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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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Wallace SL, Syan R, Lee K, Sokol ER. Vaginal hysteropexy compared with vaginal hysterectomy with apical suspension for the treatment of pelvic organ prolapse: A 5-year cost-effectiveness Markov model. BJOG 2024; 131:362-371. [PMID: 37667669 DOI: 10.1111/1471-0528.17642] [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: 09/01/2021] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Our objective was to perform a 5-year cost-effectiveness analysis of transvaginal hysteropexy (HP) via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) versus vaginal hysterectomy (VH) with apical suspension via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) for the treatment of uterine prolapse. DESIGN A decision analytic model assessed the cost-effectiveness of the surgical intervention over a 5-year horizon. SETTING This model was constructed using TreeAge® software. POPULATION OR SAMPLE Healthy women undergoing surgery for uterine prolapse were modeled. METHODS A Markov model was constructed to simulate the possible recurrence of prolapse. Recurrence rates, repeat surgery for surgical failures and complication rates were modeled. Base case, sensitivity analyses and probabilistic modeling were performed. MAIN OUTCOME MEASURES The primary outcome was the incremental cost-effectiveness ratio (ICER) of <$100 000 per quality-adjusted life year (QALY). RESULTS Using the available prolapse recurrence rates and repeat surgery rates in the literature, both HP-SS and HP-US are cost-effective at a willingness-to-pay (WTP) threshold of <$100 000 per QALY. The incremental cost-effectiveness ratio (ICER) for HP-US compared to HP-SS is $90 738.14, while VH-US and VH-SS are both dominated strategies. HP-US is the optimal cost-effective strategy but decays exponentially with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. The cost-effectiveness acceptability curve (CEAC) favors sacrospinous hysteropexy until reaching a WTP threshold between $90 000 and $100 000. CONCLUSION Hysteropexy surgical strategies are cost-effective transvaginal surgical approaches for uterine prolapse. Vaginal hysterectomy with apical suspension becomes more cost-effective with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. Given the variability of prolapse recurrence rates in the literature, more comparative studies are needed to understand the cost-effectiveness relationship between these different surgical approaches.
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Affiliation(s)
- Shannon L Wallace
- Division of Urogynecology and Pelvic Floor Disorders, Department of Obstetrics and Gynecology, Ob/Gyn & Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Raveen Syan
- Division of Female Urology and Urogynecology, Department of Urology, Desai Sethi Medical Institute, University of Miami, Miami, Florida, USA
| | - Kyueun Lee
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Eric R Sokol
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Deldar Pesikhani M, Ghanbari Z, Eftekhar T, Kazemi M, Nassiri S, Sabzi Shahrbabaki F, Ghaemi M. Long-term outcomes and quality of life after Manchester procedure for pelvic reconstructive surgery in women with cervical elongation. Eur J Obstet Gynecol Reprod Biol 2023; 289:152-157. [PMID: 37678128 DOI: 10.1016/j.ejogrb.2023.08.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/03/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Native-tissue techniques for Pelvic Organ Prolapse (POP) repairs, such as the Manchester Procedure (MP), have recently been revitalized. However, there are conflicting opinions regarding correcting cervical elongation support by the MP, and the risk of possible poor outcomes and postoperative complications. Therefore, this study aimed to investigate anatomical and patient-reported outcomes during one year after MP. DESIGN Prospective cohort study. SETTING This study was conducted on women who underwent the MP for cervical elongation between 2010 and 2020. PATIENTS Women with apical compartment prolapse up to stage 3 due to cervical elongation. INTERVENTIONS Manchester Procedure. MEASUREMENTS Pre and postoperative evaluations by POP Quantification (POP-Q) system were performed, and patients filled out the quality-of-life questionnaires including Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 12 months after the procedure. Anatomical outcomes were measured by POP-Q and the changes in POP-related symptoms were evaluated and reported. MAIN RESULTS 33 participants were recruited in the study. Significant anatomical improvements were obtained in all compartments after the surgery. After 12 months in POP-Q examination, the mean (±SD) of Ba was changed from +1.82 (±1.71) to -1.18 (±1.50), C was changed from -1.25 (±2.81) to -6 (±1.82), and D from -6.30 (±1.42) to -7.1 (±1.25) respectively (P < 0.001). POP-Q stage 0-1 was obtained inof7% in the apical compartment (C < -1), but only in 45.4% in the anterior compartment (Ba < -1). A significant reduction in symptom scores was obtained for PFDI-20 (P < 0.01) and PISQ-12 (P = 0.011). CONCLUSIONS Our findings suggest that the MP provides adequate apical support with improvement in anatomic and subjective findings for patients with cervical elongation.
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Affiliation(s)
- Maryam Deldar Pesikhani
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Ghanbari
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Tahereh Eftekhar
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kazemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saina Nassiri
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Sabzi Shahrbabaki
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Shoureshi PS, Dubinskaya A, Magner D, Eilber KS. Robotic Sacrohysteropexy With Concurrent Rectopexy using Fascia Lata Graft. Urology 2023; 173:228. [PMID: 36577453 DOI: 10.1016/j.urology.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/15/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND OBJECTIVE There is limited data regarding the use of mesh for pelvic organ prolapse (POP) repair in young women of childbearing age who wish to preserve their uterus.1 Sacrohysteropexy with concurrent rectopexy can be performed in this population with a biologic graft, to decrease the risk of contamination with colorectal surgery and allow for future pregnancy.2-4 The objective of this video is to present the surgical management of prolapse repair in a young woman with uterine and rectosigmoid prolapse, causing rectal outlet obstruction. MATERIALS AND METHODS Our patient is a 21-year-old woman with over a decade of severe constipation. Her past medical history includes anxiety, depression and sexual abuse. She previously underwent robotic rectopexy for intra-rectal intussusception and mucosal prolapse with immediate improvement in her symptoms; however, two months after rectopexy, she suffered from persistent abdominal pain and severe difficulty passing stool. Dynamic resonance imaging demonstrated descent of the bladder with significant uterine prolapse, causing impingement of rectum and rectocele, blocking the evacuation of stool. The patient was thus indicated for concurrent sacrohysteropexy and rectopexy. RESULTS She underwent a robotic procedure. Given her age, in an effort to preserve future child-bearing potential, we performed the surgery with a biologic graft made of fascia lata. For the sacrohysteropexy, the graft was sutured to the posterior cervix. Intraoperatively she was noted to have an intact enterocele repair and posterior rectopexy from her previous surgery; however, there was an angulation at the recto sigmoid. This was corrected by performing a rectopexy to the fascia lata graft. She discharged home the day of surgery without incident. CONCLUSION Biologic grafts can be used for multi compartment prolapse repair in women of child-bearing age. Fascia lata provides a safe alternative to mesh to allow for future pregnancy. Also, sacrohysteropexy with concurrent rectopexy can be performed with same day discharge.
