Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta-analysis and cost-effectiveness analysis

Surgical correction of the genital hiatus at the time of sacrocolpopexy - a 7-year Markov analysis: a cost-effectiveness analysis

INTRODUCTION AND HYPOTHESIS

To perform a cost-effectiveness analysis of concurrent posterior repair performed at the time of laparoscopic hysterectomy with sacrocolpopexy over a 7-year time period. We hypothesize it is not cost-effective to perform a posterior colporrhaphy.

METHODS

We used TreeAge Pro® to construct a decision model with Markov modeling to compare sacrocolpopexy with and without concurrent posterior repair (SCP and SCP+PR) over a time horizon of 7 years. Outcomes included probability and costs associated with prolapse recurrence, prolapse retreatment, and complications including rectal injury, rectovaginal hematoma requiring reoperation, and postoperative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) calculated as ∆ costs /∆ effectiveness and the willingness to pay (WTP) was set at $100,000/QALY.

RESULTS

Our model showed that SCP was the dominant strategy, with lower costs (-$ 2681.06) and higher effectiveness (+0.10) compared to SCP+PR over the 7-year period. In two-way sensitivity analyses, we varied the probability of prolapse recurrence after both strategies. Our conclusions would only change if the probability of recurrence after SCP was at least 29.7% higher than after SCP+PR. When varying the probabilities of dyspareunia for both strategies, SCP+PR only became the dominant strategy if the probability of dyspareunia for SCP+PR was lower than the rate of SCP alone.

CONCLUSIONS

In this 7-year Markov cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy. SCP+PR costs more with lower effectiveness than SCP alone, due to higher surgical cost of SCP+PR and higher probability of dyspareunia after SCP+PR.

Safety and Efficacy of Vaginal Implants in Pelvic Organ Prolapse Surgery: A Meta-analysis of 161 536 Patients

CONTEXT

Among the many surgical treatments for pelvic organ prolapse (POP), better results can be achieved with the use of vaginal implants. However, owing to perceived complications, vaginal implant surgeries have been restricted or banned in many countries.

OBJECTIVE

To assess the real value of vaginal implants in POP surgery and compare the safety and efficacy of operations with and without implants.

EVIDENCE ACQUISITION

A systematic search was performed in three medical databases. Randomised controlled trials and observational studies comparing the safety and efficacy of vaginal POP surgery with implants versus native tissue were included. Safety outcomes were defined as different types of complications (functional and non-functional) and reoperations for complications. Efficacy outcomes were parameters of anatomical success and the rate of reoperations due to recurrence. A multivariate meta-analysis framework was used to estimate pooled odds ratios (ORs) with confidence intervals (CIs) with simultaneous control for study correlations and estimation of multiple correlated outcomes.

EVIDENCE SYNTHESIS

We included 50 comparative studies in the analysis. Rates of reoperation for complications (OR 2.15, 95% CI 1.20-3.87), vaginal erosion (OR 14.05, 95% CI 9.07-21.77), vaginal bleeding (OR 1.67, 95% CI 1.25-2.23), and de novo stress urinary incontinence (OR 1.44, 95% CI 1.18-1.75) were significantly higher in the implant group. Rates of anatomical success (OR 3.22, 95% CI 2.06-5.0) and reoperation for recurrence (OR 0.55, 95% CI 0.36-0.85) were superior in the implant group.

CONCLUSIONS

POP surgeries with vaginal implants are more effective than surgeries without implants, with acceptable complication rates. Therefore, the complete prohibition of implants for POP surgeries should be reconsidered.

PATIENT SUMMARY

We compared vaginal surgery with and without implants for repair of pelvic organ prolapse. Despite higher complication rates, vaginal implants provide better long-term results overall than surgery without implants.

The effect evaluation of traditional vaginal surgery and transvaginal mesh surgery for severe pelvic organ prolapse: 5 years follow-up

The objective of this study was to compare the clinical effectiveness of traditional vaginal surgery and transvaginal mesh (TVM) surgery on severe pelvic organ prolapse (POP). We performed a retrospective chart review study of 258 severe POP patients who underwent surgery between November 2010 and September 2016. One hundred forty patients underwent traditional vaginal surgery and 118 TVM surgery. The Pelvic Organ Prolapse Quantitation (POP-Q) staging was used for objective evaluation. The Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Disease Life Impact Questionnaire Simplified Version-7 (PFIQ-7), and Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) were used for subjective evaluation. Their complications were also recorded. All the data were collected in the outpatient department through the follow-up at 3 months, 1, 3, and 5 years after the operation. Forty patients in the traditional vaginal surgery group and 25 in the TVM group were lost to follow-up. There was no difference in the POP-Q score between the groups (P = 0.346). The recurrence rate increased with follow-up time, reaching nearly 20% in the two groups by 5 years. The TVM group has higher PFDI-20 and PFIQ-7 scores and lower PISQ-12 scores than the traditional vaginal surgery group at six months, 1, 3, and 5 years, respectively (P < 0.001). Mesh exposure has occurred in the TVM group. Both surgeries showed similar objective satisfaction and recurrence rate. However, traditional vaginal surgery has higher subjective satisfaction than TVM in our study and does not risk exposure to prosthetic material.

Utilization of Time Series Tools in Life-sciences and Neuroscience

Time series tools are part and parcel of modern day research. Their usage in the biomedical field; specifically, in neuroscience, has not been previously quantified. A quantification of trends can tell about lacunae in the current uses and point towards future uses. We evaluated the principles and applications of few classical time series tools, such as Principal Component Analysis, Neural Networks, common Auto-regression Models, Markov Models, Hidden Markov Models, Fourier Analysis, Spectral Analysis, in addition to diverse work, generically lumped under time series category. We quantified the usage from two perspectives, one, information technology professionals', other, researchers utilizing these tools for biomedical and neuroscience research. For understanding trends from the information technology perspective, we evaluated two of the largest open source question and answer databases of Stack Overflow and Cross Validated. We quantified the trends in their application in the biomedical domain, and specifically neuroscience, by searching literature and application usage on PubMed. While the use of all the time series tools continues to gain popularity in general biomedical and life science research, and also neuroscience, and so have been the total number of questions asked on Stack overflow and Cross Validated, the total views to questions on these are on a decrease in recent years, indicating well established texts, algorithms, and libraries, resulting in engineers not looking for what used to be common questions a few years back. The use of these tools in neuroscience clearly leaves room for improvement.