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Barba M, Cola A, Melocchi T, De Vicari D, Costa C, Volontè S, Sandullo L, Frigerio M. High Uterosacral Ligaments Suspension for Post-Hysterectomy Vaginal Vault Prolapse Repair. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:320. [PMID: 38399607 PMCID: PMC10890601 DOI: 10.3390/medicina60020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault prolapse repair through high uterosacral ligaments suspension is limited. Consequently, with this study, we aimed to assess the efficiency, complications frequency, and functional results of native-tissue repair through USLs in vaginal vault prolapse. Materials and Methods: This was a retrospective study. Women with symptomatic vaginal vault prolapse (≥stage 2) who underwent surgery with transvaginal native-tissue repair by high uterosacral ligaments were included. Patient characteristics, preoperative assessment, operative data, postoperative follow-up visits, and re-interventions were collected from the hospital's record files. High uterosacral ligament suspension was performed according to the technique previously described by Shull. A transverse apical colpotomy at the level of the post-hysterectomy scar was performed in order to enter the peritoneal cavity. USLs were identified and transfixed from ventral to dorsal with three absorbable sutures. Sutures were then passed through the vaginal apex and tightened to close the transverse colpotomy and suspend the vaginal cuff. At the end of the surgical time, a diagnostic cystoscopy was performed in order to evaluate ureteral bilateral patency. Using the POP-Q classification system, we considered an objective recurrence as the descensus of at least one compartment ≥ II stage, or the need for a subsequent surgery for POP. The complaint of bulging symptoms was considered the item to define a subjective recurrence. We employed PGI-I scores to assess patients' satisfaction. Results: Forty-seven consecutive patients corresponding to the given period were analyzed. No intraoperative complications were observed. We observed one postoperative hematoma that required surgical evacuation. Thirty-three patients completed a minimum of one-year follow-up (mean follow-up 21.7 ± 14.6 months). Objective cure rate was observed in 25 patients (75.8%). No patients required reintervention. The most frequent site of recurrence was the anterior compartment (21.2%), while apical compartment prolapse relapsed only in 6% of patients. An improvement in all POP-Q parameters was recorded except TVL which resulted in a mean 0.5 cm shorter. Subjective recurrence was referred by 4 (12.1%) patients. The mean satisfaction assessed by PGI-I score was 1.6 ± 0.8. Conclusion: This analysis demonstrated that native-tissue repair through high USL suspension is an effective and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse. Objective, subjective, functional, and quality of life outcomes were satisfactory, with minimal complications.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Tomaso Melocchi
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Desirèe De Vicari
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Lucia Sandullo
- Department of Gynecology, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy;
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
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van Oudheusden AMJ, van IJsselmuiden MN, Menge LF, Coolen ALWM, Veen J, van Eijndhoven HWF, Dietz V, Kluivers KB, Spaans WA, Vollebregt A, van de Pol G, Radder CM, van der Ploeg JM, van Kuijk SMJ, Bongers MY. Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse: a randomised controlled trial and prospective cohort (SALTO-2 trial). BJOG 2023; 130:1542-1551. [PMID: 37132094 DOI: 10.1111/1471-0528.17525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP-Q stage ≥2 vaginal vault prolapse (VVP). DESIGN Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. SETTING Seven non-university teaching hospitals and two university hospitals in the Netherlands. POPULATION Patients with symptomatic post-hysterectomy vaginal vault prolapse, requiring surgical treatment. METHODS Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP-Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. MAIN OUTCOME MEASURES Primary outcome was disease-specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri-operative data, complications and sexual function. RESULTS A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease-specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). CONCLUSIONS LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow-up period of 12 months.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynaecology and Obstetrics, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Mèlanie N van IJsselmuiden
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Isala Medical Centre, Zwolle, The Netherlands
| | - Leah F Menge
- Department of Gynaecology and Obstetrics, Reinier de Graaf Guesthouse, Delft, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynaecology and Obstetrics, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Joggem Veen
