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Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial. Int Urogynecol J 2022; 33:2021-2030. [PMID: 35044477 DOI: 10.1007/s00192-021-05071-8] [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: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The main objective of the study was to evaluate the rates of de novo stress urinary (SUI) and postoperative dyspareunia after both sacrocolpopexy/hysteropexy (SCP) and vaginal mesh surgery. METHODS A prospective, multicenter, randomized, open-label study with two parallel groups treated by either SCP or Uphold Lite vaginal mesh was carried out. Study participants were ≥ 50 and < 80 years old patients with Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 who were considered eligible for reconstructive surgery and who were sexually active with no dyspareunia and free from bothersome SUI at presentation. Women were assessed before surgery and at 4-8 weeks and 11-13 months after using validated measures including POP-Q, Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Patient Global Impression of Improvement (PGI-I). Data were also collected for health economics evaluation. RESULTS Of the required sample of 156 women, 42 women (19 SCP and 23 vaginal mesh) were only recruited owing to the discontinuation of vaginal mesh worldwide. The median follow-up was 376 days. The rates of bothersome de novo SUI were similar in the SCP and Uphold vaginal mesh groups (15.79 vs 15.00%, OR 0.95 [95% CI 0.22-4.14]). Among 30 sexually active patients at follow-up, the rates of women reporting de novo dyspareunia "usually or always" were 6.7% after SCP vs 13.3% after vaginal mesh (p = 1). Health economics evaluation showed a cost saving of 280€ in favor of the Uphold vaginal mesh technique, but no significant difference in the total cost (2,934.97€ for SCP vs 3,053.26€ for Uphold vaginal mesh). CONCLUSIONS Bothersome de novo SUI and de novo dyspareunia occurred in approximately 15% and 23% of our study cohorts, with no significant difference between sacrocolpopexy/hysteropexy and anterior/apical vaginal mesh surgery. However, these results should be interpreted with caution owing to the small sample size.
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Laparoscopic promontofixation: Where to stop the anterior dissection? Med Hypotheses 2019; 124:60-63. [DOI: 10.1016/j.mehy.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/10/2018] [Accepted: 02/01/2019] [Indexed: 11/23/2022]
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André B, Jourdain O, Guerby P, Vidal F, Léonard F. [Laparoscopic sacrocolpopexy for exteriorized pelvic organ prolapse: Mid-term functional results]. ACTA ACUST UNITED AC 2018; 46:7-13. [PMID: 29289471 DOI: 10.1016/j.gofs.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess feasibility and postoperative outcomes associated with laparoscopic sacrocolpopexy in patients presenting with exteriorized pelvic organ prolapse (stage>3). METHODS Prospective study involving patients undergoing laparoscopic sacrocolpopexy for advanced stage pelvic organ prolapse. Symptoms and quality of life were evaluated at baseline and at 1, 4 and 18 months after surgery using validated questionnaires (PFDI-20 and PFIQ-7). RESULTS Sixty-three patients were included between September 2012 and January 2014. Sub-total hysterectomy and sub-urethral sling were performed at the time of surgery in 36% and 34% of patients, respectively. We observed 1 per-operative complication (bladder wound). De novo stress urinary incontinence and de novo dyspareunia persisting at 18 months occurred in 10% and 3% of cases, respectively. Recurrence rate was 1.6% at 18 months. The follow-up also revealed a significant and prolonged improvement in PFDI-20 and PFIQ-7 scores: from 98.8 at baseline to 33.9 at 18 months (P<0.01) and from 89.6 to 26.5 (P<0.001), respectively. CONCLUSION Laparoscopic sacrocolpopexy seems feasible and safe in patients suffering from exteriorized pelvic organ prolapse, leading to high anatomic success rate. It is also associated with a prolonged improvement in quality of life and a positive impact on symptoms related to prolapse.
