that hysterectomy (HY) alone cannot resolve apical prolapse, vaginal hysterectomy (VH) remains the most common surgical procedure for this issue. In recent years, various procedures for uterine conservation have been proposed to avoid the surgical risks of HY. Furthermore, most women with symptomatic pelvic organ prolapse (POP) prefer uterine conservation in the absence of considerable benefit in uterine removal. In 2017, we proposed a new technique for hysteropexy and anterior vaginal native tissue repair (NTR) in women with cystocele and apical prolapse. The objective of this study is to assess the efficacy and safety of this new procedure after at least 5 years of follow-up. We included only patients with stage II or greater prolapse of the anterior vaginal wall and a concomitant stage II uterine prolapse in accordance with Pelvic Organ Prolapse Quantification (POP-Q) system. A Patient Global Impression of Improvement (PGI-I) score ≤ 2 in addition with the absence of POP symptoms was defined as subjective success. A descensus with a maximum point of less than −1 in any compartment was considered objective cure. A total of 102 patients who fulfilled the inclusion criteria were enrolled. At 60 months follow-up, 90 out of 102 patients (88%) were subjectively cured, whereas 88 out of the 102 (86%) patients were objectively cured. Subjective and objective cure rates persisted during the entire study period. Uni- and multivariate analysis of possible predictive factors associated with recurrence of prolapse showed that only a preoperative point C > 0 cm and BMI ≥ 25 kg/m2 were risk factors for failure. In conclusion, our study showed that hysteropexy with anterior vaginal native tissue repair may be an effective and safe option for the treatment of anterior vaginal prolapse and concomitant stage II uterine prolapse by at least 5 years of follow-up.
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Sacrospinous Hysteropexy Versus Prolapse Hysterectomy with Apical Fixation: A Retrospective Comparison over an 18 Year Period. J Clin Med 2023; 12:jcm12062176. [PMID: 36983178 PMCID: PMC10059856 DOI: 10.3390/jcm12062176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background. Pelvic organ prolapse (POP) is a common health problem, with a high lifetime risk for prolapse surgery. Uterine-preserving procedures such as vaginal sacrospinous hysteropexy (SSH) have become an increasingly utilized surgical option for the primary treatment of POP. We wanted to evaluate peri- and postoperative outcome parameters of SSH as an alternative to vaginal hysterectomy with apical fixation. Methods. A retrospective cohort study was conducted (2003–2021). All patients who underwent primary SSH (study group) for symptomatic POP were matched 1:1 by age and BMI with patients who underwent primary prolapse hysterectomy with apical fixation (control group). Results. A total of 192 patients were included with 96 patients in the each of the SSH and hysterectomy groups. There were no statistically significant differences in baseline characteristics. The SSH group show a significantly shorter mean surgery time (p < 0.001), significantly fewer hospitalization days (p < 0.001), and significantly less intraoperative blood loss (p = 0.033) in comparison to the control group. Neither group had any intraoperative complication, or an intraoperative conversion to other surgical management options. No statistically significant difference was found in postoperative complications as categorized by the Clavien–Dindo classification or in postoperative urogynecological issues (UTI, de-novo, incontinence, residual urine, voiding disorders). Through log regression, none of the confounding factors such as age, BMI, or preoperative POP-Q stage could be identified as independent risk factors for the occurrence of postoperative complications. Conclusions. Our results confirm that a uterus-preserving technique has many benefits and, thus, should be considered as an additional intermediate step in a long-term treatment plan of pelvic organ prolapse.
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Laparoscopic pectopexy with native tissue repair for pelvic organ prolapse. Arch Gynecol Obstet 2023; 307:1867-1872. [PMID: 36879174 PMCID: PMC9988597 DOI: 10.1007/s00404-023-06980-3] [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: 10/30/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The use of mesh for vaginal repair is currently problematic; consequently, there is increased interest in native tissue repair. Combining native tissue repair with sufficient mesh-applied apical repair might provide effective treatment. We describe the study focusing on the combination of pectopexy and native tissue repair. METHODS Between April 2020 and November 2021, 49 patients with symptomatic stage III or IV were treated with laparoscopic pectopexy combined with native tissue repair. The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. The perioperative parameters including surgical time, blood loss, hospital stay, and complications were recorded. The anatomical cure rate was evaluated according to the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. Validated questionnaires of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were recorded to evaluate the symptom severity and quality of life. RESULTS The mean duration of follow-up was 15 months. All domains of POP-Q, PFDI-20, and PFIQ-7 scores improved significantly after surgery. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. CONCLUSION The overall repair concept of laparoscopic pectopexy as the core, assisted by vaginal natural tissue repair for severe pelvic organ prolapse can achieve satisfactory clinical results and improve patient satisfaction.
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Pizzoferrato AC, Thuillier C, Vénara A, Bornsztein N, Bouquet S, Cayrac M, Cornillet-Bernard M, Cotelle O, Cour F, Cretinon S, De Reilhac P, Loriau J, Pellet F, Perrouin-Verbe MA, Pourcelot AG, Revel-Delhom C, Steenstrup B, Vogel T, Le Normand L, Fritel X. Management of female pelvic organ prolapse-Summary of the 2021 HAS guidelines. J Gynecol Obstet Hum Reprod 2023; 52:102535. [PMID: 36657614 DOI: 10.1016/j.jogoh.2023.102535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
When a patient presents with symptoms suggestive of pelvic organ prolapse (POP), clinical evaluation should include an assessment of symptoms, their impact on daily life and rule out other pelvic pathologies. The prolapse should be described compartment by compartment, indicating the extent of the externalization for each. The diagnosis of POP is clinical. Additional exams may be requested to explore the symptoms associated or not explained by the observed prolapse. Pelvic floor muscle training and pessaries are non-surgical conservative treatment options recommended as first-line therapy for pelvic organ prolapse. They can be offered in combination and be associated with the management of modifiable risk factors for prolapse. If the conservative therapeutic options do not meet the patient's expectations, surgery should be proposed if the symptoms are disabling, related to pelvic organ prolapse, detected on clinical examination and significant (stage 2 or more of the POP-Q classification). Surgical routes for POP repair can be abdominal with mesh placement, or vaginal with autologous tissue. Laparoscopic sacrocolpopexy is recommended for cases of apical and anterior prolapse. Autologous vaginal surgery (including colpocleisis) is a recommended option for elderly and fragile patients. For cases of isolated rectocele, the posterior vaginal route with autologous tissue should be preferentially performed over the transanal route. The decision to place a mesh must be made in consultation with a multidisciplinary team. After the surgery, the patient should be reassessed by the surgeon, even in the absence of symptoms or complications, and in the long term by a primary care or specialist doctor.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France, INSERM CIC 1402, Poitiers University, Poitiers, France.
