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Mothes AR, Raguse I, Kather A, Runnebaum IB. Native-tissue pelvic organ prolapse (POP) repair with perineorrhaphy for level III support results in reduced genital hiatus size and improved quality of life in sexually active and inactive patients. Eur J Obstet Gynecol Reprod Biol 2023; 280:144-149. [PMID: 36493583 DOI: 10.1016/j.ejogrb.2022.11.023] [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: 08/15/2022] [Revised: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Recent findings address the importance of Level III defects with increased genital hiatus being associated with pelvic organ prolapse (POP), correlated with Level I defects and strongly related to POP recurrence. We hypothesised that concomitant perineorrhaphy in POP repair reduces genital hiatus (gh) and increases perineal body (pb), that gh would be larger with number of vaginal deliveries and that patients' QOL was not different comparing sexually active vs inactive patients with overall judgement of cure comparable to the literature at evaluation. METHODS Retrospective observational study including consecutive patients with indications for posterior repair and Level III support between 2016 and 2018. Concomitant perineorrhaphy was indicated due to complaints of wide introitus or genital hiatus of ≥ 3.5 cm. Primary objective was to compare pre- and postoperative gh and pb according to POP-Q. Secondary objectives were preoperative gh and pb values by parity, POMs obtained with P-QOL/D comparing sexually active vs inactive patients, and subjective judgement of cure according to EGGS system. RESULTS In n = 121 patients, mean gh value was reduced postoperatively by 29.5 % (31 ± 6 vs 44 ± 10 mm, p < 0.001), mean pb value increased by 25.5 % (47 ± 8 vs 35 ± 8 mm, p < 0.001). Influence of parity on preoperative gh (p = 0.020), but not pb values (p = 0.119) was observed. All P-QOL/D domain scores improved significantly postoperatively without differences seen in sexually active vs inactive patients. EGGS responses indicated partial/full goal achievement in 90 % and cure in 87 %. CONCLUSIONS In the study cohort, perineorrhaphy as concomitant in POP repair led to Level III support reflected by decreased genital hiatus size. Functional QOL was improved regardless of sexual activity status and the majority of patients reported partial or full cure.
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Affiliation(s)
- Anke R Mothes
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany; Department of Gynaecology, St. Georg Hospital Eisenach, Academic Teaching Hospital of Friedrich-Schiller-University Jena, Eisenach, Germany
| | - Isabel Raguse
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany; Department of Traumatology, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Angela Kather
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany.
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202
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Wu C, Zhang Z, He H, Zhou Z, Li H, Tong X. Six-year follow-up outcomes of the P(LLA-CL)/Fg bio-patch for anterior vaginal wall prolapse treatment. Int Urogynecol J 2023; 34:115-124. [PMID: 35831453 DOI: 10.1007/s00192-022-05284-5] [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: 05/09/2022] [Accepted: 06/11/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There were few data about the long-term outcomes of bio-compatible patches for pelvic organ prolapse (POP). The efficacy of poly (L-lactide-co-caprolactone) blended with fibrinogen [P(LLA-CL)/Fg] bio-patches were investigated for anterior vaginal wall prolapse treatment in a 6-year follow-up. METHODS The P(LLA-CL)/Fg bio-patch was fabricated through electrospinning. Nineteen patients with symptomatic anterior prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage ≥ 2) were treated with anterior pelvic reconstruction surgery using a P(LLA-CL)/Fg bio-patch and were followed up at 1, 2, 3, 6 months, and 6 years. The primary outcome was objective anatomical cure (anterior POP-Q stage ≤ 1). Secondary outcomes included complications, MRI evaluation, and scores of the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory-20 (PFDI-20). RESULTS The micro-morphology of the bio-patch resembled the extracellular matrix, which was suitable for the growth of fibroblasts. Sixteen (84.2%) patients were finally assessed, with a mean follow-up of 6.08 ± 0.18 years. The cure rate without anterior prolapse recurrence was 93.8% at 6 years. Compared with baseline, the POP-Q measurements of Aa, Ba, and C points and scores of PFIQ-7 and PFDI-20 manifested significant differences at all times (all p < 0.05). One (5.26%) case of bio-patch-related infection, 1 (5.26%) case of urinary retention, and no exposures and erosion occurred. MRI evaluation showed that the bio-patch gradually degraded to fragments at 1 month and was completely absorbed at 3 months. CONCLUSIONS Among long-term follow-ups, anterior pelvic reconstruction surgery with a P(LLA-CL)/Fg bio-patch demonstrated significant improvements in anatomical correction of anterior pelvic prolapse and pelvic function without severe morbidity.
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Affiliation(s)
- Chenghao Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Shanghai, 200065, People's Republic of China
| | - Zhixia Zhang
- Department of Obstetrics and Gynecology, Jiading District Maternal and Child Health Hospital, Shanghai, 201800, People's Republic of China
| | - Hongbing He
- Shanghai Pine & Power Biotech Co. Ltd., Shanghai, 201108, People's Republic of China.
| | - Zixuan Zhou
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Shanghai, 200433, People's Republic of China
| | - Huaifang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Shanghai, 200065, People's Republic of China.
| | - Xiaowen Tong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Shanghai, 200065, People's Republic of China.
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203
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Hua E, Binelli C, Toullalan O, Villefranque V, Tourette C, Agostini A. Outpatient laparoscopic sacrocolpopexy: Feasibility and patient satisfaction. J Gynecol Obstet Hum Reprod 2023; 52:102497. [PMID: 36375393 DOI: 10.1016/j.jogoh.2022.102497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE To assess the feasibility and patient satisfaction of outpatient management of laparoscopic sacrocolpopexy. DESIGN Observational study. SETTING Multicentric study in four French centers: La Conception University Hospital, Marseille; Simone Veil Hospital, Cannes; Simone Veil Hospital, Eaubonne; and Jules Verne Clinic, Nantes. PATIENTS A total of 125 patients required laparoscopic sacrocolpopexy and accepted outpatient surgery. INTERVENTIONS Assessment of outpatient surgery success, patient satisfaction, and self-evaluated symptom improvement after surgery. MEASUREMENTS AND MAIN RESULTS During the study period, 574 patients required laparoscopic sacrocolpopexy, and 21.8% (125) of them met the inclusion criteria for outpatient surgery. The success rate for outpatient surgery was 95.2% (119/125). The perioperative complication rate was 4% (5/125). Among the successfully discharged outpatients, 2.5% (3/119) of them had an unscheduled visit within seven days. Among the discharged patients, 84% (105/125) answered the satisfaction questionnaire, and 88.5% (93/105) declared themselves as "satisfied" or "very satisfied" with the procedures. Patients who declared their conditions to have been "very improved" or "improved" compared to their preoperative symptomatology were 76.9% (83/108) of cases. CONCLUSION A high success rate for outpatient laparoscopic sacrocolpopexy associated with a high satisfaction rate were found in our study. The development of outpatient options for laparoscopic sacrocolpopexy was supported by our data.
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204
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Drost LE, Stegeman M, Gerritse MBE, Franx A, Vos MC, Lamers RED, Ezendam NPM, Dam A, Schrickx J, van Wijk HF. A web-based decision aid for shared decision making in pelvic organ prolapse: the SHADE-POP trial. Int Urogynecol J 2023; 34:79-86. [PMID: 36378318 PMCID: PMC9665015 DOI: 10.1007/s00192-022-05405-0] [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: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Among women worldwide, pelvic organ prolapse (POP) is a common problem. There are three different treatment options for POP: pelvic floor muscle therapy, pessary treatment and prolapse surgery. As none of the three treatment options is clearly superior, shared decision making (SDM) is very important. A decision aid (DA) is known to facilitate patient participation and SDM. We hypothesise that the use of a web-based DA for POP increases patients' satisfaction with information and care and reduces decisional conflict. METHODS This two-arm, multicentre, cluster randomised controlled trial was performed in women with POP in five different Dutch hospitals. The control group received usual care (UC) and the intervention group received the DA in addition to UC. Primary outcome measures were satisfaction with treatment decision making and satisfaction with information. Analyses were performed using independent sample t tests, Chi-squared tests, and multilevel linear regression analyses. RESULTS Between the DA group (n=40) and the UC group (n=56) no differences were found concerning patients' satisfaction with information, with scores of 45.63 and 46.14 out of 50 respectively (p=0.67). Also, no differences were found concerning the perceived role in decision making, as patients scored 46.83 in the DA group and 46.41 in the UC group, out of a maximum of 54 (n=0.81). CONCLUSIONS No differences were found concerning patients' satisfaction with information and treatment decision making between the DA and UC. However, both groups scored high on the questionnaires, which suggests that the decision process is already of high quality.
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Affiliation(s)
- Larissa Esmeralda Drost
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000, LC, Tilburg, the Netherlands.
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Marjan Stegeman
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000, LC, Tilburg, the Netherlands
| | - Maria B E Gerritse
- Department of Obstetrics and Gynaecology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000, LC, Tilburg, the Netherlands
| | | | - Romy E D Lamers
- Department of Urology, UMC Utrecht, Utrecht, the Netherlands
| | - Nicole P M Ezendam
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands and Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Anika Dam
- Department of Obstetrics and Gynaecology, VieCuri Medical Center, Venlo, the Netherlands
| | - Jan Schrickx
- Department of Obstetrics and Gynaecology, Rivas Beatrix Hospital, Gorinchem, The Netherlands
| | - Heidy F van Wijk
- Department of Obstetrics and Gynaecology, Bravis Hospital, Roosendaal, The Netherlands
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205
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Graefe F, Schwab F, Tunn R. Double-layered anterior colporrhaphy (DAC)-video and mid-term follow-up of 60 patients. Int Urogynecol J 2023; 34:297-300. [PMID: 35576014 PMCID: PMC9109656 DOI: 10.1007/s00192-022-05216-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/25/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Anterior colporrhaphy (AC) exhibits high recurrence rates, and this issue is not appropriately addressed by alloplastic material, which often necessitates reoperation. Aiming to improve the anatomical cure rate, we implemented double-layered anterior colporrhaphy (DAC). With a retrospective investigation, precise description and video of the surgical technique, we want to contribute to the development of native tissue anterior repair. METHODS Women treated by DAC and vaginal hysterectomy were included. Primary outcome was anatomic cure defined as prolapse < stage 2. Secondary outcomes were complication rate, resolution of postvoid residual urine, reoperation for prolapse and patient satisfaction. Follow-up encompassed a clinical gynecologic examination, the German Pelvic Floor Questionnaire and a response scale for postoperative quality of life (QoL). The key difference between DAC and AC is the continuous suture followed by the traditional interrupted sutures. RESULTS One hundred one patients were eligible, and 60 patients attended follow-up. Cure was achieved in 49 cases (81.7%) of cystocele with a median follow-up of 19.3 months. Fifty-five patients (91.7%) indicated an improvement in QoL. CONCLUSIONS We observed high anatomic cure rate and satisfaction after DAC. With description and video of the technique, it is reproducible and comparable to other methods. Randomized controlled trials should follow.
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Affiliation(s)
- F Graefe
- German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | - F Schwab
- Department of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - R Tunn
- German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany
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206
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Kikuchi JY, Yanek LR, Handa VL, Chen CCG, Jacobs S, Blomquist J, Patterson D. Prolapse and mesh reoperations following sacrocolpopexy: comparing supracervical hysterectomy, total hysterectomy, and no hysterectomy. Int Urogynecol J 2023; 34:135-145. [PMID: 35689689 DOI: 10.1007/s00192-022-05263-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/22/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy is effective for apical prolapse repair and is often performed with hysterectomy. It is unknown whether supracervical or total hysterectomy at time of sacrocolpopexy influences prolapse recurrence and mesh complications. The primary objective of this study is to compare reoperations for recurrent prolapse after sacrocolpopexy with either supracervical hysterectomy or total hysterectomy, or without concomitant hysterectomy. We also sought to compare these three groups for the incidence of mesh complications and describe cervical interventions following supracervical hysterectomy. METHODS A retrospective cohort study of sacrocolpopexy was performed using the MarketScan® Research Database. Women > 18 years who underwent sacrocolpopexy between 2010 to 2014 were identified. Utilizing diagnostic and procedural codes, reoperations for prolapse and mesh complications were identified. Women with < 2 years of follow-up were excluded. RESULTS From 2010 to 2014, 3463 women underwent sacrocolpopexy with at least 2 years of follow-up, 910 (26.3%) with supracervical hysterectomy, 1243 (35.9%) with total hysterectomy, and 1310 (37.8%) without hysterectomy. Reoperations for prolapse were similar after supracervical hysterectomy (1.5%), after total hysterectomy (1.1%, p = 0.40), and without hysterectomy (1.5%, p = 0.98). Mesh complications after sacrocolpopexy were similar after supracervical hysterectomy (1.8%), after total hysterectomy (1.5%, p = 0.68), and without hysterectomy (2.8%, p = 0.11). Following supracervical hysterectomy, 0.9% underwent cervical procedures. CONCLUSIONS When comparing supracervical and total hysterectomy at time of sacrocolpopexy, there were no significant differences in reoperations for recurrent prolapse, reoperations for mesh complications, or mesh complication diagnoses. This study shows that surgeons can be reassured on performing hysterectomy with sacrocolpopexy.
