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Hornemann A, Weissenbacher T, Hoch B, Franz W, Lingwal N, Suetterlin M, Holthaus B. From thigh to pelvis: female genital prolapse repair with an autologous semitendinosus tendon transplant : Data of the German multicenter trial. Int Urogynecol J 2023; 34:2373-2380. [PMID: 37129627 PMCID: PMC10590289 DOI: 10.1007/s00192-023-05512-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/22/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The use of synthetic mesh for prolapse and incontinence surgery is discussed controversially and in several countries is either no longer used or permissible. Previous approaches with autologous tissue did not show from a patient´s perspective convincing long-term results. As there have been repeatedly significant complications with synthetic mesh, a new approach is urgently needed. During orthopedics and trauma surgeries, tendons from the thigh have been used for decades to replace cruciate ligament. The procedure of tendon removal from the thigh is fast, easy to learn and morbidity is low. In addition, a long-term durability of the transplant ought to be expected. The objective of this investigation was to show our experience with a semitendinosus tendon instead of a mesh for genital prolapse repair. METHOD After the first successful attempts using such tendons in cervicosacropexy and pectopexy in patients with genital prolapse, we initiated a national multicenter study in 2020. Five German hospitals participated in order to determine the feasibility of cervicosacropexy with tendon tissue instead of mesh. RESULT Up until now, we have operated and observed 113 patients for at least 6 months and have seen stable results in terms of fixation of the apical compartment. The expected low morbidity at the donor site was also confirmed through subjective assessment of the patients (Knee and Osteoarthritis Outcome Score). Improvement of quality of life was confirmed after the procedure with the Short Form Health Survey 12, Version 2.0. The results of this multicenter study showed that the desired elevation of the apical compartment with tendon tissue can be achieved with low morbidity and without a synthetic mesh. CONCLUSION Women with uterine prolapse can be treated minimally invasively and with very low morbidity by using the semitendinosus tendon. The involvement of multiple (five) medical centers confirms that the technique is easy to learn and be transferred to other clinical centers.
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Affiliation(s)
- Amadeus Hornemann
- Krankenhaus Sachsenhausen, Schulstraße 31, 60594, Frankfurt am Main, Germany.
| | | | - Benjamin Hoch
- Krankenhaus Sachsenhausen, Schulstraße 31, 60594, Frankfurt am Main, Germany
| | - Wolfgang Franz
- Lutrina Klinik, Brüsseler Straße 7, 67657, Kaiserslautern, Germany
| | - Neelam Lingwal
- Department of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Marc Suetterlin
- Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Bernd Holthaus
- St. Elisabeth Krankenhaus Damme, Lindenstraße 3, 49401, Damme, Germany
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Muraleedharan KL, Nisa Sushilal CM, Unnikrishnan P, Muraleedharan A, Krishnarajabhatt HS. Ayurveda management of cystocele, uterine prolapse and weak pelvic floor strength-A case report. J Ayurveda Integr Med 2023; 14:100775. [PMID: 37556865 PMCID: PMC10424129 DOI: 10.1016/j.jaim.2023.100775] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
Pelvic organ prolapse (POP) is the downward displacement of pelvic organs. The condition is very common in women and negatively affects their quality of life. The aging process reflects in the form of structural and functional weakness of the pelvic floor which leads to pelvic floor dysfunction (PFD). The strength and endurance of the Pelvic floor muscles (PFM) decrease significantly by these dysfunctions. In the present study, Pelvic floor strength (PFS) and endurance were assessed with the help of a perineometer. The patient was diagnosed with cystocele, uterine prolapse and weak PFS was assessed with the Perineometer. Patient was treated with Ayurvedicsthanika chikitsa (local treatment)- Yoni abhyanga (vaginal massage) and improvement in PFS was assessed after treatment. The present article aims to assess the pre and post-outcome results of PFM by using the objective tool perineometer. Seven days of yoni abhyanga along with oral medication were given and on follow-up after three months, the patient showed increased strength and endurance on the perineometer. Early diagnosis and management of the PFD will help to improve the QoL (Quality of Life) and prevent further deterioration of PFS.
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Affiliation(s)
- Kasthoory Lekshmy Muraleedharan
- Department of Stri Roga & Prasuti Tantra (Gynecology & Obstetrics), Amrita School of Ayurveda, Amritapuri, Amrita Vishwa Vidyapeetham, India
| | - Cinu Mithra Nisa Sushilal
- Department of Stri Roga & Prasuti Tantra (Gynecology & Obstetrics), Amrita School of Ayurveda, Amritapuri, Amrita Vishwa Vidyapeetham, India
| | - Parvathy Unnikrishnan
- Department of Stri Roga & Prasuti Tantra (Gynecology & Obstetrics), Amrita School of Ayurveda, Amritapuri, Amrita Vishwa Vidyapeetham, India
| | - Anjaly Muraleedharan
- Department of Stri Roga & Prasuti Tantra (Gynecology & Obstetrics), Amrita School of Ayurveda, Amritapuri, Amrita Vishwa Vidyapeetham, India
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Hornemann A, Franz W. Think outside the box. Arch Gynecol Obstet 2023; 307:1315-1316. [PMID: 35670848 DOI: 10.1007/s00404-022-06654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Amadeus Hornemann
- Krankenhaus Sachsenhausen, Schulstr. 31, 60594, Frankfurt am Main, Germany.
| | - Wolfgang Franz
- Lutrina Klinik, Brüsseler Str. 7, 67657, Kaiserslautern, Germany
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Chatterjee S, Bulchandani S. Retrospective review of history vs. ePAQ-PF in complex urogynaecology patients. Eur J Obstet Gynecol Reprod Biol 2022; 276:69-73. [PMID: 35809461 DOI: 10.1016/j.ejogrb.2022.07.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND AIM OF THE STUDY Urinary incontinence and prolapse are debilitating conditions significantly affecting quality of life. They are extremely prevalent, affecting a significant number of women attending gynaecology clinics with complex symptoms. ePAQ-PF offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation which is an advantage over history and may enhance the clinical episodes detection as well as the quality of care for women with pelvic floor disorders. The aim of the study is to compare effectiveness of ePAQ-PF against history for diagnosis in complex urogynaecology patients. MATERIALS AND METHODS Data was collected retrospectively from ePAQ-PF and history in a tertiary level urogynaecology unit and collated onto microsoft excel. 40 patients were selected randomly from 56 eligible (administered and succeessfully completed ePAQ-PF) patients attending Urogynaecology and PEARL (combined urogynaecology and colorectal) clinics between July 2018 and July 2021. Fisher's exact test was used for inferring on statistical significance in the comparative analysis. The software used for this analysis was SAS version 9.4. RESULTS Thirty-four out of the forty patients were eligible for analysis for overactive bladder and stress urinary incontinence; twenty-four for prolapse and twenty-six patients for voiding difficulty. Patients were between 18 and 80 years of age with highest participants between 40 and 69 years. Four scored symptom domain was chosen for statistical analysis due to adequate power of comparative data in these domains. The additional diagnostic yield by ePAQ-PF for overactive bladder (OAB), stress urinary incontinence (SUI), voiding difficulty (VD) and prolapse was 26.47%, 0%, 67% and 16.67% respectively. P value for OAB, VD and prolapse was 0.0294, 0.0031 and 0.01 respectively. Apart from these four symptoms ePAQ-PF contributed additional symptoms over and above history in all 40 patients due to its wide range of symptom domains. History provided additional symptoms in 3 women with recurrent urinary tract infection which was not identified on ePAQ-PF. INTERPRETATION OF RESULTS ePAQ-PF has shown significant additional diagnostic yield for overactive bladder, voiding difficulty and prolapse. P value for each has supported this statement. Although there was no additional diagnostic yield for stress urinary incontinence by ePAQ-PF, it has shown an accuracy of 96.97% (n = 33) for diagnosing the cases like history taking for SUI. ePAQ-PF enabled us to identify more symptoms in 100% cases (n = 40) which includes body image, general sex life, pain and altered sensation of vagina, reduced capacity of vagina etc, in comparison to history, for complex urogynaecology patients. History contributed to additional symptom diagnosis such as recurrent urinary tract infection in 7.5% (n = 40) of cases. CONCLUSION ePAQ-PF is a useful diagnostic tool providing additional benefit for the diagnosis of the complex urogynaecology patient. Overall recommendation is to implement a policy of using ePAQ-PF evaluation in all complex urogynaecology patients in addition to history. Further studies are needed to assess the pattern of the yield across age, parity, disease severity related to complex urogynaecology symptoms.