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Viviane Dietz
- Department of Gynaecology and Obstetrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wilbert A Spaans
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Astrid Vollebregt
- Department of Gynaecology and Obstetrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Geerte van de Pol
- Department of Gynaecology and Obstetrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Celine M Radder
- Department of Gynaecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | | | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
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van Oudheusden AMJ, Weemhoff M, Menge LF, Essers BAB. Gynecologists' perspectives on surgical treatment for apical prolapse: a qualitative study. Int Urogynecol J 2023; 34:2705-2712. [PMID: 37392227 PMCID: PMC10682281 DOI: 10.1007/s00192-023-05587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/21/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal sacrospinous fixation (VSF) without mesh and sacrocolpopexy (SCP) with mesh are the most frequently performed surgical procedures for apical prolapse in the Netherlands. There is no long-term evidence suggesting the optimal technique, however. The aim was to identify which factors play a role in the choice between these surgical treatment options. METHODS A qualitative study using semi-structured interviews amongst Dutch gynecologists was carried out. An inductive content analysis was performed with Atlas.ti. RESULTS Ten interviews were analyzed. All gynecologists performed vaginal surgeries for apical prolapse, six gynecologists perform SCP themselves. Six gynecologists would perform VSF for a primary vaginal vault prolapse (VVP); three gynecologists preferred a SCP. All participants prefer a SCP for recurrent VVP. All participants have stated that multiple comorbidities could be a reason for choosing VSF, as this procedure is considered less invasive. Most participants choose a VSF in the case of older age (6 out of 10) or higher body mass index (7 out of 10). All treat primary uterine prolapse with vaginal, uterine-preserving surgery. CONCLUSIONS Recurrent apical prolapse is the most important factor in advising patients which treatment they should undergo for VVP or uterine descent. Also, the patient's health status and the patient's own preference are important factors. Gynecologists who do not perform the SCP in their own clinic are more likely to perform a VSF and find more reasons not to advise a SCP. All participants prefer a vaginal surgery for a primary uterine prolapse.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynecology and Obstetrics, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Mirjam Weemhoff
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Leah F Menge
- Department of Gynecology and Obstetrics, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA, Delft, The Netherlands
| | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Huang LX, Guo M, Sha LX, Chen C, Lin XH, Dong XX. Clinical Effect of Uterosacral and Cardinal Ligament Fixation versus Sacrospinous Ligament Fixation of Vaginal Vault Prolapse: A Retrospective Analysis. Int J Clin Pract 2023; 2023:1489928. [PMID: 37305223 PMCID: PMC10257538 DOI: 10.1155/2023/1489928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study aimed at comparing sacrospinous ligament fixation (SSLF) with uterosacral and cardinal ligament fixation (USCLF) concerning complications and outcomes in patients with pelvic organ prolapse (POP). Methods A retrospective analysis was performed on the clinical data of patients with POP stage III or above uterine prolapse treated at Wenzhou People's Hospital from January 2013 to December 2019. Patients were divided into two groups: USCLF group and SSLF group. The perioperative indicators, postoperative complications, pelvic organ prolapse quantification (POP-Q), Pelvic Floor Distress Inventory-20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores of the groups were analyzed and compared. Results (1) The operative time and intraoperative blood loss in the USCLF group were lower than those in the SSLF group, with statistical significance (p < 0.05). (2) The incidence of postoperative buttock pain in the SSLF group was 10.7% (6/56), higher than that in the USCLF group (0/56) (Fisher's exact test, p = 0.027). (3) At one year of follow-up, significant improvement in Aa, Ba, C, Ap, and Bp values was observed in both groups (p < 0.05). The values of the Aa and Ba sites in the USCLF group were lower than those in the SSLF group one year after surgery (p < 0.05). (4) The PFDI-20 and PISQ-12 scores of the groups one year after surgery were lower than those before surgery (p < 0.05). Conclusion Uterosacral and cardinal ligament suture fixation leads to less bleeding and better postoperative quality of life than preoperative and may be better than SSLF at preventing the recurrence of anterior wall prolapse after surgery.