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Affiliation(s)
- Jacqueline Y Kikuchi
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA.
| | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA
| | - Stephanie Jacobs
- Department of Obstetrics and Gynecology, Greater Baltimore Medical Center, Towson, MD, USA
| | - Joan Blomquist
- Department of Obstetrics and Gynecology, Greater Baltimore Medical Center, Towson, MD, USA
| | - Danielle Patterson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA
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207
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Ackenbom MF, Zyczynski HM, Butters MA, Lopa S, Orris SR, Davis EM. Postoperative delirium in older patients after undergoing pelvic organ prolapse surgery. Int Urogynecol J 2023; 34:201-209. [PMID: 35403880 PMCID: PMC10320862 DOI: 10.1007/s00192-022-05170-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/25/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To determine the 7-day incidence and risk factors of postoperative delirium (POD) occurring after prolapse surgery in women aged ≥60 years. METHODS A prospective study of women ≥60 years undergoing prolapse surgery at a large academic center. The primary outcome is positive Confusion Assessment Method delirium screen administered in person or by telephone at the time of hospital discharge and postoperative days 1, 3, 5, and 7. RESULTS This analysis included 165 patients, mean ± SD age of 72.5 ± 6.1 years, with median (IQR) years of education of 13 (12-16), and baseline Modified Mini-Mental Status (3MS) Exam score of 95 (92-98). Prolapse repair type was vaginal for 70% (n=115) and laparoscopic for 30% (n=50) of patients; most under general anesthesia, 151 (92.1%). The incidence of positive delirium screen during the first week after surgery was 12.1% (n=20). Most of these participants screened positive on postoperative day 0, 8.4% (n=14). In univariate analyses, a positive screen was associated with older age and fewer education years, lower 3MS exam score, greater baseline geriatric depression scale score, and greater frailty score. Lower 3MS score was the only variable that remained significant in the final model (adjusted odds ratio 0.84, 95% CI 0.75-0.95). CONCLUSIONS One in 12 women ≥60 years deemed eligible for discharge on the day of prolapse surgery screens positive for delirium. The 7-day POD incidence is comparable to other elective non-cardiac surgery cohorts. Given the increasing trend toward same day discharge after major prolapse surgery, more research is needed to determine the impact of universal delirium screening as part of discharge assessments.
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Affiliation(s)
- Mary F Ackenbom
- Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Halina M Zyczynski
- Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samia Lopa
- Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Steven R Orris
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Esa M Davis
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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208
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Kindie W, Yiheyis A, Aragaw A, Wudineh KG, Miskir D. Quality of life among women with a diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: an institutional based cross-sectional study. Int Urogynecol J 2023; 34:225-230. [PMID: 35511251 DOI: 10.1007/s00192-022-05209-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse is among the most common gynecologic problems worldwide. It greatly influences women's quality of life. However, research regarding the effect of pelvic organ prolapse on quality of life is limited in our study area. METHODS An institutional-based study design among women with the diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital was employed from May to July 2018. Interviewer-administered questionnaire and Prolapse Quality of Life assessment tool were used to collect data. Gynecologic speculum examination was done to collect objective data. Data were entered into Epi info version 7 and then exported in to SPSS, version 20.0, for analysis. Descriptive statistics and logistic regression were used. All the statistical tests were significant at P < 0.05. RESULTS The average prolapse quality of life score was 48.35 ± 22.75 SD. The physical limitation (score: 69.83 ± 28.77 SD) and general health perception (score: 67.39 ± 20.26 SD) domains were the most affected life domains. Younger age (AOR = 3.02 [95% CI: 1.22-7.45]), being illiterate (AOR = 3.52 [95% CI: 1.12-11.10]), and having stage IV POP (AOR = 2.84 [95% CI: 1.16-7.00]) were associated with lower quality of life. CONCLUSIONS The QOL score showed huge variability among the study participants. The physical limitation and general health perception domains were most affected. Being illiterate, being < 35 years old, and having stage IV pelvic organ prolapse were the factors associated with lower quality of life.
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Affiliation(s)
- Walelign Kindie
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aemiro Yiheyis
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amanu Aragaw
- Department of Reproductive Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kihinetu Gelaye Wudineh
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Miskir
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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209
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Shewarega ES, Geremew AB, Fentie EA. Prevalence of symptomatic pelvic organ prolapse and associated factors in Southern Nations, Nationalities, People's Region referral hospitals, Ethiopia. Int Urogynecol J 2023; 34:125-134. [PMID: 35779109 DOI: 10.1007/s00192-022-05280-9] [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: 04/13/2022] [Accepted: 06/05/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse is one of the major causes of morbidity among women that affect their quality of life. Despite the severity of the problem, there is limited information in Ethiopia. Therefore, this study was aimed at assessing the prevalence of symptomatic POP and its associated factors. METHODS An institution-based cross-sectional study was carried out in the referral hospitals of Southern Nations, Nationalities, People's Region, Ethiopia. Women were initially interviewed about their prolapse symptoms using validated questionnaires, and if they answered yes to one or more of the questions, they were examined by gynecologists using simplified POP quantification. Pelvic examination results and patient-reported symptoms were used to determine symptomatic POP. A multivariate logistic regression analysis model was used to identify factors associated with symptomatic prolapse. RESULTS A total of 1,196 respondents were included in this study. The prevalence of symptomatic POP was found to be 20.1%. Age of women ≥55 years (AOR=8.39; 95% CI 3.41-20.62), carrying heavy objects for ≥ 5 h (AOR= 5.18; 95% CI 2.51-10.69), parity ≥4 times (AOR=2.98; 95% CI 1.60-5.53), history of home delivery (AOR= 2.90; 95% CI 1.50-5.61), giving birth through assisted vaginal delivery (AOR=5.01; 95% CI 1.73-14.53), history of chronic constipation (AOR=2.66; 95% CI 1.38-5.15), and a history of a chronic cough (AOR=9.18; 95% CI 4.52-18.61) were associated with symptomatic POP. CONCLUSIONS In this study the prevalence of symptomatic POP is high. Older age, long hours of carrying heavy objects, a high parity, last birth through assisted vaginal delivery, a history of home delivery, a history of chronic constipation, and a history of a chronic cough were found to be associated with symptomatic POP.
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Affiliation(s)
- Ever Siyoum Shewarega
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia.
| | - Alehegn Bishaw Geremew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia
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210
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Strohbehn K, Wadensweiler P, Hanissian P. A novel, collapsible, space-occupying pessary for the treatment of pelvic organ prolapse. Int Urogynecol J 2023; 34:317-319. [PMID: 36462059 PMCID: PMC10697197 DOI: 10.1007/s00192-022-05415-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Kris Strohbehn
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Paul Wadensweiler
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Paul Hanissian
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
- Reia, LLC, Lyme, Lebanon, NH, USA
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Woodburn KL, Bradley SE, Ward SA, Schirm KA, Clarke B, Gutman RE, Sokol AI. Assessing the Impact of Vaginal Hysterectomy with Vaginal Mesh Attachment on Outcomes and Complications during Minimally Invasive Sacrocolpopexy. J Minim Invasive Gynecol 2023; 30:25-31. [PMID: 36223863 DOI: 10.1016/j.jmig.2022.09.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To compare mesh complications and failure rates after 1 year in laparoscopic minimally invasive sacrocolpopexy (MISC) with ultralightweight mesh attached vaginally during total vaginal hysterectomy (TVH), laparoscopically if posthysterectomy (PH), or laparoscopically during supracervical hysterectomy. DESIGN Single-center retrospective cohort study. SETTING Tertiary referral center. PATIENTS Women with symptomatic pelvic organ prolapse who elected for MISC. INTERVENTIONS Laparoscopic MISC with ultralightweight mesh attached vaginally during TVH, laparoscopically if PH, or laparoscopically during supracervical hysterectomy. Composite failure was defined as recurrent prolapse symptoms, prolapse past the hymen, or retreatment for prolapse. MEASUREMENTS AND MAIN RESULTS Between 2010 and 2017, 650 patients met the inclusion criteria with 278 PH, 82 supracervical hysterectomy, and 290 vaginal hysterectomy patients. Median follow-up was similar for all groups (382 days vs 379 vs 345; p = .31). The majority in all groups were white (66.6%), nonsmokers (74.8%), postmenopausal (82.5%), and did not use estrogen (70.3%). Mesh complications did not differ among groups (1.6% PH, 2.5% supracervical hysterectomy, 2.2% vaginal hysterectomy; p >.99). There was no difference in anatomic failure (5% PH, 1.2% supracervical hysterectomy, 2.1% vaginal hysterectomy; p = .07), reoperation for prolapse (1.4% vs 1.2% vs 0.7%; p = .57), or composite failure (9.0% vs 3.7% vs 4.8%; p = .07). CONCLUSIONS TVH with vaginal mesh attachment of ultralightweight mesh had similar adverse events, mesh exposure rates, and failure rates to those of laparoscopic PH sacrocolpopexy or supracervical hysterectomy with laparoscopic mesh attachment.
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212
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Glass Clark S, Shepherd JP, Sassani JC, Bonidie M. Surgical cost of robotic-assisted sacrocolpopexy: a comparison of two robotic platforms. Int Urogynecol J 2023; 34:87-91. [PMID: 36282303 DOI: 10.1007/s00192-022-05391-3] [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: 07/18/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Robotic assistance in pelvic organ prolapse surgery can improve surgeon ergonomics and instrument dexterity compared with traditional laparoscopy but at increased costs. OBJECTIVE To compare total costs for robotic-assisted sacrocolpopexy (RSC) between two robotic platforms at an academic medical center. METHODS Retrospective cohort of Senhance (Ascensus) RSC between 1/1/2019 and 6/30/21 who were matched 2:1 with DaVinci (Intuitive) RSC. Primary outcome was total costs to hospital system; secondarily we evaluated cost sub-categories. Purchase costs of the robotic systems were not included. T-test, chi-square, and Fisher's exact tests were used. A multivariable linear regression was performed to model total costs adjusting for potential confounders. RESULTS The matched cohort included 75 subjects. The 25 Senhance and 50 DaVinci cases were similar overall, with mean age 60.5 ± 9.7, BMI 27.9 ± 4.7, and parity 2.5 ± 1.0. Majority were white (97.3%) and postmenopausal (86.5%) with predominantly stage III prolapse (64.9%). Senhance cases had longer OR times (Δ = 32.1 min, p = 0.01). There were no differences in concomitant procedures, intraoperative complications, or short-term postoperative complications between platforms (all p > 0.05). On univariable analysis, costs were similar (Senhance $5368.31 ± 1486.89, DaVinci $5741.76 ± 1197.20, p = 0.29). Cost subcategories (medications, supplies, etc.) were also similar (all p > 0.05). On multivariable linear regression, total cost was $908.33 lower for Senhance (p = 0.01) when adjusting for operative time, estimated blood loss, concomitant mid-urethral sling, and use of the GelPoint mini port system. CONCLUSIONS Despite longer operating times, total cost of robotic-assisted sacrocolpopexy was significantly lower when using the Senhance compared to the DaVinci system.
