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Vermeulen CKM, Tunnissen W, Coolen ALWM, Veen J, Dietz V, van Leijsen SAL, Bongers MY. Central Sensitisation Syndrome: A Frequent Finding in Women with Pelvic Floor Symptoms Without Evident Urogenital Prolapse. Int Urogynecol J 2024; 35:227-236. [PMID: 38165443 DOI: 10.1007/s00192-023-05697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Women with central sensitisation syndrome (CSS) experience poorer subjective post-operative outcomes even after successful pelvic floor reconstruction. This study tests the hypothesis that women with pelvic floor symptoms (PFS) without relevant pelvic organ prolapse (POP), are more likely to have CSS. METHODS A questionnaire was sent to women who participated in the POP-UP study in 2017. The POP-UP study evaluated POP in 247 women 16 years after laparoscopic or vaginal hysterectomy. POP-Q data and Pelvic Floor Distress Inventory (PFDI-20) results were used and supplemented with CSS-specific questionnaires. A Central Sensitisation Inventory (CSI) score above 40 implicates CSS. Women were divided into groups based on POP beyond the hymen in relation to the PFDI-20 score. Outcomes of women with PFS and without POP (called 'group 1') were compared with the rest of the cohort (groups 2-4; women without PFS and/or with POP). RESULTS A total of 136 women were included in the analysis. A CSI score above 40 was present in 16 out of 42 women of group 1 (37%) versus 11 out of 93 women of groups 2-4 (12%), p < 0.0001. Passive coping was more prevalent in group 1 (p = 0.039), and more deviations in somatisation, depression, anxiety and distress were found in group 1 (p values of < 0.0001, 0.018, 0.003 and 0.002 respectively). CONCLUSIONS This study suggests that CSS might be more prevalent in women with PFS without relevant POP. More awareness of CSS and valid individual counselling may overcome unnecessary surgery for POP and help in setting realistic expectations.
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands.
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Willemijn Tunnissen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Joggem Veen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Viviane Dietz
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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Vermeulen CKM, Schuurman B, Coolen ALWM, Meijs-Hermanns PR, van Leijsen SAL, Veen J, Bongers MY. The effectiveness and safety of laparoscopic uterosacral ligament suspension: A systematic review and meta-analysis. BJOG 2023; 130:1568-1578. [PMID: 37271736 DOI: 10.1111/1471-0528.17565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Laparoscopic uterosacral ligament suspension (LUSLS) is a technique to correct apical pelvic organ prolapse (POP) by shortening the uterosacral ligaments with sutures. OBJECTIVE A systematic review with meta-analysis of the effectiveness and safety of LUSLS as treatment for apical POP. SEARCH STRATEGY PubMed and Cochrane search using 'pelvic organ prolapse', 'laparoscopy' and 'uterosacral', including synonyms. SELECTION CRITERIA All articles in English presenting outcome of an original series of women with LUSLS as treatment of apical POP. Case reports were excluded. DATA COLLECTION AND ANALYSIS Study enrollment was performed by two reviewers. Our primary outcome measures were objective and subjective effectiveness of the procedure. Secondary outcome measures regarded complications and recurrence. Bias was assessed with the Newcastle Ottawa Scale. MAIN RESULTS Of 138 hits, 13 studies were included with 933 LUSLS patients. The average follow-up was 22 months. All were nonrandomised cohort studies. The pooled anatomic success rate is 90% for all LUSLS procedures (95% confidence interval [CI] 83.3-95.5). LUSLS with hysterectomy resulted in an anatomic success rate of 96.6% (95% CI 87.5-100) and LUSLS with uterus preservation 83.4% (95% CI 67.7-94.6). The pooled subjective cure rate was 90.5% (95% CI 81.9-96.5). The rate of major complications was 1%. CONCLUSIONS Laparoscopic uterosacral ligament suspension (with or without uterus preservation) seems to be an effective and safe treatment for women with apical POP, but long-term prospective trials and randomised controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Britt Schuurman
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Puck R Meijs-Hermanns
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Joggem Veen
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
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Enklaar RA, Schulten SFM, van Eijndhoven HWF, Weemhoff M, van Leijsen SAL, van der Weide MC, van Bavel J, Verkleij-Hagoort AC, Adang EMM, Kluivers KB. Manchester Procedure vs Sacrospinous Hysteropexy for Treatment of Uterine Descent: A Randomized Clinical Trial. JAMA 2023; 330:626-635. [PMID: 37581670 PMCID: PMC10427949 DOI: 10.1001/jama.2023.13140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