| | - Caroline Thuillier
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | - Aurélien Vénara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - Nicole Bornsztein
- General practice office, Evry France, College of General Medicine, Paris, France
| | - Sylvain Bouquet
- General practice office, Lamastre, France, College of General Medicine, Paris, France
| | - Mélanie Cayrac
- GYNEPOLE, Obstetrics and Gynecology Center, Montpellier, France
| | | | - Odile Cotelle
- Department of Obstetrics and Gynaecology, AP-HP, GHU Sud, Antoine Béclère Hospital, Clamart, France
| | - Florence Cour
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Sophie Cretinon
- Department of Obstetrics and Gynaecology, AP-HP Louis Mourier Hospital, Colombes, France
| | | | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Françoise Pellet
- French Association of Gougerot Sjögren and Dry Syndromes, Paris, France
| | | | - Anne-Gaëlle Pourcelot
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Christine Revel-Delhom
- Clinical practice guidelines Unit, French National Authority for Health, Saint Denis La Plaine, France
| | | | - Thomas Vogel
- Geriatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Loïc Le Normand
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Xavier Fritel
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France, INSERM CIC 1402, Poitiers University, Poitiers, France
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Elsibai Anter M, Elsayed Ellakwa H, Fouad Sanad Z, Abd-Elhameed Nasr-Eldin M, Ramzy Rashid M. Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial. Actas Urol Esp 2023:S2173-5786(23)00013-6. [PMID: 36750158 DOI: 10.1016/j.acuroe.2023.02.004] [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: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/07/2023]
Abstract
IMPORTANCE uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. OBJECTIVE compare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. STUDY DESIGN This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. RESULTS High statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). CONCLUSIONS Using Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.
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Affiliation(s)
| | | | - Z Fouad Sanad
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - M Ramzy Rashid
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Andebrhan SB, Caron AT, Szlachta-McGinn A, Parameshwar PS, Jackson NJ, Rosenman AE, Anger JT, Ackerman AL. Pelvic organ prolapse recurrence after pregnancy following uterine-sparing prolapse repair: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:345-356. [PMID: 35920935 DOI: 10.1007/s00192-022-05306-2] [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: 06/03/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We sought to determine rates of pelvic organ prolapse (POP) recurrence following pregnancy and delivery in reproductive-age women with prior hysteropexy. METHODS Scopus, MEDLine, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched from inception to May 2020 for combinations of any of the keywords: "pregnancy", "delivery", "fertility", or "cesarean" with a comprehensive list of uterine-sparing surgical procedures for POP repair. Using approach, 1,817 articles were identified describing surgical, uterine-sparing POP repair techniques and subsequent pregnancy and delivery outcomes in reproductive-age women. RESULTS: Twenty-seven studies describing 218 pregnancies, including 215 deliveries and 3 abortions, were summarized using narrative review and descriptive statistics. Successful pregnancies were reported following a diverse range of uterine-sparing prolapse repairs, both native tissue and mesh-augmented, that utilized vaginal, open abdominal, and laparoscopic approaches. We observed shifts from native tissue repairs to mesh-augmented laparoscopic repairs over time. POP recurrence occurred in 12% of subjects overall, 15% after vaginal and 10% after abdominal prolapse repairs. While meta-analysis identified higher recurrence rates after vaginal delivery (15%) than cesarean section (10%), due to small study numbers, multiple confounders, and heterogeneity between studies, no significant differences in recurrence rates could be identified between vaginal and abdominal surgical approaches, utilization of mesh augmentation, or mode of delivery. CONCLUSION Although literature on pregnancy following uterine-sparing POP repair is limited, available data suggest that prolapse recurrence after pregnancy and delivery remains similar to that after prolapse repair without subsequent pregnancies with few documented perinatal complications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021247722.
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Affiliation(s)
- Sarah B Andebrhan
- Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, IL, USA
| | - Ashley T Caron
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Alec Szlachta-McGinn
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Nicholas J Jackson
- Department of Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
| | - Amy E Rosenman
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Urology, University of California, San Diego, CA, USA
| | - A Lenore Ackerman
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Box 951738, Los Angeles, CA, 90095-1738, USA.
