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Kakinuma T, Kakinuma K, Ueyama K, Shinohara T, Okamoto R, Imai K, Takeshima N, Yanagida K, Ohwada M. Mid-term outcomes of laparoscopic vaginal stump?round (Kakinuma method) and stump?uterosacral (Shull method) ligament fixation for pelvic organ prolapse: a retrospective comparative study. BMC Surg 2024; 24:137. [PMID: 38711094 PMCID: PMC11071197 DOI: 10.1186/s12893-024-02429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) using mesh are popular approaches for treating pelvic organ prolapse (POP). However, it is not uncommon that native tissue repair (NTR) should be presented as an option to patients who are expected to have extensive intraperitoneal adhesion or patients for whom LSC or RSC is difficult owing to various risk factors. Laparoscopic vaginal stump-uterosacral ligament fixation (Shull method) has been introduced as a method for NTR in case of POP. However, effective repair using this surgical procedure may not be possible in severe POPs. To solve the problems of the Shull method, we devised the laparoscopic vaginal stump-round ligament fixation (Kakinuma method) in which the vaginal stump is fixed to the uterine round ligament, a histologically strong tissue positioned anatomically higher than the uterosacral ligament. This study aimed to retrospectively and clinically compare the two methods. METHODS Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed. RESULTS No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.003) in the Kakinuma group. Recurrence was observed in six patients (15.0%) in the Shull group and two patients (5.3%) in the Kakinuma group. Hence, compared with the Shull group, recurrence was significantly less in the Kakinuma group (P = 0.015). No patients experienced perioperative complications in either group. CONCLUSIONS The results suggest that the Kakinuma method can serve as a novel and viable NTR procedure for POP.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Kyouhei Ueyama
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Takumi Shinohara
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Rora Okamoto
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
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Wu X, Zheng X, Yi X, Fan B. Association of the second birth mode of delivery and interval with maternal pelvic floor changes: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:178. [PMID: 38454330 PMCID: PMC10918865 DOI: 10.1186/s12884-024-06366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes. METHODS This prospective cohort study included women who had a first delivery and were in weeks 36-41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver. RESULTS There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001). CONCLUSIONS In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva.
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Affiliation(s)
- Xiaoli Wu
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China.
| | - Xiu Zheng
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China
| | - Xiaohong Yi
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China
| | - Bolin Fan
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China
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Agrawal M, Kumari R, Sharma JB, Nisha N, Manasi D, Bhatla N. Surgical Outcomes and Feasibility of Transvaginal Sacrospinous Ligament Fixation through Anterior Approach for Women with Pelvic Organ Prolapse. J Midlife Health 2023; 14:280-284. [PMID: 38504730 PMCID: PMC10946682 DOI: 10.4103/jmh.jmh_224_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Supporting vaginal vault or apex is a central component of primary therapy and to prevent recurrence of prolapse. This study aims to review the surgical outcomes and feasibility of the anterior approach following both sacrospinous fixation (SSF) and sacrospinous hysteropexy (SSHP) in a single center over a specific period. And also to review its impact on quality of life. Materials and Methods This was a retrospective study that included all women who underwent unilateral SSF or SSHP through anterior approach for pelvic organ prolapse (POP) from May 2021 to May 2023 after institutional ethical approval for the study. The anterior approach was undertaken in 47 patients which were included in final review. A retrospective case note review to assess urinary symptoms was undertaken at baseline and 3 months by urinary distress inventory 6 score. The main outcome measure was recurrence of prolapse, predominant compartment for prolapse, presenting complaints, concomitant surgeries performed, and associated urinary complaints. Results The mean age was 56.17 ± 11.95 years and the average body mass index was 26.12 ± 3.11 kg/m2. Except for 4 cases of SSHP, remaining women were postmenopausal at the time of surgery. Ten women presented with urinary complaints as their chief complaint. On examination, POP Quantification evaluation, 35 cases have Ba as leading point, 10 have Ap as their leading point and in two cases C was the leading point. Conclusion Anterior unilateral sacrospinous ligament fixation is a safe, effective strategy to treat POP and other concomitant surgery can also be well combined with it.