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Affiliation(s)
- Poone S Shoureshi
- Department of Urology and Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Alexandra Dubinskaya
- Department of Urology and Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - David Magner
- Department of Urology and Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Karyn S Eilber
- Department of Urology and Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Tanaka LF, Schoffer O, König J, Weyer-Elberich V, Blettner M, Klug SJ. Changes in the probability of hysterectomy in the city of Mainz and Mainz-Bingen region, Germany. BMC Public Health 2023; 23:84. [PMID: 36631748 PMCID: PMC9832650 DOI: 10.1186/s12889-022-14916-w] [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: 09/30/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To assess the hysterectomy probability by calendar period and age, the overall and the age-specific prevalence of hysterectomy in women aged 30-65 years. METHODS Baseline data (2005-2007) from the population-based MARZY study conducted in Mainz and Mainz-Bingen, Germany, were analysed. 6429 women aged 30-65 years were asked whether they had undergone a hysterectomy and the date and indication of the procedure. We calculated the 5-year age-specific prevalence of hysterectomy and estimated the probability of undergoing a hysterectomy combining two approaches: 1) Kaplan-Meier and 2) Inverse probability weighting (IPW). We assessed potential changes over calendar periods by simulating survival curves, having hysterectomy as the event, employing a Cox proportional hazard model. RESULTS Data on hysterectomy were available for 4719 women. Of these, 961 (20.4%) had undergone a hysterectomy between 1960 and 2006. The hysterectomy prevalence was highest among the 60-64 year-olds (40.7%). The IPW-corrected probability of having a hysterectomy up to the age of 65 years was 36.4%. The age-specific probability of hysterectomy increased from 0.1% (20-24 years), peaking at 45-49 years (7.8%) and declining thereafter to less than 5% among women aged 50 and older. Over time, women were hysterectomised at an increasingly older age. Most hysterectomies (86.7%) were done due to benign disease. CONCLUSIONS A shift to older age at hysterectomy with an advancing calendar period likely reflects changes in clinical practice in Germany. TRIAL REGISTRATION Landesärztekammer Rheinland-Pfalz: 837.438.03 (4100).
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Affiliation(s)
- Luana F. Tanaka
- grid.6936.a0000000123222966Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany ,grid.5252.00000 0004 1936 973XCenter for International Health, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Olaf Schoffer
- grid.6936.a0000000123222966Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany ,grid.4488.00000 0001 2111 7257Center of Evidence-Based Health Care, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochem König
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Veronika Weyer-Elberich
- grid.5949.10000 0001 2172 9288Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Maria Blettner
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefanie J. Klug
- grid.6936.a0000000123222966Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Complications After Uterosacral Ligament Suspension Versus Sacrospinous Ligament Fixation at Vaginal Hysterectomy: A Retrospective Cohort Study of the National Surgical Quality Improvement Program Database. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:834-841. [PMID: 36409640 DOI: 10.1097/spv.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Apical suspension, including uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF), is the standard of care at vaginal hysterectomy. Although the equivalence of anatomic and clinical outcomes after USLS and SSLF is established, comparing surgical complications specific to patients undergoing concurrent vaginal hysterectomy further informs decision making regarding operative approach. OBJECTIVE This study aims to compare complications in the first 30 days after surgery in patients undergoing USLS and SSLF at vaginal hysterectomy for pelvic organ prolapse. STUDY DESIGN This retrospective, population-based cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing USLS or SSLF at vaginal hysterectomy for pelvic organ prolapse between 2012 and 2019. The primary outcome was a composite of surgical complications excluding urinary tract infection (UTI). Odds of the primary outcome, readmission, reoperation, and UTI were evaluated by multivariable logistic regression models. RESULTS Of 10,210 eligible patients, 7,127 patients underwent USLS and 3,083 patients underwent SSLF. Uterosacral ligament suspension was associated with a 25% lower odds of the composite complication outcome that excluded UTI compared with SSLF (adjusted odds ratio, 0.75; 95% confidence interval, 0.63-0.90). Urinary tract infection was the most common complication and occurred more commonly in patients undergoing USLS (6.5% vs 4.9%; adjusted odds ratio, 1.29; 95% confidence interval, 1.06-1.56). There was no significant difference in Clavien-Dindo class IV complications, readmission, or reoperation between approaches. CONCLUSION Uterosacral ligament suspension was associated with a lower odds of complications excluding UTI compared with SSLF. Urinary tract infection was more common among patients having USLS. The odds of serious complications, readmission, and reoperation were low and comparable between groups.
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Pregnancy outcomes after abdominal sacrocervicopexy. Int Urogynecol J 2022; 33:3449-3454. [PMID: 35716198 DOI: 10.1007/s00192-022-05265-8] [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: 12/02/2021] [Accepted: 05/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Various methods are used in pelvic organ prolapse (POP) surgery. Organ-preserving methods are gaining importance and popularity. Although the success rates of abdominal sacrocervicopexy, which is one of these methods, are known, data on pregnancy outcomes are insufficient. The aim of this study was to investigate pregnancy outcomes after abdominal sacrocervicopexy. METHODS This study included 72 patients with a diagnosis of POP who underwent abdominal sacrocervicopexy with monofilament polypropylene mesh in Diyarbakir Gazi Yaşargil Training and Research Hospital between 2008 and 2016. Anterior and posterior colporrhaphy operations were performed. Postoperatively, these patients were followed up for a mean of 29.68 ± 6.55 (20-49) months. Pregnancy and recurrence outcomes of those who became pregnant were recorded and analyzed. RESULTS On average, pregnancies occurred 23.2 (18-30) months after the operation. During follow-up, eight patients became pregnant and gave birth without any issues or complications. One had a normal vaginal delivery, and seven gave birth by cesarean section. One of the pregnant women had a twin pregnancy. When 24 patients who underwent bilateral tubal ligation and postmenopausal (n = 2) were excluded, the pregnancy rate was found to be 17.3%. The weeks of the deliveries were 35 weeks (twin pregnancy), 38 weeks (n = 2), 39 weeks (n = 3), and 40 weeks (n = 1), for an average of 38.5 weeks. CONCLUSIONS Eight patients who had undergone abdominal sacrocervicopexy had healthy pregnancies and deliveries.
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Doganay M, Tugrul D, Ersak B, Kuntay Kokanalı M, Cavkaytar S, Seyfi Aksakal O. A Blind Spot: Manchester Fothergill operation for cervical elongation without uterine descensus. Eur J Obstet Gynecol Reprod Biol 2022; 271:83-87. [DOI: 10.1016/j.ejogrb.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
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Hegde's Modification of Fothergill Surgery for Cervical Elongation: A 7-Year Retrospective Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:300-305. [PMID: 33436347 DOI: 10.1016/j.jogc.2020.10.010] [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: 05/08/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of Hegde's modification of Fothergill surgery, an innovative procedure for cervical elongation (CE), and to report perioperative challenges and follow-up. METHODS This is a retrospective review of data from 12 patients who underwent successful repair of CE by Hegde's modification of Fothergill surgery from June 2012 to May 2019. Primary outcomes were cervical viability and stenosis. Secondary outcomes were perioperative complications, Pelvic Organ Prolapse Quantification system (POP-Q) measurement and staging, recurrence, conception rates, and World Health Organization Quality of Life (QOL) BREF (WHOQOL-BREF) scores. RESULTS All women had a viable, patent cervix at 1-month follow-up. Perioperative complications included total intraoperative blood loss (>50 mL) and febrile morbidity (both 16.7%) and urinary tract infections (8.3%). The mean reduction of point C was 5.78 cm (2.87 ± 0.13 cm to -2.91 ± 1.55 cm). Recurrence was noted in 1 patient (8.3%) who had POP-Q stage 2 prolapse at 6 and 12 months of follow-up. The conception rate was 8.3% at 12 months. All women conceived spontaneously. Mean preoperative WHOQOL-BREF scores improved in all 4 domains, with major improvement seen in the physical domain, from 24.66 ± 8.18 to 70.91 ± 11.01, 19.0 ± 6.48 to 54.92 ± 8.21, 9.33 ± 7.46 to 59.33 ± 14.33, and 19.0 ± 4.89 to 47.07 ± 7.14, for the physical, psychological, social, and environmental domains, respectively. CONCLUSION Hegde's modification of Fothergill surgery can be considered as a surgical option for the repair of isolated CE with a healthy cervix in women who desire uterine preservation with the major advantage of preventing cervical stenosis.