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Chill HH, Cohen A, Dick A, Reuveni-Salzman A, Shveiky D. The effect of uterine volume on surgical outcomes following uterine preserving apical prolapse repair. Eur J Obstet Gynecol Reprod Biol 2023; 281:49-53. [PMID: 36535070 DOI: 10.1016/j.ejogrb.2022.12.019] [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: 10/09/2022] [Revised: 11/22/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In recent years uterine preservation has become a popular option in women undergoing pelvic organ prolapse repair. The aim of this study was to evaluate the effect of uterine volume on outcomes following uterine preserving surgical treatment for apical prolapse. METHODS We performed a retrospective comparative study at a tertiary university hospital. Included were women who had uterine preserving surgical treatment for apical prolapse. The cohort was divided into two groups: 1) Patients with a uterine volume ≥ 35 cm3 (large uterus group); 2) Patients with uterine volume < 35 cm3 (small uterus group). Pre-, intra-, and post-operative data were compared between groups. Our primary outcome was composite outcome success including clinical and anatomical success and no need for reoperation. Secondary outcomes included clinical success, anatomical success, and patient satisfaction evaluated using the PGI-I questionnaire. RESULTS Eighty-four patients were included in the final analysis. The large uterus group (≥35 cm3) consisted of 37 patients as opposed to 47 in the small uterus group (<35 cm3). Clinical (91.9 % vs 87.1 %, p = 0.725) and anatomical success (84.8 % vs 90.9 %, p = 0.508) were high and did not differ between groups. Composite outcome success was 76.1 % in the small uterus group compared to 87.9 % in the large uterus group, but this difference was not statistically significant. Post-operative points Ba, C and Bp were similar between groups. No difference was found in patient satisfaction measured using the PGI-I questionnaire. CONCLUSION Women undergoing uterine preserving apical prolapse repair with uterine volume ≥ 35 cm3 have comparable surgical outcomes to patients with a smaller uterus.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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Chang OH, Tewari S, Yao M, Walters MD. Who Places High Value on the Uterus? A Cross-sectional Survey Study Evaluating Predictors for Uterine Preservation. J Minim Invasive Gynecol 2023; 30:131-136. [PMID: 36332820 DOI: 10.1016/j.jmig.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To determine predictors for placing high value on the uterus in patients who no longer desire fertility. The secondary objective was to identify reasons for placing high value on the uterus. DESIGN Cross-sectional survey study. SETTING Three hospitals within a large healthcare system in the United States. PATIENTS New patients ≥45 years old seeking care for benign gynecologic conditions, including abnormal uterine bleeding, uterine myomas, pelvic organ prolapse, endometriosis, or pelvic pain. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the summative score of the validated Value of Uterus (VALUS) instrument for measuring value placed on the uterus and the validated visual analog scale with the question "how important is it to you to keep your uterus when you have a gynecologic condition?" A total of 163 surveys were returned for analysis (79.2%). Using the VALUS cutoff, 64 patients (45.7%) were considered to have low value for their uterus (VALUS score <14), whereas 76 patients (54.3%) were considered to have high value for their uterus (VALUS score ≥14). The adjusted odds of placing high value for the uterus was 5.06 times higher among those who wanted to be sexually active in the future than those who do not desire to be sexually active (95% confidence interval, 1.55-16.52, p = .01). Patients who are sexually active have 3.94 higher adjusted odds of placing high value on the uterus than those who are not sexually active and do not desire to be (95% confidence interval, 1.36-11.43; p = .01). Race, religion, and personal history of cancer were not statistically significant. CONCLUSION Patients who highly value the uterus were highly motivated by the desire to be sexually active. Nonwhite race, religion, and personal history of cancer were not predictors for placing high value on uterine preservation.
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Affiliation(s)
- Olivia H Chang
- Division of Female Urology, Pelvic Reconstructive Surgery and Voiding Dysfunction, Department of Urology, University of California Irvine (Dr. Chang), Orange, CA.
| | - Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (Ms. Tewari), Cleveland Clinic, Cleveland, Ohio
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic (Mr. Yao), Cleveland, Ohio
| | - Mark D Walters
- Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute (Dr. Walters), Cleveland Clinic, Cleveland, Ohio
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Aksin Ş, Andan C. Postoperative results of laparoscopic lateral suspension operation: A clinical trials study. Front Surg 2023; 10:1069110. [PMID: 36793321 PMCID: PMC9924084 DOI: 10.3389/fsurg.2023.1069110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Background Pelvic organ prolapse surgery carries potential risks, and Laparoscopic lateral suspension (LLS) surgery is being performed in increasing numbers with advances in minimally invasive surgery. Our study aims to report the postoperative results of LLS operations. Patients and Methods 41 patients at POP Q stage 2 and above underwent LLS operations in a tertiary center between 2017 and 2019. Postoperative patients 12 (12-37) months and older were evaluated in terms of anterior and apical compartments. Results In our study, laparoscopic lateral suspension (LLS) was applied to 41 patients. The mean age of all patients was 51.45 ± 11.51, and the operation time was 71.13 ± 18.70 min, The mean hospital stay was 1.35 ± 0.4 days. The apical compartment success rate was 78% and the anterior compartment success rate was 73%. In terms of patient satisfaction, 32 (78.1%) patients were satisfied, While 37 (90.1%) patients did not have abdominal mesh pain, 4 (9.9%) patients had mesh pain. Dyspareunia was not observed. Conclusions Laparoscopic lateral suspension in pop surgery; Considering the success rate below expectation, some patient groups can be applied as an alternative surgical method.
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Affiliation(s)
- Şerif Aksin
- Obstetrics and Gynecology Department, Fakulty of Medicine, Siirt University, Siirt, Turkey,Correspondence: Şerif Aksin
| | - Cengiz Andan
- Obstetrics and Gynecology Department, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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A scoping review of theories used to investigate clinician adherence to clinical practice guidelines. Int J Clin Pharm 2023; 45:52-63. [PMID: 36385205 PMCID: PMC9938823 DOI: 10.1007/s11096-022-01490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine utilization of evidence-based clinical practice guidelines (CPGs) is an effective strategy to optimize patient care and reduce practice variation. Healthcare professionals' failure to adhere to CPGs introduces risks to both patients and the sustainability of healthcare systems. The integration of theory to investigate adherence provides greater insight into the often complex reasons for suboptimal behaviors. AIM To determine the coverage of literature surrounding the use of theory in studies of CPG adherence, report the key findings and identify the knowledge gaps. METHOD In April 2021, three bibliographic databases were searched for studies published since January 2010, adopting theory to investigate health professionals' adherence to CPGs. Two reviewers independently screened the articles for eligibility and charted the data. A narrative approach to synthesis was employed. RESULTS The review includes 12 articles. Studies were limited to primarily investigations of physicians, quantitative designs, single disease states and few countries. The use of behavioral theories facilitated pooling of data of barriers and facilitators of adherence. The domains and constructs of a number of the reported theories are captured within the Theoretical Domains Framework (TDF); the most common barriers aligned with the TDF domain of environmental context and resources, fewer studies reported facilitators. CONCLUSION There is emerging use of behavioral theories investigating physicians' adherence to CPGs. Although limited in number, these studies present specific insight into common barriers and facilitators, thus providing valuable evidence for refining existing and future implementation strategies. Similar investigations of other health professionals are warranted.