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Affiliation(s)
- Mohini Agrawal
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - J. B. Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - N Nisha
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Deoghare Manasi
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Lanpher NW, Schnittka EM, Haggag A. Transdermal scopolamine and urinary retention following urogynecologic surgery: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:1689-1696. [PMID: 36719449 DOI: 10.1007/s00192-023-05467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Both urogynecologic surgeries and transdermal scopolamine (TDS) patches are independently associated with postoperative urinary retention (POUR). It is unclear if the risk of POUR increases when these interventions are used in combination. This systematic review and meta-analysis aim to synthesize current evidence to optimize clinical management and outcomes for patients undergoing urogynecologic procedures. METHODS This systematic review was conducted in concordance with the PRISMA 2020 guidelines. MEDLINE, ClinicalTrials.gov, and Cochrane Library were searched. Publications were filtered by inclusion and exclusion criteria. Inclusion criteria required: (1) preoperative or perioperative application of TDS, (2) surgery indicated for stress urinary incontinence and/or pelvic organ prolapse, (3) results given for postoperative voiding trials, and (4) were available in English. Exclusion criteria included: (1) oral or parenteral formulations of scopolamine, (2) administration of alternative preoperative antiemetics, and (3) use of combination antiemetic therapy. Quality was assessed using the Joanna Briggs Institute Checklist. Publication bias was evaluated via the ROBINS-I assessment tool, and Egger regression and Begg and Mazumumdar rank correlation tests. A meta-analysis was conducted using Meta-Essentials Excel Workbook. RESULTS Four publications were identified which complied with inclusion and exclusion criteria. Included studies comprised 752 patients (237 experimental group, 515 control group). All were retrospective cohort studies conducted via chart review in America. Meta-analysis revealed a risk ratio (RR) of 2.35 with a confidence interval (CI) of 0.61 to 9.07, indicating a positive association between TDS and POUR, but without statistical significance. CONCLUSIONS Current evidence suggests that TDS application may be associated with increased risk of POUR following urogynecologic procedures. While research on this topic is greatly limited, this systematic review and meta-analysis highlights that alternative antiemetic therapy may be necessary for patients undergoing such interventions in effort to limit the risk of POUR.
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Affiliation(s)
- Nick W Lanpher
- Alabama College of Osteopathic Medicine, Dothan, AL, USA.
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Călinescu BC, Neacșu A, Martiniuc AE, Dumitrescu D, Stănică CD, Roșu GA, Chivu LI, Ioan RG. Surgical Treatments for Women with Stress Urinary Incontinence: A Systematic Review. Life (Basel) 2023; 13:1480. [PMID: 37511855 PMCID: PMC10381666 DOI: 10.3390/life13071480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient.
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Affiliation(s)
- Bogdan Cristian Călinescu
- Department of Obstetrics-Gynecology, INSMC Alessandrescu Russescu, 38-52 Gheorghe Polizu Str., 127715 Bucharest, Romania; (B.C.C.); (R.G.I.)
| | - Adrian Neacșu
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Str., 020021 Bucharest, Romania; (A.N.); (A.E.M.); (C.D.S.)
| | - Ana Elena Martiniuc
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Str., 020021 Bucharest, Romania; (A.N.); (A.E.M.); (C.D.S.)
| | - Dan Dumitrescu
- Department of General Surgery, Emergency University Hospital, University of Medicine and Pharmacy “Carol Davila”, 168 Splaiul Independentei Str., 050098 Bucharest, Romania;
| | - Catalina Diana Stănică
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Str., 020021 Bucharest, Romania; (A.N.); (A.E.M.); (C.D.S.)
| | - George-Alexandru Roșu
- Department of Obstetrics-Gynecology and Neonatology, Saint Pantelimon Emergency Hospital, University of Medicine and Pharmacy “Carol Davila”, 340-342 Pantelimon Str., 021659 Bucharest, Romania;
| | - Laura Ioana Chivu
- Department of Pathophysiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Raluca Gabriela Ioan
- Department of Obstetrics-Gynecology, INSMC Alessandrescu Russescu, 38-52 Gheorghe Polizu Str., 127715 Bucharest, Romania; (B.C.C.); (R.G.I.)
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Kakinuma T, Kaneko A, Kakinuma K, Imai K, Takeshima N, Ohwada M. New native tissue repair for pelvic organ prolapse: Medium-term outcomes of laparoscopic vaginal stump–round ligament fixation. World J Clin Cases 2023; 11:3457-3463. [PMID: 37383910 PMCID: PMC10294204 DOI: 10.12998/wjcc.v11.i15.3457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) is a new and widely used approach; however, ever since the United States Food and Drug Administration warned against the use of surgical mesh, repairs performed using patients’ tissues [i.e. native tissue repair (NTR)] instead of mesh have attracted much attention. At our hospital, laparoscopic sacrocolpopexy (the Shull method) was introduced in 2017. However, patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.
AIM To validate a new NTR treatment for POP, we examined patients undergoing laparoscopic vaginal stump–round ligament fixation (the Kakinuma method).
METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for > 12 mo after surgery. We retrospectively examined surgical outcomes for surgery duration, blood loss, intraoperative complications, and incidence of recurrence. The Kakinuma method involves round ligament suturing and fixation on both sides, effectively lifting the vaginal stump after laparoscopic hysterectomy.
RESULTS The patients’ mean age was 66.5 ± 9.1 (45-82) years, gravidity was 3.1 ± 1.4 (2-7), parity was 2.5 ± 0.6 (2-4) times, and body mass index was 24.5 ± 3.3 (20.9-32.8) kg/m2. According to the POP quantification stage classification, there were 8 patients with stage II, 11 with stage III, and 11 with stage IV. The mean surgery duration was 113.4 ± 22.6 (88-148) min, and the mean blood loss was 26.5 ± 39.7 (10-150) mL. There were no perioperative complications. None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge. No cases of POP recurrence were observed 12 mo after the operation.
