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Lopez AD, Carter J, Rubin R, Allen IE, Shaw NM, Hampson LA. Sexual and Urinary Health among Women following Bariatric Surgery. Obes Surg 2024:10.1007/s11695-024-07226-0. [PMID: 39160367 DOI: 10.1007/s11695-024-07226-0] [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: 10/17/2023] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Women with obesity are more likely to experience bothersome urinary and sexual symptoms, but the long-term effect of metabolic and bariatric surgery (MBS) on these outcomes is poorly understood. We aimed to describe how MBS longitudinally impacted women's urinary and sexual health. METHODS Patients who underwent MBS at the University of California, San Francisco Medical Center (UCSF) between 2009 and 2021 participated in a survey examining sexual health, pelvic organ prolapse (POP), and urinary health using three validated questionnaires: a modified version of the Female Sexual Function Index (FSFI), the Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and the Urinary Distress Inventory 6 (UDI-6). All questions asked referenced two time points: before surgery and at the time of survey. Logistic regression identified predictors of symptom improvement. RESULTS Of 162 participants contacted, 118 (73%) had complete survey data. Mean body mass index (BMI) decreased from 52.4 ± 12.6 to 36.3 ± 9.7 kg/m2 (p < 0.01) with an average follow-up of 6 years. The mean UDI-6 score amongst women was 24 ± 24 prior to MBS and 24 ± 26 at the time of survey administration (p = 0.458). Mean modified FSFI scores amongst women were 15 ± 5 prior to surgery and 14 ± 7 at the time of survey administration (p = 0.005). The overall mean POPDI-6 score amongst women was 13 ± 15 prior to surgery and 9 ± 14 at the time of survey administration (p = 0.056). CONCLUSION Women who underwent MBS reported a high rate of sexual and urological dysfunction that did not improve longitudinally, despite significant weight loss.
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Affiliation(s)
- Alejandro D Lopez
- Department of Urology, School of Medicine, University of California San Francisco, 400 Parnassus Ave, Box 0738, San Francisco, CA, 94143, USA
| | - Jonathan Carter
- Department of General Surgery, School of Medicine, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Rachel Rubin
- Department of Urology, MedStar Georgetown Department of Urology, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Nathan M Shaw
- Department of Urology, School of Medicine, University of California San Francisco, 400 Parnassus Ave, Box 0738, San Francisco, CA, 94143, USA
- Department of Urology, MedStar Georgetown Department of Urology, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
- Department of Reconstructive and Plastic Surgery, MedStar Georgetown Department of Urology, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
| | - Lindsay A Hampson
- Department of Urology, School of Medicine, University of California San Francisco, 400 Parnassus Ave, Box 0738, San Francisco, CA, 94143, USA.
- Department of Surgery, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA.
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Wu PC, Hsiao SM, Lin HH. The prevalence of overt, occult, and no-demonstrated stress urinary incontinence and their clinical and urodynamic findings in women with advanced-stage cystoceles. J Formos Med Assoc 2024:S0929-6646(24)00287-0. [PMID: 38918083 DOI: 10.1016/j.jfma.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To elucidate the prevalence of overt, occult and no demonstrated (ND) stress urinary incontinence (SUI) in women with advanced-stage cystoceles. STUDY DESIGN Between November 2011 and January 2017, all women with ≥stage 2 cystoceles were retrospectively enrolled. Overt SUI was diagnosed before the prolapse reduction test, and occult SUI was diagnosed when urine leakage was noted after a reduction test with vaginal gauze. Otherwise, a diagnosis of ND-SUI was made. MAIN OUTCOME MEASURES The prevalence, clinical and urodynamic findings of overt SUI, occult SUI, and ND-SUI. RESULTS In 480 enrolled women, 62% had overt SUI, 17% had occult SUI, and 21% had ND-SUI. The occult SUI group had the most advanced prolapse. The pad weight results after prolapse reduction (37.3 ± 44.3 vs. 13.4 ± 21.9, p < 0.05), the bladder capacity (243 ± 54 vs. 273 ± 48, p < 0.001), and questionnaires regarding life quality were significantly different between the overt SUI and the occult SUI groups. Bladder oversensitivity (BO) was the most common urodynamic diagnosis (389/480, 81%), especially in overt SUI, while urodynamic stress incontinence (56/480, 12%) and detrusor overactivity (60/480, 13%) were uncommon. The cutoff value of stage 3 uterine prolapse was the strongest predictor for predicting occult SUI (sensitivity = 30.3%, specificity = 78.5%; area = 0.60, 95% CI: 0.52-0.68). CONCLUSIONS SUI occurs in a ratio of 3:1:1 among cases with overt, occult, and no demonstrable symptoms. BO is the most common urodynamic diagnosis. Pad test with prolapse reduction remains an important tool, especially for coexistent stage 3 uterine prolapse.
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Affiliation(s)
- Pei-Chi Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
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Lo TS, Harun F, Chua S, Shen YH, Tan YL, Hsieh WC. Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up. J Formos Med Assoc 2024; 123:331-339. [PMID: 37996329 DOI: 10.1016/j.jfma.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND PURPOSE We present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. METHODS This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. RESULTS Objective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. CONCLUSION The UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Yu-Hua Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ Healthcare Group, Sarawak, Malaysia
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC
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Lourenço DB, Santos HOD, Hirakawa EY, Rios LAS, Lemos GC, Bianco B, Carneiro A. Does vaginal surgery for correction of pelvic organ prolapse improve urinary function? A prospective cohort study. Int Urogynecol J 2024; 35:149-156. [PMID: 37999760 DOI: 10.1007/s00192-023-05683-2] [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: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.