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Affiliation(s)
- B André
- Service de chirurgie générale et gynécologique, CHU Rangueil, 1, avenue du Professeur Jean-Poulhès, 31059 Toulouse, France
| | - O Jourdain
- Poly-clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France
| | - P Guerby
- Hôpital Paule-de-Vigiuier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - F Vidal
- Hôpital Paule-de-Vigiuier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
| | - F Léonard
- Centre hospitalier de Cahors, 335, rue Président-Wilson, 46000 Cahors, France
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Rambeaud C, Marcelli M, Cravello L, Boubli L, Tourette C, Agostini A. Étude pilote de faisabilité de la promontofixation cœlioscopique en ambulatoire. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Transrectal Mesh Erosion Requiring Bowel Resection. J Minim Invasive Gynecol 2017; 24:717-721. [DOI: 10.1016/j.jmig.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
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Lamblin G, Dubernard G, de Saint Hilaire P, Jacquot F, Chabert P, Chene G, Golfier F. Assessment of Synthetic Glue for Mesh Attachment in Laparoscopic Sacrocolpopexy: A Prospective Multicenter Pilot Study. J Minim Invasive Gynecol 2017; 24:41-47. [DOI: 10.1016/j.jmig.2016.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 01/06/2023]
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Boudy AS, Thubert T, Vinchant M, Hermieu JF, Villefranque V, Deffieux X. Outcomes of laparoscopic sacropexy in women over 70: A comparative study. Eur J Obstet Gynecol Reprod Biol 2016; 207:178-183. [DOI: 10.1016/j.ejogrb.2016.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/24/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
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Chevrot A, Droupy S, Linares E, de Tayrac R, Costa P, Wagner L. Impact de la promontofixation cœlioscopique sur les symptômes pelviens, la qualité de vie et la sexualité : résultats à 3ans d’une étude prospective. Prog Urol 2016; 26:558-65. [DOI: 10.1016/j.purol.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 11/26/2022]
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Willecocq C, Pizzoferrato AC, Fauconnier A, Bader G. Utilisation de la colle chirurgicale dans la promontofixation laparoscopique. Étude comparative à propos de 32 cas. ACTA ACUST UNITED AC 2014; 42:822-6. [DOI: 10.1016/j.gyobfe.2014.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
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Kozal S, Ripert T, Bayoud Y, Menard J, Nicolacopoulos I, Bednarzyck L, Staerman F, Larré S. Morbidity and functional mid-term outcomes using Prolift pelvic floor repair systems. Can Urol Assoc J 2014; 8:E605-9. [PMID: 25295130 DOI: 10.5489/cuaj.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We assess midterm morbidity and functional outcomes using the Prolift (Gynecare/Ethicon, Somerville, NJ) system and identify potential related risk factors. The Prolift mesh system to treat genital prolapse was introduced in 2005. It was withdrawn from the market in early 2013 after rising doubts about safety. METHODS Over a 7-year period, we retrospectively analyzed a cohort of 112 consecutive patients who underwent the Prolift procedure since 2006. Intraoperative and postoperative complications, anatomical and functional outcomes were recorded. RESULTS The median follow-up was 49.5 months (range: 16-85). The mean age was 64.7 ± 10.9 years (range: 40-86). Of the 112 patients, 74 patients had stage 3 (66.1%) and 8 patients had stage 4 (7.14%) vaginal prolapse. Prolift surgery was performed for pro-lapse recurrence for 26 patients (23.2%). Total mesh was used in 32 patients (29%), an isolated anterior mesh in 57 patients (51%) and an isolated posterior mesh in 23 patients (21%). Concomitant surgical procedures were performed for 44 patients (39.3%). Overall, 72% (18/25) of the complications were managed medically. We reported a failure rate of 8% (n = 9) occurring after a median follow-up of 9.5 months (range: 1-45). Among the 64 patients who had preoperative sexual activity (57.1%), de novo dyspareunia occurred in 9 patients (16.07%). We extracted predictive factors concerning failure, complications and sexuality. CONCLUSION Despite its market withdrawal, the Prolift system was associated with good midterm anatomic outcomes and few severe complications. Long-term follow-up data are still lacking, but surgeons and patients may be reassured.