CONCLUSION The Kakinuma method, similar to conventional NTR, may be an effective treatment for POP.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
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Galan LE, Bartolo S, De Graer C, Delplanque S, Lallemant M, Cosson M. Comparison of Early Postoperative Outcomes for Vaginal Anterior Sacrospinous Ligament Fixation with or without Transvaginal Mesh Insertion. J Clin Med 2023; 12:jcm12113667. [PMID: 37297862 DOI: 10.3390/jcm12113667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Pelvic organ prolapse affects one in three women, and cystocele accounts for 80% of the indications for surgery. Following the withdrawal of transvaginal mesh from the market, the objective of the present before-and-after study was to compare of the previous reference technique (UpholdTM (Boston Scientific, Marlborough, MA, USA) mesh insertion) with anterior sacrospinous ligament fixation with suturing in terms of the outcomes 2 months after surgery. We performed a retrospective, observational, before-and-after study at Lille University Medical Center (Lille, France) by including consecutive patients operated on between 2011 and 2018 for UpholdTM mesh insertion and between 2018 to 2020 for anterior sacrospinous ligament fixation. The primary outcome was the early recurrence of prolapse, and the secondary outcomes were the occurrence of early per-operative or post-operative complications and the development of de novo stress urinary incontinence. Here, 466 patients were included in the study (382 in the UpholdTM group and 84 in the anterior sacrospinous ligament fixation group). The failure rate at 2 months was 6.0% (5 out of 84) for anterior sacrospinous ligament fixation and 1.3% (5 out of 382) for UpholdTM (p < 0.01). The prevalence of acute urinary retention was significantly lower in the anterior sacrospinous ligament fixation group (3.6%) than in the UpholdTM group (14.1%; p < 0.01), as was the de novo stress urinary incontinence rate (11.9% vs. 33.8%, respectively; p < 0.01). Anterior sacrospinous ligament fixation appears to be an effective, safe alternative to mesh insertion in the management of cystocele via the vaginal approach; the early complication rate was slightly lower, but the early failure rate was slightly higher.
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Affiliation(s)
- Louis-Edouard Galan
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, University of Lille, Avenue Eugène Avinée, 59000 Lille, France
| | - Stéphanie Bartolo
- Douai Hospital, Route de Cambrai-BP 10740 CEDEX, 59507 Douai, France
| | - Céline De Graer
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Sophie Delplanque
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, University of Lille, Avenue Eugène Avinée, 59000 Lille, France
| | - Marine Lallemant
- Pôle Mère-Femme, Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Besançon, Université de Franche-Comté, 3 Boulevard Alexandre Fleming, 25000 Besançon, France
| | - Michel Cosson
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, University of Lille, Avenue Eugène Avinée, 59000 Lille, France
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Guo T, Xie T, Lang J, Sun Z. Telomerase-mediated immortalization of human vaginal wall fibroblasts derived from patients with pelvic organ prolapse. Chin Med J (Engl) 2023; 136:578-587. [PMID: 36914936 PMCID: PMC10106167 DOI: 10.1097/cm9.0000000000002278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Extracellular matrix (ECM) remodeling is the most important pathomechanism of pelvic organ prolapse (POP). Fibroblasts are the key to ECM regulation. The passaging capacity of human vaginal wall fibroblasts (hVWFs) is limited in vitro . Here, we aimed to immortalize hVWFs through the introduction of human telomerase reverse transcriptase (hTERT). METHODS Primary cells were derived from the vaginal wall tissue of patients with POP. Cellular senescence was detected via senescence-associated β-galactosidase staining. We employed a lentiviral transfection vector to stably express hTERT in hVWFs at passage 3, generating immortalized hVWFs (i-hVWFs). We then assessed cellular proliferation via the CCK-8 and EdU assays as well as cellular migration via wound healing assays. G-banded chromosome karyotypic analysis was performed to evaluate chromosomal karyotype stability. Finally, cellular tumorigenesis capacity was assessed in nude mice. A two-tailed Student's t test was used to compare differences between the two groups. RESULTS Our results showed that senescence of primary hVWFs significantly increased from passage seven. From passage 11, hVWFs showed a significantly higher senescence percentage than i-hVWFs. During the continuous passage, i-hVWFs presented stability in proliferation, migration capacity, expression of ECM regulation-related genes, and chromosome karyotype. In vivo tumorigenesis was absent in i-hVWFs. CONCLUSIONS The senescence of hVWFs significantly increased from the seventh passage, and we successfully used hTERT to immortalize hVWFs derived from patients with POP. Studies on POP that require a long-lived hVWF line will benefit from our technique.