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Chan JCY, Yu CH, Go WW. Clinical outcomes and complications of laparoscopic sacrocolpopexy with versus without concomitant hysterectomy for pelvic organ prolapse in Hong Kong Chinese patients after median follow-up of 7 years. Int Urogynecol J 2023; 34:271-278. [PMID: 36394632 DOI: 10.1007/s00192-022-05403-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This retrospective cohort study is aimed at comparing outcomes and complications of laparoscopic sacrocolpopexy (LSC) with or without concomitant hysterectomy in the Hong Kong Chinese population. METHODS Women with stage II or above uterine or apical vault prolapse who underwent LSC with or without concomitant hysterectomy in a regional referral unit from 2007 to 2019 were included. The primary objectives were to compare the anatomical outcomes by pelvic organ prolapse quantification system (POP-Q) and recurrence of apical vault prolapse (≥stage II). The secondary objective was to compare the functional outcomes and complications. Anatomical recurrence and incidence of mesh exposure were analyzed using the Kaplan-Meier method. Cox proportional hazard regression was performed to identify risk factors of anatomical recurrence. RESULTS Seventy-six women were included for analysis. The recurrence rate of apical vault prolapse was 3.9% after a median follow-up time of 83 months (20-190 months). A significant reduction of POP-Q scores of three compartments in both groups of women were demonstrated (p<0.001). There was no difference between the two groups in terms of functional outcomes and complications. 6.6% of women developed mesh exposure. The time to recurrence of apical vault prolapse was shorter in women who had LSC with prior hysterectomy (p =0.019). No risk factors were identified for recurrence of apical vault prolapse. CONCLUSIONS Laparoscopic sacrocolpopexy with concomitant hysterectomy is comparable with LSC alone. The recurrence and complication rates are low. We suggest that LSC with concomitant hysterectomy might be offered to women with pelvic organ prolapse, with women's preference taken into account.
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Affiliation(s)
- Joyce Chung Yin Chan
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
| | - Chun Hung Yu
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Wing Wa Go
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Kumbasar S, Salman S, Sogut O, Gencer FK, Bacak HB, Tezcan AD, Timur GY. Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse. J Obstet Gynaecol Res 2023; 49:341-349. [PMID: 36196844 DOI: 10.1111/jog.15459] [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: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. METHODS LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. RESULTS The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p ˂ 0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. CONCLUSION LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.
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Affiliation(s)
- Serkan Kumbasar
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Suleyman Salman
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ozlem Sogut
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Fatma K Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Havva B Bacak
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ayse D Tezcan
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Gözde Y Timur
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
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Ramage K, Ducey A, Scime NV, Knox E, Brennand EA. Factors affecting women's decision between uterine-preserving versus hysterectomy-based surgery for pelvic organ prolapse. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231181015. [PMID: 37387264 PMCID: PMC10333630 DOI: 10.1177/17455057231181015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/09/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Given the prevalence of women seeking surgical treatment for pelvic organ prolapse (POP), there is a need to understand women's decision-making regarding uterine-preserving versus hysterectomy-based surgeries. Historically, hysterectomy-based surgeries have been the preferred treatment for pelvic organ prolapse; however, contemporary evidence supports uterine-preserving surgeries as equivalent. At present, the lack of information available to the general public and limited options presented at surgical consultation for pelvic organ prolapse may hinder women's autonomy as they navigate surgical treatment. OBJECTIVES To examine the factors affecting women's decision-making processes regarding uterine-preserving or hysterectomy-based surgery for pelvic organ prolapse. DESIGN This is a qualitative study. METHODS We conducted semi-structured, qualitative interviews with women seeking surgery for pelvic organ prolapse to explore the factors affecting women's decision-making between hysterectomy-based and uterine-preserving surgeries. RESULTS Women (n = 26) used clinical and personal factors to determine which surgery was best. Women noted that the lack of evidence (clinical and/or anecdotal) available to them hindered their decision-making, causing them to rely more on their own interpretations of the evidence, what they perceived to be "normal," and what their surgeon recommended. Even with standardized discussion regarding the existing clinical equipoise between surgeries at the clinical consultation, some women still had misperceptions that hysterectomy-based surgery would convey the lowest risk of prolapse recurrence and be best for severe prolapse. CONCLUSION There is a need for more transparency in discussions about prolapse and the factors affecting women's decision-making for surgical repair of pelvic organ prolapse. Clinicians should be prepared to offer the option of hysterectomy-based or uterine-preserving surgeries and to clearly explain the clinical equipoise between these procedures.
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Affiliation(s)
- Kaylee Ramage
- Department of Obstetrics and
Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
| | - Ariel Ducey
- Department of Sociology, Faculty of
Arts, University of Calgary, Calgary, AB, Canada
| | - Natalie V Scime
- Department of Obstetrics and
Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
- Department of Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
| | - Erin Knox
- Department of Sociology, Faculty of
Arts, University of Calgary, Calgary, AB, Canada
| | - Erin A Brennand
- Department of Obstetrics and
Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
- Department of Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
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Gopinath D, Yong C, Harding-Forrester S, McIntyre F, McKenzie D, Carey M. Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison. Int Urogynecol J 2023; 34:105-113. [PMID: 35881174 PMCID: PMC9834130 DOI: 10.1007/s00192-022-05283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/11/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Our study was aimed at comparing the outcomes of laparoscopic and robot-assisted laparoscopic suture-based hysteropexy (SutureH) versus sacral hysteropexy using mesh (MeshH) for bothersome uterine prolapse. Our hypothesis is that MeshH is more successful and provides better uterine support than SutureH. METHODS A retrospective cohort study of 228 consecutive women who underwent re-suspension of the uterus using uterosacral ligaments (SutureH n=97) or a "U-shaped" mesh from the sacral promontory (MeshH, n=132). Surgery was performed by laparoscopy or robot-assisted laparoscopy. Subjects were assessed at baseline, 1 year, and beyond 1 year. The null hypothesis, that SutureH and MeshH have similar success, was based on a composite outcome ("composite success"), and that they provide the same level of uterine support, was based on POP-Q point C at 1 year. "Composite success" was defined as: POP-Q point C above the hymen; absence of a vaginal bulge; no repeat uterine prolapse surgery or pessary placement. Other outcomes included improvement in symptomology using Patient Global Impression of Improvement, POP-Q point C change and complications. RESULTS Follow-up data were available for 191 out of 228 women. "Composite success" was not significantly different between MeshH and SutureH groups (81.7% vs 84.5%, p=0.616). MeshH provided better elevation of the uterus than SutureH (point C change: -7.38cm vs -6.99cm; p<0.001). Similar symptom improvement and low complications occurred in both groups. CONCLUSIONS Laparoscopic and robot-assisted laparoscopic suture hysteropexy and mesh sacral hysteropexy provide women with minimally invasive, durable surgical options for uterine preservation. "Composite success" was similar in the two groups, but MeshH provided better uterine support than SutureH. However, SutureH gives women an effective mesh-free option.