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Li PC, Ding DC. Outcomes of laparoscopic hysteropexy and supracervical hysterectomy plus cervicopexy: A retrospective study. Tzu Chi Med J 2020; 32:262-266. [PMID: 32955524 PMCID: PMC7485679 DOI: 10.4103/tcmj.tcmj_131_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives: The objective of this study is to compare the outcomes of laparoscopic hysteropexy (LHP) and laparoscopic supracervical hysterectomy plus cervicopexy (LSHCP) for the treatment of pelvic organ prolapse (POP). Materials and Methods: We retrospectively included patients who had undergone laparoscopic sacral hysteropexy or hysterectomy plus cervicopexy between January 2015 and May 2019 at Hualien Tzu Chi Hospital, Taiwan. Age at surgery, body mass index (BMI) at admission, the initial stage of genital prolapse, operative and postoperative data, and anatomical results were recorded. Cure for uterine prolapse was evaluated objectively through vaginal examinations using the POP quantification scale. Visual analog scale (VAS) scores were recorded at 24 h postoperatively. The Mann–Whitney U-test was used to compare continuous variables. Results: A total of 23 women were included in the study; 12 had received LHP (n = 12) and 11 had received LSHCP (n = 11). No differences existed in age, parity, BMI, blood loss, or hospital stay between groups. The difference in mean surgical times between the LHP and LSHCP groups was nonsignificant (154 and 176 min, respectively; P = 0.2). VAS scores were significantly lower in the LSHCP group than in the LHP group (0.1 vs. 1.75; P = 0.004). Furthermore, mean hospital stay was significantly longer in the LSHCP group than in the LHP group (4.0 vs. 3.1 days; P = 0.016). The procedure was successful in 100% of patients (23 of 23), with no objective evidence of uterine prolapse on examination at follow-up at 6 months. Conclusion: LHP had a significantly shorter hospital stay and a higher VAS score than LSHCP. LHP and LSHCP are both feasible and effective procedures for correcting uterine prolapse.
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Affiliation(s)
- Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Time-frame comparison of hystero-preservation in the surgical treatment of uterine prolapse: a population-based nation-wide follow-up descriptive study, 2006-2013 versus 1997-2005. Int Urogynecol J 2019; 31:1839-1850. [PMID: 31802163 DOI: 10.1007/s00192-019-04128-z] [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: 03/16/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of our study was to describe the surgical trend and time-frame comparison between 1997-2005 (1stperiod) and 2006-2013 (2nd period) of hystero-preservation for uterine prolapse, based upon a nationwide population-based National Health Insurance (NHI) claim data in Taiwan. METHODS Women, who underwent primary surgeries for uterine prolapse, either uterine suspension with hystero-preservation or hysterectomy during 1997-2013, were identified from National Health Insurance Research Database (NHIRD).We analyzed the related variables including surgical types (hystero-preservation or hysterectomy), patient age and concomitant anti-incontinence surgery, surgeon age, gender, and service volume; and hospital accreditation level, and service volume. RESULTS We identified a total of 46,968 inpatients, 6629 (14.11%) hystero-preservation group, and 40,339 (85.89%) hysterectomy group. Hystero-preservation significantly increased during the 17 year follow-up study period (1997 to 2013) (P value =0.0147). The overall surgeries for uterine prolapse increased among patients ≥70 years, with concomitant anti-incontinence surgery, surgeons ≥45 years, high volume surgeons, and hospitals. Multiple logistic regression revealed hysterectomy was less used in 2nd period (OR 0.45, 95%, confidence interval (CI) 0.43-0.48). Hysterectomy was more often used in patient aged ≥50 years, surgeon aged ≥45 years, and low volume hospitals. In case of concomitant anti-incontinence surgery (OR 0.48, CI 0.45-0.52), high volume surgeons (more than 30 surgeries) and hospitals (more than 73 surgeries) hystero-preservation was more often used. CONCLUSIONS Time-frames, younger patients, concomitant anti-incontinence surgery, younger surgeons, and high volume surgeons and hospitals increase hystero-preservation for uterine prolapse. Surgeons and hospitals should be ready to respond to the wishes of female patients who want to preserve the uterus.
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Park YJ, Kong MK, Lee J, Kim EH, Bai SW. Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation. Yonsei Med J 2019; 60:1074-1080. [PMID: 31637890 PMCID: PMC6813150 DOI: 10.3349/ymj.2019.60.11.1074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/11/2019] [Accepted: 08/14/2019] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Descent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by "true cervical elongation," compared with vaginal hysterectomy (VH). MATERIALS AND METHODS Medical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤-4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage. RESULTS During the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08-2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01-0.75) were identified as significant risk factors for recurrence of POP. CONCLUSION The Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.
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Affiliation(s)
- Yun Jin Park
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Kong
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jinae Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wook Bai
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Dogan AR, Tapisiz OL, Akdag Cirik D, Kiykac Altinbas S. Laparoscopic lateral hysterosuspension with mesh using a special device via retroperitoneal tunneling. Eur J Obstet Gynecol Reprod Biol 2019; 239:72-73. [PMID: 31167743 DOI: 10.1016/j.ejogrb.2019.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/07/2019] [Accepted: 05/24/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Ali R Dogan
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Omer L Tapisiz
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.
| | - Derya Akdag Cirik
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Sadiman Kiykac Altinbas
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
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Citgez S, Oncul M, Demirdag C, Ercili B, Cetinel B. Does being performed by urologist or gynecologist affect the outcomes of women who have had sacrocolpopexy? Eur J Obstet Gynecol Reprod Biol 2019; 237:64-67. [PMID: 31015069 DOI: 10.1016/j.ejogrb.2019.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/18/2019] [Accepted: 04/16/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To compare the outcomes of women who underwent abdominal sacrocolpopexy (ASC) by urologist and gynecologist. STUDY DESIGN A total of 61 women underwent transabdominal sacrocolpopexy, with 31 by a urologist (Group 1) and 30 by a gynecologist (Group 2). The patients were presented with symptomatic pelvic organ prolapse (POP). The results were evaluated with Baden-Walker system and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) to assess anatomical and continence outcomes. Postoperative complications were documented based on the Dindo and Clavien Classification. Statistical analyses were done using Mann-Whitney U test and Fisher's exact test with SPSS version 21.0. RESULTS The mean follow-up time was 21.4 (12-36) and 21.8 (12-36) months for Group 1 and Group 2, respectively (p = 0.72). The mean estimated blood loss and length of hospitalization were similar in both groups. The success rates were; 93.5% for Group 1 and 93.3% for Group 2 (p = 0.89). There was no difference in complication rates between the two groups (p > 0.05). CONCLUSION The fact that it was administered by gynocologist or urologist does not affect the outcomes of sacrocolpopexy surgery. Similar success and complication rates were found in the patients for both groups.