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Affiliation(s)
- Tao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Ting Xie
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Zhijing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
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Sun G, de Haas RJ, Trzpis M, Broens PMA. A possible physiological mechanism of rectocele formation in women. Abdom Radiol (NY) 2023; 48:1203-1214. [PMID: 36745205 PMCID: PMC10115871 DOI: 10.1007/s00261-023-03807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to determine the anorectal physiological factors associated with rectocele formation. METHODS Female patients (N = 32) with severe constipation, fecal incontinence, or suspicion of rectocele, who had undergone magnetic resonance defecography and anorectal function tests between 2015 and 2021, were retrospectively included for analysis. The anorectal function tests were used to measure pressure in the anorectum during defecation. Rectocele characteristics and pelvic floor anatomy were determined with magnetic resonance defecography. Constipation severity was determined with the Agachan score. Information regarding constipation-related symptoms was collected. RESULTS Mean rectocele size during defecation was 2.14 ± 0.88 cm. During defecation, the mean anal sphincter pressure just before defecation was 123.70 ± 67.37 mm Hg and was associated with rectocele size (P = 0.041). The Agachan constipation score was moderately correlated with anal sphincter pressure just before defecation (r = 0.465, P = 0.022), but not with rectocele size (r = 0.276, P = 0.191). During defecation, increased anal sphincter pressure just before defecation correlated moderately and positively with straining maneuvers (r = 0.539, P = 0.007) and defecation blockage (r = 0.532, P = 0.007). Rectocele size correlated moderately and positively with the distance between the pubococcygeal line and perineum (r = 0.446, P = 0.011). CONCLUSION Increased anal sphincter pressure just before defecation is correlated with the rectocele size. Based on these results, it seems important to first treat the increased anal canal pressure before considering surgical rectocele repair to enhance patient outcomes.
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Affiliation(s)
- Ge Sun
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Monika Trzpis
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Paul M A Broens
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands.,Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands
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Fitzpatrick KE, Abdel-Fattah M, Hemelaar J, Kurinczuk JJ, Quigley MA. Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study. PLoS Med 2022; 19:e1004119. [PMID: 36413515 PMCID: PMC9681109 DOI: 10.1371/journal.pmed.1004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The global rise in cesarean sections has led to increasing numbers of pregnant women with a history of previous cesarean section. Policy in many high-income settings supports offering these women a choice between planned elective repeat cesarean section (ERCS) or planned vaginal birth after previous cesarean (VBAC), in the absence of contraindications to VBAC. Despite the potential for this choice to affect women's subsequent risk of experiencing pelvic floor disorders, evidence on the associated effects to fully counsel women is lacking. This study investigated the association between planned mode of birth after previous cesarean section and the woman's subsequent risk of undergoing pelvic floor surgery. METHODS AND FINDINGS A population-based cohort study of 47,414 singleton term births in Scotland between 1983 to 1996 to women with 1 or more previous cesarean sections was conducted using linked Scottish national routine datasets. Cox regression was used to investigate the association between planned as well as actual mode of birth and women's subsequent risk of having any pelvic floor surgery and specific types of pelvic floor surgery adjusted for sociodemographic, maternal medical, and obstetric-related factors. Over a median of 22.1 years of follow-up, 1,159 (2.44%) of the study population had pelvic floor surgery. The crude incidence rate of any pelvic floor surgery per 1,000 person-years was 1.35, 95% confidence interval (CI) 1.27 to 1.43 in the overall study population, 1.75, 95% CI 1.64 to 1.86 in the planned VBAC group and 0.66, 95% CI 0.57 to 0.75 in the ERCS group. Planned VBAC compared to ERCS was associated with a greater than 2-fold increased risk of the woman undergoing any pelvic floor surgery (adjusted hazard ratio [aHR] 2.38, 95% CI 2.03 to 2.80, p < 0.001) and a 2- to 3-fold increased risk of the woman having surgery for pelvic organ prolapse or urinary incontinence (aHR 3.17, 95% CI 2.47 to 4.09, p < 0.001 and aHR 2.26, 95% CI 1.79 to 2.84, p < 0.001, respectively). Analysis by actual mode of birth showed these increased risks were only apparent in the women who actually had a VBAC, with the women who needed an in-labor non-elective repeat cesarean section having a comparable risk of pelvic floor surgery to those who had an ERCS. The main limitation of this study is the potential for misclassification bias. CONCLUSIONS This study suggests that among women with previous cesarean section giving birth to a singleton at term, planned VBAC compared to ERCS is associated with an increased risk of the woman subsequently undergoing pelvic floor surgery including surgery for pelvic organ prolapse and urinary incontinence. However, these risks appear to be only apparent in women who actually give birth vaginally as planned, highlighting the role of vaginal birth rather than labor in pelvic floor dysfunction requiring surgery. The findings provide useful additional information to counsel women with previous cesarean section about the risks and benefits associated with their future birth choices.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Mohamed Abdel-Fattah
- The Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Joris Hemelaar
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Obstetrics, Women’s Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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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] [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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Qin Z, Dong Z, Tang H, Zhang S, Wang H, Bao M, Wei W, Shi R, Chen J, Xia B. A preliminary clinical report of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse. Front Surg 2022; 9:931691. [PMID: 35965861 PMCID: PMC9372293 DOI: 10.3389/fsurg.2022.931691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To study the efficacy and safety of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse. Design Patients were selected into this study on a voluntary basis to evaluate the short-term efficacy of this surgery by comparing the OP-Q scores before the operation, three months after the operation, and six months after the operation. Setting and Patients Evaluate the clinical efficacy and safety by a retrospective analysis of the clinical data of the 18 patients with POP-Q grade III–IV pelvic organ prolapse treated by the Department of Gynecology of Nanjing Medical University Affiliated Changzhou No.2 People's Hospital from April 2020 to November 2020, and their post-operation follow-ups. Interventions Patients with postoperative follow-ups found no obvious relapse without intervention measures. Measurements and Main Results The transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation was performed successfully, and the anterior and posterior walls of vagina and/or trans-vaginal hysterectomy were repaired as appropriate. Except the total vaginal length (TVL), the P values of numerical analysis for all points before, three months after, and six months after the operation were all <0.05, being statistically significant. Conclusion This method is effective in the treatment of moderate and severe pelvic organ prolapse with few complications, but more cases and longer-term follow-up data are needed to determine the long-term effect of this procedure. For the selection of puncture sites, more anatomical data are needed to get more accurate result.
