Infracoccygeal sacropexy or sacrospinous suspension for uterine or vaginal vault prolapse

OBJECTIVE

To compare infracoccygeal sacropexy (IS) and sacrospinous suspension (SS) for the treatment of uterine or vault prolapse.

METHODS

A randomized trial of 49 women assigned to either the IS group using IVS tape (n=24) or SS group (n=25). Concomitant hysterectomy and repairs were performed as appropriate. Evaluations included prolapse staging using the POP-Q system and validated questionnaires for symptoms (PFDI), quality of life (PFIQ), and sexuality (PISQ-12). The primary outcome measure was postoperative pain.

RESULTS

Patients' characteristics were similar in both groups. IS was quicker, easier, and less painful than SS (P<0.01). Hemorrhage or hematoma rates were similar. Neither rectal injury nor vaginal erosion occurred. Mean follow-up was 16.8 months. Prolapse cure rates, symptom scores, and quality of life were similar. Postoperative cystocele occurred in 4.8% of women after IS and 25% after SS (P>0.05).

CONCLUSION

Infracoccygeal sacropexy is equivalent to sacrospinous suspension, with a decreased rate of postoperative pain and cystocele recurrence.

Comparaison de différents biomatériaux destinés à la chirurgie vaginale dans un modèle in vivo d'infection de prothèse chez le rat

OBJECTIVES

The purpose of this study was to develop an animal model of prosthetic infection and compare in vivo bacterial infectiosity of different biomaterials used in vaginal surgery.

MATERIALS AND METHODS

We implanted 36 prostheses of poly(lactic acid) with 94% L forms (PLA94), in a model of incisional abdominal hernia in Wistar rats. Bacterial inoculation was done just after implantation with three strains of Escherichia coli of variable virulence, two different concentrations and two different times of inoculation (during surgery or 48 hours after). All meshes were explanted and animals sacrificed on day 30 after intervention. Bacteriology and histology were then performed. In the same way, three materials used in vaginal surgery (knitted light-weight polypropylene [PP], thermoformed PP [Uratape] and polyurethane coated poly[ethylene terephtalate] [PTFE]) were tested and compared to the PLA94 using the same protocol.

RESULTS

All inoculated prostheses were still infected at day 30 after implantation with the same E. coli strain. There was a significant difference in bacterial infectiosity linked to virulence of the inoculated strain (p=.005) and the amount injected (P<0.001). Infectiosity was significantly lower for PLA94 when compared to the three other prostheses (P=0.008). The most important infectiosity was seen with PTFE and thermoformed PP. For histologists, PLA94 also gave the weakest inflammatory reaction.

DISCUSSION AND CONCLUSION

An original animal model of prosthetic infection allowed us to compare in vivo bacterial infectiosity of different biomaterials used in vaginal surgery and to demonstrate that the PLA94 mesh induces a milder risk of infection than polypropylene.