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Affiliation(s)
- Sébastien Kozal
- Department of Urology and Andrology. Robert Debré, University Hospital, Reims, France
| | - Thomas Ripert
- Department of Urology and Andrology. Robert Debré, University Hospital, Reims, France; ; Department of Urology and Andrology, Polyclinic Courlancy, Reims, France
| | - Younes Bayoud
- Department of Urology and Andrology. Robert Debré, University Hospital, Reims, France
| | - Johan Menard
- Department of Urology and Andrology. Robert Debré, University Hospital, Reims, France
| | | | - Laurence Bednarzyck
- Department of Obstetrics and Gynecology, Manchester General Hospital, Charleville, France
| | - Frederic Staerman
- Department of Urology and Andrology. Robert Debré, University Hospital, Reims, France; ; Departement of Urology and Andrology, Polyclinic Les Bleuets, Reims, France
| | - Stéphane Larré
- Department of Urology and Andrology. Robert Debré, University Hospital, Reims, France
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[Laparoscopic promontofixation: defining early morbidity using a standardized method]. ACTA ACUST UNITED AC 2014; 42:378-82. [PMID: 24852907 DOI: 10.1016/j.gyobfe.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/10/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Adverse event reporting for laparoscopic promontofixation is highly variable and non-standardized in the literature. The aim of this study was to better characterize early postoperative complications of laparoscopic promontofixation for genital prolapse using a standardized reporting methodology. PATIENTS AND METHODS A retrospective study was conducted on 174 women with genital prolapse undergoing laparoscopic promontofixation from January 2008 to January 2013. Complications arising during the first month after surgery were reviewed according to the Clavien and Dindo classification. RESULTS At least one postoperative adverse event was reported in 57 out of 174 (33 %) women, grade 1 in 22 patients (13 %), grade 2 in 31 patients (18 %) and grade 3 in 4 patients (2 %). No patient experienced a grade 4 or 5 complication. Fifty-three out of 57 (93 %) complications were grade 1 or 2. The most frequently reported adverse event (n=24; 14 %) was constipation (grade 2). DISCUSSION AND CONCLUSION Laparoscopic promontofixation is a safe procedure with almost exclusively benign (grade 1 or 2) early complications. The hypothesis of induction or increasing constipation by this type of genital prolapse surgery should be further evaluated.
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Impact des cures de prolapsus pelviens par promontofixation laparoscopique sur la sexualité du couple. Prog Urol 2014; 24:247-55. [DOI: 10.1016/j.purol.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 10/03/2013] [Accepted: 10/04/2013] [Indexed: 11/20/2022]
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Daher A, Renouvel F, Lauratet B, Guillot E, Lefranc JP. Étude préliminaire sur la faisabilité de la double promontofixation robotique comparée à la voie cœlioscopique. ACTA ACUST UNITED AC 2013; 42:570-6. [DOI: 10.1016/j.jgyn.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 06/19/2013] [Accepted: 07/01/2013] [Indexed: 11/25/2022]
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Thibault F, Wagner L, Rouvellat P, Seni G, Brouziyne M, de Tayrac R, Droupy S, Costa P. [Sexual function before surgery for pelvic organ prolapse]. Prog Urol 2012; 22:665-70. [PMID: 22999092 DOI: 10.1016/j.purol.2012.08.266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 08/07/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
AIM The aim of our study was to assess the link between pelvic organ prolapse (POP) characteristics and sexual well-being using validated tools. MATERIAL A prospective analysis was carried out in 148 women with a POP. The degree of prolapse was measured by using the Pelvic Organ Prolapse Quantification (POPQ). Pelvic Floor Distress Inventory (PFDI-20) questionnaire score was used to estimate the severity of symptoms. Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores determined sexual function level. RESULTS No correlation was found concerning the global sexual function score and the POP stage (P=0.24). Pelvic and urinary symptoms were associated with a decrease in sexual function score (P=0.04 and P=0.002). Defecation symptoms were correlated with decreased sexual satisfaction (P ≤ 0.05) and were associated with premature ejaculation (P ≤ 0.05). Urinary symptoms were associated with dyspareunia (P ≤ 0.01), avoidance of sexual activities (P ≤ 0.05), negative emotions during intercourse (P ≤ 0.01) and decreased sexual excitement (P ≤ 0.05). Pelvic symptoms were significantly tied to avoidance of sexual activities (P ≤ 0.01), dyspareunia (P ≤ 0.05) and a poorer orgasm quality (P ≤ 0.05). CONCLUSION The degree of pelvic organ prolapse was not statistically associated with sexual function. However, urinary, pelvic and defecatory (ano-rectal) symptoms were associated with a decrease in the couple's sexual well-being.