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Affiliation(s)
- Ling-xiao Huang
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Min Guo
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Li-xiao Sha
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Cong Chen
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Xiao-hua Lin
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
| | - Xiao-xia Dong
- Department of Gynecology, Wenzhou People's Hospital, Wenzhou 325000, China
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Tunn R, Baessler K, Knüpfer S, Hampel C. Urinary Incontinence and Pelvic Organ Prolapse in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:71-80. [PMID: 36647585 PMCID: PMC10080228 DOI: 10.3238/arztebl.m2022.0406] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/01/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pelvic floor disorders are common, especially in pregnancy and after delivery, in the postmenopausal period, and old age, and they can significantly impact on the patient's quality of life. METHODS This narrative review is based on publications retrieved by a selective search of the literature, with special consideration to original articles and AWMF guidelines. RESULTS Pelvic floor physiotherapy (evidence level [EL] 1), the use of pessaries (EL2), and local estrogen therapy can help alleviate stress/urge urinary incontinence and other symptoms of urogenital prolapse. Physiotherapy can reduce urinary incontinence by 62% during pregnancy and by 29% 3-6 months post partum. Anticholinergic and β-sympathomimetic drugs are indicated for the treatment of an overactive bladder with or without urinary urge incontinence (EL1). For patients with stress urinary incontinence, selective serotonin-noradrenaline reuptake inhibitors can be prescribed (EL1). The tension-free tape is the current standard of surgical treatment (EL1); in an observational follow-up study, 87.2% of patients were satisfied with the outcome 17 years after surgery. Fascial reconstruction techniques are indicated for the treatment of primary pelvic organ prolapse, and mesh-based surgical procedures for recurrences and severe prolapse (EL1). CONCLUSION Urogynecological symptoms should be specifically asked about by physicians of all relevant specialties; if present, they should be treated conservatively at first. Structured surgical techniques with and without mesh are available for the treatment of urinary incontinence and pelvic organ prolapse. Preventive measures against pelvic floor dysfunction should be offered during pregnancy and post partum.
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Affiliation(s)
- Ralf Tunn
- Department of Urogynecology, German Pelvic Floor Center, Alexianer St. Hedwig Hospital, Berlin
| | - Kaven Baessler
- Pelvic Floor CenterFranziskus and St Joseph Hospitals Berlin
| | - Stephanie Knüpfer
- Clinic and Policlinic for Urology and Pediatric Urology, University Hospital of Bonn
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Perioperative Pain Management With Opioid Analgesics in Colpopexy Increases Risk of New Persistent Opioid Usage. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:183-190. [PMID: 36735432 DOI: 10.1097/spv.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Although the use of perioperative pain medications is highly investigated, limited studies have examined the usage of pain medication for post hysterectomy prolapse repair and the few that have have been restricted to smaller sample sizes. OBJECTIVE Our objective was to assess the association of perioperative opioid usage after posthysterectomy prolapse repairs with development of new persistent opioid usage. STUDY DESIGN The TriNetX Diamond Research Network was queried to create our cohorts of opioid-naive adult women with vaginal repair or laparoscopic sacrocolpopexy. The primary study outcomes were (1) the rate of perioperative opioid usage and (2) development of new persistent opioid usage. All cohorts were matched on age, race, ethnicity, chronic kidney disease, hypertensive diseases, ischemic heart disease, diseases of the liver, obstructive sleep apnea, affective mood disorders, pelvic and perineal pain, obesity, tobacco use, and utilization of office/outpatient, inpatient, or emergency department services. RESULTS We identified 10,414 opioid-naive women who underwent laparoscopic sacrocolpopexy and 13,305 opioid-naive women who underwent vaginal reconstruction. Rates of perioperative opioid usage were higher after laparoscopic sacrocolpopexy. Rates of developing new opioid usage were higher in both surgical-approach populations that received perioperative opioids compared with those that did not. Rates of new and persistent opioid usage did not differ by surgical approach when stratified by perioperative opioid usage. CONCLUSIONS We identified that opioid dependence may occur after surgery if patients are given opioids within 7 days of either approach, associating opioid dependence with perioperative opioid usage rather than the approach taken.