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Affiliation(s)
- Deepa Gopinath
- Nepean Clinical School, Nepean Hospital, Sydney, Kingswood, 2747, Australia.
| | - Chin Yong
- Epworth HealthCare, Melbourne, Australia
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Enklaar RA, Knapen FMFM, Schulten SFM, van Osch LADM, van Leijsen SAL, Gondrie ETCM, Weemhoff M. The modified Manchester Fothergill procedure compared with vaginal hysterectomy with low uterosacral ligament suspension in patients with pelvic organ prolapse: long-term outcome. Int Urogynecol J 2023; 34:155-164. [PMID: 35652948 PMCID: PMC9160845 DOI: 10.1007/s00192-022-05240-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/19/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to compare the long-term outcome between vaginal hysterectomy with low uterosacral ligament suspension (VH) and the modified Manchester Fothergill procedure (MF) as surgical treatment in patients with pelvic organ prolapse (POP). We hypothesize that MF is non-inferior to VH in the long term. METHODS In this single-center retrospective cohort study patients who underwent MF or VH for primary apical compartment prolapse between 2003 and 2009 were eligible for inclusion. The primary outcome was subjective recurrence of POP. Secondary outcomes included number and type of reinterventions, time to reintervention and the degree of complaints. RESULTS One hundred sixty of 398 patients (53 MF, 107 VH) returned the questionnaires (40%). The mean follow-up was 12.97 years for MF and 13.24 years for VH (p = 0.38). There were similar rates of subjective POP recurrence (51% in both groups). The reintervention rate in the MF group was higher but reached no statistical significance [19/53 (36%) versus 29/107 (27%), p = 0.26]. Kaplan-Meier curve showed no statistically significant difference in risk of reintervention after MF at the maximum follow-up of 16.5 years [HR 1.830 (95% CI 0.934-3.586), p = 0.08]. The mean time to reintervention was 3 years shorter in the MF group (p = 0.03). CONCLUSIONS The subjective recurrence after MF is similar to VH in treatment of POP at the long term. MF appears to be non-inferior to VH when comparing the risk of reintervention. However, the small sample size precludes a definitive conclusion of non-inferiority, and future studies are needed.
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Affiliation(s)
- Rosa A Enklaar
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands.
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Femke M F M Knapen
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sascha F M Schulten
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Sanne A L van Leijsen
- Department of Obstetrics & Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Ed T C M Gondrie
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
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Lozo S, Chill HH, Botros C, Goldberg RP, Gafni-Kane A. Long term surgical outcomes of vaginal colposuspension using the Uphold Lite™ mesh system vs. vaginal vault uterosacral ligament suspension for treatment of apical prolapse. Eur J Obstet Gynecol Reprod Biol 2023; 280:150-153. [PMID: 36493584 DOI: 10.1016/j.ejogrb.2022.11.025] [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: 08/29/2022] [Revised: 09/29/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The aim of this study is to compare long-term outcomes (7-10 years) between vaginal hysterectomy with uterosacral ligament suspension (VHUSLS) and sacrospinous hysteropexy with the Uphold™ Lite mesh System (SHU) for management of apical prolapse. METHODS Patients undergoing VHUSLS or SHU from 2008 to 2012 at a single tertiary referral center were included. Patients were contacted, asked to return for physical examination, and to complete the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Our primary outcome was anatomic failure defined as Stage 2 POP or higher of any compartment. The secondary outcome was subjective changes in symptoms based upon PFDI-20 responses. RESULTS Two-hundred and two women were identified to have undergone the index surgeries from 2008 to 2012. Sixty-three agreed to return for follow up symptom evaluation and examination (30 VHUSLS and 33 SHU). Baseline characteristics were similar between groups. Clinical cure was high for both groups reaching 93.4 % and 94.0 % for the VHUSLS and SHU groups, respectively (p = 0.721). Anatomical success was lower with 44.7 % and 66.7 % of patients in the VHUSLS and SHU groups, respectively, meeting criteria for success (p = 0.138). There were no mesh complications among patients returning for exams. However, two patients who were contacted and were not interested in this study reported mesh complications and need for additional surgeries. Anterior vaginal wall support was noted to be significantly better supported for SHU (Ba -2.03 ± 0.75 vs -1.42 ± 0.92, p = 0.008). There were no differences between groups for overall PFDI-20 scores postoperatively. However, SHU patients reported higher rates of stress urinary incontinence compared to VHUSLS patients. CONCLUSION In women with apical prolapse, VHUSLS and SHU afford similar long-term outcomes. SHU patients reported higher rates of stress urinary incontinence.