Importance In many countries, sacrospinous hysteropexy is the most commonly practiced uterus-preserving technique in women undergoing a first operation for pelvic organ prolapse. However, there are no direct comparisons of outcomes after sacrospinous hysteropexy vs an older technique, the Manchester procedure. Objective To compare success of sacrospinous hysteropexy vs the Manchester procedure for the surgical treatment of uterine descent. Design, Setting, and Participants Multicenter, noninferiority randomized clinical trial conducted in 26 hospitals in the Netherlands among 434 adult patients undergoing a first surgical treatment for uterine descent that did not protrude beyond the hymen. Interventions Participants were randomly assigned to undergo sacrospinous hysteropexy (n = 217) or Manchester procedure (n = 217). Main Outcomes and Measures The primary outcome was a composite outcome of success, defined as absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by a standardized vaginal support quantification system, absence of bothersome bulge symptoms, and absence of prolapse retreatment (pessary or surgery) within 2 years after the operation. The predefined noninferiority margin was 9%. Secondary outcomes were anatomical and patient-reported outcomes, perioperative parameters, and surgery-related complications. Results Among 393 participants included in the as-randomized analysis (mean age, 61.7 years [SD, 9.1 years]), 151 of 196 (77.0%) in the sacrospinous hysteropexy group and 172 of 197 (87.3%) in the Manchester procedure group achieved the composite outcome of success. Sacrospinous hysteropexy did not meet the noninferiority criterion of -9% for the lower limit of the CI (risk difference, -10.3%; 95% CI, -17.8% to -2.8%; P = .63 for noninferiority). At 2-year follow-up, perioperative outcomes and patient-reported outcomes did not differ between the 2 groups. Conclusions Based on the composite outcome of surgical success 2 years after primary uterus-sparing pelvic organ prolapse surgery for uterine descent, these results support a finding that sacrospinous hysteropexy is inferior to the Manchester procedure. Trial Registration TrialRegister.nl Identifier: NTR 6978.
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Affiliation(s)
- Rosa A. Enklaar
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sascha F. M. Schulten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Mirjam Weemhoff
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Marijke C. van der Weide
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen van Bavel
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, the Netherlands
| | | | - Eddy M. M. Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Vermeulen CKM, Veen J, Adang C, Coolen ALWM, van Leijsen SAL, Bongers MY. Long-term pelvic floor symptoms and urogenital prolapse after hysterectomy. BMC Womens Health 2023; 23:115. [PMID: 36944980 PMCID: PMC10029236 DOI: 10.1186/s12905-023-02286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study was to describe the natural course of pelvic floor symptoms and pelvic floor anatomy for women long-term after hysterectomy. METHODS Women who underwent hysterectomy between 1996-2004 carried out the PFDI-20 questionnaire and POP-Q examination. We collected data on the presence and type of pelvic floor symptoms and its relation to the degree of pelvic organ prolapse (POP) per compartment (≥ stage 2). RESULTS We obtained data from 247 women on average sixteen years after hysterectomy, with no prolapse (n = 94), anterior prolapse (n = 76), posterior prolapse (n = 38), both anterior- and posterior prolapse (n = 20), and a prolapse involving the vaginal vault (n = 19). Of all 153 women with ≥ stage 2 prolapse, 80 (52%) experienced moderate and/or severe symptoms of the PFDI-20. Most frequently reported symptoms by women with POP were uncontrollable flatus, urinary frequency and urge incontinence. Bulging was associated with a prolapse beyond the hymen. 39% Of women without prolapse experienced bothersome pelvic floor symptoms as well. Most often these were stress incontinence, straining to pass stool and incomplete bowel emptying. Women with a history of hysterectomy for prolapse have more pelvic floor symptoms than women who underwent hysterectomy for other indications, regardless of the current presence of POP (57% versus 40%, p = 0.009). CONCLUSION In a group of post-hysterectomy women who did not actively seek help, 47% experienced problematic pelvic floor symptoms, independent of the presence or absence of an anatomic POP. Creating more knowledge and awareness of the impact of hysterectomy on the pelvic floor can help women in the future. TRIAL REGISTRATION The study was registered in the Dutch Trial Registry; Trial NL5967 (NTR6333, 2017-02-01) and approved by the Medical Research Ethics Committee of the Máxima Medical Center (NL60096.015.16, 2017-02-24).