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Obsa MS, Worji TA, Kedir NA, Kute NG. Risk factors of pelvic organ prolapse at Asella Teaching and Referral Hospital: Unmatched case control study. Front Glob Womens Health 2022; 3:833823. [PMID: 36177338 PMCID: PMC9513197 DOI: 10.3389/fgwh.2022.833823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundProlapse is one of the sub-types of pelvic floor dysfunction (PFD) which occurs due to abnormal fall of the pelvic organs from their normal anatomic positions. Although the cause of prolapse is multifactorial, it primarily occurs due to pregnancy and vaginal delivery. Hence, the present study aimed to identify risk factors of prolapse among women who undergo gynecological surgery.Materials and methodsFacility-based-unmatched case–control design was employed. Cases were all gynecological women who were diagnosed with pelvic organ prolapse (POP) at Asella teaching referral hospital (ATRH) while controls were all charts of gynecological women who were diagnosed with other gynecological problems rather than POP at ATRH. For each case, two controls were selected using a simple random sampling technique. The data were entered into Epidata version 4.3.1 and finally exported to SPSS version 25 for further analysis. Then variables that had an association in the bivariate model (p < 0.25) were entered and analyzed by a multivariable conditional logistic regression model to identify the independent effect of different factors. Statistical significance was declared at p < 0.05.ResultsA total of 147 cases and 293 controls were included in this study. Women who had a history of chronic cough, previous pelvic floor surgery, constipation, and vaginal tear during delivery, history of pelvic trauma, age of the women, rural resident, and maternal gravidity were strongly associated with prolapse at p-value of < 0.05. Multigravida [adjusted odds ratio (AOR) 2.987 (95% CI 1.237–6.853), p = 0.014], age >50 years [AOR: 2.496 (95% CI 1.372–4.539), p = 0.003], women with a history of pelvic floor surgery [AOR: 0.3.666 (95% CI 1.328–10.124), p = 0.012], women who had diabetes mellitus [AOR: 4.676 (95% CI 0.908–24.075), p = 0.065], and resided in rural areas [AOR = 1.878; (95% CI: 0.984–3.585), I2 = 47.5%, p = 0.056] were the independent predictors were of prolapse.ConclusionsIn this study, women with diabetes mellitus, previous pelvic floor surgery, rural residents, being multigravida, and age >40 were independent predictors of prolapse. Therefore, delivering health education by focusing on the identified risk factors was strongly recommended.
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Affiliation(s)
| | - Tahir A Worji
- Department of Anesthesia, Wolaita Sodo University, Sodo, Ethiopia
| | - Nemo A Kedir
- School of Medicine, Arsi University, Asella, Ethiopia
| | - Negeso G Kute
- Department of Anesthesia, Hawassa University, Hawassa, Ethiopia
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Rocher G, Azaïs H, Favier A, Uzan C, Castela M, Moawad G, Lavoué V, Morandi X, Nyangoh Timoh K, Canlorbe G. Relationships between pelvic nerves and levator ani muscle for posterior sacrocolpopexy: an anatomic study. Surg Radiol Anat 2022; 44:891-898. [DOI: 10.1007/s00276-022-02955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
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Prospective Evaluation of Laparoscopic Sacrocolpopexy with Concomitant Laparoscopic-Assisted Total Vaginal Hysterectomy. SURGERIES 2022. [DOI: 10.3390/surgeries3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.
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Favre-Inhofer A, Carbonnel M, Murtada R, Revaux A, Asmar J, Ayoubi JM. Sacrospinous ligament fixation: medium and long-term anatomical results, functional and quality of life results. BMC WOMENS HEALTH 2021; 21:66. [PMID: 33579252 PMCID: PMC7881556 DOI: 10.1186/s12905-021-01195-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate the medium and long-term anatomical results of sacrospinous ligament fixation (SLF) and its impact on quality of life (QoL). METHODS We conducted a retrospective and observational single centre study. Fifty-nine patients were interviewed using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire and underwent physical examination using POP-Q several years after SLF. Primary outcome was the comparison of anatomic results of SLF at medium-term (group 1: 1-5 years after surgery) and long-term (group 2: more than 5 years after surgery). The secondary outcome was QoL evaluation. RESULTS The overall recurrence and complication rates were respectively 22% and 10%, with no significant differences between groups 1 and 2. The recurrence rate was similar in both groups [twelve (35%) in group 1 and nine (20%) in group 2, p = 0.09]. Two patients (12%) in the recurrence and none in the no recurrence group had clinical symptoms (p = 0.08). Two patients (12%) in the recurrence and one patient (2%) in the no-recurrence group had a significant impact on their quality of life (p = 0.12). CONCLUSION This study showed sustainable anatomic and functional results of SLF in medium and long-term analysis with overall low morbidity.