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Affiliation(s)
| | - Zhiyong Dong
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | | | | | | | - Weiwei Wei
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Ruxia Shi
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Correspondence: Jiming Chen Bairong Xia
| | - Bairong Xia
- Department of Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Correspondence: Jiming Chen Bairong Xia
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Daniel W, Valerie T, Alan L. Ten-year surgical complications and mesh erosion of transvaginal Elevate™ mesh for management of pelvic organ prolapse. J OBSTET GYNAECOL 2022; 42:2354-2359. [PMID: 35503566 DOI: 10.1080/01443615.2022.2049728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aims to review the surgical complications and mesh erosion with a cohort of patients who underwent Elevate™ mesh repair. This was a single-centre, retrospective study of women undergoing Elevate™ mesh reconstruction between 2006 and 2016. Women who presented with symptomatic prolapse of stage II or above were enrolled. The study outcomes were intra-operative and peri-operative complications (including mesh complications) at six weeks, one year and five years reporting with a standardised communicable method-the International Urogynecological Association (IUGA)/International Continence Society (ICS) scale and the Clavien and Dindo Classification. A total number of 350 women had Elevate™ mesh insertion. The mesh exposure rate was 1.1% and the surgical complication rate in our series was low and self-limiting (2% were Dindo grade 3). With the low morbidity and mesh-related complications, Elevate™ mesh should be at least kept as an alternative treatment of pelvic organ prolapse. Impact statementWhat is already known on this subject? Transvaginal mesh repair surgery was popular to treat advanced pelvic organ prolapse 10 years ago. However, after announcement of the Food and Drug Administration (FDA) public notification regarding mesh-related complications, particularly mesh exposure, use of transvaginal mesh and its safety have been scrutinised. Despite the increasing challenging and difficult medico-legal climate, several studies on second generation mesh kits, such as Elevate™ have shown favourable outcomes with low complication rates including our group.What do the results of this study add? In this paper, the surgical complications and mesh erosion of Transvaginal mesh was reported in a quantified communicable method-the International Urogynecological Association (IUGA)/International Continence Society (ICS) scale and the Clavien and Dindo Classification. This is significant because it is the largest case studies from a single centre with 350 patients.What are the implications of these findings for clinical practice and/or further research? This study well demonstrated using a standardised way to classify mesh exposure and peri-operative complications which is lacking in the past, while majority studies only focus to discuss on surgical outcome instead of complications. This may make a spark for future research analysis.