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Affiliation(s)
- S Citgez
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Turkey.
| | - M Oncul
- Department of Gynecology and Obstetrics, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Turkey
| | - C Demirdag
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Turkey
| | - B Ercili
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Turkey
| | - B Cetinel
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Turkey
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Kriplani A, Dalal V, Mahey R, Kachhawa G, Thariani K, Kriplani I, Vanamail P, Sharma JB. Long-Term Outcome of Laparoscopic Sacrohysteropexy for Uterovaginal Prolapse in Young Women. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Venus Dalal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Karishma Thariani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Senturk MB, Doğan O. Sacrospinous Ligament Fixation Under Local Anesthesia in Elderly Patients at High Risk of General Anesthesia. J INVEST SURG 2018; 33:1-7. [PMID: 29733751 DOI: 10.1080/08941939.2018.1466218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction and Hypothesis: Sacrospinous ligament fixation(SSLF) is a commonly used surgical procedure in pelvic organ prolapse due to high treatment success rates. Many intraoperative and postoperative anesthesia-related obstacles may be encountered by the elderly population. Local anesthesia alone or with intravenous sedation may provide simple, cheap, and safe anesthesia. For elderly patients at high risk for general anesthesia according to the American Society of Anesthesiologists(ASA), it is better to operate through the vaginal route under local anesthesia. To perform minimal invasive SSLF surgery, the Pelvic Floor Repair Tissue Fixing Anchor, which is a target-specific system, can be used. In this prospective observational study, evaluation was made of elderly patients who underwent SSLF under local anesthesia. Materials and Methods: The study included 11 patients evaluated as high risk for general and regional anesthesia who underwent SSLF under local anesthesia as pelvic organ prolapse surgery. All operations were performed by a single experienced surgeon using 1% lidocaine infiltration and the Pelvic Floor Repair Tissue Fixing Anchor system. Results: The mean age of the patients was 69.6 years. Stage IV prolapse was determined in 7 (63.6%) patients, 4 (36.3%) had a history of hysterectomy, 5 (45.4%) were classified as ASA 3, and 6 (54.6%) as ASA 4. No complications occurred and patients were followed up for 24 months. In two patients, recurrence of POP was observed at postoperative 8 and 10 months, respectively. Conclusions: The results of this study demonstrated the surgical and anesthetic safety of SSLF under local anesthesia for pelvic organ prolapse in elderly patients.
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Affiliation(s)
- Mehmet Baki Senturk
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Health Sciences University, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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Oversand SH, Staff AC, Borstad E, Svenningsen R. The Manchester procedure: anatomical, subjective and sexual outcomes. Int Urogynecol J 2018. [PMID: 29532126 DOI: 10.1007/s00192-018-3622-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Classical native-tissue techniques for pelvic organ prolapse (POP) repairs, such as the Manchester procedure (MP), have been revitalized because of vaginal mesh complications. However, there are conflicting opinions regarding sufficient apical (mid-compartment) support by the MP and concerns about the risk of dyspareunia. The aims of this study were therefore to investigate anatomical and patient-reported outcomes 1 year after MP. METHODS Prospective cohort study of 153 females undergoing an MP for anterior compartment POP between October 2014 and June 2016. Pre- and 1-year postoperative evaluations included POP-Q measurements and the questionnaires Pelvic Floor Distress Inventory Short Form 20 (PFDI-20) and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12). RESULTS At 1 year, 97% (148/153) attended the follow-up. Significant anatomical improvements (p < 0.01) were obtained in all compartments. Mean Ba was -1.1 (± 1.4), mean C -5.9 (± 1.7) and mean D -7.0 (± 1.2) at follow-up. Point C ≤ -5 was present in 81.1%. POP-Q stage 0-1 was obtained in 99.3% in the mid-compartment (C < -1), but only in 48.6% in the anterior compartment (Ba < -1). A significant reduction in symptom scores was obtained for PFDI-20 (p < 0.01) and PISQ-12 (p = 0.01). No significant changes were seen in dyspareunia rates (q.5, PISQ-12), but 5.6% reported de novo dyspareunia. Concerning POP symptoms, 96.0% reported being cured or significantly improved. CONCLUSIONS The Manchester procedure provides adequate apical support, albeit inferior anatomical anterior compartment results, and 96.0% reported being subjectively cured or substantially better at 1-year follow-up, with no significant change in dyspareunia.
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Affiliation(s)
- Sissel Hegdahl Oversand
- Department of Gynaecology, Oslo University Hospital, Ulleval, Pb 4956 Nydalen, 0424, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne C Staff
- Department of Gynaecology, Oslo University Hospital, Ulleval, Pb 4956 Nydalen, 0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Borstad
- Department of Gynaecology, Oslo University Hospital, Ulleval, Pb 4956 Nydalen, 0424, Oslo, Norway
| | - Rune Svenningsen
- Department of Gynaecology, Oslo University Hospital, Ulleval, Pb 4956 Nydalen, 0424, Oslo, Norway
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Ramadan MK, Badr DA, Saheb W, Wehbeh G. Transposition of Cardinal Ligaments for Stages II-III Uterine Prolapse: A Minimally Invasive Procedure. Gynecol Minim Invasive Ther 2018; 7:36-39. [PMID: 30254934 PMCID: PMC6135155 DOI: 10.4103/gmit.gmit_5_17] [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: 11/29/2022] Open
Abstract
Uterine and other pelvic organ prolapse (POP) are becoming more frequently encountered due to increased life expectancy among menopausal women. Traditionally, most surgical procedures included hysterectomy as an integral part of the management. POP might, however, though less commonly, affect women not willing to accept hysterectomy, especially young females who did not complete their family. For these patients, uterine prolapse could be managed by a number of uterine-sparing surgical procedures that are performed through either abdominal or vaginal route according to patient's condition, surgeon's choice, and skills. Most of these operations, however, are usually lengthy, invasive, need good experience, and sometimes special accessories and instruments. We performed anterior transposition of the cardinal ligaments on two patients with POP quantification Stages II-III uterine prolapse without amputating the cervix. Both patients were interviewed at 6, 12, and 18-month intervals and reported no undue pain or dyspareunia with complete satisfaction regarding self-assessment of gynecologic anatomy. Furthermore, examination by the lead author revealed satisfactory anatomic correction. We recommend this simple, easy, and minimally invasive vaginal procedure to fellow gynecologists for repair of mild degrees of uterine prolapse in women declining hysterectomy or amputation of the cervix.