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands.
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Joggem Veen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Caroline Adang
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Anne Lotte W M Coolen
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Woman Care, Bergman Clinics, Professor Bronkhorstlaan 10, 3723 MB, Bilthoven, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Enklaar RA, Knapen FMFM, Schulten SFM, van Osch LADM, van Leijsen SAL, Gondrie ETCM, Weemhoff M. The modified Manchester Fothergill procedure compared with vaginal hysterectomy with low uterosacral ligament suspension in patients with pelvic organ prolapse: long-term outcome. Int Urogynecol J 2023; 34:155-164. [PMID: 35652948 PMCID: PMC9160845 DOI: 10.1007/s00192-022-05240-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/19/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to compare the long-term outcome between vaginal hysterectomy with low uterosacral ligament suspension (VH) and the modified Manchester Fothergill procedure (MF) as surgical treatment in patients with pelvic organ prolapse (POP). We hypothesize that MF is non-inferior to VH in the long term. METHODS In this single-center retrospective cohort study patients who underwent MF or VH for primary apical compartment prolapse between 2003 and 2009 were eligible for inclusion. The primary outcome was subjective recurrence of POP. Secondary outcomes included number and type of reinterventions, time to reintervention and the degree of complaints. RESULTS One hundred sixty of 398 patients (53 MF, 107 VH) returned the questionnaires (40%). The mean follow-up was 12.97 years for MF and 13.24 years for VH (p = 0.38). There were similar rates of subjective POP recurrence (51% in both groups). The reintervention rate in the MF group was higher but reached no statistical significance [19/53 (36%) versus 29/107 (27%), p = 0.26]. Kaplan-Meier curve showed no statistically significant difference in risk of reintervention after MF at the maximum follow-up of 16.5 years [HR 1.830 (95% CI 0.934-3.586), p = 0.08]. The mean time to reintervention was 3 years shorter in the MF group (p = 0.03). CONCLUSIONS The subjective recurrence after MF is similar to VH in treatment of POP at the long term. MF appears to be non-inferior to VH when comparing the risk of reintervention. However, the small sample size precludes a definitive conclusion of non-inferiority, and future studies are needed.
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Affiliation(s)
- Rosa A Enklaar
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands.
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Femke M F M Knapen
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sascha F M Schulten
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Sanne A L van Leijsen
- Department of Obstetrics & Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Ed T C M Gondrie
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
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Schulten SFM, Essers B, Notten KJB, Enklaar RA, van Leijsen SAL, van Eijndhoven HWF, Kluivers KB, Weemhoff M. Patient’s preference for sacrospinous hysteropexy or modified Manchester operation: a discrete choice experiment. BJOG 2022; 130:99-106. [PMID: 36043332 PMCID: PMC10087824 DOI: 10.1111/1471-0528.17280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/19/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse. DESIGN Labelled discrete choice experiment (DCE). SETTING Eight Dutch hospitals. POPULATION Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation. METHODS DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success ( levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models. MAIN OUTCOME MEASURES Women's preference for MM or SH. RESULTS 137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision-making. For SH, all attributes were relevant for decision-making. CONCLUSIONS The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare.