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Affiliation(s)
- Angeline Favre-Inhofer
- Department of Obstetrics Gynecology and Reproductive Medecine, Hospital Foch, Suresnes, France. .,University Versailles, Saint-Quentin en Yvelines, France.
| | - Marie Carbonnel
- Department of Obstetrics Gynecology and Reproductive Medecine, Hospital Foch, Suresnes, France.,University Versailles, Saint-Quentin en Yvelines, France
| | - Rouba Murtada
- Department of Obstetrics Gynecology and Reproductive Medecine, Hospital Foch, Suresnes, France
| | - Aurélie Revaux
- Department of Obstetrics Gynecology and Reproductive Medecine, Hospital Foch, Suresnes, France.,University Versailles, Saint-Quentin en Yvelines, France
| | - Jennifer Asmar
- Department of Obstetrics Gynecology and Reproductive Medecine, Hospital Foch, Suresnes, France
| | - Jean-Marc Ayoubi
- Department of Obstetrics Gynecology and Reproductive Medecine, Hospital Foch, Suresnes, France.,University Versailles, Saint-Quentin en Yvelines, France
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Okcu NT, Gürbüz T, Uysal G. Comparison of patients undergoing vaginal hysterectomy with sacrospinous ligament fixation, laparoscopic hysterectomy with sacrocolpopexy and abdominal hysterectomy with sacrocolpopexy in terms of postoperative quality of life and sexual function. J Gynecol Obstet Hum Reprod 2020; 50:101977. [PMID: 33166707 DOI: 10.1016/j.jogoh.2020.101977] [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: 09/04/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
AIM To investigate whether there is a significant difference among the patients who underwent vaginal hysterectomy with sacrospinous ligament fixation (VH + SSLF), laparoscopic hysterectomy with sacrocolpopexy (LH + SCP) and abdominal hysterectomy with sacrocolpopexy (AH + SCP) in terms of sexual function and quality of life. MATERIAL AND METHOD Sixty-five patients undergoing vaginal hysterectomy with sacrospinous ligament fixation (VH + SSLF), laparoscopic hysterectomy with sacrocolpopexy (LH + SCP) or abdominal hysterectomy with sacrocolpopexy (AH + SCP) participated in the study. The Quality of Life Scale and Sexual Function Scale Index (PISQ-12) were used to see whether there is a significant difference among the three groups (VH + SSLF, LH + SCP, AH + SCP) at least 1 year after surgery. The Pelvic Floor Distress Inventory-20 (PFDI-20) Scale consisting of Pelvic Organ Prolapse Distress Inventory (POPDI-6), Urinary Distress Inventory (UDI-6), and Colorectal-Anal Distress Inventory (CRADI-8) was used to evaluate the functional outcomes. RESULTS The participants had a mean age of 60 ± 8.79 years. The mean PFDI-20 score in the VH + SSLF groups is higher than that in the AH + SCP group (p = 0.047). There is no significant difference among three VH + SSLF, LH + SCP and AH + SCP groups regarding scores of POPDI-6, UDI-6, CRADI-8, and PISQ-12. CONCLUSION In the present study, it was concluded that AH + SCP group had a higher quality of life than the VH + SSLF group did while the sexual function was not affected significantly by the vaginal or abdominal surgical procedures. The pelvic surgeon should skillfully choose different prolapse surgical techniques to tailor the surgical treatment to the patient's needs.
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Affiliation(s)
- Nefise Tanrıdan Okcu
- Department of Obstetrics and Gynaecology, University of Health Sciences, Adana City Training and Research Center, Adana, Turkey.
| | - Tuğba Gürbüz
- Department of Obstetrics and Gynaecology, Medistate Kavacık Hospital, Istanbul, Turkey.
| | - Gülsüm Uysal
- Department of Obstetrics and Gynaecology, University of Health Sciences, Adana City Training and Research Center, Adana, Turkey.