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Affiliation(s)
- Svjetlana Lozo
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, NYC, NY, USA
| | - Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Carolyn Botros
- Atlantic Urogynecology Associates, Department of Obstetrics and Gynecology, Morristown, NJ, USA
| | - Roger P Goldberg
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Adam Gafni-Kane
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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Yan L, Lu S, Zhao C, Lei L, Liu L. Comparison of Different Laparoscopic Sacropexy Procedures for Advanced Uterine Prolapse: A Retrospective Analysis. J Minim Invasive Gynecol 2022; 30:300-307. [PMID: 36563872 DOI: 10.1016/j.jmig.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To compare the long-term outcomes and complications of 3 different variants of laparoscopic sacropexy. DESIGN Single-center retrospective cohort study. SETTING A tertiary university hospital. PATIENTS A total of 483 patients with advanced uterine prolapse who underwent laparoscopic sacrohysteropexy (LSH), laparoscopic supracervical hysterectomy with concomitant laparoscopic sacrocervicopexy (LSCH + LSC), or total laparoscopic hysterectomy with concomitant laparoscopic sacrocolpopexy (TLH + LSC). INTERVENTIONS Demographic data, Pelvic Organ Prolapse Quantification scores, questionnaire results, surgical conditions, postoperative outcomes, and complications were all extracted from medical and follow-up records. MEASUREMENTS AND MAIN RESULTS Between April 2012 and December 2020, 277 women underwent LSH, 95 women underwent LSCH + LSC, and 111 women underwent TLH + LSC. LSH procedures were associated with statistically significantly least blood loss and least postoperative hospital days and catheterization days (all p <.001). During the median follow-up of 32 months (13-117 months), analysis of the data revealed notable anatomic correction in all groups regarding Pelvic Organ Prolapse Quantification measurements (p <.001), and the anatomic cure rate showed no significant difference among these 3 groups (p = .273). No statistically significant differences were detected for prolapse recurrence (p = .171) and functional improvements among these groups. Neither intraoperative injuries (p = .098) nor total postoperative complications (p = .218) differed considerably, whereas the rate of severe postoperative complications (p <.001) including mesh exposure (p = .004) was significantly higher in the TLH + LSC group than that in the other groups. CONCLUSIONS LSH is the appropriate choice for women with uterine prolapse without contraindications for uterine preservation. For patients with benign uterine lesions and a normal cervix, LSCH + LSC is a safer approach that provides similar anatomic results and improved quality of life scores that are similar to those of TLH + LSC. For patients with lesions in the uterus and cervix, TLH + LSC should be selected.
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Affiliation(s)
- Li Yan
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Shentao Lu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Chengzhi Zhao
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Li Lei
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Lubin Liu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China..
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Chill HH, Shusel O, Dick A, Moss NP, Cohen A, Reuveni-Salzman A, Shveiky D. The Effect of Age on Surgical Outcomes Following Uterine Preserving Surgery for Treatment of Apical Prolapse. J Minim Invasive Gynecol 2022; 29:1303-1309. [PMID: 35995324 DOI: 10.1016/j.jmig.2022.08.005] [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: 03/31/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the effect of age on outcomes after uterine-preserving surgical treatment for apical prolapse. DESIGN Retrospective cohort study. SETTING Female pelvic medicine and reconstructive surgery unit at a tertiary, university-affiliated teaching medical center. PATIENTS Women who underwent surgical management of apical prolapse with uterine preservation between 2010 and 2020. Excluded were women who had ≤1 month of follow-up and those for whom medical records were substantially incomplete. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Included in the study were 140 women who underwent apical prolapse repair with uterine preservation and who met the inclusion criteria. The cohort was divided into 2 groups: (1) women aged 65 years and older (≥65 group) and (2) women younger than 65 years of age (<65 group). Pre-, intra-, and postoperative data were compared between the groups. A total of 103 women (73.6%) were in the <65 group and 37 women (26.4%) in the ≥65 group. Mean age for the entire cohort was 58 ± 9.8 years, body mass index 25.9 ± 4.8 kg/m2, and duration of follow-up was 25.9 ± 21.0 months. Women in the ≥65 group had more comorbidities, were less sexually active, and were less likely to have a midurethral sling performed during their surgery. Clinical and anatomical success rates were somewhat higher in the ≥65 group; however, these differences did not reach statistical significance (97.3% vs 85.4%, p = .069 and 89.2% vs 81.2%, p = .264, respectively). Composite outcome success was higher in the ≥65 group (89.2% vs 72.5%, p = .039). Patient satisfaction recorded using the Patient Global Impression of Improvement questionnaire was high for both groups. A multivariable logistic regression analysis for the dependent parameter of composite outcome success was performed, during which none of the parameters investigated reached statistical significance. Subgroup analysis was performed including only women who were postmenopausal. This was done to address the possible confounding effect that menopausal status may have had on our results. No differences were found between the groups with regard to clinical, anatomical, and composite outcomes. CONCLUSION Uterine-preserving surgery is a safe and effective surgical treatment for women aged ≥65 years.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem (Drs. Chill and Moss), Skokie, Illinois.
| | - Ofek Shusel
- Hebrew University Medical School (Mr. Shusel), Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel
| | - Nani P Moss
- Division of Urogynecology, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem (Drs. Chill and Moss), Skokie, Illinois
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Reuveni-Salzman and Shveiky), Ein Kerem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Reuveni-Salzman and Shveiky), Ein Kerem, Jerusalem, Israel
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Muacevic A, Adler JR, Choudhary N, Chandra R, Anupma A, Munda G, Anand U, Kollabathula P, Jesingh B. Laparoscopic Sacrocervicopexy Using Ethibond Suture Graft: A Very Economic Yet Effective Fertility Preserving Surgery for Pelvic Organ Prolapse. Cureus 2022; 14:e33086. [PMID: 36721547 PMCID: PMC9884064 DOI: 10.7759/cureus.33086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The modern era has witnessed a transition to a phase of uterus-preserving surgeries and so holds true for pelvic organ prolapse (POP) surgeries as well. Laparoscopic sacrocervicopexy has become a preferred surgical modality for moderate to severe degrees of POP in most women of the childbearing age group. With the alarming incidences of mesh erosion, synthetic mesh has almost gone off the market. We advocate a very simple and cost-effective technique of laparoscopic sacrocervicopexy using an Ethibond suture graft. MATERIALS AND METHODS It was a pilot prospective observational study over one year. Consecutive consenting women with symptomatic prolapsed uterus Stage-II of the central component of the quantitative POP classification (POP-Q) were recruited. Laparoscopic sacrocervicopexy was performed under general anesthesia using the standard protocols, and patients were prospectively followed for six months after surgery. The duration of surgery and hospital stay were noted. Patient satisfaction was rated using a five-point Likert scale. The vaginal length was measured immediately after and six months post-surgery. Sexual function was assessed using the validated female sexual function index (FSFI) scale six months after sacrocervicopexy. RESULTS Out of 28 recruited women, the majority were multiparous, highly qualified, and belonged to the middle socio-economic class. Seven patients had co-morbidity in the form of hypertension (17.8%), diabetes (7.1%), and cardiovascular diseases (7.1%). The mean duration of surgery was 105.8±7.2 minutes in the study population. The mean duration of hospital stay was 2.2±0.6 days. No surgical site infection was noted in any of the cases. Most patients rated "very satisfied" experiences following surgery (67.9%). The mean vaginal length after surgery was 7.6±1.2 centimeters. After a follow-up period of six months, the mean vaginal length was 7.4±0.8 centimeters. The mean FSFI score was 30.8±2.4. CONCLUSION Laparoscopic sacrocervicopexy with Ethibond suture graft is a cost-effective and safe surgical technique for POP in resource-limited settings. It also obviates the additional cost of synthetic mesh and the long-term risks of mesh erosion.