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Affiliation(s)
- Stephanie Glass Clark
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jonathan P Shepherd
- Department of Obstetrics & Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Jessica C Sassani
- Division of Urogynecology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Michael Bonidie
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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213
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Fenocchi L, Best C, Mason H, Elders A, Hagen S, Maxwell M. Long-term effects and costs of pelvic floor muscle training for prolapse: trial follow-up record-linkage study. Int Urogynecol J 2023; 34:239-246. [PMID: 35763050 PMCID: PMC9834099 DOI: 10.1007/s00192-022-05272-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/29/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse affects around 40% of women aged over 50 years. A multicentre parallel group randomised trial (the Pelvic Organ Prolapse PhysiotherapY (POPPY) trial) demonstrated that pelvic floor muscle training (PFMT) was effective in reducing prolapse symptoms compared with no treatment. However, insight into the long-term impact of PFMT on health outcomes and health-service utilisation is scarce. METHODS This study utilised linkage of Scottish administrative health records to follow-up POPPY trial participants resident in Scotland over 11 years. Mixed effects logistic regression determined the likelihood of receiving further prolapse treatment for those in the PFMT and control groups. Analyses were adjusted for age group, prolapse stage, baseline symptom severity and attitude towards surgery. A cost assessment estimated longitudinal costs to the UK National Health Service (in Scotland) of accessing further prolapse treatment for each trial group. RESULTS Two hundred and ninety-three women, aged 25 to 79 years, were followed up. One hundred and forty-one women (48.1%) had received further prolapse treatment: 65 (of 149; 43.6%) in the PFMT group compared with 76 (of 144; 52.8%) in the control group. PFMT was associated with a reduction in the odds of any prolapse treatment during follow-up (AOR 0.61; 95% CI 0.37 to 0.99). Total cost of secondary care was £154,544 (GBP) in the PFMT group and £172,549 (GBP) in the control group. CONCLUSIONS Although PFMT did not lead to significant differences in total costs for further prolapse treatment over a post-intervention period of more than 10 years, it reduced the overall long-term risk of requiring hospital-based treatment for pelvic floor disorders.
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Affiliation(s)
- Linda Fenocchi
- Yunus Centre for Social Business & Health, M201 George Moore Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Catherine Best
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Helen Mason
- Yunus Centre for Social Business & Health, M201 George Moore Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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214
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Luo J, Swenson CW, Betschart C, Feng F, Wang H, Ashton-Miller JA, DeLancey JOL. Comparison of in vivo visco-hyperelastic properties of uterine suspensory tissue in women with and without pelvic organ prolapse. J Mech Behav Biomed Mater 2023; 137:105544. [PMID: 36332398 DOI: 10.1016/j.jmbbm.2022.105544] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
The uterine suspensory tissue (UST) complex includes the cardinal (CL) and uterosacral "ligaments" (USL), which are mesentery-like structures that play a role in resisting pelvic organ prolapse (POP). Since there is no information on the time-dependent material properties of the whole structure in situ and in vivo, we developed and tested an intraoperative technique to quantify in vivo whether there is a significant difference in visco-hyperelastic behavior of the CL and USL between women with and without POP. Thirteen women with POP (cases) and four controls scheduled for surgery were selected from an ongoing POP study. Immediately prior to surgery, a computer-controlled linear servo-actuator with a series force transducer applied a continuous, caudally directed traction force while simultaneously recording the resulting cervical displacement in the same direction. After applying an initial 1.1 N preload, a ramp rate of 4 mm/s was used to apply a maximum force of 17.8 N in three "ramp-and-hold" test trials. A simplified bilateral four-cable biomechanical model was used to identify the material behavior of each ligament. For this, the initial cross-section areas of the CL and USL were measured on 3-T magnetic resonance image-based 3D models from each subject. The time-dependent strain energy function of CL/USL was defined with a three-parameter hyperelastic Mooney-Rivlin material model and a two-term Prony series in relaxation form. When cases were compared with controls, the estimated time-dependent material constants of CL and USL did not differ significantly. These are the first measurements that compare the in vivo and in situ visco-hyperelastic response of the tissues comprising the CL and USL to loading in women with and without prolapse. Larger sample sizes would help improve the precision of intergroup differences.
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Affiliation(s)
- Jiajia Luo
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biomedical Engineering Department, Peking University, Beijing, China.
| | - Carolyn W Swenson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Fei Feng
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Wang
- Biomedical Engineering Department, Peking University, Beijing, China
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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215
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Korkut Z, Demir ET, Celenay ST. Effects of interferential current stimulation in women with pelvic organ prolapse: a prospective randomized sham-controlled study. Int Urogynecol J 2023; 34:279-289. [PMID: 36326860 DOI: 10.1007/s00192-022-05402-3] [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: 09/06/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the effects of interferential (IF) current stimulation on pelvic floor symptoms, prolapse stages, pelvic floor muscle (PFM) strength/endurance, quality of life (QoL), sexual function, perception of subjective improvement (PSI), and satisfaction in women with pelvic organ prolapse (POP). METHODS The patients were randomly divided into the IF (n=13) and sham groups (n=12). Lifestyle advice was given in both groups. Active IF current was applied in the IF group and sham IF was applied in the sham group 3 days a week for 8 weeks. The following tools were used for data evaluation: pelvic floor symptom severity with the Pelvic Floor Distress Inventory-20 (PFDI-20), POP with the simplified POP-quantification system, PFM strength/endurance with a perineometer, QoL with the Prolapse Quality of Life Scale (P-QoL), and sexual function with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Scale (PISQ-12). Evaluations were made before treatment (BT), mid-term (MT, 4th week), and after treatment (AT). PSI and satisfaction were evaluated AT with Likert-type scales. RESULTS In the intergroup comparison AT, a greater increase in PFM strength/endurance, P-QoL-role limitations, P-QoL-sleep/energy scores, PSI, and satisfaction level, and a decrease in cystocele stages were observed in the IF group than in the sham group (p<0.05). Further, there was a greater increase in PFM endurance in the IF group in MT (p<0.05). CONCLUSIONS Interferential current stimulation was effective in improving POP stage, PFM strength/endurance, and QoL in women with POP. IF current stimulation can be used as a complementary treatment method in women with POP.
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Affiliation(s)
- Zehra Korkut
- Health Sciences Institute, Physiotherapy and Rehabilitation Doctoral Program, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Emine Turen Demir
- Meram Faculty of Medicine, Department of Gynecology and Obstetrics, Necmettin Erbakan University, Konya, Turkey
| | - Seyda Toprak Celenay
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey.
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216
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Isenlik BS, Aksoy O, Erol O, Mulayim B. Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial. Int Urogynecol J 2023; 34:231-238. [PMID: 35737006 DOI: 10.1007/s00192-022-05267-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We compared the outcomes of women who underwent laparoscopic lateral suspension with concurrent total laparoscopic hysterectomy (LLS-TLH) with those of women who underwent laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy (LSC-TLH) for apical and/or anterior vaginal wall prolapse. METHODS Eighty women underwent LLS-TLH or LSC-TLH operations. According to the Pelvic Organ Prolapse Quantification System (POP-Q), women with symptomatic pelvic organ prolapse of stage 2 or higher apical and/or anterior compartment prolapse were enrolled in the study. The objective cure rate according to the POP-Q system was the primary (objective) outcome. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Impression of Improvement (PGI-I) questionnaire scores were the secondary (subjective) outcomes. The primary and secondary outcomes were evaluated at 1 year after surgery. RESULTS The primary and secondary outcomes indicated significant improvements in both groups (p < 0.05). The objective cure rate was 92.5% for apical and 78.6% for anterior compartment prolapse in the LLS-TLH group; the respective rates were 100% and 74.1% in the LSC-TLH group. The subjective cure rate was 87.5% for the LLS-TLH group and 90% for the LSC-TLH group. No statistically significant differences between groups were found in the objective cure rate, subjective cure rate, or ICIQ-VS, ICIQ-SF, or PGI-I scores at 1 year (p > 0.05). CONCLUSIONS LLS-TLH can serve as a safe, effective, and feasible alternative to LSC-TLH, with low complication rates and similar short-term objective and subjective outcomes.
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Affiliation(s)
- Bekir Sıtkı Isenlik
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Orhan Aksoy
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Barıs Mulayim
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey.
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217
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Durand B, Sänger I, Santillán Iturres M. A case of myiasis in stage IV pelvic organ prolapse. Int Urogynecol J 2023; 34:313-315. [PMID: 36418568 DOI: 10.1007/s00192-022-05410-3] [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: 05/30/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Barbara Durand
- Urogynecology Section of Gynecology Unit-José María Penna Hospital, 3380, Autonomous City of Buenos Aires, Buenos Aires, Argentina.
| | - Ileana Sänger
- Urogynecology Section of Gynecology Unit-José María Penna Hospital, 3380, Autonomous City of Buenos Aires, Buenos Aires, Argentina
| | - Martina Santillán Iturres
- English Translation, Faculty of Medicine, Buenos Aires University, Autonomous City of Buenos Aires, Buenos Aires, Argentina
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218
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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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Lozo S, Chill HH, Botros C, Goldberg RP, Gafni-Kane A. Long term surgical outcomes of vaginal colposuspension using the Uphold Lite™ mesh system vs. vaginal vault uterosacral ligament suspension for treatment of apical prolapse. Eur J Obstet Gynecol Reprod Biol 2023; 280:150-153. [PMID: 36493584 DOI: 10.1016/j.ejogrb.2022.11.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/29/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The aim of this study is to compare long-term outcomes (7-10 years) between vaginal hysterectomy with uterosacral ligament suspension (VHUSLS) and sacrospinous hysteropexy with the Uphold™ Lite mesh System (SHU) for management of apical prolapse. METHODS Patients undergoing VHUSLS or SHU from 2008 to 2012 at a single tertiary referral center were included. Patients were contacted, asked to return for physical examination, and to complete the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Our primary outcome was anatomic failure defined as Stage 2 POP or higher of any compartment. The secondary outcome was subjective changes in symptoms based upon PFDI-20 responses. RESULTS Two-hundred and two women were identified to have undergone the index surgeries from 2008 to 2012. Sixty-three agreed to return for follow up symptom evaluation and examination (30 VHUSLS and 33 SHU). Baseline characteristics were similar between groups. Clinical cure was high for both groups reaching 93.4 % and 94.0 % for the VHUSLS and SHU groups, respectively (p = 0.721). Anatomical success was lower with 44.7 % and 66.7 % of patients in the VHUSLS and SHU groups, respectively, meeting criteria for success (p = 0.138). There were no mesh complications among patients returning for exams. However, two patients who were contacted and were not interested in this study reported mesh complications and need for additional surgeries. Anterior vaginal wall support was noted to be significantly better supported for SHU (Ba -2.03 ± 0.75 vs -1.42 ± 0.92, p = 0.008). There were no differences between groups for overall PFDI-20 scores postoperatively. However, SHU patients reported higher rates of stress urinary incontinence compared to VHUSLS patients. CONCLUSION In women with apical prolapse, VHUSLS and SHU afford similar long-term outcomes. SHU patients reported higher rates of stress urinary incontinence.
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Affiliation(s)
- Svjetlana Lozo
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, NYC, NY, USA
| | - Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Carolyn Botros
- Atlantic Urogynecology Associates, Department of Obstetrics and Gynecology, Morristown, NJ, USA
| | - Roger P Goldberg
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Adam Gafni-Kane
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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Zhu Y, Wei J, Yang X, Zhu W, Zhang W. Investigation on prevalence and risk factors associated with genitourinary syndrome of menopause in middle-aged and older women in Beijing community: a cross sectional study. BMC Womens Health 2022; 22:558. [PMID: 36585649 PMCID: PMC9801667 DOI: 10.1186/s12905-022-02099-w] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/29/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections) associated with menopause. To avoid invasive testing and painful physical examinations, validated questionaries, which can assess the prevalence and risk factors associated with symptoms of GSM. We aimed to investigate the prevalence and risk factors associated with GSM in middle-aged and older women in the communities of Beijing, China. METHODS A cross-sectional, questionnaire study was performed among 35-70 years old Chinese woman. Vaginal health index score and urinary distress inventory (UDI-6) was used to evaluate vulvovaginal atrophy (VVA) and urinary incontinence (UI). Stages of pelvic organ prolapse (POP) was measured during gynecological examination with POP-Q system. Mean ± standard deviation (SD) and proportion/percentages were used to summarize continuous and categorial variables respectively. The Bonferroni method was used to adjust for multiple comparisons. RESULTS A total of 2702/3000 participants completed the questionnaire survey. The mean ± SD age of participants was 53.7 ± 7.0 years and prevalence of VVA among participants was 34.8% (941/2702). In UDI-6 questionnaires total 47.5% (1284/2702) participants reported experiencing urinary incontinence (UI). Further, POP was highly prevalent in anterior vaginal wall 38.9% (1050/2702) followed by posterior vaginal wall 25.3% (683/2702) and uterine 22.2% (599/2702). Besides, multiple logistic regression analysis inferred older age (45-54 years [OR (95% CI): 3.38 (2.03, 5.64)]; 55-64 years [OR (95% CI): 8.63 (5.09, 14.64)]), menopause [OR (95% CI): 2.20 (1.71, 2.85)] and Faecal Inconsistence (FI) [OR (95% CI): 1.31(1.00, 1.72)] as independent risk factors for VVA. CONCLUSIONS Our study evidenced that GSM is prevalent in old age Chinese women. GSM is related with UI, POP and VVA. Further older age, menopause and FI were risk factors associated with VVA. Our findings could help health care personnel to get a comprehensive overview of factors associated with VVA and urinal distress, which may facilitate early detection and prevention of GSM.