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Affiliation(s)
- Wong Daniel
- Centre for Advanced Reproductive Endosurgery (C.A.R.E.), Sydney, NSW, Australia.,Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | - To Valerie
- Centre for Advanced Reproductive Endosurgery (C.A.R.E.), Sydney, NSW, Australia.,Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Canada
| | - Lam Alan
- Centre for Advanced Reproductive Endosurgery (C.A.R.E.), Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
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Wang H, Shen J, Li S, Gao Z, Ke K, Gu P. The feasibility of uterine-vaginal axis MRI-based as evaluation of surgical efficacy in women with pelvic organ prolapse. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:447. [PMID: 35571410 PMCID: PMC9096420 DOI: 10.21037/atm-22-1173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to provide a potential surgical efficacy assessment in the treatment of pelvic organ prolapse (POP). Methods A retrospective cohort study was performed on magnetic resonance imaging (MRI) imaging data of 16 non-prolapsed (control group) and 30 preoperative and postoperative POP (case group) women from 2019 to 2021 at the First Affiliated Hospital of Kunming Medical University. MRI diagnoses and measures of the relevant anatomical points at rest were used to analyze the healthy control data and the data from POP women before and after surgery. Results The middle vaginal-PICS line angle (78.12°±15.03° vs. 69.35°±11.51°, 78.12°±15.03° vs. 61.56°±9.58°, P<0.05) and the middle-lower vaginal angle (179.30°±12.96° vs. 161.73°±10.42°, 179.30°±12.96° vs. 147.01°±12.20°, P<0.05) in the preoperative group were significantly larger than those in the control and postoperative groups. Y-axis coordinates of the endocervical orifice (−52.39±15.63 vs. −59.04±11.49 mm, −52.39±15.63 vs. −65.27±7.25 mm, P<0.05), posterior vaginal fornix (−34.25±13.30 vs. −46.69±11.09 mm, −34.25±13.30 vs. −49.93±8.02 mm, P<0.05), the junction of the middle and lower vagina (−0.48±8.65 vs. −11.34±7.33 mm, −0.48±8.65 vs. −10.11±9.77 mm, P<0.05), and anterior vaginal fornix (−23.14±13.71 vs. −34.68±9.07 mm, −23.14±13.71 vs. −38.64±6.48 mm, P<0.05), as well as the x-axes of the junction of the middle and lower parts of the vagina (26.79±6.71 vs. 19.56±5.24, 26.79±6.71 vs. 17.67±5.81, P<0.05), and vaginal introitus (23.39±7.12 vs. 18.55±4.22, 23.39±7.12 vs. 19.00±4.55, P<0.05) in the preoperative group were smaller than those of the control and postoperative groups. Differences between the control and postoperative groups were not statistically significant (P>0.05). Conclusions The current study established that the uterine-vaginal axis of POP women moved backward and downward in the coordinate system, as shown on MRI sagittal images. Further, it moved forward and upwards after surgical repair and more closely resembled that of the control group. The uterine-vaginal axis may provide an evaluation of surgical efficacy in women with POP.
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Affiliation(s)
- Haifeng Wang
- Department of Urology, Yunnan Province Clinical Research Center for Chronic Kidney Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jihong Shen
- Department of Urology, Yunnan Province Clinical Research Center for Chronic Kidney Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Song Li
- Department of Urology, Yunnan Province Clinical Research Center for Chronic Kidney Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenhua Gao
- Department of Urology, Yunnan Province Clinical Research Center for Chronic Kidney Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kunbin Ke
- Department of Urology, Yunnan Province Clinical Research Center for Chronic Kidney Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Peng Gu
- Department of Urology, Yunnan Province Clinical Research Center for Chronic Kidney Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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15
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Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse. Obstet Gynecol 2022; 139:597-605. [DOI: 10.1097/aog.0000000000004708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022]
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16
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Kose O, Atik YT, Gul D, Uysal B, Cimen HI, Bostanci MS. Influence of toileting behavior on the natural course of anterior vaginal wall prolapse. BMC Womens Health 2022; 22:56. [PMID: 35241052 PMCID: PMC8896381 DOI: 10.1186/s12905-022-01637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many risk factors for pelvic organ prolapse (POP) have been proposed, and the cause is most likely multifactorial. This study aimed to investigate the effect of toileting behaviors on the natural course of anterior vaginal wall prolapse (AVWP).
Methods Data on 75 women who underwent surgery for symptomatic AVWP were collected. Patients with grade ≥ II AVWP were included in this study and were divided into two groups according to their voiding and defecation position. The volunteers who voided and defecated in a sitting position comprised Group 1, and those who voided and defecated in a squatting position comprised Group 2. The Colorectal-Anal Impact Questionnaire (CRAIQ), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic Organ Prolapse Impact Questionnaire (POPIQ), Urinary Impact Questionnaire (UIQ) and visual analog scale (VAS) pain scores were used to evaluate the patients’ symptoms. Results Forty-four patients were included in Group 1 (sitting position), and 31 patients were included in Group 2 (squatting position). The groups were similar in terms of BMI, parity, menopause duration, topical estrogen use, comorbidities, the presence of constipation and urinary incontinence, and the pad count for incontinence. The time from initial symptoms to surgery was shorter in Group 2 than in Group 1 12 (3–73) and 24 (2–182) months (p = 0.001), respectively. The PFIQ, POPIQ and POP-related VAS scores were significantly higher in patients who voided and defecated in a squatting position. Conclusion In patients with symptomatic POP, increased IAP while performing the squat position during defecation and voiding may increase the severity of patients' symptoms related to prolapse more than that of sitting position. Therefore, questioning the toileting position of patients with AVWP may help inform management decisions, with changing to a sitting position encouraged.