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Affiliation(s)
- Sascha F. M. Schulten
- Radboud university medical center Radboud Institute for Health Sciences, department of Obstetrics and Gynaecology, Geert Grooteplein Zuid 10 GA Nijmegen The Netherlands
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem The Netherlands
| | - Brigitte Essers
- Department of clinical epidemiology and medical technology assessment, P. Debyelaan 25, 6202 AZ Maastricht university medical centre+ The Netherlands
| | - Kim J. B. Notten
- Department of Obstetrics and Gynaecology Radboud university medical center GA Nijmegen The Netherlands
| | - Rosa A. Enklaar
- Radboud university medical center Radboud Institute for Health Sciences, department of Obstetrics and Gynaecology, Geert Grooteplein Zuid 10 GA Nijmegen The Netherlands
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen The Netherlands
| | - Sanne A. L. van Leijsen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre Veldhoven, De Run 4600, 5500 MB Veldhoven The Netherlands
| | - Hugo W. F. van Eijndhoven
- Department of Gynaecology and Obstetrics, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle The Netherlands
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynaecology Radboud university medical center GA Nijmegen The Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen The Netherlands
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Vermeulen CKM, Veen J, Adang C, van Leijsen SAL, Coolen ALWM, Bongers MY. Pelvic organ prolapse after laparoscopic hysterectomy compared with vaginal hysterectomy: the POP-UP study. Int Urogynecol J 2020; 32:841-850. [PMID: 33170314 PMCID: PMC8009772 DOI: 10.1007/s00192-020-04591-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to review the long-term prevalence of pelvic organ prolapse (POP) after laparoscopic hysterectomy (LH) compared with vaginal hysterectomy (VH). METHODS An observational cohort study was conducted amongst women who underwent an LH or a VH for benign indications during the period 1996-2004: the POP-UP study. The prevalence of POP was inventoried by a questionnaire involving the Pelvic Floor Distress Inventory (PFDI-20) and a pelvic floor examination (POP-Q). Women were divided into groups based on route and indication of hysterectomy: LH, VH-1 (for nonprolapse), and VH-2 (prolapse). RESULTS Four hundred and six of the 706 eligible patients (58%) returned the questionnaire and 247 underwent POP-Q examination. Sixty-eight patients (17%) received treatment for prolapse; 8% LH, 10% VH-1, and 29% VH-2 (Chi-squared test, p < 0.001). The prevalence of vaginal vault prolapse (apical surgery or ≥ stage 2 at POP-Q) was 4.4% for LH and 5.8% for VH-1 (p = 0.707); and 23% for VH-2 (VH-2 versus others, p < 0.0001). The prevalence of prolapse ≥ stage 2 in any compartment was 62% (n = 153) in total and in 42% of the LH group, 51% of the VH-1 group, and 84% of the VH-2 group (Chi-squared test, p < 0.001). A symptomatic POP (anatomical POP ≥ stage 2 with bulging) was present in 11% of the population. CONCLUSIONS No difference was found in the prevalence of POP between LH and VH for nonprolapse indications. However, POP after VH for prolapse occurs more frequently than after hysterectomy for other indications.
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands.