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12
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Tagliaferri V, Ruggieri S, Taccaliti C, Gentile C, Didonna T, D'asta M, Legge F, Guida P, Scambia G, Guido M. Comparison of absorbable and permanent sutures for laparoscopic sacrocervicopexy: A randomized controlled trial. Acta Obstet Gynecol Scand 2020; 100:347-352. [PMID: 32970837 DOI: 10.1111/aogs.13997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Pelvic organ prolapse is a common cause of morbidity and decreased quality of life among women and is treatable by laparoscopic sacrocolpopexy. Recent data suggest that absorbable sutures are a feasible and appealing option for mesh attachment given a potential decreased risk of complications related to mesh erosion. The aim of the present study was to demonstrate the non-inferiority of absorbable sutures to permanent sutures for laparoscopic sacrocervicopexy. MATERIAL AND METHODS We performed a randomized, single-blinded, non-inferiority trial comparing late-absorbable sutures (group A) to non-absorbable sutures (group B) for anterior and posterior vaginal mesh fixation during laparoscopic sacrocervicopexy at a single center in Italy. The primary outcome was prolapse correction at 12 months after surgery, defined as the absence of a pelvic organ prolapse leading edge reaching or extending below the level of the hymen and the absence of bulge symptoms. Secondary outcomes included intraoperative parameters, postoperative characteristics, and long-term morbidity. Statistical analyses were performed using STATA version 16. RESULTS A total of 150 patients with pelvic organ prolapse were prospectively randomized 1:1 into two groups (A or B). Baseline characteristics and intraoperative parameters including blood loss, operation time, and intraoperative complications were comparable between groups. The success rate was 100% in both groups and no differences in prolapse correction were observed. The rates of de novo urinary incontinence and persistent urinary incontinence were also similar between groups. The rate of mesh erosion at 12 months was 0% in group A and 4% in group B (P = .24). CONCLUSIONS Late absorbable sutures are non-inferior to non-absorbable sutures for laparoscopic sacrocervicopexy in terms of procedural success. Moreover we did not see any differences in terms of operative parameters, or intraoperative and postoperative characteristics, although the study was not powered to these outcomes.
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Affiliation(s)
- Valeria Tagliaferri
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Stefania Ruggieri
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Chiara Taccaliti
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Cosimo Gentile
- Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Teodora Didonna
- Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Marco D'asta
- Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy.,Department of Obstetrics and Gynecology, Presidio Ospedaliero Garibaldi-Nesima, Catania, Italy
| | - Francesco Legge
- Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Piero Guida
- Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Maurizio Guido
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
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13
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Takayama M, Nomura M, Tokiwa S, Sawada Y, Hayashi T, Kitagawa Y. Laparoscopic sacrocolpopexy for vault prolapse: The technique of anterior dissection. Int J Urol 2020; 27:569-570. [DOI: 10.1111/iju.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Misato Takayama
- Urogynecology CenterKameda Medical Center Kamogawa Japan
- Department of Urology Iwate Medical University Morioka Japan
| | | | - Shino Tokiwa
- Urogynecology CenterKameda Medical Center Kamogawa Japan
| | - Yugo Sawada
- Urogynecology CenterKameda Medical Center Kamogawa Japan
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14
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Orhan A, Ozerkan K, Kasapoglu I, Ocakoglu G, Aslan K, Uncu G. A Meshless Practical Laparoscopic Sacrohysteropexy Modification and Long-term Outcomes. J Minim Invasive Gynecol 2020; 27:1573-1580. [PMID: 32135244 DOI: 10.1016/j.jmig.2020.02.011] [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: 12/18/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes. DESIGN A prospective cohort study. SETTING Minimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey. PATIENTS Women who were diagnosed with ≥ stage 2 uterine prolapse. INTERVENTIONS A laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh. MEASUREMENTS AND MAIN RESULTS The primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period. CONCLUSION Laparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative.