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Affiliation(s)
- Suvalagna Chatterjee
- Clinical Research Fellow, Urogynaecology, University Hospitals Coventry and Warwickshire, UK.
| | - Supriya Bulchandani
- Consultant Gynaecologist and Subspecialist Urogynaecology, University Hospitals Coventry and Warwickshire, UK
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Gueudry P, Cardaillac C, Gauthier S, Brulefert K, Dochez V, Thubert T. [Pelvic fracture and urogenital dysfunction in women: A literature review]. Prog Urol 2021; 31:1167-1174. [PMID: 34489155 DOI: 10.1016/j.purol.2021.08.042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The consequences of a pelvic fracture on pelvic statics and sexuality in women are often overlooked and relegated to secondary care. OBJECTIVE To carry out a state of knowledge on disorders of pelvic statics and sexuality in patients with a history of pelvic fracture: incidence, risk factors, management. METHODS Literature review on the Pubmed, Medline, Embase and Cochrane database using the following keywords and MeSH terms: pelvis floor dysfunction, urinary dysfunction, sexual dysfunction, pelvic organ prolapse, in association with the terms pelvic fracture, pelvic trauma. RESULTS Among the 270 initial articles, 21 were selected. Finally, one retrospective cohort study has evaluated the impact of pelvic fracture on the onset of a genital prolapse, 2 comparative retrospective studies and one prospective study focused on the impact of pelvic fracture on lower urinary tract symptoms. One comprehensive review studied pelvic fracture and sexuality outcomes. The incidence of prolapse following pelvic fracture could not be identified. The incidence of lower urinary tract symptoms varies between 21 and 67% with a significant difference for urinary urgency without leakage (P=0.016) and SUI (P=0.004). The incidence of sexual disorders varies between 21 and 62% with a predominance of dyspareunia. The mechanism of the trauma is thought to be a contributing factor, as well as the damage of the pubic symphysis (RR 4.8 95% CI 2.0-11.2). CONCLUSION The evaluation of urogenital, sexual and anorectal dysfunctions following trauma to the pelvis has so far been little explored in the literature. Future prospective studies are to be carried out to improve patient care.
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Affiliation(s)
- P Gueudry
- Service de gynécologie obstétrique, CHU de Nantes, France
| | - C Cardaillac
- Service de gynécologie obstétrique, CHU de Nantes, France
| | - S Gauthier
- Service de gynécologie obstétrique, CHU de Nantes, France
| | | | - V Dochez
- Service de gynécologie obstétrique, CHU de Nantes, France
| | - T Thubert
- Service de gynécologie obstétrique, CHU de Nantes, France.
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Lucot JP, Cosson M, Verdun S, Debodinance P, Bader G, Campagne-Loiseau S, Salet-Lizee D, Akladios C, Ferry P, De Tayrac R, Delporte P, Curinier S, Deffieux X, Blanc S, Capmas P, Duhamel A, Fritel X, Fauconnier A. Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial. BJOG 2021; 129:127-137. [PMID: 34264001 DOI: 10.1111/1471-0528.16847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN Extended follow up of a randomised trial. SETTING Eleven centres. POPULATION Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).
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Affiliation(s)
- J-P Lucot
- Service de gynécologie-obstétrique, Hôpital Saint Vincent de Paul, Groupe des Hôpitaux de l'Institut Catholique de Lille (GHICL), Lille, France
| | - M Cosson
- Service de Gynécologie médico chirurgicale Pôle Femme, mère, nouveau-né, Hôpital Jeanne de Flandre, CHRU de Lille, France
| | - S Verdun
- Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | | | - G Bader
- Service de gynécologie-obstétrique CHI Poissy-St-Germain, Université Versailles Saint-Quentin, Poissy, France
| | | | - D Salet-Lizee
- Groupe Hospitalier Diaconesses Croix St-Simon, Paris, France
| | | | - P Ferry
- Service de Gynécologie Obstétrique, Centre Hospitalier, La Rochelle, France
| | - R De Tayrac
- Hôpital Carémeau CHU de Nîmes, Nîmes, France
| | - P Delporte
- Centre Hospitalier de Dunkerque, Dunkerque, France
| | | | - X Deffieux
- Hôpital Antoine Béclère, Clamart, France
| | - S Blanc
- Service de Gynécologie, Centre Hospitalier de la Région d'Annecy, Pringy, France
| | - P Capmas
- Service de Gynécologie Obstétrique Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - A Duhamel
- Univ Lille, CHU Lille, ULR 2694 METRICS, Lille, France
| | - X Fritel
- Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - A Fauconnier
- Centre Hospitalier de Dunkerque, Dunkerque, France.,Unité de recherche EA 7285, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
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Kayembe AT, Muela AM, Baleka AM, Mushengezi DS, Tozin RR. Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa. Pan Afr Med J 2020; 37:196. [PMID: 33505565 PMCID: PMC7813651 DOI: 10.11604/pamj.2020.37.196.21818] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 10/01/2020] [Indexed: 11/11/2022] Open
Abstract
The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital of Kinshasa. This is a descriptive study carried out from medical files of patients who have suffered from genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital from January 1st, 2008 to December 31st, 2017. It is based on the no probabilistic sampling of suitability. We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. The symptomatology consisted of pelvic mass associated with urinary and digestives troubles (94.0%, n=140). The stage III of cysto-colpocele was the most frequent (56.0%, n=82). The vaginal hysterectomy associated to rectocele and cystocele cure was the most performed operation (52.0%, n=69). The recurrence rate was of 2.0% (3 out of 148 cases). The genital prolapse really exist in our milieu, its symptomatology is classical and its treatment is mostly surgical by vaginal access.