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
| | - Joggem Veen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Caroline Adang
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
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Schulten SFM, Enklaar RA, Kluivers KB, van Leijsen SAL, Jansen-van der Weide MC, Adang EMM, van Bavel J, van Dongen H, Gerritse MBE, van Gestel I, Malmberg GGA, Mouw RJC, van Rumpt-van de Geest DA, Spaans WA, van der Steen A, Stekelenburg J, Tiersma ESM, Verkleij-Hagoort AC, Vollebregt A, Wingen CBM, Weemhoff M, van Eijndhoven HWF. Evaluation of two vaginal, uterus sparing operations for pelvic organ prolapse: modified Manchester operation (MM) and sacrospinous hysteropexy (SSH), a study protocol for a multicentre randomized non-inferiority trial (the SAM study). BMC Womens Health 2019; 19:49. [PMID: 30940171 PMCID: PMC6444578 DOI: 10.1186/s12905-019-0749-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/22/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pelvic organ prolapse (POP) affects up to 40% of parous women which adversely affects the quality of life. During a life time, 20% of all women will undergo an operation. In general the guidelines advise a vaginal operation in case of uterine descent: hysterectomy with uterosacral ligament plication (VH), sacrospinous hysteropexy (SSH) or a modified Manchester operation (MM). In the last decade, renewed interest in uterus sparing techniques has been observed. Previous studies have shown non-inferiority between SSH and VH. Whether or not SSH and MM are comparable concerning anatomical and functional outcome is still unknown. The practical application of both operations is at least in The Netherlands a known cause of practice pattern variation (PPV). To reveal any difference between both techniques the SAM-study was designed. METHODS The SAM-study is a randomized controlled multicentre non-inferiority study which compares SSH and MM. Women with symptomatic POP in any stage, uterine descent and POP-Quantification (POP-Q) point D at ≤ minus 1 cm are eligible. The primary outcome is the composite outcome at two years of absence of prolapse beyond the hymen in any compartment, the absence of bulge symptoms and absence of reoperation for pelvic organ prolapse. Secondary outcomes are hospital parameters, surgery related morbidity/complications, pain perception, further treatments for prolapse or urinary incontinence, POP-Q anatomy in all compartments, quality-of-life, sexual function, and cost-effectiveness. Follow-up takes place at 6 weeks, 12 and 24 months. Additionally at 12 weeks, 6 and 9 months cost-effectiveness will be assessed. Validated questionnaires will be used and gynaecological examination will be performed. Analysis will be performed following the intention-to-treat and per protocol principle. With a non-inferiority margin of 9% and an expected loss to follow-up of 10%, 424 women will be needed to prove non-inferiority with a confidence interval of 95%. DISCUSSION This study will evaluate the effectiveness and costs of SSH versus MM in women with primary POP. The evidence will show whether the existing PPV is detrimental and a de-implementation process regarding one of the operations is needed. TRIAL REGISTRATION Dutch Trial Register (NTR 6978, http://www.trialregister.nl ). Date of registration: 29 January 2018. Prospectively registered.
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Affiliation(s)
- Sascha F M Schulten
- Department of Obstetrics and Gynaecology, Radboud university medical center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Department of Obstetrics and Gynaecology, Isala Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,Radboud university medical center, Department of Obstetrics and Gynaecology, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Rosa A Enklaar
- Department of Obstetrics and Gynaecology, Radboud university medical center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Department of Obstetrics and Gynecology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynaecology, Radboud university medical center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Sanne A L van Leijsen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre Veldhoven, De Run, 4600 5500, MB, Veldhoven, The Netherlands
| | - Marijke C Jansen-van der Weide
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Eddy M M Adang
- Department for Health Evidence, Radboud university medical center, Geert Grooteplein 27, 6525 EZ, Nijmegen, The Netherlands
| | - Jeroen van Bavel
- Department of Obstetrics and Gynaecology Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Heleen van Dongen
- Department of Obstetrics and Gynaecology Groene Hart Hospital, Bleulandweg 10, 2803 HH, Gouda, The Netherlands
| | - Maaike B E Gerritse
- Department of Obstetrics and Gynaecology Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Iris van Gestel
- Department of Obstetrics and Gynaecology, Viecuri Hospital, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - G G Alec Malmberg
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Ronald J C Mouw
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | | | - Wilbert A Spaans
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Annemarie van der Steen
- Department of Obstetrics and Gynaecology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.,Department of obstetrics and Gynaeology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ, Enschede, The Netherlands