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Affiliation(s)
- Adnan Orhan
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu).
| | - Kemal Ozerkan
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
| | - Isil Kasapoglu
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
| | - Gokhan Ocakoglu
- Department of Biostatistics (Dr. Ocakoglu), Uludag University Hospital, Bursa, Turkey
| | - Kiper Aslan
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, Urogynecology, and Minimally Invasive Gynecology Unit (Drs. Orhan, Ozerkan, Kasapoglu, Aslan, and Uncu)
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15
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Gluck O, Blaganje M, Veit-Rubin N, Phillips C, Deprest J, O'reilly B, But I, Moore R, Jeffery S, Haddad JM, Deval B. Laparoscopic sacrocolpopexy: A comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol 2019; 245:94-101. [PMID: 31891897 DOI: 10.1016/j.ejogrb.2019.12.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
Sacrocolpopexy is considered the preferred treatment for vaginal vault. However, numerous technical variants are being practiced. We aimed to summarize the recent literature in relation to technical aspects of laparoscopic sacrocolpopexy (LSC). We focused on surgical technique, mesh type, concomitant surgeries, and training aspects. We performed 2 independent literature searches in Medline, Scopus, the Cochrane library, and Embase electronic databases including the keywords: 'sacrocolpopexy', 'sacral colpopexy' and 'promontofixation'. Full text English-language studies of human patients, who underwent LSC, published from January 1, 2008 to February 26, 2019, were included. Levels of evidence using the modified Oxford grading system were assessed in order to establish a report of the available literature of highest level of evidence. Initially, 953 articles were identified. After excluding duplicates and abstracts screening, 35 articles were included. Vaginal fixation of the mesh can be performed with barbed or non-barbed (level 1), absorbable or non-absorbable sutures (level 2). Fixation of the mesh to the promontory can be performed with non-absorbable sutures or non-absorbable tackers (level 2). The current literature supports using type 1 mesh (level 2). Ventral mesh rectopexy can safely be performed with LSC while concurrent posterior repair has no additional benefit (level 2). There is no consensus regarding the preferred type of hysterectomy or the benefit of an additional anti urinary incontinence procedure. A structured learning program, as well as the number of procedures needed in order to be qualified for performing LSC is yet to be established. There are numerous variants for performing LSC. For many of its technical aspects there is little consensus.
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Affiliation(s)
- Ohad Gluck
- Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Mija Blaganje
- Department of Gynecology, University Medical Center, Ljubljana, Slovenia
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Christian Phillips
- Department of Gynecology and Urogynecology, Hampshire Hospitals NHS Trust & University of Winchester, Hampshire, United Kingdom
| | - Jan Deprest
- Department of Obstetrics and Gynecology, Unit Pelvic Floor Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Barry O'reilly
- Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Igor But
- Department of General Gynecology and Gynecologic Urology, University Medical Center, Maribor, Slovenia
| | - Robert Moore
- Department of Obstetrics and Gynecology, Emory School of Medicine, Atlanta, USA
| | - Stephen Jeffery
- Department of Gynecology and Obstetrics, University of Cape Town, Cape Town, South Africa
| | - Jorge Milhem Haddad
- Urogynaecology Division, Hospital das clinicas da faculdade de medicina da universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Deval
- Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
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16
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Apostolopoulos NV, Alexandraki KI, Gorry A, Coker A. The early benefits of Laparoscopic Sacrocolpopexy. J Gynecol Obstet Hum Reprod 2019; 48:799-804. [PMID: 31276843 DOI: 10.1016/j.jogoh.2019.07.006] [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: 12/25/2018] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prospective evaluation of the 6 months functional and clinical outcome of 27 patients treated with Laparoscopic Sacrocolpopexy (LSC). METHODS Pelvic organ prolapse was assessed by Baden-Walker system along with a validated quality of life questionnaire preoperatively and at 6 months postoperatively to assess vaginal, urinary, bowel and sexual symptoms. RESULTS At a mean 6 months follow-up, 96% of the symptomatic women had successful vaginal vault support with no recurrence of prolapse symptoms. Successful anatomical outcome (any prolapse ≤ stage 1) was found in 89%. Regarding the urinary functional symptoms, significant improvement was reported in the voiding function, painful symptoms and the relevant quality of life. Stress urinary incontinence resolved in 67% without concomitant continence surgery; 4% from the stress incontinence was de novo. Bowel symptoms were common, both pre- and postoperatively; 40% from the postoperative bowel symptoms was de novo. Sexually active women reported significant improvement in sexual function; there was one case of de novo dyspareunia. CONCLUSION LSC is an effective treatment for vault prolapse as soon as in the 6-months follow-up. The outcome for anterior and posterior support is less predictable. The pelvic organ vaginal, urinary and sexual functional symptoms improve. The effects on bowel function are less clear. Long-term prospective studies are required to establish the duration of the benefits.