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Chang OH, Walters MD, Yao M, Lapin B. Development and validation of the Value of Uterus instrument and visual analog scale to measure patients' valuation of their uterus. Am J Obstet Gynecol 2022; 227:746.e1-746.e9. [PMID: 35764134 DOI: 10.1016/j.ajog.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/19/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Currently, there are no clear frameworks or tools to objectively or subjectively evaluate patient attitudes toward uterine preservation and how they influence the decision to proceed with hysterectomy vs uterine preservation when undergoing prolapse surgery. OBJECTIVE This study aimed to develop a reliable and valid instrument to measure patients' valuation of their uterus. STUDY DESIGN The Value of Uterus instrument was developed on the basis of existing literature and created with structured patient-reported outcome measurement development methodology. An initial 14-question instrument was administered to 152 patients, and the instrument was revised on the basis of an analysis of internal consistency. The resulting Value of Uterus instrument has 6 items and includes a visual analog scale for the question "How important is it to you to keep your uterus when you have a gynecologic condition?" To validate the instrument, we recruited 51 patients aged >45 years with uterovaginal prolapse who presented to the urogynecology department and were scheduled to undergo vaginal surgery with or without hysterectomy. Internal reliability of the instrument was measured with Cronbach alpha. For known-groups validity, Value of Uterus summary scores were compared between women who underwent hysteropexy and those who underwent hysterectomy using the t test. Intraclass correlation coefficient was used to assess test-retest reliability with Value of Uterus administered to women twice. Lastly, a receiver-operating characteristic curve analysis was conducted to identify a cutoff Value of Uterus and visual analog scale score for predicting whether a woman would undergo hysteropexy (vs hysterectomy). RESULTS A total of 51 patients were recruited (26 patients in the hysterectomy and 25 in the hysteropexy group), with a mean age of 64±10 years; 87.8% of patients self-identified as White. There were no differences in demographics between the groups. Cronbach's alpha was 0.94, suggesting excellent internal consistency of the items in the Value of Uterus instrument. The Value of Uterus instrument was highly correlated with the visual analog scale question, with r=0.82 (95% confidence interval, 0.69-0.89; P<.001). Patients in the hysteropexy group had significantly higher Value of Uterus scores (indicating greater value placed on the uterus) than women who underwent hysterectomy (20.8 vs 12.2; P<.001). Receiver-operating characteristic curve analysis identified a Value of Uterus cutoff score ≥14, with good accuracy for predicting hysteropexy (area under the curve, 0.87; sensitivity, 92.0%; specificity, 68%). CONCLUSION Value of Uterus is a reliable and valid 6-item instrument that measures patients' valuation of the uterus and preferences for uterine preservation when undergoing surgery for pelvic organ prolapse. Value of Uterus and visual analog scale were shown to reliably predict whether a patient undergoes uterine-preserving prolapse surgery. The Value of Uterus instrument and visual analog scale tool can be useful tools to ensure that the patient's preferences are included in the medical decision-making. Value of Uterus may be useful for future research in other gynecologic conditions where uterine preservation is an option.
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Affiliation(s)
- Olivia H Chang
- Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
| | - Mark D Walters
- Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Brittany Lapin
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH
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Bilateral Sacrospinous Hysteropexy Versus Bilateral Sacrospinous Ligament Fixation with Vaginal Hysterectomy for Apical Uterovaginal Prolapse. Int Neurourol J 2022; 26:239-247. [PMID: 36203256 PMCID: PMC9537431 DOI: 10.5213/inj.2244076.038] [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: 03/22/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this retrospective study was to compare the anatomical and functional outcomes between bilateral sacrospinous hysteropexy (BSHP) and bilateral sacrospinous ligament fixation with vaginal hysterectomy (BSLF/VH) in women with apical-predominant uterovaginal prolapse. Methods Clinical data from patients with symptomatic Pelvic Organ Prolapse-Quantification (POP-Q) stage 2 or higher uterovaginal prolapse who underwent either BSHP (48 patients) or BSLF/VH (69 patients) between January 2014 and December 2018 were reviewed retrospectively. The primary outcome was the subjective satisfaction rate evaluated by Patient Global Impression of Improvement, and the secondary outcomes included objective anatomical success rates, impact on disease-specific quality of life evaluated by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, Pelvic Floor Distress Inventory-Short Form 20, and Pelvic Floor Impact Questionnaire 7, and surgical complications. Results After a median follow-up of 35 months (range, 25–58 months), all patients in both groups demonstrated significant postoperative improvements in anatomical and functional outcomes (P<0.001). There were no significant differences in postoperative subjective and objective results, sexual satisfaction outcomes, or disease-specific quality of life between the BSHP and BSLF/VH groups, and similar incidence rates of intraoperative and postoperative complications were also recorded. Conclusions The uterus-sparing BSHP procedure yielded noninferior anatomical and functional outcomes compared to the BSLF/VH procedure and could be adopted as an alternative to conventional hysterectomy-based native-tissue repair modalities for symptomatic apical-predominant uterovaginal prolapse.
