Lateral extension and attachment of mesh to the lateral vagina during laparoscopic sacrocolpopexy: a modified technique aimed at lowering recurrences in the anterior vaginal compartment. A surgical video

PURPOSE/OBJECTIVE

Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. Most recurrences seem to occur in the anterior compartment, especially if a paravaginal defect is present. To reduce the incidence of anterior recurrence after laparoscopic sacrocolpopexy we modified our previous published technique by placing the anterior mesh not only deep under the bladder but also laterally and fixing it to the lateral edge of the vagina. With this video article, we would like to show and explain our modified technique and demonstrate how lateral mesh placement can be easily and safely performed using laparoscopy.

METHODS

The video demonstrates our modified technique with lateral extension and fixation of the anterior mesh to the lateral vagina during laparoscopic sacrocolpopexy in a patient with severe uterine prolapse (grade III) and a large cystocele (grade III). Special emphasis is given to the topographical anatomy of the paravaginal space and the surgical technique of lateral fixation.

RESULTS

This modified new technique shows excellent perioperative results in more than 100 cases without any occurrences of lesions of the ureters. Our initial experience also shows very good anatomical results in all three compartments.

CONCLUSIONS

Paravaginal dissection and exposure of the ureters to extend the mesh placement and fixation to the lateral border of the vagina in the anterior compartment during laparoscopic sacrocolpopexy seem to be feasible and safe, helping to significantly reduce the risk of anterior recurrences. Prospective data are needed to evaluate this interesting technique.

[Urinary incontinence in the woman--pathophysiology and diagnosis]

Since urinary incontinence is one of the most frequent female health problems and may severely affect a woman's life quality, knowledge about its pathophysiology, evaluation and therapy is very important. Even basic diagnostic tests can determine the type of incontinence (stress or urge urinary incontinence) thus permitting appropriate therapy to be initiated. The patients history, micturition diary, clinical evaluation, perineal ultrasound and urinalysis are important parts of these basic diagnostic tests. The positive stress cough test and the typical symptoms such as urine loss during physical activity point to the diagnosis of stress urinary incontinence. Frequency, nocturia and urgency with or without urine loss as well as more objective criteria such as micturition diaries and urinalysis indicate urge incontinence. Questions to help determine how quality of life is affected by the incontinence symptoms aid in deciding how urgent the treatment is. An urodynamic evaluation together with perineal ultrasound and cystoscopy is performed in patients with complex or recurrent urinary incontinence after surgery or with micturition disorders.