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Affiliation(s)
- Antoine Tshimbundu Kayembe
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University Notre-Dame of Kasayi, Central Kasaï, Democratic Republic of the Congo
| | - Andy Mbangama Muela
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alex Mutombo Baleka
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Dieudonné Sengeyi Mushengezi
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Rahma Rachid Tozin
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Mortier A, Cardaillac C, Perrouin-Verbe MA, Meurette G, Ploteau S, Lesveque A, Riant T, Dochez V, Thubert T. [Pelvic and perineal pain after genital prolapse: A literature review]. Prog Urol 2020; 30:571-587. [PMID: 32651103 DOI: 10.1016/j.purol.2020.06.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic and perineal pain after genital prolapse surgery is a serious and frequent post-operative complication which diagnosis and therapeutic management can be complex. MATERIALS ET METHODS A literature review was carried out on the Pubmed database using the following words and MeSH : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery. RESULTS Among the 133 articles found, 74 were selected. Post-operative chronic pelvic pain persisting more than 3 months after surgery according to the International Association for the Study of Pain. It can be nociceptive, neuropathic or dysfunctional. Its diagnosis is mainly clinical. Its incidence is estimated between 1% and 50% and the risk factors are young age, the presence of comorbidities, history of prolapse surgery, severe prolapse, preoperative pain, invasive surgical approach, simultaneous placement of several meshes, less operator experience, increased operative time and early post-operative pain. The vaginal approach can cause a change in compliance and vaginal length as well as injury to the pudendal, sciatic and obturator nerves and in some cases lead to myofascial pelvic pain syndrome, whereas the laparoscopic approach can lead to parietal nerve damage. Therapeutic management is multidisciplinary and complex. CONCLUSION Pelvic pain after genital prolapse surgery is still obscure to this day.
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Affiliation(s)
- A Mortier
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - C Cardaillac
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France
| | - G Meurette
- Service de chirurgie viscérale, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - S Ploteau
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - A Lesveque
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - T Riant
- Centre fédératif de pelvi-périnéologie, Nantes, France
| | - V Dochez
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, Centre d'investigation clinique, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France
| | - T Thubert
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, Centre d'investigation clinique, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France; Centre fédératif de pelvi-périnéologie, Nantes, France.
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Oliveira J, Arfi A, Boudy AS, Bendifallah S, Daraï E. Efficacy and safety outcomes after genital prolapse repair by the vaginal route using the Avaulta Plus® mesh. Eur J Obstet Gynecol Reprod Biol 2020; 250:48-53. [PMID: 32387892 DOI: 10.1016/j.ejogrb.2020.04.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE(S) With aging population, a rise in anterior wall prolapse surgery is expected. The aim of this study is to evaluate the efficacy and safety of genital prolapse repair by the vaginal route using a mixed polypropylene and porcine skin mesh (Avaulta Plus®). STUDY DESIGN Retrospective study conducted at Tenon University Hospital, Paris, France. We included seventy-nine women who underwent anterior wall prolapse repair using Avaulta Plus® mesh by the transobturator route for genital prolapse ≥ stage II from September 2008 to December 2017. Pre- and postoperative pelvic organ prolapse classification, functional symptoms, quality of life scores were evaluated, and complications were recorded. RESULTS The anatomical success rate for anterior wall prolapse was 97 %. The postoperative complication rate was 29.1 % among which the mesh exposure rate was 7.6 %. Pelvic symptoms such as vaginal discomfort and pelvic heaviness were significantly improved (p < 0.01). Voiding dysfunction were significantly improved (p < 0.01). A significant improvement in the PFDI-20 score (p < 0.01) and PFIQ-7 score (p < 0.01) was observed. After 3 years of follow-up, the recurrence rate was 12 %. CONCLUSION(S) Prolapse repair using the Avaulta Plus® mesh is effective and results in a significant improvement in quality of life. The complication rate, including mesh exposure, is acceptable.
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Affiliation(s)
- Joana Oliveira
- Service de Gynécologie -Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), UPMC, Sorbonne Université, Paris, France.
| | - Alexandra Arfi
- Service de Gynécologie -Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), UPMC, Sorbonne Université, Paris, France
| | - Anne-Sophie Boudy
- Service de Gynécologie -Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), UPMC, Sorbonne Université, Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie -Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), UPMC, Sorbonne Université, Paris, France; INSERM UMR_S_707, "Epidémiologie, Information des Systèmes, Modèles", Université Pierre et Marie Curie, Paris 6, France; UMR_S938 Université Pierre et Marie Curie, Paris 6, France
| | - Emile Daraï
- Service de Gynécologie -Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), UPMC, Sorbonne Université, Paris, France; INSERM UMR_S_707, "Epidémiologie, Information des Systèmes, Modèles", Université Pierre et Marie Curie, Paris 6, France; UMR_S938 Université Pierre et Marie Curie, Paris 6, France
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Ben-Zvi M, Herman HG, Schreiber L, Sagiv R, Bar J, Condrea A, Ginath S. Expression of Heparanase in uterosacral ligaments of women with or without uterine prolapse. Eur J Obstet Gynecol Reprod Biol 2019; 244:110-113. [PMID: 31785466 DOI: 10.1016/j.ejogrb.2019.11.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) is a global health problem for which the pathophysiological mechanism remains unclear. The loss of extracellular matrix proteins is considered an important molecular basis for this pathology. Heparanase is a heparin sulfate degrading endoglycosidase that has an important role in various biological processes and is a key component of extracellular matrix. The aim of this study was to compare expression of Heparanase in connective tissue of uterosacral ligaments in women with or without uterine prolapse. STUDY DESIGN Thirty-nine women who underwent hysterectomy for benign reasons were enrolled in the study. Twenty-three women with uterine prolapse (stage ≥3) who underwent vaginal hysterectomy (VH) - POP group, were compared to sixteen women without uterine prolapse who underwent abdominal hysterectomy (stage <2) - control group. Uterosacral ligaments (USL) biopsies were obtained from all uterine specimens near their origin. All tissue samples were analyzed by immunohistochemistry and tested for the presence of Heparanase using antiheparanse antibody 733. RESULTS Heparanse positive staining was more common in the connective tissue of uterosacral ligaments in women with uterine prolapse. Positive staining was seen in 17/23 (73.9 %) women with uterine prolapse compared to 4/16 (25 %) without uterine prolapse (p = 0.003). On multivariate logistic regression analysis, positive staining displayed a trend for an independent association with POP, after controlling for menopausal status and parity (OR 13.57, 95 %CI 0.82-224.4, p = 0.06). CONCLUSION Heparanase expression is more common in the connective tissue of uterosacral ligaments in women with uterine prolapse compared to women with no prolapse.