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Affiliation(s)
- Ye Zhu
- grid.411634.50000 0004 0632 4559Department of Obstetrics and Gynecology, Peking University People’s Hospital, Xicheng District, No. 11, Xizhimen South Street, Beijing, 100044 China
| | - Junxiu Wei
- grid.459324.dDepartment of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, China
| | - Xin Yang
- grid.411634.50000 0004 0632 4559Department of Obstetrics and Gynecology, Peking University People’s Hospital, Xicheng District, No. 11, Xizhimen South Street, Beijing, 100044 China
| | - Wei Zhu
- grid.416243.60000 0000 9738 7977Mudanjiang Medical University, No.3 Tong Xiang Street, Mudanjiang City, 157011 China
| | - Weiting Zhang
- grid.416243.60000 0000 9738 7977Mudanjiang Medical University, No.3 Tong Xiang Street, Mudanjiang City, 157011 China
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Khalil N, Moubarak M, Alkassis M, Kassis N, Moukarzel M, Atallah D. Long term follow-up after minimally invasive sacrocolpopexy. Int Urogynecol J 2022:10.1007/s00192-022-05430-z. [PMID: 36576540 DOI: 10.1007/s00192-022-05430-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a benign condition that can adversely affect women's quality of life. Minimally invasive mesh sacrocolpopexy is an effective surgical treatment for POP. This study aims to assess the perioperative, postoperative, and long term (10 years) outcome of a single institution cohort undergoing minimally invasive sacrocolpopexy. METHODS This retrospective study included all cases of laparoscopic sacrocolpopexy performed between 2003 and 2016. Patients were contacted by phone in 2022 for long term follow-up. Data on operative time, length of hospital stay, conversion rate, perioperative injuries, early and late postoperative complications and subjective success rates were collected. RESULTS Ninety-five patients were included aged 60±12 years. Most patients (72%) presented grade 3 POP. Grade of prolapse (3±0.4 vs 3±0.5, p<0.01) and hospital stay (3±1.1 vs 3.1±1.7; p<0.01) were significantly higher in patients who developed early postoperative complications (1st year). At long term follow-up (12±3 years), 48 patients responded. Nine subjects (19%) presented a subjective recurrence with bulge symptoms. Surgery satisfaction was of 79%. The most frequent de novo reported symptom was urge urinary incontinence followed by stress urinary incontinence. Three cases (3%) of mesh erosion were described, all occurred after the 5th postoperative year. CONCLUSIONS Laparoscopic mesh sacrocolpopexy is a safe surgical technique that shows satisfying and consistent long-term results despite the occasional onset of new urinary symptoms.
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Affiliation(s)
- Nour Khalil
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon.
| | - Malak Moubarak
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon.,Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen Mitte, Essen, Germany
| | - Marwan Alkassis
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon
| | - Nadine Kassis
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon
| | - Maroun Moukarzel
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon
| | - David Atallah
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon
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222
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Yan L, Lu S, Zhao C, Lei L, Liu L. Comparison of Different Laparoscopic Sacropexy Procedures for Advanced Uterine Prolapse: A Retrospective Analysis. J Minim Invasive Gynecol 2022; 30:300-307. [PMID: 36563872 DOI: 10.1016/j.jmig.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/29/2022] [Revised: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To compare the long-term outcomes and complications of 3 different variants of laparoscopic sacropexy. DESIGN Single-center retrospective cohort study. SETTING A tertiary university hospital. PATIENTS A total of 483 patients with advanced uterine prolapse who underwent laparoscopic sacrohysteropexy (LSH), laparoscopic supracervical hysterectomy with concomitant laparoscopic sacrocervicopexy (LSCH + LSC), or total laparoscopic hysterectomy with concomitant laparoscopic sacrocolpopexy (TLH + LSC). INTERVENTIONS Demographic data, Pelvic Organ Prolapse Quantification scores, questionnaire results, surgical conditions, postoperative outcomes, and complications were all extracted from medical and follow-up records. MEASUREMENTS AND MAIN RESULTS Between April 2012 and December 2020, 277 women underwent LSH, 95 women underwent LSCH + LSC, and 111 women underwent TLH + LSC. LSH procedures were associated with statistically significantly least blood loss and least postoperative hospital days and catheterization days (all p <.001). During the median follow-up of 32 months (13-117 months), analysis of the data revealed notable anatomic correction in all groups regarding Pelvic Organ Prolapse Quantification measurements (p <.001), and the anatomic cure rate showed no significant difference among these 3 groups (p = .273). No statistically significant differences were detected for prolapse recurrence (p = .171) and functional improvements among these groups. Neither intraoperative injuries (p = .098) nor total postoperative complications (p = .218) differed considerably, whereas the rate of severe postoperative complications (p <.001) including mesh exposure (p = .004) was significantly higher in the TLH + LSC group than that in the other groups. CONCLUSIONS LSH is the appropriate choice for women with uterine prolapse without contraindications for uterine preservation. For patients with benign uterine lesions and a normal cervix, LSCH + LSC is a safer approach that provides similar anatomic results and improved quality of life scores that are similar to those of TLH + LSC. For patients with lesions in the uterus and cervix, TLH + LSC should be selected.
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Affiliation(s)
- Li Yan
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Shentao Lu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Chengzhi Zhao
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Li Lei
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China
| | - Lubin Liu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University) (all authors), Chongqing, China..
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Deng T, Wang S, Liang X, Chen L, Wen Y, Zhang X, Xu L. Medium- to long-term outcomes of vaginally assisted laparoscopic sacrocolpopexy in the treatment of stage III-IV pelvic organ prolapse. BMC Womens Health 2022; 22:503. [PMID: 36476590 PMCID: PMC9727883 DOI: 10.1186/s12905-022-02105-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vaginally assisted laparoscopic sacrocolpopexy (VALS) refers to the placement of synthetic meshes through the vagina in addition to traditional laparoscopic sacrocolpopexy. In this study, we aimed to investigate the medium- to long-term efficacy and safety of VALS for treating stage III-IV pelvic organ prolapse (POP). METHODS The study was designed as a case series at a single center. Patients with stage III-IV POP in our hospital from January 2010 to December 2018 were included. Perioperative parameters, objective and subjective outcomes, and complications were assessed. RESULTS A total of 106 patients completed the follow-up and were included in our study. Within a median follow-up duration of 35.4 months, the objective cure ratio of VALS reached 92.45% (98/106), and the subjective success rate was 99.06% (105/106). Patients reported significant improvements in subjective symptoms. In eight patients suffering anatomic prolapse recurrence, two posterior POP cases were treated by posterior pelvic reconstruction surgery, while six anterior POP cases did not need surgical therapies. The reoperation rate was 1.89% (2/106). No intraoperative complications occurred. Three patients (2.83%) had postoperative fever, and one (0.94%) had wound infection during hospitalization. Six patients (5.66%) had mesh exposure on the vaginal wall, and de novo urinary incontinence occurred in two patients (1.89%) during the follow-up period. CONCLUSION VALS is an effective and safe surgical method for treating severe POP. Therefore, VALS should be considered in the treatment of severe POP due to its favorable subjective and objective outcomes, relatively low rate of infection and acceptable rate of mesh exposure.
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Affiliation(s)
- Tuo Deng
- grid.410737.60000 0000 8653 1072Female Pelvic Floor Unit, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230 Guangdong China ,grid.410737.60000 0000 8653 1072Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Su Wang
- grid.410737.60000 0000 8653 1072Female Pelvic Floor Unit, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230 Guangdong China ,grid.410737.60000 0000 8653 1072Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xuezao Liang
- grid.452881.20000 0004 0604 5998Department of Obstetrics and Gynecology, The First People’s Hospital of Foshan, Foshan, China
| | - Liquan Chen
- grid.410737.60000 0000 8653 1072Female Pelvic Floor Unit, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230 Guangdong China ,grid.410737.60000 0000 8653 1072Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yanli Wen
- grid.413432.30000 0004 1798 5993Department of Obstetrics and Gynecology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Xiaowei Zhang
- grid.410737.60000 0000 8653 1072Female Pelvic Floor Unit, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230 Guangdong China ,grid.410737.60000 0000 8653 1072Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Lizhen Xu
- grid.410737.60000 0000 8653 1072Female Pelvic Floor Unit, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230 Guangdong China ,grid.410737.60000 0000 8653 1072Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
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Yohay NZ, Weiss A, Weintraub AY, Daya K, Katz ME, Elharar D, Yohay Z, Madar RT, Eshkoli T. Knowledge of women during the third trimester of pregnancy regarding pelvic floor disorders. Int Urogynecol J 2022; 33:3407-3414. [PMID: 35588318 DOI: 10.1007/s00192-022-05098-5] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine knowledge regarding pelvic floor disorders (PFDs) among women during the third trimester of pregnancy. METHODS A cross-sectional study was conducted at a large teaching medical center in Israel between June and September 2020. Women in their third trimester (N = 649) were asked to complete the validated Hebrew and Arabic versions of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). The PIKQ instrument examines the knowledge of two major PFDs: urinary incontinence (UI) and pelvic organ prolapse (POP). The study population included women over 18 years of age, in the third trimester, who speak and read Hebrew or Arabic fluently. Two separate scores were calculated, one for each section of the PIKQ. The association of questionnaire scores with the different independent variables was examined using Student's t test or one-way ANOVA. Correlations were examined using Pearson's or Spearman's correlation coefficient. RESULTS The Hebrew version was filled out by 405 women, and 244 women completed the Arabic version. The average questionnaire scores were 7.65 ± 2.8 and 5.32 ± 2 for the UI and POP sections respectively. Significantly higher average scores in both the UI and the POP sections were noted among health care workers (UI: 10.19 ± 2.3 vs 7.34 ± 2.6, p < 0.001; POP: 8.27 ± 2.7 vs 4.97 ± 2.6, p < 0.001), women with higher education (p < 0.001 in both parts) and those with higher incomes (p < 0.001 for both parts). CONCLUSIONS Knowledge of PFD among women in the third trimester of pregnancy in Israel was found to be low. Founding educational programs for targeted groups may improve both the knowledge of PFD and the quality of life for these women.
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Affiliation(s)
- Neriya Zion Yohay
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem and Medical Corps, Israel Defense Forces, Jerusalem, Israel. .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ari Weiss
- Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kochav Daya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | | | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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225
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OuYang Y, Xu W, Li F, Wang R, Zhao X. Anatomic identification of laparoscopic uterosacral ligament suspension: A step-by-step procedure. Int Urogynecol J 2022; 33:3587-90. [PMID: 35723712 DOI: 10.1007/s00192-022-05257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOSTHESIS The uterosacral ligament (USL) is the main structure of physiological apical support, and USL suspension is one of the most commonly used methods for native tissue apical suspension. Structures surrounding the USL are complex, and the USL itself is difficult to identify, especially the sacral portion of the USL. Laparoscopy improves visualization, but exposure of the USL is still unsatisfactory. METHODS In this study, we report a simple method for exposing and suturing the USL laparoscopically, with step-by-step instructions, well-presented figures and videos. The key techniques are shown as follows: keeping tension on the USL with a uterine manipulator, dissecting the space medial to the USL, exposing the portion of the USL near the sacrum through the natural space, and then suturing it medially and connecting it directly to the posterior cervix. RESULTS 95 consecutive patients have undergone this modified USLS and none had serious perioperative complication. CONCLUSION In this way, the USL anatomy is exposed well, which may make placement of sutures in USL suspension safe and effective.