| | - Jelle Stekelenburg
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - E Stella M Tiersma
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Anneke C Verkleij-Hagoort
- Department of Obstetrics and Gynaecology, st. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Astrid Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Chantal B M Wingen
- Department of Obstetrics and Gynaecology, Laurentius Hospital, Monseigneur Driessenstraat 6, 6043 CV, Roermond, The Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
| | - Hugo W F van Eijndhoven
- Department of Obstetrics and Gynaecology, Isala Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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9
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Mengerink BB, Nelen WLDM, van Leijsen SAL, Heesakkers JPFA, Kluivers KB. De-implementation of urodynamics in The Netherlands after the VALUE/VUSIS-2 results: a nationwide survey. Int Urogynecol J 2018; 29:1261-1277. [PMID: 29679158 PMCID: PMC6132705 DOI: 10.1007/s00192-018-3648-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/28/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to estimate the level of de-implementation of preoperative routine urodynamics (UDS) before stress urinary incontinence (SUI) surgery in The Netherlands and to analyze facilitators and barriers. Routine UDS was performed by 37% of the medical specialists in 2010. We hypothesized that the recommendations from the recent Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) and Value of Urodynamic Evaluation (ValUE) studies would have been followed by a reduction of routine UDS. METHODS A national survey was performed among all Dutch gynecologists and urologists dealing with SUI in daily practice. The questionnaire contained two parts: (1) respondents' characteristics and their actual care concerning preoperative UDS, and (2) facilitators and barriers. RESULTS The response rate was 41% (127/308). Of the respondents, 93% (n = 118) did not perform routine UDS in the preoperative workup for women in this group. Professional characteristics associated with not following the recommendations were profession urologist, academic hospital, and a lower number of midurethral sling (MUS) placed yearly. Facilitators to follow the recommendation not to perform routine UDS were adequate design of the VUSIS-II study and outcome and recommendations from the studies. Barriers not to follow the recommendation were believe in the additional value of UDS, especially the pressure transmission ratio, and the presence of detrusor overactivity. CONCLUSION According to respondents to this questionnaire, VUSIS-II and ValUE study results are well implemented in The Netherlands. The vast majority of respondents replied as not performing routine preoperative UDS in women with primary, uncomplicated (predominant) SUI. Therefore, there is no need for a further de-implementation strategy.
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Affiliation(s)
- Bianca B Mengerink
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, 791, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Willianne L D M Nelen
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, 791, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sanne A L van Leijsen
- Department of Obstetrics & Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - John P F A Heesakkers
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, 791, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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10
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van Leijsen SAL, Kluivers KB, Mol BWJ, Vierhout ME, Heesakkers JPFA. Authors' response re: Do preoperative urodynamics still have a role in female stress urinary incontinence? Neurourol Urodyn 2013;32:1144-5. Neurourol Urodyn 2013; 32:1146-7. [PMID: 23925729 DOI: 10.1002/nau.22339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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11
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van Leijsen SAL, Kluivers KB, Mol BWJ, Vierhout ME, Heesakkers JPFA. The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence. Int Urogynecol J 2011; 23:423-8. [PMID: 21927939 PMCID: PMC3305873 DOI: 10.1007/s00192-011-1565-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/30/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to assess variations in practice in the use of preoperative urodynamics in women with stress urinary incontinence (SUI). METHODS We performed an E-survey among all Dutch gynecologists and urologists who have SUI as focus in daily practice. The questions concerned the common policy and preferred policy. Descriptive statistics were used. RESULTS Of the 260 targeted specialists, 163 (63%) responded. We found that 37% of the respondents performed standard preoperative urodynamics; in the preferred practice, this would reduce to only 18%. Eighty percent indicated they would operate a patient with a positive stress test without urodynamic SUI, whereas 21% would do this also in case the clinical stress test was negative. Only 9% of the respondents indicated they adapted the choice of the type of sling based on urethral pressure profilometry parameters. CONCLUSIONS Urodynamics are not routinely performed, and outcomes hardly influence the choice of treatment.