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Affiliation(s)
- Masha Ben-Zvi
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Condrea
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pirtea L, Balint O, Secoșan C, Grigoraș D, Ilina R. Laparoscopic Pectopexy with Burch Colposuspension for Pelvic Prolapse Associated with Stress Urinary Incontinence. J Minim Invasive Gynecol 2019; 27:1023-1024. [PMID: 31683027 DOI: 10.1016/j.jmig.2019.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/04/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To present a case of pelvic organ prolapse associated with stress urinary incontinence treated by laparoscopic pectopexy followed by Burch colposuspension. DESIGN Case report. SETTING University Gynecology Clinic of the Emergency Clinical City Hospital Timișoara, Romania. PATIENTS We present the case of a 41-year-old woman, gravida 1 para 1, with no notable medical or surgical history, with a body mass index of 40 kg/m2, who presented in our service with heavy menstrual bleeding, dysmenorrhea, pelvic pressure, dyspareunia, stress urinary incontinence, and voiding difficulties. Local examination revealed a cervix descended 2 cm below the hymenal ring, cystocele, urethrocele, and a positive cough stress test. The pelvic prolapse was classified as pelvic organ prolapse quantification stage 3. Ultrasound exam revealed a uterus with diffuse adenomyosis of the posterior uterine wall and normal adnexa. Because of the patient's obesity, the treatment plan was laparoscopic supracervical hysterectomy for the treatment of adenomyosis, laparoscopic pectopexy for the correction of the apical defect, and Burch colposuspension for the cure of stress incontinence. INTERVENTIONS The patient was placed in the standard dorsal lithotomy position with the hips in extension and the knees flexed and the table in 45° Trendelenburg position. One 10-mm umbilical optical trocar and three 5-mm trocars were used-2 inserted 2 cm above and medial to the anterior superior iliac crests, and the third, 5 cm below the umbilical trocar. The dissection started on the left side of the pelvis. The peritoneum was incised in the center of a V-shaped area bordered by the left round ligament and the obliterated umbilical artery (the medial umbilical ligament). The soft tissue was dissected, and the left iliopectineal ligament (also known as the inguinal ligament of Cooper) was identified right under the external iliac vein and prepared. The same steps were repeated on the right side of the pelvis. The procedure continued with the dissection of the vesicovaginal space. The anterior vaginal wall was exposed with the help of a retractor placed inside the vagina and held by an assistant. A supracervical hysterectomy was performed. An 8 × 15-cm polypropylene mesh, cut in a T shape, was introduced in the abdomen. First, the short arm of the T was fixed on the anterior vaginal wall using multiple absorbable tacks (AbsorbaTack fixation device; Medtronic, Dublin, Ireland). To use a type of nonabsorbable fixation, we decided to also fix the mesh to the cervix stump with 3 isolated stitches (Silk Suture 2-0; Ethicon, Somerville, NJ). Second, with the purpose of ensuring a permanent fixation, the lateral arms of the mesh were attached to the iliopectineal ligaments with multiple nonabsorbable tacks on both sides (ProTack fixation device; Medtronic, Dublin, Ireland). The procedure continued with the complete closure of the peritoneum with VICRYL 2-0 sutures (Ethicon). Because the patient also had stress urinary incontinence, a Burch colposuspension was performed. To expose its limits, the urinary bladder was filled with 200 mL of saline. After the incision of the peritoneum, the avascular space of Retzius was opened. The dissection continued until the Cooper's ligaments were exposed bilaterally. The proper suture placement points on the vaginal wall were facilitated by an assistant's intravaginal finger. Two isolated nonabsorbable silk stitches (Silk Suture 2-0) were placed through the Cooper's ligament and through the anterior vaginal wall on each side. The knots were tied just enough to properly lift the vaginal wall in the normal position, assessed by the assistant by vaginal route, but not too tight to avoid urethral obstruction. MEASUREMENTS AND MAIN RESULTS The duration of the surgery was 95 minutes, with minimal blood loss of about 60 mL. The patient recovered well, with the Foley catheter being removed after 12 hours. The patient was discharged after 48 hours. The 6-month follow-up examination revealed a correct anatomical position of the anterior vaginal wall and of the cervix at 6 cm above the hymenal ring and no urinary incontinence. CONCLUSION Laparoscopic pectopexy represents a new option for the treatment of pelvic organ prolapse. In the case we reported, no intraoperative or postoperative complications were present, and the follow-up assessment revealed an effective correction of the prolapse. Further studies are needed to conclude the efficiency and safety of this new procedure.
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Affiliation(s)
- Laurentiu Pirtea
- Victor Babeș University of Medicine and Pharmacy Timișoara (Drs. Pirtea, Balint, Secoșan, Grigoraș, and Ilina), Timișoara, Romania
| | - Oana Balint
- Victor Babeș University of Medicine and Pharmacy Timișoara (Drs. Pirtea, Balint, Secoșan, Grigoraș, and Ilina), Timișoara, Romania.
| | - Cristina Secoșan
- Victor Babeș University of Medicine and Pharmacy Timișoara (Drs. Pirtea, Balint, Secoșan, Grigoraș, and Ilina), Timișoara, Romania
| | - Dorin Grigoraș
- Victor Babeș University of Medicine and Pharmacy Timișoara (Drs. Pirtea, Balint, Secoșan, Grigoraș, and Ilina), Timișoara, Romania
| | - Razvan Ilina
- Victor Babeș University of Medicine and Pharmacy Timișoara (Drs. Pirtea, Balint, Secoșan, Grigoraș, and Ilina), Timișoara, Romania
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Chene G, Cerruto E, Lebail-Carval K, Chabert P, Lamblin G, Nohuz E, Mellier G. [How I do… easily anterior and posterior colpoperineorraphy without mesh (with video)]. ACTA ACUST UNITED AC 2019; 47:816-8. [PMID: 31585182 DOI: 10.1016/j.gofs.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Indexed: 11/23/2022]
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Ahmed AA, Abdellatif AH, El-Helaly HA, Tagreda IA, El-Feky MM, Agha MM, Abdelraouf AG, Abdelrahim AF. Concomitant transobturator tape and anterior colporrhaphy versus transobturator subvesical mesh for cystocele-associated stress urinary incontinence. Int Urogynecol J 2020; 31:1633-40. [PMID: 31375873 DOI: 10.1007/s00192-019-04068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) and cystocele often occur concomitantly and thus may potentially be treated via a single surgical procedure. This study evaluated the efficacy and safety of concomitant transobturator tape (TOT) with anterior colporrhaphy versus subvesical transobturator mesh (TOM) for cystocele-associated SUI. METHODS This prospective, clinical trial included women with cystocele-associated SUI. Patients were randomly allocated into either group I (anterior colporrhaphy with concomitant TOT "in-out" fixation) or group II (implantation of a subvesical four-armed TOM). All patients were followed up at 1, 3, 6, 9, and 12 months postoperatively. Statistical tests were performed to compare the group outcomes based on objective, subjective, and anatomical variables. RESULTS There were 81 patients in group I and 83 in group II. Median follow-up duration was 12 months. The demographic data and baseline clinical characteristics of both groups were comparable. There were no significant differences between groups regarding the success rates of SUI and cystocele repair. Groups I and II had similar cure rates of SUI (82.9 and 88.4%, respectively; p = 0.369) and incidences of successful cystocele repair (85.4 and 97.7%, respectively; p = 0.055). No urethral or bladder injuries or mesh erosions were reported. Both groups had comparable postoperative complications, except the greater incidence of micturition difficulty in group I than group II, during the early follow-up (12.2% vs. 0.0%; p = 0.024). CONCLUSIONS Transvaginal mesh was not superior to native tissue repair. Anterior colporrhaphy and TOT may be an appropriate alternative to four-armed TOM application for concomitant correction of SUI and cystocele.