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226
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Fernández Rísquez AC, Mendoza Ladrón de Guevara N, Carballo García A, Hijona Elósegui JJ, Presa Lorite JC. Study of pelvic organ prolapse as a predictor of osteoporotic fracture risk. Gynecol Endocrinol 2022; 38:1147-1152. [PMID: 36549334 DOI: 10.1080/09513590.2022.2159024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: The present study aimed to examine the association between the stage of pelvic organ prolapse (POP) and the risk of fracture in postmenopausal women.Methods: A cross-sectional design was used, which included 133 women with POP over 50 years of age. The participants were classified according to their POP stage, underwent blood tests (hemogram, biochemistry, bone remodeling markers, and hormone tests), and completed a sociodemographic and lifestyle questionnaire along with densitometry, FRAX, and FRIDEX tests.Results: Of the 133 women studied, 66 presented stages I-II POP (49.6%) and 67 III-IV POP (50.4%). The mean age of the participants was 64.47 years. Women with a high POP stage showed higher FRAX scores for major osteoporotic and hip fracture (p .001 and p < .001p). Bivariate analysis revealed that higher scores on the FRIDEX scale were associated with a higher POP stage (p = .032). In addition, there was a marginally significant negative association between bone mineral density (BMD) and POP stage (p = .054).Conclusions: High-stage POP can be considered an independent predictor of osteoporotic fracture risk, as measured using the FRAX and FRIDEX scales.
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Affiliation(s)
| | | | - A Carballo García
- Department Gynecology and Obstetrics, University Hospital of Jaén, Jaén, Spain
| | - J J Hijona Elósegui
- Department Gynecology and Obstetrics, University Hospital of Jaén, Jaén, Spain
| | - J C Presa Lorite
- Department Gynecology and Obstetrics, University Hospital of Jaén, Jaén, Spain
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227
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Delacroix C, Allegre L, Chatziioannidou K, Gérard A, Fatton B, de Tayrac R. Anterior bilateral sacrospinous ligament fixation with concomitant anterior native tissue repair: a pilot study. Int Urogynecol J 2022; 33:3519-27. [PMID: 35226145 DOI: 10.1007/s00192-022-05092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Anterior bilateral sacrospinous ligament fixation (ABSSLF) was first described in 2000 but only evaluated in a limited number of studies. However, due to the FDA's ban on transvaginal mesh, interest in this technique has re-emerged. The SSLF procedure is known for its inherent high risk for anterior compartment failure; hence, in our center we started performing a preemptive concomitant anterior repair with the intention to reduce such risk. The aim of this study was to review the feasibility and clinical outcomes of this innovative technique. METHODS We performed a retrospective cohort study of all the women who had an ABSSLF and a concomitant anterior native tissue repair between May 2019 and July 2020 in a tertiary hospital in France. Our primary endpoint was surgical feasibility, while as secondary endpoints we wanted to explore the perioperative morbidities and clinical outcomes associated with this technique. RESULTS A total of 50 women were operated on in the studied period. The median follow-up time was 10 [8.5] months. It was feasible to perform the combined ABSSLF and concomitant anterior native tissue repair in all cases. The most frequent perioperative complications reported were urinary tract infection (14%) and difficulty in resuming voiding (16%). Anatomical and functional results were improved. The rate of anterior compartment recurrence was 37%. CONCLUSIONS ABSSLF with a concomitant anterior native tissue repair is feasible and relatively safe for treating anterior and apical pelvic prolapse. However, anterior compartment failure rate is still a limitation. Further larger studies with long-term anatomical and functional results comparing this technique to alternative transvaginal surgical approaches are needed.
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228
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Brülle AL, Wu C, Rasch V, Simonsen MK, Schøyen IS, Dahl C, Nohr EA. How do reproductive history and anthropometry in midlife relate to later risk of pelvic organ prolapse? A prospective cohort study. Int Urogynecol J 2022; 33:3373-3380. [PMID: 35254470 DOI: 10.1007/s00192-022-05122-8] [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: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine the association between reproductive and anthropometric factors and later risk of pelvic organ prolapse (POP). METHODS We carried out a prospective cohort study including 11,114 female nurses > 44 years from the Danish Nurse Cohort. In 1993, the study population was recruited through the Danish Nurse Organization and self-reported data on age, height, weight, age at menarche, age at first birth and number of childbirths were obtained. POP diagnosis was obtained from the National Patient Registry. Risk of POP was estimated using COX regression and presented as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Overall, 10% of the women received a diagnosis of POP within a median follow-up of 22 years. A 4% increase in risk of POP was seen for each increasing BMI (kg/m2) unit at baseline. Compared to women of normal weight, higher risks of POP were seen in overweight (HR 1.18: 1.02-1.36) and obese women (HR 1.33: 1.02-1.74), while underweight had a lower risk (HR 0.51: 0.27-0.95). Compared to women with one childbirth, women with no childbirths had a reduced risk of 57% while increased risks of 46%, 78% and 137% were observed in women with two, three and four childbirths. Women with menarche before the age of 12 tended to have a higher risk of POP as did women who were 30-33 years at their first childbirth. CONCLUSIONS POP is a common health problem in women, and BMI and number of childbirths are strong predictors.
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Affiliation(s)
- Anne-Line Brülle
- Occupational and Environmental Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Chunsen Wu
- Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark
| | - Vibeke Rasch
- Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark
| | - Mette Kildevæld Simonsen
- Department of Neurology and Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ine Schmidt Schøyen
- Department of Gynaecology and Obstetrics, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Carina Dahl
- Department of Paediatrics, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Ellen Aagaard Nohr
- Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark
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Chill HH, Shusel O, Dick A, Moss NP, Cohen A, Reuveni-Salzman A, Shveiky D. The Effect of Age on Surgical Outcomes Following Uterine Preserving Surgery for Treatment of Apical Prolapse. J Minim Invasive Gynecol 2022; 29:1303-1309. [PMID: 35995324 DOI: 10.1016/j.jmig.2022.08.005] [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: 03/31/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the effect of age on outcomes after uterine-preserving surgical treatment for apical prolapse. DESIGN Retrospective cohort study. SETTING Female pelvic medicine and reconstructive surgery unit at a tertiary, university-affiliated teaching medical center. PATIENTS Women who underwent surgical management of apical prolapse with uterine preservation between 2010 and 2020. Excluded were women who had ≤1 month of follow-up and those for whom medical records were substantially incomplete. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Included in the study were 140 women who underwent apical prolapse repair with uterine preservation and who met the inclusion criteria. The cohort was divided into 2 groups: (1) women aged 65 years and older (≥65 group) and (2) women younger than 65 years of age (<65 group). Pre-, intra-, and postoperative data were compared between the groups. A total of 103 women (73.6%) were in the <65 group and 37 women (26.4%) in the ≥65 group. Mean age for the entire cohort was 58 ± 9.8 years, body mass index 25.9 ± 4.8 kg/m2, and duration of follow-up was 25.9 ± 21.0 months. Women in the ≥65 group had more comorbidities, were less sexually active, and were less likely to have a midurethral sling performed during their surgery. Clinical and anatomical success rates were somewhat higher in the ≥65 group; however, these differences did not reach statistical significance (97.3% vs 85.4%, p = .069 and 89.2% vs 81.2%, p = .264, respectively). Composite outcome success was higher in the ≥65 group (89.2% vs 72.5%, p = .039). Patient satisfaction recorded using the Patient Global Impression of Improvement questionnaire was high for both groups. A multivariable logistic regression analysis for the dependent parameter of composite outcome success was performed, during which none of the parameters investigated reached statistical significance. Subgroup analysis was performed including only women who were postmenopausal. This was done to address the possible confounding effect that menopausal status may have had on our results. No differences were found between the groups with regard to clinical, anatomical, and composite outcomes. CONCLUSION Uterine-preserving surgery is a safe and effective surgical treatment for women aged ≥65 years.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem (Drs. Chill and Moss), Skokie, Illinois.
| | - Ofek Shusel
- Hebrew University Medical School (Mr. Shusel), Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel
| | - Nani P Moss
- Division of Urogynecology, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem (Drs. Chill and Moss), Skokie, Illinois
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Reuveni-Salzman and Shveiky), Ein Kerem, Jerusalem, Israel
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Dick, Cohen, Reuveni-Salzman, and Shveiky), Ein Kerem, Jerusalem, Israel; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hadassah - Hebrew University Medical Center (Drs. Reuveni-Salzman and Shveiky), Ein Kerem, Jerusalem, Israel
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Moss NP, Chill HH, Chang C, Goldberg RP. Same-day Discharge vs Planned Admission after Surgical Treatment for Apical Prolapse. J Minim Invasive Gynecol 2022; 29:1323-30. [PMID: 36130703 DOI: 10.1016/j.jmig.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/14/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE Same-day discharge (SDD) after surgery is becoming more common, with studies supporting the safety of this practice in gynecologic surgeries. The aim of this study was to compare short-term outcomes of SDD with planned admission in patients undergoing apical pelvic organ prolapse repair, through 30-day complications and 30-day unanticipated healthcare encounters. SETTING Female pelvic medicine and reconstructive surgery practice at a university-affiliated tertiary medical center. PATIENTS Patients with apical prolapse who underwent surgical treatment during the study period were eligible for inclusion. Excluded were patients under the age of 18, cases planned for SDD with an unexpected admission, cases with a planned open procedure, and those performed in combination with another surgical service. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 296 patients were included in the final analysis. A total of 154 patients had a planned admission, and 142 were discharged on the day of surgery (SDD group). There were no differences in reoperations, development of venous thromboembolism, and blood transfusions between the 2 groups. Patients in the SDD group were more likely to have no postoperative complications (95% vs 88.3%, p = .037). Number of unanticipated urogynecology office visits, urgent/immediate care visits, readmissions, or unplanned phone calls were also similar between the 2 groups. There was a statistically significant difference observed in mean emergency department (ED) visits (0.16 ± 0.40 in the planned admission group vs 0.06 ± 0.27 in the SDD group, p = .02); however, this number was low in both groups. CONCLUSION This comparative study suggests that SDD after apical prolapse repair is safe and may be considered for patients interested in this option.
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Wu C, Zhou Z, Yang Y, Li H, Guo Y, Tong X. Bioinformatically deciphering immune cell infiltration and signature genes in pelvic organ prolapse. Int Urogynecol J 2022. [PMID: 36208338 DOI: 10.1007/s00192-022-05378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 10/10/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The study is aimed at bioinformatically deciphering immune cell infiltration, signature genes, and their correlations in POP. METHODS Three microarray datasets were included. Matrixes representing the uterosacral ligament were merged as a test matrix and the others representing vaginal tissues were merged as a validation matrix. The single-sample Gene Set Enrichment Analysis (ssGSEA) algorithm was performed to evaluate immune cell infiltration. Correlations among differential immune cells were revealed by Spearman's rank correlation. Differentially expressed genes (DEGs) were screened by both "Batch correction" and "RobustRankAggreg" methods. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes were conducted for functional analysis. Hub genes were identified through cytoHubba of Cytoscape, and further validated by a validation matrix and clinical samples as signature genes. Correlations of differential immune cells with signature genes were analyzed by Spearman's rank correlation. RESULTS Five differential immune cells (macrophages, monocytes, regulatory T cell [Treg], type 1 T cell [Th1], and natural killer T cells [NKT]) were identified and eight pairs of immune cells had significant correlations. Screened 230 DEGs were extracellular matrix (ECM) and immune related. Eleven hub genes were initially identified and five of them (LOX, IL-6, SDC1, ICAM1, and CD38) were validated as signature genes. Significant correlations of differential immune cells with signature genes were shown in twelve pairs, especially Th1-IL6, NKT-IL6, Th1-ICAM1, macrophage-IL6, and macrophage-LOX pairs. CONCLUSIONS Pelvic organ prolapse could be considered immune related. Significantly infiltrated immune cells may contribute to the development of POP through close involvement with ECM- and immune-related signature genes.