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Rate of Mesh Erosion After Sacrocolpopexy With Concurrent Supracervical Compared With Total Hysterectomy: A Systematic Review and Meta-analysis. Obstet Gynecol 2022; 140:412-420. [PMID: 35926201 DOI: 10.1097/aog.0000000000004901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/02/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To estimate the effect of concomitant supracervical hysterectomy compared with total hysterectomy during abdominal sacrocolpopexy on the rate of mesh erosion by performing a systematic review and meta-analysis of the existing literature. DATA SOURCES From database inception through January 2022, we explored MEDLINE, Web of Science, EMBASE, CINAHL, ClinicalTrials.gov , and Cochrane Central Register of Controlled Trials. Studies comparing the rate of mesh erosion in women undergoing abdominal sacrocolpopexy who had concomitant supracervical hysterectomy compared with total hysterectomy were included. DATA EXTRACTION AND SYNTHESIS Two reviewers separately ascertained studies, obtained data, and gauged study quality. The rate of mesh erosion was compared, and odds ratios (ORs) with 95% CIs were estimated. TABULATION, INTEGRATION, AND RESULTS Nineteen studies with 10,572 women who underwent abdominal sacrocolpopexy were identified, including 4,285 women in the supracervical group and 6,287 women in the total hysterectomy group. The overall mean postprocedure follow-up time was 30.7±15.1 months (median 12.4, range 1.5-44.2). The median (95% CI) point prevalence of mesh erosion was 0.36% (0-1.9%) in women who had supracervical hysterectomy compared with 3.8% (1.8-8.7%) in women who had total hysterectomy. The overall rate of mesh erosion in women who had supracervical hysterectomy was lower compared with women who had total hysterectomy (pooled OR 0.26, 95% CI 0.18-0.38, I 2 0%). CONCLUSION In women with symptomatic apical pelvic organ prolapse who undergo abdominal sacrocolpopexy with concomitant hysterectomy, supracervical hysterectomy is associated with a lower risk of mesh erosion compared with total hysterectomy. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022301862.
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Wang J, Xu X, Xu J. Modified laparoscopic high uterosacral ligament suspension for treatment of apical prolapse: A feasibility study. J Obstet Gynaecol Res 2022; 48:2918-2925. [DOI: 10.1111/jog.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jing Wang
- Department of Gynecology The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital Quzhou China
| | - Xiaomin Xu
- Department of Gynecology The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital Quzhou China
| | - Jingui Xu
- Department of Gynecology The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital Quzhou China
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Schulten SFM, Essers B, Notten KJB, Enklaar RA, van Leijsen SAL, van Eijndhoven HWF, Kluivers KB, Weemhoff M. Patient’s preference for sacrospinous hysteropexy or modified Manchester operation: a discrete choice experiment. BJOG 2022; 130:99-106. [PMID: 36043332 PMCID: PMC10087824 DOI: 10.1111/1471-0528.17280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/19/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse. DESIGN Labelled discrete choice experiment (DCE). SETTING Eight Dutch hospitals. POPULATION Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation. METHODS DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success ( levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models. MAIN OUTCOME MEASURES Women's preference for MM or SH. RESULTS 137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision-making. For SH, all attributes were relevant for decision-making. CONCLUSIONS The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare.
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Affiliation(s)
- Sascha F. M. Schulten
- Radboud university medical center Radboud Institute for Health Sciences, department of Obstetrics and Gynaecology, Geert Grooteplein Zuid 10 GA Nijmegen The Netherlands
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem The Netherlands
| | - Brigitte Essers
- Department of clinical epidemiology and medical technology assessment, P. Debyelaan 25, 6202 AZ Maastricht university medical centre+ The Netherlands
| | - Kim J. B. Notten
- Department of Obstetrics and Gynaecology Radboud university medical center GA Nijmegen The Netherlands
| | - Rosa A. Enklaar
- Radboud university medical center Radboud Institute for Health Sciences, department of Obstetrics and Gynaecology, Geert Grooteplein Zuid 10 GA Nijmegen The Netherlands
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen The Netherlands
| | - Sanne A. L. van Leijsen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre Veldhoven, De Run 4600, 5500 MB Veldhoven The Netherlands
| | - Hugo W. F. van Eijndhoven
- Department of Gynaecology and Obstetrics, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle The Netherlands
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynaecology Radboud university medical center GA Nijmegen The Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen The Netherlands
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Yuan AS, Propst KA, Ferrando CA. Postoperative pain and the need for intervention after sacrospinous ligament hysteropexy compared to colpopexy: a retrospective cohort study. Int Urogynecol J 2022; 33:2525-2531. [PMID: 35881177 DOI: 10.1007/s00192-022-05301-7] [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: 02/25/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare postoperative pain between patients undergoing sacrospinous ligament colpopexy (SSLF) and hysteropexy (SSLH). METHODS This was a retrospective cohort study of all patients undergoing native tissue SSLF and SSLH between January 2013 and March 2020. The electronic medical record was queried for demographic and perioperative data until the postoperative visit. The primary outcome was a composite incidence of any of the following: telephone calls, urgent office visits, additional analgesic prescriptions and need for intervention for pain in the buttocks, posterior thigh or perirectal area. Secondary outcomes were the incidence of persistent pain at the postoperative visit and perioperative risk factors associated with reported pain. RESULTS A total of 406 patients met inclusion criteria (308 SSLF, 98 SSLH). The composite pain outcome was seen in 99 patients (24.4%; 95% CI 20.5%-28.8%), and there was no statistical difference between cohorts. Persistent pain was seen in 15.6% and 13.3% of SSLF and SSLH patients at 6 weeks (p = 0.58). Twelve patients (3.0%) underwent interventions for pain, including physical therapy (2), trigger point injections (5) and suture release (5). Compared to SSLF patients, SSLH patients were more likely to need interventions (7 [7.1%] vs. 5 [1.6%], p = 0.005) and office visits (14 [14.3%] vs. 13 [4.2%], p = 0.0005) for pain. CONCLUSIONS There was no difference in the overall incidence of postoperative pain between patients who underwent SSLF or SSLH. However, patients who underwent hysteropexy were more likely to need intervention and office evaluation for postoperative pain.
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Affiliation(s)
- Angela S Yuan
- Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave/A81, Cleveland, OH, 44195, USA.
| | - Katie A Propst
- Department of Obstetrics & Gynecology, Division of Urogynecology, University of South Florida, Tampa, FL, USA
| | - Cecile A Ferrando
- Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave/A81, Cleveland, OH, 44195, USA
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