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Joueidi Y, Gueudry P, Cardaillac C, Vaucel E, Lopes P, Winer N, Dochez V, Thubert T. [Uterine preservation or not during prolapse surgery: Review of the literature]. Prog Urol 2019; 29:1021-1034. [PMID: 31130408 DOI: 10.1016/j.purol.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/02/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of hysterectomy in case of genital prolapse on the anatomical and functional results, and on per and post operative complications compared with uterine preservation. MATERIAL AND METHODS We conducted a review of the Pubmed, Medline, Embase and Cochrane literature using the following terms and MeSH (Medical Subject Headings of the National Library of Medicine): uterine prolapse; genital prolapse; prolapse surgery; vaginal prolapse surgery; abdominal prolapse surgery; hysterectomy; hysteropexy; sacrocolpopexy; surgical meshes; complications; sexuality; neoplasia; urinary; incontinence; cancer. RESULTS Among the 168 abstracts studied, 63 publications were retained. Whatever performance of hysterectomy or not, anatomical and functional results were similar in abdominal surgery (sacrocolpopexy) (OR=2.21 [95% CI: 0.33-14.67]) or vaginal surgery (OR=1.07 [95% CI: 0.38-2.99]). There was no difference in terms of urinary symptoms or sexuality after surgery. Hysterectomy was associated to a higher morbidity (bleeding, prolonged operating time, longer hospital stay), to an increased risk of mesh exposure particularly in case of total hysterectomy (8.6%; 95% CI: 6.3-11). CONCLUSION In the absence of evidence of superiority in terms of anatomical and functional outcomes, with an increased rate of complications, concomitant hysterectomy with prolapse surgery should probably not be performed routinely.
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Affiliation(s)
- Y Joueidi
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - P Gueudry
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - C Cardaillac
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - E Vaucel
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - P Lopes
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - N Winer
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - V Dochez
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - T Thubert
- Service de gynécologie, CHU de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigation clinique de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France.
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Chattot C, Deffieux X, Lucot JP, Fritel X, Fauconnier A. Preoperative predictors and a prediction score for perception of improvement after mesh prolapse surgery. Int Urogynecol J 2019; 31:1393-1400. [PMID: 31115611 DOI: 10.1007/s00192-019-03953-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/07/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) surgery using a mesh has a complication rate of 26%, and an estimated 10% of those operated on do not consider it brings improvement. The objective of this study was to identify preoperative predictors of improvement after POP repair with mesh to develop a predictive score. METHODS This is a secondary analysis of the randomized multicenter trial PROSPERE, which compared morbidity after prolapse repair with mesh according to the vaginal or laparoscopic approach. Improved women [PGI-I score at 1-year follow-up = 1 (much better) or 2 (better)] were compared with unimproved women. Two hundred fifty-five women were included to derive the prediction score based on multiple logistic regression. An internal validation by bootstrapping estimated the unbiased performance of the model. RESULTS Criteria independently related to improvement were: (1) cystocele stage > II [OR: 2.93 95% CI (1.22-7.04), p = 0.015]; (2) preoperative expectation related to bulge symptom improvement [OR: 2.57 95% CI (1.07-6.04), p = 0.031] and (3) absence of chronic pelvic pain [OR: 4.55 95% CI (1.77-11.46), p = 0.001]. A score (scored from 0 to 11) was constructed from the aOR of the predictive model: the ROC-AUC of the score was 0.75, and a score ≥ 9 predicted a 97% chance of improvement (95% CI 92-99), with a specificity of 85% (95% CI 68-94). The ROC-AUC corrected for optimism by the bootstrap procedure was 0.70. CONCLUSIONS This score could be used by surgeons in preoperative counseling of women.
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Affiliation(s)
- Chloé Chattot
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France.
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France.
| | - Xavier Deffieux
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics and Reproductive Medicine, APHP, Hôpital Antoine Béclère, 92140, Clamart, France
| | - Jean-Philippe Lucot
- Gynecological Surgery Unit, Centre Hospitalier Universitaire Jeanne de Flandre, 59 000, Lille, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Centre Hospitalier Universitaire de Poitiers, 86021, Poitier, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France
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Zilliox M, Lecointre L, Boisramé T, Akladios C. Sacrospinofixation of Richter in 8 Points: Original Contribution of the Laparoscopic Column in the Visualization of the Sacrospinous Ligaments. J Minim Invasive Gynecol 2019; 26:1227-8. [PMID: 31059783 DOI: 10.1016/j.jmig.2019.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/20/2019] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Although the standard technique is currently based on laparoscopic promontofixation, the standard vaginal technique for the treatment of uterine prolapse is sacrospinofixation according to Richter [1-3]. Described by Kurt Richter in 1968, this intervention corrects the middle floor and consists of fixing the vaginal dome (after hysterectomy or not) on the sacrospinous ligament(s) [4,5]. The technique includes a wide dissection of the pararectal fossa using several Breisky valves to grip the sacrospinous ligament under strict visual control. This crucial step of the intervention implies optimal visual control for the operator but does not allow visual access to the operative assistants, which is regrettable for the purpose of teaching [2,4-6]. The aim of this surgical video is to describe the different stages of the sacrospinofixation surgical technique, showing sacrospinous ligaments during the crucial step thanks to a laparoscopic camera. DESIGN A step-by-step explanation of the surgery using a video (an instructive video [Video 1]) approved by the local ethics committee. SETTING Gynecological Surgery Unit, University Hospital of Strasbourg, Strasbourg, France. PATIENTS A 70-year-old woman with multicompartment pelvic organ prolapse. INTERVENTIONS Installation in the conventional gynecologic position with 2 operating assistants on both sides of the operator. The steps are as follows: step 1, posterior colpotomy; step 2, rectovaginal dissection and opening of the pararectal fossa; step 3, dissection of the sacrospinous ligament; and step 4, gripping of the sacrospinous ligament. The following 4 steps are realized bilaterally: step 5, suspension of the vaginal dome; step 6, beginning of vaginal closure; step 7, tightening the spinofixation threads; and step 8, ending the closure of the vaginal colpotomy. MEASUREMENTS AND MAIN RESULTS The operative time was 60 minutes. The operation was simple and shows precisely the sacrospinous ligaments. There were no intraoperative complications. The vaginal mesh urinary catheter was removed on day 1, and the patient was discharged on day 3. CONCLUSION Thanks to a laparoscopic column, this video of the surgical technique of sacrospinofixation using the Richter procedure is an original approach to show sacrospinous ligaments. The latter is a crucial step of this surgery, which remains the reference vaginal technique for the treatment of a uterine prolapse.
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Chene G, Cerruto E, Formont C, Lebail-Carval K, Chabert P, Lamblin G, Mellier G, Nohuz E. [How I do… easily a vaginal sacrospinous colpopexy using an isthmic posterior mesh]. ACTA ACUST UNITED AC 2018; 47:321-323. [PMID: 30503236 DOI: 10.1016/j.gofs.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 10/27/2022]
Affiliation(s)
- G Chene
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France; Université Claude-Bernard Lyon 1, EMR 3738, 69000 Lyon, France.
| | - E Cerruto
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - C Formont
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - K Lebail-Carval
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - G Lamblin
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - E Nohuz
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
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Pizzoferrato AC, Fritel X. [Preoperative functional explorations of genital prolapse (urodynamics, dynamic MRI)]. ACTA ACUST UNITED AC 2018; 46:593-597. [PMID: 29997048 DOI: 10.1016/j.gofs.2018.06.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 11/28/2022]
Abstract
The evaluation of genital prolapse is essentially clinical; however imaging tests such as dynamic MRI or urodynamic explorations may be useful in complex cases, especially before surgical management. Dynamic MRI allows morphological and dynamic analysis of pelvic floor and levator ani function. It can also detect post-obstetric injuries, although the long-term significance of these injuries remains to be discovered. Quantification of the severity of prolapse is possible with MRI; however, the correlation of these measures with clinical examination seems poor. Its interest lies mainly in the qualitative assessment of the three stages of prolapse and the detection of elytroceles, which can be difficult to clinical examination. Urodynamics provides useful information on vesico-sphincteric function, but none of these parameters seems to be decisive in the management of prolapse.