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Affiliation(s)
- F Thibault
- Service d'urologie, centre hospitalier Carémeau, rue du Professeur-Debré, 30000 Nîmes, France.
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Letouzey V, Panel L, Courtieu C. [Rectocele repair with porcine dermal collagen implant associated with infracoccygeal sacropexy]. Prog Urol 2012; 22:240-4. [PMID: 22516787 DOI: 10.1016/j.purol.2012.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/12/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate an infracoccygeal colpopexy procedure by tension-free synthetic tape for vaginal apical prolapse associated with a posterior mesh procedure using porcine dermal graft for rectocele repair. METHODS A retrospective study concerning 35 women. The surgical procedure included rectocele repair with porcine dermal collagen implant (porcine dermal matrix, native) associated with transgluteal infracoccygeal sacropexy using a polypropylene sling. RESULTS Median follow up was 48 months (42-54). A vaginal hysterectomy was associated in 43% and a cure of cystocele was associated in 63% of cases. No intra-operative complication was noted. The prevalence of dyschesia decreased from 25% (eight patients) preoperatively to 3% (one patient) postoperatively. No cases of de novo dyspareunia was noted. Five (14%) patients had a recurrent prolapse (two cases of rectocele stage 2, one case of grade 3 rectocele associated with a cystocele, a case of uterine prolapse associated with cystocele and one case of recurrent isolated uterine prolapse). Among them, three patients (9%) required a re-intervention for prolapse recurrence. No vaginal mesh exposure was observed. Perineal pain was reported by 12 (33%) patients at one month follow-up, but no patient complained with perineal pain one year follow-up. CONCLUSION Infracoccygeal sacropexy associated with rectocele repair using porcine dermal collagen implant was associated with satisfactory results at medium term follow-up.
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Affiliation(s)
- V Letouzey
- Service de gynécologie obstétrique, CHU Caremeau, place du Professeur-Robert-Debré, 30000 Nîmes cedex, France.
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Incontinence urinaire d’effort de novo après promontofixation. Prog Urol 2011; 21:631-5. [DOI: 10.1016/j.purol.2011.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/23/2022]
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Larue S, Meurette G, Lehur P, Leveau E, Branchereau J, Bouchot O, Rigaud J. Double promontofixation laparoscopique versus laparoscopique robot-assistée : morbidité, résultats anatomiques et fonctionnels à court terme. Prog Urol 2011; 21:473-8. [DOI: 10.1016/j.purol.2010.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 11/26/2022]
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Deffieux X, Pachy F, Donnadieu AC, Trichot C, Faivre E, Fernandez H. Péritonisation avec un fil cranté résorbable sans nœud en cours de promontofixation laparoscopique. ACTA ACUST UNITED AC 2011; 40:65-7. [DOI: 10.1016/j.jgyn.2010.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 07/31/2010] [Accepted: 08/17/2010] [Indexed: 11/30/2022]
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