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Affiliation(s)
| | | | - Anwen Gorry
- Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK
| | - Adeyemi Coker
- Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK
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17
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Wu YM, Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Rep Urol 2019; 11:179-188. [PMID: 31355157 PMCID: PMC6590839 DOI: 10.2147/rru.s191555] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 02/02/2023] Open
Abstract
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Vaginal pessaries continue to be an effective and reversible option to manage SUI and POP symptoms. The midurethral sling remains the gold standard for surgical treatment of SUI, although patients and clinicians should acknowledge the potentially serious complications of TVM. Burch urethropexy and pubovaginal sling offer good SUI cure and may be preferred in women wishing to avoid mesh implants; however, their operative morbidities and more challenging surgical approach may limit their use. Site-specific cystocele or rectocele repairs may be indicated for isolated anterior or posterior vaginal compartment prolapse; however, in women with more severe POP, evidence supports using a vaginal native-tissue repair involving apical suspension as the primary surgical technique. Although abdominal and laparoscopic sacrocolpopexies are both effective in treating POP, their failure and mesh complication rates increase with time. There is insufficient evidence to support the widespread use of uterine-preserving surgical POP repairs at present due to the lack of long-term data. Routine TVM use is not recommended in POP surgeries and should only be considered on a case-by-case basis by trained surgeons, primarily in women with multiple risk factors for POP recurrence. In general, clinicians should individualize SUI and POP treatment options for women based on their symptoms, comorbidities, and risk factors for mesh-related complications.
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Affiliation(s)
- You Maria Wu
- Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
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18
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Meili G, Christmann C, Schneider J. [Long-term Outcome after Prolapse Surgery in a General Gynecological Teaching Hospital]. PRAXIS 2018; 107:497-504. [PMID: 29690850 DOI: 10.1024/1661-8157/a002960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Untersucht wurden objektive und subjektive Langzeitergebnisse vaginaler und laparoskopischer Prolapsoperationen in einem allgemeinen gynäkologischen Lehrkrankenhaus. Es handelt sich um eine retrospektive Studie mit 269 Frauen. Das subjektive Ergebnis wurde anhand des P-QOL-Fragebogens und Befragungen beurteilt, die objektiven Ergebnisdaten wurden prä- und postoperativ nach drei bis neun Monaten beurteilt. Die Krankengeschichte wurde bezüglich Anamnese sowie intra- und postoperativen Komplikationen analysiert. Wir führten 87 laparoskopische Sakrokolpopexien, 100 Kolpofixationen nach Richter, 164 anteriore oder/und posteriore vaginale Plastiken, oft in Kombination mit anderen Eingriffen, sowie weitere Eingriffe durch. 80 % (185/206) der behandelten Frauen waren mit dem postoperativen Ergebnis zufrieden. Kenntnisse der Anamnese und der Symptome der Patientin sind sehr wichtig, um die Frauen über chirurgische Optionen und Erwartungen hinsichtlich des objektiven postoperativen Ergebnisses orientieren zu können.
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19
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Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5727165. [PMID: 29675427 PMCID: PMC5851336 DOI: 10.1155/2018/5727165] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/12/2018] [Indexed: 01/22/2023]
Abstract
Objective Our aim was to study the efficacy of transvaginal bilateral sacrospinous fixation (TBSF) and its impact on quality of life (QoL) and sexual functions in women affected by second recurrences of vaginal vault prolapse (VVP). Materials and Methods We performed a prospective observational study on 20 sexually active patients affected by second recurrence of VVP, previously treated with monolateral sacrospinous fixation. TBSF was performed in all the patients. They had been evaluated before the surgery and at 12-month follow-up through pelvic organ prolapse quantification (POP-Q) system, Short Form-36 (SF-36), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results At 12-month follow-up, 18 out of 20 (90%) patients were cured of their recurrent VVP. No major intra- and postoperative complications occurred. We found a significant improvement in 4/5 POP-Q landmarks (excluding total vaginal length), SF-36, and PISQ-12 scores. Conclusion According to our data analysis, TBSF appears to be safe, effective, and able to improve both QoL and sexual functions in patients affected by second recurrence of VVP after previous monolateral sacrospinous fixation.
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