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Affiliation(s)
- Mohamad K. Ramadan
- Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
| | - Dominique A. Badr
- Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
| | - Walid Saheb
- Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
| | - Georges Wehbeh
- Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Beirut, Lebanon
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19
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Laparoscopic sacrohysteropexy versus vaginal hysterectomy for uterovaginal prolapse using validated questionnaires: 2-year prospective study. Int Urogynecol J 2017; 29:71-79. [DOI: 10.1007/s00192-017-3405-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/14/2017] [Indexed: 12/22/2022]
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20
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Jefferis H, Price N, Jackson S. Laparoscopic hysteropexy: 10 years' experience. Int Urogynecol J 2017; 28:1241-1248. [PMID: 28101639 DOI: 10.1007/s00192-016-3257-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Uterine prolapse is common and has traditionally been treated by vaginal hysterectomy. Increasingly, women are seeking uterine-preserving alternatives. Laparoscopic hysteropexy offers resuspension of the uterus using polypropylene mesh. We report on 10 years' experience with this technique. METHODS All hysteropexy procedures in our unit since 2006 were reviewed. Primary outcome was safety of hysteropexy, as assessed by intraoperative and major postoperative complications. Secondary outcomes were measures of feasibility, including operating time, length of stay, conversion to alternative procedures, change in point C, patient satisfaction, and repeat apical prolapse surgery. RESULTS Data were available for 507 women. Complications were rare (1.8%) with no evidence of any mesh exposure. Mean operating time was 62.5 min and median length of stay 2 nights. In 17 patients (3.4%), hysteropexy was abandoned. There was a mean change in point C of 7.9 cm and 93.8% of patients felt that their prolapse was "very much" or "much" better. Of these women, 2.8% have had repeat apical surgery. CONCLUSIONS To our knowledge, this is the largest series to date, describing 10 years' experience with laparoscopic hysteropexy. The surgical technique appears to be safe, with low complication rates, which supports the choice of appropriately selected women to opt for uterine preservation surgery as an alternative to hysterectomy for the management of uterine prolapse.
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Affiliation(s)
- Helen Jefferis
- Department of Urogynaecology, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Natalia Price
- Department of Urogynaecology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Simon Jackson
- Department of Urogynaecology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Nair R, Nikolopoulos K, Claydon L. Clinical outcomes in women undergoing laparoscopic hysteropexy: A systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 208:71-80. [DOI: 10.1016/j.ejogrb.2016.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/18/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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Collins AF, Doyle PJ, Vilasagar S, Buchsbaum GM. Utility of anterior vaginal wall length measurement in vaginal reconstructive surgery. Int Urogynecol J 2016; 28:1197-1200. [PMID: 28025684 DOI: 10.1007/s00192-016-3247-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The pelvic organ prolapse quantification system (POP-Q) is the most commonly used method to quantify the extent of pelvic organ prolapse. However, it does not include assessment of anterior vaginal wall length (AVL). The objectives of this study were to characterize AVL and distance to the sacrospinous ligament (SSL), and to examine associations between total vaginal length (TVL), AVL, body mass index (BMI) and age. METHODS This was a retrospective chart review of 139 patients with cervix in situ presenting during an 8-month period for initial evaluation to the University of Rochester Medical Center Urogynecology practice. AVL, TVL and distance to the SSL were measured in addition to POP-Q measurements. Age, height, BMI, presenting complaint and prolapse stage were obtained from medical records. Simple linear regression was used to assess the relationship between TVL and AVL. Multivariate regression was used to test independent variables. RESULTS The mean ± SD TVL, AVL and distance to the SSL were 9.4 ± 1.2 cm, 7.4 ± 0.9 cm and 7.2 ± 0.9 cm, respectively. All three measurements approached a normal distribution. TVL decreased slightly with age. No association was found between vaginal length and BMI or parity. CONCLUSIONS AVL is a useful measurement that may aid in surgical decision-making. Providers should consider using AVL when planning sacrospinous hysteropexy.
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Affiliation(s)
- Amy F Collins
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Paula J Doyle
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Smitha Vilasagar
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Gunhilde M Buchsbaum
- University of Rochester Medical Center, 601 Elmwood Ave, Suite 668, Rochester, NY, 14642-8668, USA.
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Grimminck K, Mourik SL, Tjin-Asjoe F, Martens J, Aktas M. Long-term follow-up and quality of life after robot assisted sacrohysteropexy. Eur J Obstet Gynecol Reprod Biol 2016; 206:27-31. [PMID: 27614268 DOI: 10.1016/j.ejogrb.2016.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/14/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effect of robot assisted laparoscopic sacrohysteropexy (RALS), with preservation of the uterus, in patients with pelvic organ prolapse on short and long term outcome. We report on (anatomical) status of the prolaps and the associated health related quality of life of women treated with RALS before and five years after surgery. STUDY DESIGN A prospective cohort study in a teaching hospital in The Netherlands was performed. Quality of life was assessed pre-operative, post-operative and five years after RALS using the UDI/IIQ validated self-questionnaire designed for Dutch-speaking patients. Clinical and operative data were prospectively collected up to five years. Statistical analysis of categorical data was performed with the paired T-test. Descriptive statistics were computed with the use of standard methods for means, median and proportions. RESULTS Hundred women with utero vaginal prolapse were treated with RALS with preservation of the uterus. The overall success rate of pelvic organ prolapse (POP) was 89.2%. After surgery the quality of life improved (P<0.05) Overall health status, based on a 0-100% visual analogue scale (VAS), improved from 72.6% pre-operative to 82.2% six weeks postoperative (P<0.05). Postoperative patients experienced less feelings of nervousness (P=0.01), shame (P<0.05) and frustration (P<0.05). The positive effects on these feelings remained present after five years. The learning curve shows a decrease in operating time with gained experience. CONCLUSION RALS has proven to be a safe and effective treatment for uterine preserving surgery in cases of pelvic organ prolapse. The long term anatomical outcomes and quality of life after RALS compare favorably with laparoscopic and open hysteropexy.
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Affiliation(s)
- K Grimminck
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands.
| | - S L Mourik
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
| | - F Tjin-Asjoe
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
| | - J Martens
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
| | - M Aktas
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
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Chhetri K. Pelvic Floor Support Defect in Apical Anterior Vaginal Prolapse with Cervical Hypertrophy. Review with Case Report in a 20-year-old Cadaver. J Clin Diagn Res 2015; 9:AD01-4. [PMID: 26557506 DOI: 10.7860/jcdr/2015/14966.6614] [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: 05/22/2015] [Accepted: 08/07/2015] [Indexed: 11/24/2022]
Abstract
Apical anterior vaginal wall prolapse (AVWP) with central defect is uncommon in young non hysterectomized patients causing considerable mortality after the fourth decade of life. Its high propensity to recurrence poses the greatest challenge to pelvic reconstructive surgeons. Approximately 40% of women with prolapse have hypertrophic cervical elongation and the extent of elongation increases with greater degrees of prolapse. Women with prolapse either have inherent hypertrophic elongation of the cervix which predisposes them to prolapse or the downward traction in prolapse leads to cervical elongation. The Pelvic Organ Prolapse Quantification (POP-Q) examination includes measurement of the location of the posterior fornix (point D) with the assumption that this measurement is associated with cervical elongation. Multifocal site involvement with apical and perineal descent primarily afflicts elderly, postmenopausal women after the fourth decade while cervical hypertrophic elongation with prolapse is observed in younger women less than 40 years of age. A review of the anatomical implication of the association of cervical hypertrophy in prolapse is carried out in this article. We observed a combination of distension type anterior vaginal prolapse with apical descent and cervical hypertrophy in a 20-year-old cadaver during routine dissection for undergraduate medical students at Sikkim Manipal Institute of Medical Sciences in 2013. Distension type anterior vaginal prolapse with central defect is rarer as most reported cases are of the displacement type, paravaginal defect. Hypertrophic cervical elongation is either the cause or consequence of prolapse and its identification before reconstructive surgery is paramount as uterine suspension in the face of cervical elongation is contraindicated. Inappropriate identification of all support defects and breaking of tissues is the primary cause of failure of laparoscopic pelvic reconstructive surgery.