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Sori DA, Bretones S, Mellier G, de Rochambeau B. Prevalence and surgical outcomes of stage 3 and 4 pelvic organs prolapse in Jimma university medical center, south west Ethiopia. BMC Womens Health 2022; 22:410. [PMID: 36207709 PMCID: PMC9540999 DOI: 10.1186/s12905-022-01992-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background Pelvic organ prolapse (POP) affects about half of the women and affects their quality of life. The current study is, therefore, aimed at determining the prevalence and surgical outcomes of severe stage POP at Jimma University medical center from November 2016 to May 2018.
Method A Hospital-based cross-sectional study was conducted on all patients with stage 3 and 4 POP, who were admitted, and had surgery. Data were collected from the patient’s chart, and logbooks, which were filled up from entry till her discharge. A Simplified POPQ(S-POPQ) was used to stage the prolapse at admission, at discharge, and three months follow-ups.
Results Among 92 patients who were analyzed, POP accounts for 10.6% of all gynecologic admissions, and 43.8% of all gynecologic surgeries. The mean age of patients is 46 (± 12) years, and nearly 34% of the patients had stage 3 and 66% had stage 4 POP. Based on the type of prolapse, 93.5% of patients had stage 3 and more anterior vaginal wall prolapse (AVWP) and apical prolapse, while 57.6% had stage 3 or more posterior vaginal wall prolapse. Out of 72 patients who had anterior colporrhaphy, 58.7% had anterior colporrhaphy with colposuspension. Out of 83 patients who had apical suspension, 48.2%, 39.8%, and 12% had uterosacral, sacrospinous, and Richardson respectively. Ninety-seven patients had stage 0 or 1 POP at discharge while 90% of 20 patients who returned for follow-up at three months had stage 0 or 1 POP. Eight patients had surgery-related complications; bladder injury, urinary retention, Hemorrhage during SSLF, and rectal injury. Conclusion The prevalence of pelvic organ prolapse is high and the majority of patients presented with advanced-stage pelvic organ prolapse, with a long duration of symptoms and associated problems. The surgical techniques used have resulted in a high immediate success rate of 97% and 90% at discharge and three months follow up respectively. Therefore, awareness creation activities are important to facilitate an early presentation for treatment to improve the quality of life and the current surgical technique; native tissue vaginal repair (NTVR), being practiced in the setup has had better success.
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Affiliation(s)
- Demisew Amenu Sori
- grid.411903.e0000 0001 2034 9160Jimma University Institute of Health, Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia
| | - Stephan Bretones
- Urogynecology and Reconstructive Pelvic Surgeon, Saint Joseph-Saint Luc Hospital, Lyon, France
| | - Georges Mellier
- grid.7849.20000 0001 2150 7757Department of Obstetrics and Gynecology, Lyon 1 University, Villeurbanne, France
| | - Bertrand de Rochambeau
- Urogynecology and Reconstructive Pelvic Surgeon, Saint Joseph-Saint Luc Hospital, Lyon, France
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Hustak K, Kumbla PA, Liu S. Anatomical Changes of the Vulva Due to Childbirth and Aging. Clin Plast Surg 2022; 49:429-433. [PMID: 36162937 DOI: 10.1016/j.cps.2022.06.005] [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] [Indexed: 11/25/2022]
Abstract
The female reproductive system consists of several structures. These organs are constantly undergoing changes throughout the lifetime of a woman. Most of these occur due to changes in estrogen and progesterone levels at key transitions in life such as puberty, pregnancy, and menopause. Laxity and atrophy occur during pregnancy and menopause, respectively, can cause significant symptomology for women. Although some women do have return to normal anatomy following pregnancy, many do not and develop pelvic organ prolapse that worsens over their lifetime. Symptoms are often underreported, but for those who do have symptoms, surgical intervention may be warranted.
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Affiliation(s)
- Kristi Hustak
- Aesthetic Center for Plastic Surgery, 12727 Kimberley Lane, Suite 300, Houston, TX 77024, USA.
| | - Pallavi Archana Kumbla
- Aesthetic Center for Plastic Surgery, 12727 Kimberley Lane, Suite 300, Houston, TX 77024, USA
| | - Sofia Liu
- 4110 Turtle Trails Lane, Sugarland, TX 77479, USA
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234
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Wang X, He D, Feng F, Ashton-Miller JA, DeLancey JOL, Luo J. Multi-label classification of pelvic organ prolapse using stress magnetic resonance imaging with deep learning. Int Urogynecol J 2022; 33:2869-2877. [PMID: 35083500 PMCID: PMC9325920 DOI: 10.1007/s00192-021-05064-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to develop a deep learning-based multi-label classification model to simultaneously diagnose three types of pelvic organ prolapse using stress magnetic resonance imaging (MRI). METHODS Our dataset consisted of 213 midsagittal labeled MR images at maximum Valsalva. For each MR image, the two endpoints of the sacrococcygeal inferior-pubic point line were auto-localized. Based on this line, a region of interest was automatically selected as input to a modified deep learning model, ResNet-50, for diagnosis. An unlabeled MRI dataset, a public dataset, and a synthetic dataset were used along with the labeled image dataset to train the model through a novel training strategy. We conducted a fivefold cross-validation and evaluated the classification results using precision, recall, F1 score, and area under the curve (AUC). RESULTS The average precision, recall, F1 score, and AUC of our proposed multi-label classification model for the three types of prolapse were 0.84, 0.72, 0.77, and 0.91 respectively, which were improved from 0.64, 0.53, 0.57, and 0.83 from the original ResNet-50. Classification took 0.18 s to diagnose one patient. CONCLUSIONS The proposed deep learning-based model were demonstrated feasible and fast in simultaneously diagnosing three types of prolapse based on pelvic floor stress MRI, which could facilitate computer-aided prolapse diagnosis and treatment planning.
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Affiliation(s)
- Xinyi Wang
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Da He
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Fei Feng
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jiajia Luo
- Biomedical Engineering Department, Peking University, Beijing, 100191, China.
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Bø K, Anglès-Acedo S, Batra A, Brækken IH, Chan YL, Jorge CH, Kruger J, Yadav M, Dumoulin C. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J 2022; 33:2633-2667. [PMID: 35980443 PMCID: PMC9477909 DOI: 10.1007/s00192-022-05324-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. METHODS An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0-10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0-10). RESULTS After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. CONCLUSIONS There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, The Norwegian School of Sport Sciences, PO Box 4014, Ullevål stadion, 0806, Oslo, Norway.
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
| | | | - Achla Batra
- Department of Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Ingeborg Hoff Brækken
- Kolbotn Physical Institute, Nordre Follo Municipality, Nordre Follo, Norway
- The Pelvic Floor Centre, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Yi Ling Chan
- Department of Obstetrics and Gynaecology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Cristine Homsi Jorge
- Department of Health Science Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Manisha Yadav
- Paropakar Maternity and women's hospital, Thapathali, Kathmandu, Nepal
| | - Chantale Dumoulin
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Sato H, Otsuka S, Abe H, Tsukada S. Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan. J OBSTET GYNAECOL 2022; 42:3336-3341. [PMID: 36149283 DOI: 10.1080/01443615.2022.2125293] [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] [Indexed: 01/06/2023]
Abstract
This study was performed to investigate medium-term outcomes and reoperation rates after laparoscopic sacrocolpopexy (LSC). We examined 119 patients undergoing LSC for symptomatic pelvic organ prolapse (POP). The primary outcomes were subjective failure and anatomical failure at 2 years; a score ≥ 2 on question 3 of the PFDI-20 was considered to indicate subjective failure. POP-Q stage 2 or higher in any compartment was considered to indicate anatomical failure. Secondary outcomes were reoperations for POP recurrence, mesh-related complications, and stress urinary incontinence (SUI). The rates of subjective failure and anatomical failure were 4.2% (n = 5) and 9.2% (n = 11), respectively. Reoperations were needed in 13.4% (n = 16) of patients, including SUI with tape procedure in 7.5% (n = 9), POP recurrence in 4.2% (n = 5), and mesh-related complications in 1.6% (n = 2). The subjective failure rate at 2 years after LSC was acceptably low.Impact StatementWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) has clinical efficacy equivalent to open sacrocolpopexy, and there is evidence that LSC involves less blood loss and shorter length of hospital stay. However, there is still insufficient evidence to assess medium-term outcomes after LSC in Japan.What the results of this study revealed? The findings of this study showed excellent medium-term rates of subjective failure (4.2%) and anatomical failure (8.4%) after LSC. We demonstrated that patients with persistent postoperative vaginal bulge (subjective failure) also had no improvement in postoperative urinary and colorectal symptoms. Our cohort had low rates of reoperation (13.4%) after LSC. The most common reoperations were for stress urinary incontinence (SUI) (7.5%), followed by pelvic organ prolapse (POP) recurrence (4.2%) and mesh-related complications (1.6%).What are the implications of these findings in clinical practice and/or further research? This study showed that LSC is a safe and effective treatment for POP. Comparative evaluation of anatomical outcomes and the patient's condition is required to understand the extent to which LSC positively impacts a woman's pelvic floor-related quality of life.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Shota Otsuka
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Morsinkhof LM, Schulten MK, DeLancey JOL, Simonis FFJ, Grob ATM. Pelvic inclination correction system for magnetic resonance imaging analysis of pelvic organ prolapse in upright position. Int Urogynecol J 2022; 33:2801-2807. [PMID: 35907021 PMCID: PMC9477951 DOI: 10.1007/s00192-022-05289-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse quantification by means of upright magnetic resonance imaging (MRI) is a promising research field. This study determines the angle for the pelvic inclination correction system (PICS) for upright patient position, which is hypothesized to deviate from the supine PICS angle. The necessity of different PICS angles for various patient positions will also be discussed. METHODS Magnetic resonance scans of 113 women, acquired in an upright patient position, were used to determine the upright PICS angle, defined as the angle between the sacrococcygeal-inferior pubic point (SCIPP) line and the horizontal line. The difference and correlation between the upright and supine PICS angles were calculated using the paired Student's t-test and the Pearson's correlation coefficient (r) respectively. The effect of the difference between the upright and supine PICS angle on the measured pelvic organ extent was calculated using goniometry. RESULTS The mean (interquartile range) PICS angles were 29° (26-35°) for the upright and 33° (30-37°) for the supine patient position. They were significantly different (p<0.001) and very strongly correlated (r = 0.914, p<0.001). The 4° difference between the average upright and supine PICS angle results in an average underestimation of the measured cervix height of approximately 0.5 cm for patients scanned in upright position. CONCLUSIONS The PICS angle for the upright patient position is 29°. The use of a dedicated PICS angle for different patient positions allows for more accurate pelvic organ extent analysis in patients with prolapse.
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Affiliation(s)
- Lisan M Morsinkhof
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
| | - Martine K Schulten
- Multi Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Frank F J Simonis
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Anique T M Grob
- Multi Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Todd J, Aspell JE, Lee MC, Thiruchelvam N. How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools. BMC Womens Health 2022; 22:396. [PMID: 36180841 PMCID: PMC9523957 DOI: 10.1186/s12905-022-01977-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/15/2021] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. METHODS First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. RESULTS Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. CONCLUSIONS We recommend further qualitative research regarding women's experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.
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Affiliation(s)
- Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, Cambridgeshire, CB1 1PT, UK.
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia.
| | - Jane E Aspell
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, Cambridgeshire, CB1 1PT, UK
| | - Michael C Lee
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ali A, Yadeta E, Eyeberu A, Abdisa L, Bekana M, Dheresa M. Pelvic organ prolapse and associated factors among women admitted to gynecology ward at the Hiwot Fana Comprehensive Specialized Hospital, Harar, eastern Ethiopia. SAGE Open Med 2022; 10:20503121221126363. [PMID: 36172569 PMCID: PMC9511300 DOI: 10.1177/20503121221126363] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The major aim of this study was to assess the magnitude of pelvic organ prolapse and its associated factors among patients admitted to the gynecology ward at Hiwot Fana Specialized University Hospital, eastern Ethiopia. Methods A retrospective review of records was undertaken at Hiwot Fana Specialized University Hospital. We used a simple random sampling technique to pick 387 gynecology ward-admitted patient records from 30 December 2020 to 10 January 2021. Data were extracted from maternal medical charts using a pretested checklist. The extracted data were entered into EpiData version 3.1 and then exported into SPSS version 25 for analysis. Binary logistic regression was carried out to observe a significant correlation between independent and pelvic organ prolapse. An adjusted odds ratio and 95% confidence interval was used to report the result. A p-value of less than 0.05 was used to declare statistical significance. Results Among 387 responded women, 39 (10.1%; 95% confidence interval = 8.3-15.6) of them had at least one stage of pelvic organ prolapse. Multiparty (adjusted odds ratio = 1.88, 95% confidence interval = 1.41-10.60), grand multiparty (adjusted odds ratio = 2.63, 95% confidence interval = 1.53-12.90), older maternal age (adjusted odds ratio = 2.29, 95% confidence interval = 1.220-7.52), lifting a heavy object (adjusted odds ratio = 4.61, 95% confidence interval = 2.31-15.83), and having chronic cough (adjusted odds ratio = 2.39, 95% confidence interval = 1.10-5.19) were significantly associated with pelvic organ prolapse. Conclusion Among women admitted to the hospital because of gynecological morbidity, one in ten of them had pelvic organ prolapse. Multiparty, advanced maternal age, having a chronic cough, and lifting heavy objects were identified to be risk factors for pelvic organ prolapse. Tailored primary prevention would enhance the well-being of reproductive-age women.