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Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
| | - X Fritel
- Faculté de médecine et pharmacie, université de Poitiers, CIC1402, CESP, France
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Antovska VS, Krstevska I, Trajanova M, Chelebieva J, Gosheva I, Zdravkovski P, Kostadinova-Kunovska S, Janevska V. Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse - Case Report. Open Access Maced J Med Sci 2018; 6:1091-1094. [PMID: 29983808 PMCID: PMC6026419 DOI: 10.3889/oamjms.2018.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Endometrial cancer is the third-ranked genital malignancy in women and includes 3% of cancer deaths. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia, but high-grade endometrioid adenocarcinomas have more solid sheets of less-differentiated tumour cells, which are no longer organised into glands, often associated with surrounded atrophic endometrium. CASE REPORT: We present an unusual case of endometrial adenocarcinoma arising in adenomyoma in 74-year old woman presented with genital prolapse, without other clinical symptoms. Ultrasound evaluation revealed endometrium with 4 mm-thickness and atrophic ovaries. The cervical smear was normal. The patient underwent a total vaginal hysterectomy. The histopathology of the anterior uterine wall revealed an intramural adenomyoma of 4 mm in which some endometrial glands with malignant transformation of well-differentiated endometrioid adenocarcinoma without infiltration in surrounding myometrium and lymphovascular invasion were present. The endometrium lining the uterine cavity was predominantly atrophic, and only one focus of simplex and complex hyperplasia was found, with cell-atypia. According to AJCC/FIGO 2010, the tumour was classified: pTNM = pT1B pNX pMX G1 R0 L0 V0 NG1, Stage I. On dismiss, the near-future oncological consultation was recommended. CONCLUSION: We would like to point out the rare occurrence of such type of malignancy and the importance of meticulous histopathology evaluation, even after reconstructive surgery for genital prolapse.
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Affiliation(s)
- Vesna S Antovska
- University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Iskra Krstevska
- University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Milka Trajanova
- University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Jasmina Chelebieva
- University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Irena Gosheva
- University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Pance Zdravkovski
- Institute of Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Slavica Kostadinova-Kunovska
- Institute of Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vesna Janevska
- Institute of Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Lucot JP, Cosson M, Bader G, Debodinance P, Akladios C, Salet-Lizée D, Delporte P, Savary D, Ferry P, Deffieux X, Campagne-Loiseau S, de Tayrac R, Blanc S, Fournet S, Wattiez A, Villet R, Ravit M, Jacquetin B, Fritel X, Fauconnier A. Safety of Vaginal Mesh Surgery Versus Laparoscopic Mesh Sacropexy for Cystocele Repair: Results of the Prosthetic Pelvic Floor Repair Randomized Controlled Trial. Eur Urol 2018; 74:167-176. [PMID: 29472143 DOI: 10.1016/j.eururo.2018.01.044] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic mesh sacropexy (LS) or transvaginal mesh repair (TVM) are surgical techniques used to treat cystoceles. Health authorities have highlighted the need for comparative studies to evaluate the safety of surgeries with meshes. OBJECTIVE To compare the rate of complications, and functional and anatomical outcomes between LS and TVM. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized controlled trial from October 2012 to April 2014 in 11 French public hospitals. Women with cystocele stage ≥2 (pelvic organ prolapse quantification), aged 45-75 yr, without previous prolapse surgery. INTERVENTION Synthetic nonabsorbable mesh placed in the vesicovaginal space, sutured to the promontory (LS) or maintained by arms through pelvic ligaments (TVM). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Rate of surgical complications ≥grade II according to the modified Clavien-Dindo classification at 1 yr. Secondary outcomes were reintervention rate, and functional and anatomical results. RESULTS AND LIMITATIONS A total of 130 women were randomized in LS and 132 in TVM; five women withdrew before intervention, leaving 129 in LS and 128 in TVM. The rate of complications ≥grade II was lower after LS than after TVM, but did not meet statistical significance (17% vs 26%, treatment difference 8.6% [95% confidence interval, CI -1.5 to 18]; p=0.088). The rate of complications of grade III or higher was nonetheless significantly lower after LS (LS=0.8%, TVM=9.4%, treatment difference 8.6% [95% CI 3.4%; 15%]; p=0.001). LS was converted to TVM in 6.3%. The total reoperation rate was lower after LS but did not meet statistical significance (LS=4.7%, TVM=10.9%, treatment difference 6.3% [95% CI -0.4 to 13.3]; p=0.060). There was no difference in symptoms, quality of life, improvement, composite definition of success, anatomical results rates between groups except for the vaginal apex and length, and dyspareunia (in favor of LS). CONCLUSIONS LS is a valuable option for primary repair of cystocele in sexually active patients. LS is safer than TVM, but may not be feasible in all cases. Both techniques offer same functional outcomes, success rates, and anatomical outcomes, but sexual function is better preserved by LS. PATIENT SUMMARY Our study demonstrates that laparoscopic sacropexy (LS) is a valuable option for primary repair of cystocele. LS offers equivalent success rates to vaginal mesh procedures, but is safer with a lower rate of complications and reoperations, and sexual function is better preserved.
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Affiliation(s)
- Jean-Philippe Lucot
- Service de Gynécologie médico chirurgicale Pôle Femme, mère, nouveau-né, Hôpital Jeanne de Flandre, CHRU de Lille, France.