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Affiliation(s)
- Osman Kose
- Department of Urology, Training and Research Hospital, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yavuz Tarik Atik
- Department of Urology, Training and Research Hospital, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
| | - Deniz Gul
- Department of Urology, Training and Research Hospital, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Burak Uysal
- Department of Urology, Training and Research Hospital, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Haci Ibrahim Cimen
- Department of Urology, Training and Research Hospital, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Suhha Bostanci
- Department of Gynecology and Obstetrics, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Taylor D, Yao HH, Gani J, O’Connell HE. Long-term surgical outcome of anterior colporrhaphy and autologous fascial sling (AFS) reinforcement for treatment of high-grade cystocoele. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158211062476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the long-term outcomes of anterior colporrhaphy with pubovaginal sling reinforcement in the management of high-grade cystocoele and significant urethral dysfunction. Materials and Methods: This is a retrospective case series. From May 2008 to October 2017, all patients who underwent concurrent anterior colporrhaphy and pubovaginal fascial sling performed by a single surgeon were included. Subjective success rates were determined from patient-reported outcomes on follow-up questionnaires using The Patient Global Impression of Improvement (PGI-I) scores. Primary outcome of this study was subjective cystocoele recurrence-free survival. Secondary outcome was complication rate. Results: Eighty patients were included with a median age of 63 years. All women had urethral dysfunction (type II urethral hypermobility or intrinsic sphincter deficiency) on fluoroscopic urodynamics in association with a high-grade cystocoele. The median follow-up time for recurrence of cystocoele was 36 months. The 1- and 5-year estimated cystocoele recurrence-free survival was 97.2% and 84.8%, respectively. Conclusion: Anterior colporrhaphy with concurrent pubovaginal sling reinforcement for treatment of high-grade cystocoele is a safe procedure with a high rate of success durable up to 5 years. The risk of complications is low with no patient developing chronic pain or rejection of the fascial graft. Level of evidence: Not applicable.
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Affiliation(s)
| | - Henry H Yao
- Department of Urology, Western Health, Australia
- Department of Surgery, The University of Melbourne, Australia
| | - Johan Gani
- Department of Urology, Western Health, Australia
- Department of Surgery, The University of Melbourne, Australia
| | - Helen E O’Connell
- Department of Urology, Western Health, Australia
- Department of Surgery, The University of Melbourne, Australia
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Li S, Wen X, Gao Z, Ke K, Yang J, Wang H, Mo Y, Zeng Y, Li Y, Tian D, Shen J. Comparison of the Axes and Positions of the Uterus and Vagina Between Women With and Without Pelvic Floor Organ Prolapse. Front Surg 2022; 9:760723. [PMID: 35223974 PMCID: PMC8866694 DOI: 10.3389/fsurg.2022.760723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the role of the axial positions of the uterus and vagina in providing pelvic floor support, encourage evaluations of pelvic floor function, and improve the understanding of the pathogenesis of pelvic organ prolapse. Methods The lengths and angles of the upper, middle, and lower axes of the vagina, uterine body, and cervix of 81 women with prolapse (prolapse group) and 57 women without prolapse (non-prolapse group) were measured and compared using magnetic resonance images. The pelvic inclination correction system (PICS) line was also compared between the groups. The coordinate parameters of the anatomical points of the uterus and vagina were measured, and their positions were analyzed. Results In the prolapse group, the uterine body-cervical angle, cervical-upper vaginal angle, uterine body-PICS line angle, cervical-PICS line angle, and lower vaginal-PICS line angle were smaller (p < 0.05) and the middle-lower vaginal angle, upper vaginal-PICS line angle, and middle vaginal-PICS line angles were larger (p < 0.05) than those in the non-prolapse group. The cervical length was longer (p < 0.05) and the middle and lower vaginal lengths were shorter (p < 0.05) in the prolapse group. The coordinate system revealed that the uterine and vaginal axes were shifted backward and downward in the prolapse group. Conclusion Patients in the prolapse group were more likely to have retroversion and retroflexion of the uterus than those in the non-prolapse group. The vagina was shortened, turned forward, and straightened, and the uterus and vagina were shifted backward and downward in the prolapse group. Changes in the axial position of the uterus and vagina are important mechanisms of pelvic floor organ prolapse.
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Affiliation(s)
- Song Li
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Xuewei Wen
- Ophthalmology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Zhenhua Gao
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Kunbin Ke
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Jing Yang
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Haifeng Wang
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Yin Mo
- Medical Imaging Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Yizhen Zeng
- Medical Imaging Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Yuan Li
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Daoming Tian
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Jihong Shen
- Urology Department, Kunming Medical University First Affiliated Hospital, Kunming, China
- *Correspondence: Jihong Shen
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Aunier J, Reboul Q, Chauleur C. Evaluation of surgical treatment of genital prolapse using synthetic mesh in an outpatient procedure and patient satisfaction. J Gynecol Obstet Hum Reprod 2022; 51:102312. [PMID: 35031511 DOI: 10.1016/j.jogoh.2022.102312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE - To study a new strategy for one day prolapse surgery with mesh, to identify risk factors for one day procedure failure and patient satisfaction. METHODS - This retrospective observational study was conducted at Saint Etienne University Hospital, France. All patients who received a prolapse treatment by synthetic mesh between January 2016 and April 2019 in one day surgery procedure were included in the study. Exhaustive variables was collected and all patients were contacted for a satisfaction survey. RESULTS - During the periode patients were included. 6 of them required readmissions included 5 hospitalization for urinary retention and 1 for abnormal bleeding. Among the patients, 87% were satisfied. Only the anesthetic management was significantly associated with an ambulatory surgery success (p = 0,02) and satisfaction (p = 0,001). CONCLUSION - This study shows the technical feasibility and safety of prosthetic prolapse surgery during outpatient hospitalization. The success of a rapid pathway in one day surgery depends on a good selection of patients, proper planning of surgical procedures and optimization of anesthesia protocols. The prevention of outpatient failures is justified for medical and economic reasons respecting the quality and safety of patients.