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Affiliation(s)
- Abdek Ali
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Elias Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemesa Abdisa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Miressa Bekana
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Yu X, Chen Y, He L, Liu H, Yang Z, Lin Y. Transcriptome and metabolome analyses reveal the interweaving of immune response and metabolic regulation in pelvic organ prolapse. Int Urogynecol J 2022:10.1007/s00192-022-05357-5. [PMID: 36136109 DOI: 10.1007/s00192-022-05357-5] [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: 06/27/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The pathogenesis of pelvic organ prolapse (POP) remains unknown. Herein, we aim to reveal the molecular profile of POP by transcriptomic and metabolomic analysis. METHODS We selected 12 samples of uterosacral ligaments (USLs) from 6 POP patients and 6 controls for transcriptomic and metabolomic analyses. Differentially expressed genes (DEGs) were identified using the R package edgeR. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using clusterProfiler, and a protein-protein interaction (PPI) network was constructed using STRING and visualized in Cytoscape. Metabolomic profiling was performed by a liquid chromatography-tandem mass spectrometry system. RESULTS Transcriptomic analysis identified 487 DEGs between the POP and control groups. Functional enrichment analysis revealed that they were mostly related to immune response terms, including "adaptive immune response," "T cell differentiation," and "T cell activation." In addition, PTPRC, LCK, CD247, IL2RB, CD2, CXR5, JUN, CD3E, IL2RG, and PRF1 were the 10 nodes with the highest node degrees in the PPI network. Metabolomic profiling revealed 290 differentially expressed metabolites, which significantly enriched in "glycerophospholipid metabolism," "nicotinate and nicotinamide metabolism," "glycine, serine, and threonine metabolism," "arginine and proline metabolism," "pyrimidine metabolism," and "purine metabolism." Finally, integrated analysis revealed that the DEGs involved in these significantly enriched metabolic pathways included NT5C1A, GMPR, SDS, ALAS2, CARNS1, PYCR1, P4HA3, PGS1, and NMRK2. CONCLUSIONS Our findings demonstrate that the immune response and metabolic regulatory pathways are intertwined in POP and might provide new therapeutic targets.
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Affiliation(s)
- Xia Yu
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Ri Yue Street, Chengdu, 610091, Sichuan, China
| | - Li He
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Ri Yue Street, Chengdu, 610091, Sichuan, China
| | - Hong Liu
- Department of Surgical, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhenglin Yang
- Sichuan Provincial Key Laboratory for Human Disease Gene Study and Institute of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32 The First Ring Road West 2, Chengdu, 610071, Sichuan, China.
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Ri Yue Street, Chengdu, 610091, Sichuan, China.
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Chill HH, Moss NP, Chang C, Winer J, Goldberg RP. Risk factors for unplanned admission following surgical repair of apical prolapse. Int Urogynecol J 2022:10.1007/s00192-022-05358-4. [PMID: 36121459 PMCID: PMC9483888 DOI: 10.1007/s00192-022-05358-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Introduction and hypothesis Same-day discharge (SDD) is increasing in popularity following surgical repair of pelvic organ prolapse. The aim of this study was to evaluate factors associated with unplanned admission (UA) in women undergoing apical prolapse repair. Methods This retrospective, observational cohort study included patients who underwent apical prolapse repair and planned same-day discharge (SDD) between March 2019 and December 2021. The cohort was divided into two groups: patients who were discharged on the same day as surgery (SDD group) and patients who had an unplanned admission (UA group). Demographic, pre-, intra-, and post-operative data were collected. Risk factors associated with unplanned admission were evaluated using univariate and multivariate analyses. Results One-hundred and eighty-four cases of apical prolapse repair met the criteria for inclusion in the final analysis; this included 142 in the SDD group and 42 in the UA group. Patients in the UA group had significantly increased estimated blood loss, longer total operative time, later time arriving to the Post-Anesthesia Care unit (PACU) and longer overall stay in the PACU. No differences were observed in the 30-day complication rate, or 30-day unanticipated healthcare encounters, between groups. Multivariate analysis revealed that receiving ketorolac post-operatively was associated with a higher likelihood of SDD (OR=2.6, 95% CI 1.032–6.580, p=0.043). Conclusions Among women undergoing apical prolapse repair, same-day discharge was associated with comparable immediate and 30-day complication rates. Within our cohort, post-operative treatment with ketorolac was associated with greater likelihood of SDD.
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Affiliation(s)
- Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Nani P Moss
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Cecilia Chang
- NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Joel Winer
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Roger P Goldberg
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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Bretschneider CE, Scales CD, Osazuwa-Peters O, Sheyn D, Sung V. Adverse outcomes after minimally invasive surgery for pelvic organ prolapse in women 65 years and older in the United States. Int Urogynecol J 2022; 33:2409-2418. [PMID: 35662357 PMCID: PMC9724747 DOI: 10.1007/s00192-022-05238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To describe complications at the time of surgery, 90-day readmission and 1-year reoperation rates after minimally invasive pelvic organ prolapse (POP) in women > 65 years of age in the US using Medicare 5% Limited Data Set (LDS) Files. METHODS Medicare is a federally funded insurance program in the US for individuals 65 and older. Currently, 98% of individuals over the age of 65 in the US are covered by Medicare. We identified women undergoing minimally invasive POP surgery, defined as laparoscopic or vaginal surgery, in the inpatient and outpatient settings from 2011-2017. Patient and surgical characteristics as well as adverse events were abstracted. We used logistic regression for complications at index surgery and Cox proportional hazards regression models for time to readmission and time to reoperations. RESULTS A total of 11,779 women met inclusion criteria. The mean age was 72 (SD ± 8) years; the majority were White (91%). Most procedures were vaginal (76%) and did not include hysterectomy (68%). The rate of complications was 12%; vaginal hysterectomy (aOR 2.4, 95% CI 2.2-2.7) was the factor most strongly associated with increased odds of complications. The 90-day readmission rate was 7.3%. The most common reason for readmission was infection (2.0%), three quarters of which were urinary tract infections. Medicaid eligibility (aHR 1.5, 95% CI 1.3-1.8) and concurrent sling procedures (aHR 1.2, 95% CI 1.04-1.4) were associated with a higher risk of 90-day readmission. The 1-year reoperation rate was 4.5%. The most common type of reoperation was a sling procedure (1.8%). Obliterative POP surgery (aHR 0.6, 95% CI 0.4-0.9) was associated with a lower risk of reoperation than other types of surgery. CONCLUSIONS US women 65 years and older who are also eligible to receive Medicaid are at higher risk of 90-day readmission following minimally invasive surgery for POP with the most common reason for readmission being UTI.
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Affiliation(s)
- C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Charles D Scales
- Departments of Surgery (Urology) and Population Health Science, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Oyomoare Osazuwa-Peters
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, OH, USA
| | - Vivian Sung
- Department Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, RI, USA
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Gabra MG, Tessier KM, Fok CS, Nakib N, Oestreich MC, Fischer J. Pelvic organ prolapse and anal incontinence in women: screening with a validated epidemiology survey. Arch Gynecol Obstet 2022; 306:779-784. [PMID: 35305141 PMCID: PMC10069445 DOI: 10.1007/s00404-022-06510-7] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 03/04/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE The primary objective of this study was to determine the prevalence of pelvic organ prolapse (POP) and anal incontinence (AI) in a Minnesota population using the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ). The secondary objective of this study was to determine the association of POP and AI with parity, age, smoking status, body mass index (BMI), and co-morbidities. METHODS Women ≥ 18 years old attending the 2018 Minnesota State Fair were asked to fill out a web-based version of the EPIQ. Multivariable logistic regression models were used to investigate the association of POP and AI with the variables of interest. RESULTS A total of 1426 women were included in the analysis. There was a 4.9% prevalence of POP and 14.9% prevalence of AI. POP was significantly associated with parity and higher BMI (p < 0.01 and p = 0.02, respectively). In this cohort, POP was not associated with older age, smoking, or presence of co-morbid conditions. Anal incontinence was associated with older age (p < 0.01), smoking status (p = 0.01), and presence of co-morbid conditions (p = 0.01) but was not associated with parity or higher BMI. CONCLUSION POP and AI were associated with some, but not all, of the variables tested, which differs from prior studies. In addition, the prevalence of POP and AI were different than rates reported in similar studies. This may suggest regional differences in prevalence of POP and AI.
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Affiliation(s)
- Martina G Gabra
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota Medical Center, Minneapolis, MN, USA.
| | - Katelyn M Tessier
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Nissrine Nakib
- Department of Urology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - John Fischer
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota Medical Center, Minneapolis, MN, USA
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Laurence J, Nghiem MA, Fernandez H, Luton D, Pelhuche A, Florin M, Deffieux X, Capmas P. Concomitant vesicovaginal fistula and rectovaginal fistula in a patient with a neglected pessary placed for pelvic organ prolapse. Prog Urol 2022; 32:1543-1545. [PMID: 36041957 DOI: 10.1016/j.purol.2022.08.012] [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: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Pelvic organ prolapse is a very frequent affection especially in elderly women. Vaginal pessary is a common conservative treatment and recommended as first line therapy. Guidelines recommend to do a regular follow up every 6 to 12 months with a healthcare professional. We report the case of a patient with neglected vaginal pessary who had a vesicovaginal and a concomitant rectovaginal fistula. CASE REPORT A 84-year-old woman was admitted for chronic pelvic pain and vaginal discharge. An entrapped cube pessary was removed and the diagnostic of a 3cm rectovaginal fistula with a vesicovaginal fistula was made. The patient had a two-stage surgery, vaginal way then open abdominal way, for closing the fistulas. CONCLUSION Although vaginal pessary is a good conservative treatment for POP, it shall not be neglected or serious complications can be caused.
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Affiliation(s)
- Julie Laurence
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France.
| | - My-Anh Nghiem
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France
| | - Herve Fernandez
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France; Inserm, Centre of research in Epidemiology and population health (CESP), U1018, 94276 Villejuif, France; Faculty of medicine, université Paris Sud, 94276 Le Kremlin Bicetre, France
| | - Dominique Luton
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France
| | - Antoine Pelhuche
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France; Department of Urology, hôpital de Bicêtre, université Paris-Sud, Paris, France
| | - Marie Florin
- Université de Paris, AP-HP, hôpital Européen Georges Pompidou, Radiology Department, 20, rue Leblanc, 75015 Paris, France
| | - Xavier Deffieux
- AP-HP, GHU Sud, Antoine Béclere Hospital, Department of Obstetrics and Gynaecology, 92140 Clamart, France
| | - Perrine Capmas
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France; Inserm, Centre of research in Epidemiology and population health (CESP), U1018, 94276 Villejuif, France; Faculty of medicine, université Paris Sud, 94276 Le Kremlin Bicetre, France
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Hüsch T, Ober S, Haferkamp A, Naumann G, Tunn R, Saar M, Kranz J. Comparison of online health information between different digital platforms for pelvic organ prolapse. World J Urol 2022; 40:2529-2534. [PMID: 36006445 PMCID: PMC9512708 DOI: 10.1007/s00345-022-04129-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify differences in the content and quality of online health information for pelvic organ prolapse (POP) presented in social media and digital search engines to sustainably enhance patient guidance for adequate platforms for seeking online health information on POP. Methods The platforms Google search, Facebook, Instagram, LinkedIn, and YouTube were searched for the keyword “pelvic organ prolapse”. Results were categorized as useful, misleading, advertising, and personal experience. Data were categorized into healthcare professionals, professional organisations, industry, patients, and individuals. The readability score and Health On the Net (HON) code seal were analyzed for Google. Descriptive and univariate analysis was performed. Results The source with the highest quantity of useful content was YouTube whereas LinkedIn included mostly advertisement and misleading content. YouTube and Google provided the greatest variety of health information. Social media platforms identified emotional distress and sleep disturbances as a common side effect of POP which is limited considered in clinical practice and provide novel insights of bothersome symptoms related to the disease. The spectrum of different surgical techniques was limited in all platforms. Only 12 (40.0%) were HON-qualified websites with a mean readability score of 10.4 which is considered fairly difficult to read. Conclusion Besides Google search, YouTube was identified as a valuable online source for POP information. However, encompassing information of surgical techniques was limited in all platforms. Urogynecological association may contribute to improve patient information by providing online health information which is complete and easy to understand. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04129-6.