| | - Michel Cosson
- Service de Gynécologie médico chirurgicale Pôle Femme, mère, nouveau-né, Hôpital Jeanne de Flandre, CHRU de Lille, France
| | - Georges Bader
- Service de gynécologie-obstétrique CHI Poissy-St-Germain, Université Versailles Saint-Quentin, Poissy, France
| | | | | | | | | | | | - Philippe Ferry
- Service de Gynécologie Obstétrique, Centre Hospitalier, La Rochelle, France
| | - Xavier Deffieux
- Service de Gynécologie Obstétrique Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | | | | | - Sébastien Blanc
- Service de Gynécologie, Centre Hospitalier de la Région d'Annecy, Pringy, France
| | | | | | - Richard Villet
- Groupe Hospitalier Diaconesses Croix St-Simon, Paris, France
| | - Marion Ravit
- Unité de recherche EA 7285, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
| | | | - Xavier Fritel
- Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique CHI Poissy-St-Germain, Université Versailles Saint-Quentin, Poissy, France; Unité de recherche EA 7285, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
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Donon L, Warembourg S, Lapray JF, Cortesse A, Hermieu JF, Fatton B, Cayrac M, Deffieux X, Geraud M, Le Normand L. [Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines]. Prog Urol 2016; 26 Suppl 1:S8-S26. [PMID: 27595629 DOI: 10.1016/S1166-7087(16)30425-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique? MATERIAL AND METHODS This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]). RESULTS It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology. CONCLUSION Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
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Poizac S, Ferry P, Cayrac M, Quiboeuf E, Marcelli M, Tourette C, Agostini A. [Feasability and morbidity of apical and anterior mesh repair, a multicenter cohort study]. Prog Urol 2017; 27:497-505. [PMID: 28549730 DOI: 10.1016/j.purol.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 04/20/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess safety anatomic results, satisfaction patient and to report short-term results of a new surgical approach for a combined treatment of pelvic organ prolapse (POP) of anterior and medium compartments. MATERIAL AND METHODS A longitudinal case series of 83 consecutive patients operated between January 2012 and April 2014 in four tertiary centers by 8 surgeons. Potential complications have been reported. The satisfaction of patients was conducted at 6 weeks post-procedure. The anatomical evaluation was conducted at 6 weeks and 6 months post-procedure. Anatomic success was defined as prolapse stage<1 (POPQ) for both anterior and apical compartment. RESULTS Mean age was 69.2±8.6 years. There were two intraoperative complications: a bladder injury and an ureteral injury. Postoperative complications were 14/83 (16.8%) transient urinary retentions. Seventy-three patients out of 83 (87.9%) were available for anatomic evaluation at 6 months. Anatomical success at 6 months for both anterior and apical compartments was 68/73 (93.1%). Patient satisfaction rate at 6 months was 79/83 (95.1%). Four subjects/73 (5.5%) experienced mesh exposure treated conservatively. CONCLUSION In the current series, uterovaginal suspension anterior using a mesh Nuvia® was associated with correct anatomical results and a good satisfaction of patients. This technique seems reproducible and associated with few complications. Prospective, comparative and long-term data are required to confirm these results. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S Poizac
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - P Ferry
- Service de gynécologie-obstétrique, centre hospitalier La-Rochelle, rue du Docteur-Schweitzer, 17000 La Rochelle, France
| | - M Cayrac
- Service de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34100 Montpellier, France
| | - E Quiboeuf
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, université de Bordeaux 2, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Marcelli
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - C Tourette
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
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Zhiri H, Fatih B, Harou K, Aboulfalah A, Asmouki H, Soummani A. [Neonatal genital prolapse: an exceptional entity (about a case)]. Pan Afr Med J 2017; 25:153. [PMID: 28292115 PMCID: PMC5326057 DOI: 10.11604/pamj.2016.25.153.9853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/02/2016] [Indexed: 11/11/2022] Open
Abstract
Neonatal genital prolapse is an uncommon entity. It is usually associated with birth defects of the central nervous system. We here report the case of a full term newborn with a genital prolapse not associated with central nervous system abnormalities in order to highlight the diagnostic and therapeutic particularity of this very rare disease.
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Affiliation(s)
- Hind Zhiri
- Université Cadi Ayyad, Service de Gynécologie Obstétrique, CHU Mohammed VI, Marrakech, Maroc
| | - Btissam Fatih
- Université Cadi Ayyad, Service de Gynécologie Obstétrique, CHU Mohammed VI, Marrakech, Maroc
| | - Karam Harou
- Université Cadi Ayyad, Service de Gynécologie Obstétrique, CHU Mohammed VI, Marrakech, Maroc
| | - Abderrahim Aboulfalah
- Université Cadi Ayyad, Service de Gynécologie Obstétrique, CHU Mohammed VI, Marrakech, Maroc
| | - Hamid Asmouki
- Université Cadi Ayyad, Service de Gynécologie Obstétrique, CHU Mohammed VI, Marrakech, Maroc
| | - Abderraouf Soummani
- Université Cadi Ayyad, Service de Gynécologie Obstétrique, CHU Mohammed VI, Marrakech, Maroc
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Dubuisson JB, Veit-Rubin N, Wenger JM, Dubuisson J. [Laparoscopic lateral suspension, another way to treat genital prolapse]. ACTA ACUST UNITED AC 2017; 45:32-36. [PMID: 28238313 DOI: 10.1016/j.gofs.2016.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
The laparoscopic sacrocolpopexy is the treatment of choice of pelvic organ prolapses since more than twenty years. The laparoscopic lateral suspension with mesh is an alternative technique. Its originality is the subperitoneal passing of the lateral arm of the mesh in the lateral abdominal wall, leaving the skin above the iliac crest, in a place without risks of vascular, nerve, bowel injuries. We report in this article the results of the three main publications on the subject. The indications are cystocele and apical descent. It can be envisaged when the access of the promontory is difficult; for instance in the presence of obesity, adhesions, sigmoid megacolon, or low position of the left common iliac vein, partially covering the promontory. It is also a practical technique for surgeons having a moderate experience of the promontory access.
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Affiliation(s)
- J B Dubuisson
- Clinique La Colline, université de Genève, 1206 Genève, Suisse.
| | - N Veit-Rubin
- Service de gynécologie-obstétrique, centre hospitalo-universitaire vaudois, 46, rue de Bugnon, 1011 Lausanne, Suisse
| | - J M Wenger
- Service de gynécologie-obstétrique, hôpitaux universitaires de Genève, 30, boulevard de la Cluse, 1205 Genève, Suisse
| | - J Dubuisson
- Service de gynécologie-obstétrique, hôpitaux universitaires de Genève, 30, boulevard de la Cluse, 1205 Genève, Suisse
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Abstract
BACKGROUND Genital prolapse is an important cause of morbidity among postmenopausal and multiparous women especially in our environment where a high premium is placed on large family size. This study was done to determine the prevalence, risk factors, clinical presentation, and management options of genital prolapse. PATIENTS AND METHODS Data of those diagnosed with genital prolapse were retrieved from records in the clinic, wards, theater, and from patients' folders in the medical records department. STATISTICAL ANALYSIS USED Data were analyzed using Statistical Package for Social Sciences version 20 with P < 0.05. RESULTS Genital prolapse accounted for 0.8% of gynecological clinic attendances and 5.2% of major gynecological operations. The mean age of patients was 56.7 ± 15.5 years. Farmers constituted 60.7% of the patients while 72.1% and 70.5% were postmenopausal and grandmultiparous women, respectively. The sensation of something coming down the vagina was the most common symptom noted in 98.4% of the patients. Most (23.0%) of the patients had unsupervised delivery at home. Uterovaginal prolapse was the most common (70.5%) type of genital prolapse, and third-degree uterovaginal prolapse was its most frequent presentation. Majority of the patients (44.4%) were managed expectantly while the most common surgery performed was vaginal hysterectomy with pelvic floor repair (33.3%). CONCLUSION Widespread availability of antenatal services especially in the rural communities and limitation on family size can significantly reduce the burden of this disease.
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Affiliation(s)
| | - Maduabuchi Amagh Udensi
- Department of Obstetrics and Gynecology, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | | | - Uka Kalu Okali
- Department of Obstetrics and Gynecology, Federal Medical Centre, Umuahia, Abia State, Nigeria
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Kdous M, Zhioua F. 3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients. Arab J Urol 2014; 12:275-84. [PMID: 26019962 PMCID: PMC4435760 DOI: 10.1016/j.aju.2014.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/01/2014] [Accepted: 09/24/2014] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles. PATIENTS AND METHODS In this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ⩾2 according to the Baden-Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh®, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. The patients' characteristics and surgical variables were recorded prospectively. The anatomical outcome, as measured by a physical examination and postoperative stratification of prolapse, and functional outcome, as assessed by a questionnaire derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and the Pelvic Organ Prolapse-Urinary Incontinence-Sexual Questionnaire, were considered as the primary outcome measures. Peri- and postoperative complications constituted the secondary outcome measures. RESULTS At 36 months after surgery the anatomical success rate (stage 0 or 1) was 93%. On a functional level, all the scores of quality of life and sexuality were improved. The overall satisfaction score (visual analogue scale) was 71.4%. There were no perioperative adverse events. Mesh erosion was reported in 7.6% and mesh retraction in 5.7% of the patients. CONCLUSIONS If the guidelines and precautions are followed, vaginal prosthetic surgery for genitourinary prolapse has shown long-term benefits. It provides excellent results both anatomically and functionally. However, complications are not negligible and some are specific to prosthetic surgery.