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Affiliation(s)
- Kalpana Chhetri
- Assistant Professor, Department of Anatomy, Sikkim Manipal Institute of Medical Sciences , Gangtok East Sikkim, India
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Mothes AR, Radosa MP, Runnebaum IB. Systematic assessment of surgical complications in laparoscopically assisted vaginal hysterectomy for pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2015; 194:228-32. [DOI: 10.1016/j.ejogrb.2015.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/25/2015] [Accepted: 09/17/2015] [Indexed: 11/24/2022]
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Wu MP, Wu CJ, Weng SF. The choice of reoperation after primary surgeries for uterine prolapse: A nationwide study. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Robotic or laparoscopic sacrohysteropexy versus open sacrohysteropexy for uterus preservation in pelvic organ prolapse. Int Urogynecol J 2015; 27:593-9. [DOI: 10.1007/s00192-015-2869-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/16/2015] [Indexed: 12/28/2022]
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Tola EN, Erdemoğlu E, Erdemoğlu E. Uterine sparing surgical methods in pelvic organ prolapse. Turk J Obstet Gynecol 2015; 12:168-172. [PMID: 28913063 PMCID: PMC5558392 DOI: 10.4274/tjod.43179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/06/2015] [Indexed: 12/01/2022] Open
Abstract
Pelvic organ prolapse (POP) is defined as the protrusion of pelvic organs to the vagen and is an important health problem in patients of older age. Today, most women with POP prefer uterine sparing surgery due to the changes in lifestyle, beliefs, pregnancy desire, and understanding the role of the uterus and cervix in sexual function. Therefore, the need for newer surgical procedures that involve less invasive surgery, reduced intraoperative and postoperative risks, and a faster healing time in POP surgery have gained importance. Vaginal, abdominal, laparoscopic, and robotic methods are defined in uterine preserving surgery but there is not yet a consensus on which of them should be chosen. In choosing the proper technique, the patient's general status, accompanying disease, correct indication, and the surgeon's experience are all important. In our practice we prefer laparoscopic mesh sacrohysteropexy in patients who prefer to preserve their uterus because of the lower costs and high success rates compared with abdominal and robotic techniques.
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Affiliation(s)
- Esra Nur Tola
- Süleyman Demirel Univercity Faculty of Medicine, Department of Gyneacology and Obstetrics, Isparta, Turkey
| | - Evrim Erdemoğlu
- Süleyman Demirel Univercity Faculty of Medicine, Department of Gyneacologic Oncology, Isparta, Turkey
| | - Ebru Erdemoğlu
- Şifa Hospital, Clinic of Gyneacology and Obstetrics, Isparta, Turkey
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Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study. Int Urogynecol J 2015; 26:1687-94. [DOI: 10.1007/s00192-015-2761-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
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Pectineal Ligament Hysteropexy for Uterine Prolapse in Premenopausal Women by Open and Laparoscopic Approach in Indian Urban and Rural Centers. Female Pelvic Med Reconstr Surg 2015; 21:215-9. [DOI: 10.1097/spv.0000000000000179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lo TS, Pue LB, Hung TH, Wu PY, Tan YL. Long-term outcome of native tissue reconstructive vaginal surgery for advanced pelvic organ prolapse at 86 months: Hysterectomy versus hysteropexy. J Obstet Gynaecol Res 2015; 41:1099-107. [DOI: 10.1111/jog.12678] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/23/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Keelung/Taipei Medical Center; Keelung/Taipei Taiwan
- Division of Urogynecology; Department of Obstetrics and Gynecology; Linko, Chang Gung Memorial Hospital; Linkou Medical Center; Taoyuan Taiwan
- Chang Gung University, School of Medicine; Taoyuan Taiwan
| | - Leng Boi Pue
- Division of Urogynecology; Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Obstetrics and Gynecology; Serdang Hospital; Selangor Malaysia
| | - Tai-Ho Hung
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Keelung/Taipei Medical Center; Keelung/Taipei Taiwan
- Chang Gung University, School of Medicine; Taoyuan Taiwan
| | - Pei-Ying Wu
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Keelung/Taipei Medical Center; Keelung/Taipei Taiwan
- Division of Urogynecology; Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yiap Loong Tan
- Division of Urogynecology; Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Obstetrics and Gynecology; Kuching General Hospital; Sarawak Malaysia
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Coskun B, Lavelle RS, Alhalabi F, Christie AL, Zimmern PE. Anterior Vaginal Wall Suspension Procedure for Moderate Bladder and Uterine Prolapse as a Method of Uterine Preservation. J Urol 2014; 192:1461-7. [DOI: 10.1016/j.juro.2014.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Burhan Coskun
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Feras Alhalabi
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Alana L. Christie
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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Albowitz M, Schyrba V, Bolla D, Schöning A, Hornung R. Pregnancy After a Laparoscopic Sacrohysteropexy: a Case Report. Geburtshilfe Frauenheilkd 2014; 74:947-949. [PMID: 25364035 DOI: 10.1055/s-0034-1383032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022] Open
Abstract
Pelvic Organ Prolapse (POP) is a rare condition during pregnancy. If all conservative treatments fail, the surgical approach has proven to be in non-pregnant women a very good option due to high efficacy and a very low morbidity and mortality rate. We are reporting on the clinical results of a 33-year-old pregnant woman with a past history of laparoscopic sacrohysteropexy who delivered by caesarean section due to a foetal breech presentation. There are only a handful of cases reporting the outcome "pregnancy" after a laparoscopic sacrohysteropexy. Nevertheless, this appears to be a useful intervention for women with a POP unresponsive to conservative treatment and open family planning. Further studies with long-term follow-ups are required to confirm this.
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Affiliation(s)
- M Albowitz
- Obstetrics and Gynaecology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - V Schyrba
- Obstetrics and Gynaecology, Heiden General Hospital, Heiden, Switzerland
| | - D Bolla
- Obstetrics and Gynaecology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - A Schöning
- Obstetrics and Gynaecology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - R Hornung
- Obstetrics and Gynaecology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
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Ismail S. Prolapse surgery with or without stress incontinence for pelvic organ prolapse. BJOG 2014; 121:1313-4. [PMID: 25155323 DOI: 10.1111/1471-0528.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Si Ismail
- Royal Sussex County Hospital, Brighton, UK
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36
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Rosati M, Bramante S, Conti F. A review on the role of laparoscopic sacrocervicopexy. Curr Opin Obstet Gynecol 2014; 26:281-9. [DOI: 10.1097/gco.0000000000000079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Outcomes of trocar-guided Gynemesh PS™ versus single-incision trocarless Polyform™ transvaginal mesh procedures. Int Urogynecol J 2014; 26:71-7. [DOI: 10.1007/s00192-014-2467-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
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Larouche M, Merovitz L, Walter JE. Survey on Canadian Experience in Pelvic Organ Prolapse Repair and the Use of Transvaginal Mesh Systems. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maryse Larouche
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, Quebec, Canada
- Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Lisa Merovitz
- Department of Obstetrics and Gynecology, St. Mary's Hospital, Montreal, Quebec, Canada
| | - Jens-Erik Walter
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, Quebec, Canada
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Lonnée-Hoffmann RA, Salvesen O, Mørkved S, Schei B. Male sexual function and pelvic floor surgery of their female partner: A one-year follow-up study. Post Reprod Health 2014; 20:55-61. [PMID: 24879741 DOI: 10.1177/1754045314524950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to examine if sexual function of male partners changed after surgery for pelvic floor disorders and to explore associated factors. STUDY DESIGN This was an observational follow-up study at the Gynecological Department at the St Olavs University Hospital, Trondheim. The sample consisted of 35 male partners of women scheduled for pelvic organ prolapse or stress urinary incontinence surgery. Self-administered questionnaires, containing validated instruments as well as exploratory questions, were sent to women and their partners before and one year after pelvic floor surgery. Vaginal dimensions were measured in all women according to the Pelvic Organ Prolapse Quantification System, both before and after the surgery. MAIN OUTCOME MEASURES The Brief Sexual Function Instrument and the presence of erectile dysfunction. RESULTS One year after pelvic floor surgery, scores for sexual drive, erection and overall satisfaction from the Brief Sexual Function Instrument were unchanged; the ejaculation score (range 0-4) had mildly improved from a range of 4 (median 4) to a range of 3.5 (median 4), (p = 0.014). The proportion of men with erectile dysfunction was unchanged, while the proportion of men reporting vaginal wind had significantly decreased (p = 0.016). None of the baseline factors, subjective experiences or vaginal dimensions at baseline or follow-up were associated with the improved ejaculation score; only a reduction in the proportion of men reporting their partners with dyspareunia (ns) was significantly correlated (Spearman's rho 0.42, p = 0.019). CONCLUSION Sexual function of male partners was unchanged or mildly improved after pelvic floor surgery.