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Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Sita Ober
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.,Department of Obstetrics and Gynecology, Hospital Darmstadt, Darmstadt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Gert Naumann
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Erfurt, Germany
| | - Ralf Tunn
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
| | - Matthias Saar
- Department of Urology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jennifer Kranz
- Department of Urology, University Hospital RWTH Aachen, Aachen, Germany.,Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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Wu PC, Hsiao SM, Chang TC, Chen CH, Lin HH. Clinical outcome and urodynamic changes of tailored transvaginal mesh surgery for pelvic organ prolapse: A mid-term 40 Months follow-up. J Formos Med Assoc 2022; 121:2424-2429. [PMID: 35987746 DOI: 10.1016/j.jfma.2022.07.011] [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: 03/09/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the changes in clinical outcome and urodynamic parameters after tailored anterior transvaginal mesh (ATVM) surgeries in a mid-term follow-up. METHODS Between November 2011 and December 2015, women with ≥stage II pelvic organ prolapse (POP) who underwent ATVM surgeries were retrospectively reviewed. The data-reviewing timeframe was until December 2021. Clinical and urodynamic diagnoses regarding urinary symptoms were evaluated before and after the operation. RESULTS A total of 160 women were included. Stress urinary incontinence decreased significantly after the operation (99% (159/160) vs. 43% (68/160), p < 0.01), as well as the pad weight (20.5 ± 2.7 vs. 9.4 ± 2.0, p < 0.001) and diagnosis of urodynamic stress incontinence (83% (132/160) vs. 51% (82/160), p < 0.01). Overactive bladder syndrome increased significantly after the operation (18% (29/160) vs. 28% (45/160), p = 0.03), even though the objective parameters, such as first and strong desire to void, bladder oversensitivity, and detrusor overactivity, were all improved after the operation. The pad weight was mostly improved significantly within the first postoperative 2 years. Eighteen (11%) women had global recurrent POP, and only one (0.6%) woman had true recurrence of cystocele. Twenty-four (15%) women had mesh extrusion, and two-thirds of them could be managed in an office setting. CONCLUSIONS In women with advanced cystocele, the ATVM surgery provides a favorable anatomic reduction outcome with an acceptable mesh extrusion rate. The ATVM provides an anti-incontinence effect, both in subjective symptoms and objective parameters, but this effect might decline after postoperative 2 years.
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Affiliation(s)
- Pei-Chi Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Ting-Chen Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Hau Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
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Campagna G, Panico G, Lombisani A, Vacca L, Caramazza D, Scambia G, Ercoli A. Laparoscopic uterosacral ligament suspension: a comprehensive, systematic literature review. Eur J Obstet Gynecol Reprod Biol 2022; 277:57-70. [PMID: 36007356 DOI: 10.1016/j.ejogrb.2022.08.006] [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: 06/10/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Laparoscopic uterosacral ligament suspension (LUSLS) of the vaginal apex for the treatment of pelvic organ prolapse (POP) has gained popularity. The aim of this systematic review is to investigate perioperative outcomes and complications, subjective and objective success rates and recurrence rates in women undergoing this surgical procedure. STUDY DESIGN A systematic literature search was performed in December 2021. The critical appraisal skills program (CASP) was used to assess the methodological quality of the selected studies. The Clavien-Dindo (CD) scale and the Satava scale were used to classify periprocedural complications. Continuous variables were described as means and standard deviations while categorical were expressed as percentages of the whole group. Statistical significance was set at p < 0.05. RESULTS 26 articles were selected and analysed, with a total population of 1401 patients. Anatomical and subjective success rates after LUSLS ranged from 79% and 100% and from 76.2% to 100% respectively. The re-operation rate varied from 2% to 4.5% in the largest cohorts. The overall complication rate was 13.6%, however grade III CD complications occurred only in 1% of patients. Ureteral complications were described in only 2 cases. CONCLUSIONS LUSLS represent a safe and effective technique for vaginal apex resuspension in women with POP. Further larger prospective randomized studies are required to confirm these data.
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Affiliation(s)
- Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
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McConnell J, Murtagh L, Lim M, Pedofsky L, Kruger J, Budgett D, Jha S. A pilot study to evaluate changes in pelvic floor muscle tone following pelvic organ prolapse surgery using a novel intra-vaginal pressure sensor device. Int Urogynecol J 2022; 34:1043-1047. [PMID: 35939097 PMCID: PMC10167131 DOI: 10.1007/s00192-022-05312-4] [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: 05/09/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor muscle weakness is a common cause of pelvic organ prolapse and urinary incontinence. Surgical repair of prolapse is commonly undertaken; however, the impact on pelvic floor muscle tone is unknown. The aim of this study was to compare the effect of anterior and posterior colporrhaphy on pelvic floor activation. METHODS Patients aged under 70 undergoing primary anterior or posterior colporrhaphy were recruited. Intra-vaginal pressure was measured at rest and during pelvic floor contraction using the Femfit® device (an intra-vaginal pressure sensor device [IVPSD]). Peak pressure and mean pressure over 3 s were measured in millimetres of mercury. The pre- and post-operative measurements were compared. The difference between the means was assessed using Cohen's D test, with significance set at p<0.05 RESULTS: A total of 37 patients completed pre- and post-operative analysis, 25 in the anterior colporrhaphy group and 12 in the posterior colporrhaphy group. Anterior colporrhaphy showed no significant change in pelvic floor tone. Change in peak pressure was -1.71mmHg (-5.75 to 2.33; p=0.16) and change in mean pressure was -0.86 mmHg (-4.38 to 2.66; p=0.31). Posterior colporrhaphy showed a significant increase in peak pelvic floor muscle tone of 7.2 mmHg (0.82 to 13.58; p=0.005) and mean pressure of 4.19 mmHg (-0.09 to 8.47; p=0.016). CONCLUSIONS Posterior colporrhaphy significantly improves pelvic floor muscle tone, whereas anterior colporrhaphy does not. Improved understanding of the impact of pelvic floor surgery may guide future management options for other pelvic floor disorders. Further work is needed to confirm the association of this improvement in pelvic floor disorders.
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Affiliation(s)
- James McConnell
- Department of Urogynaecology, The Jessop Wing, Sheffield Teaching Hospitals, Tree Root Walk, Sheffield, S10 2SF, UK
| | - Lynsey Murtagh
- Department of Urogynaecology, The Jessop Wing, Sheffield Teaching Hospitals, Tree Root Walk, Sheffield, S10 2SF, UK
| | - Molly Lim
- Department of Urogynaecology, The Jessop Wing, Sheffield Teaching Hospitals, Tree Root Walk, Sheffield, S10 2SF, UK
| | - Laura Pedofsky
- Pelvic Floor Research Group, Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jennifer Kruger
- Pelvic Floor Research Group, Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David Budgett
- Pelvic Floor Research Group, Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Swati Jha
- Department of Urogynaecology, The Jessop Wing, Sheffield Teaching Hospitals, Tree Root Walk, Sheffield, S10 2SF, UK.
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Legan M, Barbič M, Osredkar J, Blaganje M. Association of vitamin D deficiency and pelvic organ prolapse in postmenopausal women: a cross-sectional study. Womens Midlife Health 2022; 8:9. [PMID: 35927747 PMCID: PMC9354377 DOI: 10.1186/s40695-022-00078-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vitamin D is vital for skeletal integrity as well as optimal muscle work. High incidence and prevalence of vitamin D deficiency as well as pelvic organ prolapse are found in postmenopausal women, thus raising the question of whether the entities could be related. METHODS We compared 50 postmenopausal women aged 50 to 75 years with pelvic organ prolapse (POP) with 48 women of same age without POP. The clinical assessment of the disorder was performed using the Pelvic Organ Prolapse Quantification system (POP-Q). An anamnestic questionnaire was filled out by the participants on their anthropometric data, life habits, reproductive history, previous and actual diseases. A blood sample was collected for determination of 25-OH-vitamin D as well as calcium and phosphorus concentrations. RESULTS The group with POP and the control group were comparable in body mass index, physical activity, life habits and general health, but differed significantly in parity (being higher in POP) and vitamin D blood level concentrations, being lower in POP patients. A significantly higher prevalence of vitamin D deficiency (25-OH-vitamin D < 50 nmol/l) was found in the POP group compared to controls. Taking into account the confounding variables the logistic regression model confirmed the significant role of vitamin D for POP. CONCLUSIONS Vitamin D deficiency might be an important systemic factor associated to pelvic organ prolapse. The determination of vitamin D levels in postmenopausal women and replenishing its deficiency might also be of importance for the pelvic floor.
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Affiliation(s)
- Mateja Legan
- Division of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Matija Barbič
- Division of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Joško Osredkar
- Institute of Clinical Chemistry and Clinical Biochemistry, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Mija Blaganje
- Division of Gynaecology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
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Jackson LA, Shi H, Acevedo J, Lee S, Annabi N, Word RA, Florian-Rodriguez M. Effect of gelatin methacryloyl hydrogel on healing of the guinea pig vaginal wall with or without mesh augmentation. Int Urogynecol J 2022; 33:2223-2232. [PMID: 34999912 DOI: 10.1007/s00192-021-05031-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aims of this study were to evaluate the effectiveness of gelatin methacryloyl as an adjunct to anterior vaginal wall injury with or without vaginal mesh compared with traditional repair with suture. METHODS Virginal cycling Hartley strain guinea pigs (n = 60) were randomized to undergo surgical injury and repair using either polyglactin 910 suture or gelatin methacryloyl for epithelium re-approximation or anterior colporrhaphy with mesh augmentation using either polyglactin 910 suture or gelatin methacryloyl for mesh fixation and epithelium re-approximation. Noninjured controls (n = 5) were also evaluated. After 4 days, 4 weeks, or 3 months, tissues were analyzed by hematoxylin & eosin in addition to immunolabeling for macrophages, leukocytes, smooth muscle, and fibroblasts. RESULTS Surgical injury repaired with suture was associated with increased inflammation and vessel density compared with gelatin methacryloyl. Vimentin and α-smooth muscle actin expression were increased with gelatin methacryloyl at 4 days (p = 0.0026, p = 0.0272). There were no differences in changes in smooth muscle or overall histomorphology after 3 months between the two closure techniques. Mesh repair with suture was also associated with increased inflammation and vessel density relative to gelatin methacryloyl. Quantification of collagen content by picrosirius red staining revealed increased thick collagen fibers throughout the implanted mesh with gelatin methacryloyl compared with suture at 4 weeks (0.62 ± 0.01 μm2 vs 0.55 ± 0.01, p = 0.018). Even at the long-term time point of 3 months, mesh repair with suture resulted in a profibrotic encapsulation of the mesh fibers, which was minimal with gelatin methacryloyl. Smooth muscle density was suppressed after mesh implantation returning to baseline levels at 3 months regardless of fixation with suture or gelatin methacryloyl. CONCLUSIONS These results suggest that gelatin methacryloyl might be a safe alternative to suture for epithelium re-approximation and anchoring of prolapse meshes to the vagina and may improve chronic inflammation in the vaginal wall associated with mesh complications.
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Affiliation(s)
- Lindsey A Jackson
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA
| | - Haolin Shi
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jesus Acevedo
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sohyung Lee
- Department of Chemical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Nasim Annabi
- Department of Chemical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - R Ann Word
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria Florian-Rodriguez
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA.
- Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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