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Affiliation(s)
- Danilo B Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Hugo O D Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Elizabeth Y Hirakawa
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Luis Augusto S Rios
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Gustavo C Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil.
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
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Page AS, Page G, Deprest J. Cervicosacropexy or vaginosacropexy for urinary incontinence and apical prolapse: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 279:60-71. [DOI: 10.1016/j.ejogrb.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
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Lyu Y, Ding H, Zhang Y, Shi S, Ding J, Zhu C, Guan X, Ni G, Luo Y. Evaluation of the clinical effectiveness of modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse: A feasibility report based on 50 patients. Front Surg 2022; 9:1010027. [DOI: 10.3389/fsurg.2022.1010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveTo describe the surgical techniques and short-term outcomes for 50 cases of modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapseMethods100 patients with pelvic organ prolapse (stage III or stage IV based on POP-Q staging) from January 2018 to January 2020 were retrospectively analyzed. Among them, 50 patients received modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse (mSSLF group), while the other 50 patients received pelvic reconstruction using T4 mesh (T4 group). Operative time, blood loss, postoperative POP-Q score, length of the hospital stay, complications, and postoperative pain were compared between the two groups.ResultsThe duration of the operation in mSSLF group was (50 ± 15.2 min), which was shorter than that of the T4 group (60 ± 14.8 min) (p = 0.02). No intraoperative complications were reported from the mSSLF group, whereas one vascular injury occurred in the T4 group. In both groups, postoperative pain and painful intercourse was significantly lower in the mSSLF group than in the SSLF group (p < 0.001). The exposed mesh rate was lower than T4 group.ConclusionsThe rates of intraoperative complications, postoperative pain and mesh erosion were significantly lower than those of the T4 group, but there was no significant difference in the efficacy and safety of the treatment of pelvic organ prolapse. So mSSLF may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety.
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Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1557256. [PMID: 35295170 PMCID: PMC8920663 DOI: 10.1155/2022/1557256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
Pelvic organ prolapse is caused by various causes, which leads to the weakness of the tissue supporting the pelvic floor and then causes the downward displacement of female reproductive organs and adjacent organs. Clinical studies have shown that pop is often associated with stress urinary incontinence. This research project aimed to clarify the clinical effect of laparoscopic sacrocolpopexy (LSC) and tension-free vaginal tape obturator (TVT-O) for stress urinary incontinence (SUI) complicated with pelvic organ prolapse (POP) and the influencing factors of postoperative urinary function (UF) recovery. The clinical data of 125 patients with SUI complicated with POP treated in Wenzhou Central Hospital and Beidahuang Industry Group General Hospital between March 2018 and December 2019 were retrospectively analyzed. Patients were assigned to the following two arms based on different treatment methods: the combination group (n = 65, treated with LSC plus TVT-O) and the control group (n = 60, treated with LSC). The alterations of perioperative clinical and urodynamic indexes were analyzed. The objective and subjective response rates were observed and compared. The degree of POP before and after surgery was evaluated. According to the urinary function recovery time, the patients were divided into the fast and non-fast recovery groups, and then, the factors influencing postoperative UF recovery were analyzed between groups. The combination group showed statistically longer operation time (OT) and postoperative indwelling catheter and higher intraoperative blood loss (IBL) than the control group (all P < 0.05), but the anal exhaust time and postoperative length of stay (LOS) differed insignificantly between the two arms. The combination group outperformed the control group in the objective response rate, as well as the scores of illness, quality of life (QOL), and sexual life (all P < 0.05). Menopause, maximum flow rate (MFR), and preoperative residual urine volume were identified as the influencing factors for normal urination. For patients with SUI complicated with POP, the efficacy of laparoscopic sacrocolpopexy was limited, while combining with TVT-O would obtain more significant short-term and long-term efficacy, which can significantly improve patients' urination and long-term quality of life, with higher safety and clinical promotion value.
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Mothes AR, Mothes HK, Kather A, Altendorf-Hofmann A, Radosa MP, Radosa JC, Runnebaum IB. Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction. Sci Rep 2021; 11:22011. [PMID: 34759288 PMCID: PMC8580999 DOI: 10.1038/s41598-021-01565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann-Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67-8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03-1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85-2.38) and defect type (p = 0.02, B - 1.42, 95% CI - 2.65 to - 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.
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Affiliation(s)
- A R Mothes
- Women's University Hospital of Jena, Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Department of Gynaecology, St. Georg Hospital Eisenach, Academic Teaching Hospital of University of Jena, Eisenach, Germany
| | - H K Mothes
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
- Department of Abdominal and Vascular Surgery, Sophien and Hufeland Hospital Weimar, Academic Teaching Hospital of University of Jena, Weimar, Germany
| | - A Kather
- Women's University Hospital of Jena, Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - M P Radosa
- Women's University Hospital of Jena, Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Department of Gynaecology and Obstetrics, Hospital Bremen North, Bremen, Germany
| | - J C Radosa
- Department of Obstetrics & Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| | - I B Runnebaum
- Women's University Hospital of Jena, Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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