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Affiliation(s)
- Risa Am Lonnée-Hoffmann
- Department of Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oyvind Salvesen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siv Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Berit Schei
- Department of Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Alkış I, Karaman E, Han A, Gülaç B, Ark HC. The outcome of Manchester-Fotergill operation for uterine decensus repair: a single center experience. Arch Gynecol Obstet 2014; 290:309-14. [PMID: 24633983 DOI: 10.1007/s00404-014-3200-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/28/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical characteristics, peri- and post-operative outcomes, and clinical effectiveness of the Manchester-Fothergill (MF) procedure for uterine descensus as a uterine-sparing surgery. METHODS In this study, 49 patients underwent the MF procedure as a uterine-sparing surgery for uterine descensus during 2008-2012 in the Department of Urogynecology at Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey. RESULTS Medical records and follow-up data were collected from 24 of the 49 patients (48.9 %). The mean age was 49.3 ± 9.1 years, and parity 3.6 ± 1.5; 41.6 % were post-menopausal; 6 patients (25 %) had grade II, and 18 (75 %) had grade III uterine prolapse; 95.8 % had associated cystoceles, and 79.1 % had associated rectoceles; 66.6 % complained of urinary incontinence. On follow-up examination, the cervical stumps were satisfactorily situated in 23 of 24 patients, and recurrent prolapse was seen in 1 patient (4.1 %). Bladder perforation was repaired at the time of the operation in 1 patient, and one complained of post-operative urinary retention. CONCLUSION The MF procedure is a viable option to surgically correct uterine descent while preserving the uterus to treat recurrent prolapse with a low complication rate and low morbidity.
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Affiliation(s)
- Ismet Alkış
- Department of Obstetric and Gynecology, Yüzüncü yıl Üniversity Hospital, Van, Turkey
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Hyakutake MT, Cundiff GW, Geoffrion R. Cervical elongation following sacrospinous hysteropexy: a case series. Int Urogynecol J 2013; 25:851-4. [DOI: 10.1007/s00192-013-2258-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
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Rahmanou P, White B, Price N, Jackson S. Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively. Int Urogynecol J 2013; 25:131-8. [PMID: 24193261 DOI: 10.1007/s00192-013-2209-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/06/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Uterine conserving re-suspension surgery has become more popular in recent years. Such surgery may allow preservation of fertility in younger women, but may also have the added benefit of augmenting weak connective tissue and possibly providing stronger apical support than the conventional hysterectomy. Our goal was to evaluate the 1- to 4-year outcome of laparoscopic hysteropexy for the surgical management of uterine prolapse. METHODS This study was a prospective observational study of 182 consecutive women who underwent laparoscopic hysteropexy, with or without additional vaginal repair, from the beginning of 2007 until the end of 2010. Women were invited to attend a dedicated clinic for interview and their prolapse was assessed using the Patient Global Impression of Improvement (PGI-I), the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (ICIQ-VS) and the pelvic organ prolapse quantification (POP-Q) scale. Wilcoxon signed-rank test was used to compare pre-operative with postoperative data. Complications and women's satisfaction were also noted. RESULTS One hundred and forty women agreed to participate; the mean interval from operation was 2.1 years (range 1-4.4). Eighty-nine percent of women felt that their prolapse is "very much" or "much" better using PGI-I subjective outcome measure. There was significant improvement for all parameters of ICIQ-VS and POP-Q scoring post-surgery (p < 0.001). Six women (4 %) had further apical prolapse; of these, 3 underwent further prolapse surgery. None of the participants had any mesh exposure. Ninety two percent of participants would recommend the operation. CONCLUSIONS Laparoscopic hysteropexy is a safe and effective treatment. The 1- to 4-year outcome suggests high patient satisfaction and low rates of apical prolapse recurrence. Longer term follow-up and randomized controlled studies are required.
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Affiliation(s)
- Philip Rahmanou
- Department of Urogynaecology, John Radcliffe Hospital, Oxford, UK,
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Lee T, Rosenblum N, Nitti V, Brucker BM. Uterine sparing robotic-assisted laparoscopic sacrohysteropexy for pelvic organ prolapse: safety and feasibility. J Endourol 2013; 27:1131-6. [PMID: 23713544 DOI: 10.1089/end.2013.0171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to describe the surgical technique and report the safety and feasibility of robotic-assisted laparoscopic sacrohysteropexy, a uterine sparing procedure to correct pelvic organ prolapse (POP). Hysterectomy at the time of POP surgery has yet to be proven to improve the durability of repair. Nevertheless, the leading indication for hysterectomy in postmenopausal women is POP. PATIENTS AND METHODS We reviewed the medical records of a consecutive case series of uterine sparing prolapse repair procedures from 2005 to 2011. Fifteen women were identified. Procedures utilized a type I polypropylene mesh securing the posterior uterocervical junction to the sacral promontory. This was later modified to utilize a Y-shaped strip that was inserted through the broad ligaments to include the anterior uterocervical junction. RESULTS Objective success was defined as Baden Walker grade 0 uterine prolapse and subjective success was defined as no complaint of vaginal bulge or pressure. The mean age of women was 51.8 years (28-64 years). No intraoperative complications were noted. The mean operating time was 159.4 minutes (130-201 minutes) and mean estimated blood loss was 35 mL (0-100 mL). The mean length of stay was 1.6 days (1-4 days) and mean length of follow-up was 10.8 months. Uterine prolapse improved in all 15 patients. Objective success was 93% (14/15) and subjective success was 80% (12/15). CONCLUSION Robotic-assisted laparoscopic sacrohysteropexy was found to be a safe and feasible surgical treatment option for POP patients who desire uterine preservation.
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Affiliation(s)
- Ted Lee
- New York University School of Medicine, New York, NY 10016, USA.