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Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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12
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van Leijsen SAL, Hoogstad-van Evert JS, Mol BWJ, Vierhout ME, Milani AL, Heesakkers JPFA, Kluivers KB. The correlation between clinical and urodynamic diagnosis in classifying the type of urinary incontinence in women. A systematic review of the literature. Neurourol Urodyn 2011; 30:495-502. [PMID: 21298721 DOI: 10.1002/nau.21047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/10/2010] [Indexed: 01/25/2023]
Abstract
AIMS To determine the reclassification rate of clinically diagnosed stress, mixed, and urge urinary incontinence after urodynamic investigation. METHODS A systematic review of the published literature in MEDLINE and EMBASE of clinical trials among women with urinary incontinence. Studies were included in case the diagnosis based on symptoms and/or signs was compared with the diagnosis after urodynamic investigation. RESULTS Twenty-three articles involving 6,282 women with urinary incontinence met the inclusion criteria. A clinical diagnosis of stress urinary incontinence was reclassified into mixed urinary incontinence in 9% of women and into detrusor overactivity (DO) in 7% of cases. The pooled reclassification rate was highest among patients with symptoms of mixed urinary incontinence, where 46% of the patients had stress urinary incontinence and 21% had DO on urodynamic investigation. The available literature does not allow the identification of the additional value of non-invasive test, such as stress test and voiding diary, accessory to symptoms. None of the studies had therapeutic effects as an outcome measure. CONCLUSIONS This review of clinical studies shows that the level of agreement between classification based on clinical evaluation and based on urodynamic investigation is poor. Urodynamic observations are regarded as gold standard, but based on the poor correlation, this assumption should be questioned.
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Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics & Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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13
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van Leijsen SAL, Kluivers KB, Mol BWJ, Broekhuis SR, Milani FL, van der Vaart CH, Roovers JPWR, Bongers MY, den Boon J, Spaans WA, de Leeuw JW, Dietz V, Kleinjan JH, Brölmann HAM, Roos EJ, Schaafstra J, Heesakkers JPFA, Vierhout ME. Protocol for the value of urodynamics prior to stress incontinence surgery (VUSIS) study: a multicenter randomized controlled trial to assess the cost effectiveness of urodynamics in women with symptoms of stress urinary incontinence in whom surgical treatment is considered. BMC Womens Health 2009; 9:22. [PMID: 19622153 PMCID: PMC2722584 DOI: 10.1186/1472-6874-9-22] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 07/21/2009] [Indexed: 11/23/2022]
Abstract
Background Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting. The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of urodynamics, in women with symptoms of SUI in whom surgical treatment is considered. Methods/design A multicentre diagnostic cohort study will be performed with an embedded randomized controlled trial among women presenting with symptoms of (predominant) SUI. Urinary incontinence has to be demonstrated on clinical examination and/or voiding diary. Physiotherapy must have failed and surgical treatment needs to be under consideration. Patients will be excluded in case of previous incontinence surgery, in case of pelvic organ prolapse more than 1 centimeter beyond the hymen and/or in case of residual bladder volume of more than 150 milliliter on ultrasound or catheterisation. Patients with discordant findings between the diagnosis based on urodynamic investigation and the diagnosis based on their history, clinical examination and/or micturition diary will be randomized to operative therapy or individually tailored therapy based on all available information. Patients will be followed for two years after treatment by their attending urologist or gynaecologist, in combination with the completion of questionnaires. Six hundred female patients will be recruited for registration from approximately twenty-seven hospitals in the Netherlands. We aspect that one hundred and two women with discordant findings will be randomized. The primary outcome of this study is clinical improvement of incontinence as measured with the validated Dutch version of the Urinary Distress Inventory (UDI). Secondary outcomes of this study include costs, cure of incontinence as measured by voiding diary parameters, complications related to the intervention, re-interventions, and generic quality of life changes. Trial registration Clinical Trials NCT00814749.
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Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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