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Affiliation(s)
- Moez Kdous
- Department of Obstetrics and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia
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Glavind K, Larsen T, Lindquist ASI. Sexual function in women before and after surgery for pelvic organ prolapse. Acta Obstet Gynecol Scand 2014; 94:80-5. [PMID: 25287151 DOI: 10.1111/aogs.12524] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate sexual function in women before and after surgery for pelvic organ prolapse (POP) using native tissue repair. DESIGN A prospective observational study. SETTING Danish university hospital, between December 2008 and May 2010. POPULATION Eighty-one patients who had a POP operation with native tissue repair performed. METHODS The patients completed a validated Danish questionnaire on prolapse, the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire - 12 Short Form (PISQ-12-SF), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) before undergoing surgery and six months postoperatively. MAIN OUTCOME MEASURES Differences in PISQ-12-SF measures six months after the operation in different types of POP operations. RESULTS Preoperatively, the PISQ-12-SF score (mean ± SD) was 35.2 ± 4.6 and postoperatively 38.3 ± 3.9, giving a significant difference of 3.0 ± 3.8. (p < 0.05). Thirty-seven women (72%) improved their PISQ-12-SF score postoperatively, nine (18%) had an equal score, and five (10%) reported a lower score. There was no significant difference in the PISQ-12-SF scores between different operations. The ICIQ-UI-SF showed an overall improvement in incontinence postoperatively with a small correlation to PISQ-12-SF. CONCLUSIONS The majority of patients who undergo operation for different kinds of POP using native tissue repair, experience an improvement in their sexual life postoperatively. Most women with preoperative urinary incontinence experienced cure or improvement after POP surgery.
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Affiliation(s)
- Karin Glavind
- Department of Gynecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark
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Joubert M, Thubert T, Lefranc JP, Vaessen C, Chartier-Kastler É, Deffieux X, Rouprêt M. Comparison of functional outcomes with purely laparoscopic sacrocolpopexy and robot-assisted sacrocolpopexy in obese women. Prog Urol 2014; 24:1106-13. [PMID: 25450756 DOI: 10.1016/j.purol.2014.09.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/22/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the functional outcomes and complication rates following laparoscopic sacrocolpopexy (LS) with those occurring in robot-assisted laparoscopic sacrocolpopexy (RALSCP) in obese women. PATIENTS AND METHODS A comparative retrospective multicentre study was made, involving 39 obese women (BMI≥30 kg/m2) who underwent LS, and 17 obese women who underwent RASCLP. The operative parameters (length of operation, associated procedures, complication rate and length of hospitalization) and the objective and subjective results were evaluated at 12 months follow-up. RESULTS The median (IQR) BMI was 30.5 kg/m2 (30-32) in the LS group vs 31.6 kg/m2 (30-34) in the RALSCP group (P=0.402). The anatomical results were comparable in both groups (LS vs RALSCP): post-operative stage of prolapse (POP-Q-ICS): stage 0-1: 34/39 (88%) vs 16/17 (94.1%), P=0.7; stage 2: 4/39 (10%) vs 0/17 (0%), P=0.7; stage 3-4: 1/39 (2%) vs 1/17 (5.9%), P=0.7. The complication rate was similar in both groups (LS vs RALSCP): bladder injury 2.5% (1/39) vs 0% (0/17), P=0.6, laparoconversion 5.1% (2/39) vs 5.9% (1/17), P=0.5. The overall reoperation rate was (LS vs RALSCP): 18% (7/39) vs 5.9% (1/17), P=0.4. CONCLUSION Laparoscopic sacrocolpopexy and robot-assisted laparoscopic sacrocolpopexy have equal results in obese women. The complication rates and outcomes appear to be similar in both groups of obese women. LEVEL OF EVIDENCE 3.
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Vieillefosse S, Thubert T, Trichot C, Deffieux X. [Cervical carcinoma and complete genital prolapse]. Prog Urol 2014; 24:533-4. [PMID: 24875573 DOI: 10.1016/j.purol.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/26/2022]
Affiliation(s)
- S Vieillefosse
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France.
| | - T Thubert
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
| | - C Trichot
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
| | - X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
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Korahanis N, Goron A, Farache C, Panel L, Courtieu C. [Transvaginal repair of genital prolapse using a light-weight mesh by the vaginal route]. Prog Urol 2014; 24:518-25. [PMID: 24875571 DOI: 10.1016/j.purol.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the results associated with the transvaginal repair of genital prolapse using a tension free light-weight polypropylene mesh. PATIENTS AND METHODS One hundred and fifteen patients have been treated in a single centre. Pre-operative and operative data and complications were recorded. Patients were examined at 1, 6 and 12 months. Anatomical failure was defined as follows: Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. RESULTS Seventy-seven (67%) patients completed 6 months follow-up and 45 (39%) patients completed 12 months follow-up. Finally, 70 (61%) patients were lost to follow-up, including 2 deaths (not related to surgery). Mean age was 66 years. All patients were treated with an anterior and apical and 20 patients were additionally treated with a posterior mesh. Among the 77 patients who completed 6 months follow-up, the complications reported were: 2 (2%) bladder injuries, 1 (1%) hematoma, 1 (1%) bleeding>200 mL and 1 (1%) vaginal mesh exposure. At one year, 6 (7%) patients suffered from urinary stress incontinence, 5 (4%) suffered from urgency and 4 (5%) had dyspareunia. Among the 45 patients who completed 12 months follow-up, functional success was 95% and anatomical success was 77%. CONCLUSION In this series, the placement of a light-weight transvaginal polypropylene mesh was associated with good functional results and a moderate prevalence of complications. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Korahanis
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France.
| | - A Goron
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
| | - C Farache
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
| | - L Panel
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
| | - C Courtieu
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
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Letouzey V, Mercier G, Adjoussou S, Bohoussou E, Mares P, de Tayrac R. Can the PFDI (Pelvic Floor Distress Inventory) or PFIQ (Pelvic Floor Impact Questionnaires) be used to predict outcome in pelvic reconstructive surgery? Prog Urol 2013; 23:940-5. [PMID: 24010925 DOI: 10.1016/j.purol.2013.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine a syndrome score threshold on PFDI or PFIQ predictive of a significant improvement in post-operative functional results. DESIGN A retrospective case review (Canadian Task Force Classification II-2). SETTING University and research hospital. POPULATION Women diagnosed with pelvic organ prolapse and repaired with synthetic vaginal mesh. METHODS Quality of life was arbitrarily considered to have improved significantly if the score decreases by more than 50% between pre-operatively and 36 months post-operatively. We investigated the pre-operative cut-off score predictive of no quality of life improvement at M36 from a prospective trial for surgical pelvic organ prolapse treatment. RESULTS The most accurate pre-operative cut-off score predicting a failure to improve quality of life at 36 months post-operatively was 62/300 (PFDI Score). This cut-off value had a positive predictive value of 83.6% and specificity of 62.1%. No significant threshold was obtained from the PFIQ score. CONCLUSION The intensity of symptoms before surgery may interfere as a predictive factor for outcome.
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