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Khunda A, Vashisht A, Cutner A. New procedures for uterine prolapse. Best Pract Res Clin Obstet Gynaecol 2013; 27:363-79. [DOI: 10.1016/j.bpobgyn.2012.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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Effect of Uterine Preservation on Outcome of Laparoscopic Uterosacral Suspension. J Minim Invasive Gynecol 2013; 20:172-7. [DOI: 10.1016/j.jmig.2012.10.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/10/2012] [Accepted: 10/18/2012] [Indexed: 11/22/2022]
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Costantini E, Porena M, Lazzeri M, Mearini L, Bini V, Zucchi A. Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy. Int Urogynecol J 2013; 24:1481-7. [PMID: 23361855 DOI: 10.1007/s00192-012-2041-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 12/29/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Incontinence and pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of hysterectomy on sexual function. We designed the present observational prospective longitudinal cohort study in order to evaluate the impact of uterus preservation after POP repair on sexual function. METHODS Between January 2006 and January 2011, 107 patients with POP, mean age 58 ± 8.9 years, underwent colposacropexy with or without hysterectomy. All the women without uterine disease were offered the chance to preserve the uterus. All patients gave written informed consent and completed the Female Sexual Function Index (FSFI) questionnaire, before and after surgery, provided detailed case history, underwent urogynaecological examination and urodynamic assessment and completed the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact on Quality of Life short form (IIQ-7) questionnaires, and the satisfaction Visual Analogue Scale (VAS). One year after surgery patients repeated the FSFI questionnaire and underwent a clinical check-up. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were objective anatomical and subjective success, defined respectively as no prolapse and no incontinence-related symptoms. RESULTS Sixty-eight patients were included: 32 underwent uterus-sparing surgery and 36 hysterectomy plus colposacropexy. After surgery both groups had significant improvements in the total FSFI score and in the domains of desire, arousal and orgasm. The median post-operative scores of desire, arousal, and orgasm domains showed significant improvements in the uterus-sparing group compared with the hysterectomy group. None of the women had a uterine or vault prolapse recurrence. CONCLUSIONS Our data demonstrate that POP plays a role in female sexual dysfunction and uterus sparing surgery is associated with a greater improvement in sexual function.
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Affiliation(s)
- Elisabetta Costantini
- Department of Urology and Andrology, University of Perugia, S.M. Misericordia Hospital, S. Andrea delle Fratte, 06100, Perugia, Italy
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Marcus-Braun N, von Theobald P. Single port laparoscopic sacrohysteropexy in a young patient presenting with grade III uterine prolapse and rectocele. Int Urogynecol J 2013; 24:1445-6. [PMID: 23344216 DOI: 10.1007/s00192-012-1997-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Uterine preservation in patients with uterine prolapse is a common practice in the last decade and the reconstructive pelvic operation can be done either by vaginal, abdominal or laparoscopic approach. In young patients, uterine preservation is a legitimate option and one of the proposed operations is sacro-hystero-pexy. Single Port Laparoscopy (SPL) is a relatively new technique. This is a case of a young patient presented with grade III uterine prolapse and rectocele. METHODS The video presents the surgical technique of sacro-hystero-pexy as was described in 2001 by von Theobald, adapted specifically for the SPL technique. CONCLUSIONS The Single Port laparoscopy is an advanced laparoscopic technique. This video demonstrate that scaro-hystero-pexy can be done safely and efficacy with Single Port Laparoscopy without prolonging the operation time significantly.
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Affiliation(s)
- Naama Marcus-Braun
- Department of Obstetrics and Gynecology, Bar-Ilan Health Faculty, Ziv Medical Center, Safed, Israel
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Costantini E, Lazzeri M, Zucchi A, Mearini L, Fragalà E, Del Zingaro M, Bini V, Porena M. Urgency, detrusor overactivity and posterior vault prolapse in women who underwent pelvic organ prolapse repair. Urol Int 2013; 90:168-73. [PMID: 23327990 DOI: 10.1159/000345944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 11/16/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We investigated the relationship between posterior vault prolapse and overactive bladder (OAB) symptoms or detrusor overactivity (DO) and their changes after surgical repair. METHODS Forty-three patients with vault prolapse and prevalent posterior compartment prolapse underwent pelvic organ prolapse repair surgery: 28 received colposacropexy and 15 were treated by the vaginal approach. Subjective success was lack of prolapse-related symptoms or urgency. OAB symptoms, voiding symptoms and constipation were evaluated. Patient satisfaction was defined by a visual analog scale score (range 0-10). Objective anatomical success was defined as no vaginal prolapse of stage ≥2 at any vaginal site. RESULTS The median follow-up was 75 months (range 24-143). Preoperatively, 33/43 patients (76.74%) reported urgency. DO was found in 11/43 patients (25.6%), and 22/43 patients reported constipation. The anatomical outcome showed 2 persistent stage II rectoceles (6.9%). After surgery, OAB symptoms disappeared in 25/33 (75.88%) and persisted in 8 patients (24.2%); there was no de novo urgency. DO disappeared in 8/11 subjects (72.7%). Preoperative constipation was present in 17/33 patients with OAB symptoms (51.5%) and disappeared postoperatively in 13/17 patients (76.4%) (p < 0.013). De novo constipation appeared in 3 patients (associated with OAB in 2 patients). CONCLUSIONS Prevalent posterior compartment pelvic organ prolapse and OAB/DO were often associated. After surgery, OAB symptoms and DO were significantly reduced.
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Detollenaere RJ, den Boon J, Kluivers KB, Vierhout ME, van Eijndhoven HWF. Surgical management of pelvic organ prolapse and uterine descent in the Netherlands. Int Urogynecol J 2012; 24:781-8. [PMID: 23001046 DOI: 10.1007/s00192-012-1934-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate current practice in the surgical treatment of uterine descent among members of the Dutch Urogynecological Society and to analyze possible trends in the surgical treatment of pelvic organ prolapse in the Netherlands during the last decade. METHODS A questionnaire, including case scenarios, was sent to the members of the Dutch Urogynecological Society. Using a nationwide registry from the Netherlands, we assessed the number and type of surgical procedures performed for pelvic organ prolapse between 1997 and 2009. RESULTS The response rate was 73%, with 161 questionnaires completed. Vaginal hysterectomy, sacrospinous hysteropexy, and the Manchester Fothergill procedure were the most frequently performed surgical interventions for uterine descent. In the case of lower stage uterine descent, uterus preservation was preferred, but in the case of higher stage there was wide variation. Two thirds of the respondents stated that in recent years they tended to save the uterus more often. The registered number of hospital admissions for uterine descent increased by 30% between 1997 and 2009 and the number of surgical procedures almost doubled. The number of vaginal hysterectomies performed because of uterine descent increased by only 15% in this period. CONCLUSIONS In the Netherlands, surgical policy in the case of uterine descent is very variable, with no clear preference for either hysterectomy or uterus preservation. There was a high increase in hospital admissions and pelvic organ prolapse procedures in the last decade. The number of vaginal hysterectomies performed because of uterine descent did not follow this change, which reflects a trend toward preserving the uterus.
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Affiliation(s)
- R J Detollenaere
- Department of Obstetrics and Gynecology, Isala klinieken, PO Box 10500, 8000 GK, Zwolle, The Netherlands.
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50
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Primary and Repeated Surgeries for Ectopic Pregnancies and Distribution by Patient Age, Surgeon Age, and Hospital Levels: An 11-Year Nationwide Population-Based Descriptive Study in Taiwan. J Minim Invasive Gynecol 2012; 19:598-605. [DOI: 10.1016/j.jmig.2012.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/06/2012] [Accepted: 05/22/2012] [Indexed: 11/18/2022]
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