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Affiliation(s)
- J Aunier
- Service de gynécologie-obstétrique, CHU Saint-Etienne, avenue Albert Raimond, 42055 Saint Etienne Cedex 2
| | - Q Reboul
- Service de gynécologie-obstétrique, CHU Saint-Etienne, avenue Albert Raimond, 42055 Saint Etienne Cedex 2.
| | - C Chauleur
- Service de gynécologie-obstétrique, CHU Saint-Etienne, avenue Albert Raimond, 42055 Saint Etienne Cedex 2
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International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs. Int Urogynecol J 2022; 33:173-187. [PMID: 34977950 DOI: 10.1007/s00192-021-05018-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs. MATERIALS AND METHODS A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research. RESULTS The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs. CONCLUSION Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.
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Bolovis D, Hitzl W, Brucker C. Robotic mesh-supported pectopexy for pelvic organ prolapse: expanding the options of pelvic floor repair. J Robot Surg 2021; 16:815-823. [PMID: 34498174 DOI: 10.1007/s11701-021-01303-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
Pelvic organ prolapse affects 30-50% of the female population. For definitive treatment surgery is unavoidable. Sacrocolpopexy has been the gold standard for anatomical correction of pelvic organ prolapse since the 1990s. Recently, pectopexy has been introduced as a new surgical procedure to correct apical prolapse. We have translated the laparoscopic pectopexy into a robotic procedure. The charts of the first 30 consecutive patients who underwent robotic pectopexy at the department for robotic and pelvic floor surgery were reviewed. All patients were analyzed for estimated blood loss, operation time, as well as complications. Treatment success was evaluated after 3-6 months using a composite endpoint including anatomical and subjective components. Of the 30 patients analyzed, 18 underwent hysteropectopexy (n = 18), 6 patients underwent vaginopectopexy and 6 patients underwent cervicopectopexy. Additional procedures were performed in 14 patients, and this influenced operation time and intraoperative blood loss. No intraoperative complications were noted and no conversions were necessary. Treatment success according to the primary composite endpoint was achieved in 30 (100%) patients. Furthermore, neither de novo urgency nor obstructive bowel symptoms were noted in any of the patients treated with robotic pectopexy. Similar to SCP, pectopexy is designed for prolapse repair. The robotic technique for pectopexy capitalizes on the advantages of robotic surgery as compared to conventional laparoscopy since it allows for anatomical preparation and simplification of applying sutures and mesh material, reducing operating time and minimizing surgical trauma. The technique is safe, and anatomical outcomes are excellent.
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Affiliation(s)
- Dimitrios Bolovis
- Paracelsus Medical University, University Women's Hospital, Klinikum Nuernberg, Nuremberg, Germany.
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria.,Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Cosima Brucker
- Paracelsus Medical University, University Women's Hospital, Klinikum Nuernberg, Nuremberg, Germany
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Brito LGO, Pereira GMV, Moalli P, Shynlova O, Manonai J, Weintraub AY, Deprest J, Bortolini MAT. Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis. Int Urogynecol J 2021; 33:15-29. [PMID: 34351465 DOI: 10.1007/s00192-021-04953-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/25/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development. METHODS Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included. RESULTS Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021-1.190]; i2 = 80%, random analysis, p = 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p = 0.035) and 50 (p < 0.001) years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927-4.668], i2 = 0%, p = 0.076). CONCLUSION Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.
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Affiliation(s)
- Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101 - Cidade Universitária, Campinas, 13148-254, Brazil.
| | - Glaucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101 - Cidade Universitária, Campinas, 13148-254, Brazil
| | - Pamela Moalli
- Division of Urogynecology & Pelvic Reconstructive Surgery, UPMC Magee-Womens Hospital, Pittsburgh, VA, USA
| | - Oksana Shynlova
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Jittima Manonai
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Bem-Gurion University of the Negev, Beer Sheva, Israel
| | - Jan Deprest
- Academic Department of Development and Regeneration, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Mao M, Li Y, Zhang Y, Kang J, Zhu L. Human umbilical cord mesenchymal stem cells reconstruct the vaginal wall of ovariectomized Sprague-Dawley rats: implications for pelvic floor reconstruction. Cell Tissue Res 2021; 386:571-583. [PMID: 34264376 DOI: 10.1007/s00441-021-03478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
Vaginal structural defects are involved in pelvic organ prolapse (POP). We tested whether mesenchymal stem cell (MSC) therapy can repair the weakened vaginal wall of POP patients as a novel POP treatment. Ninety-six ovariectomized rats were divided into 4 groups (n = 24/group): saline (sal), collagen (col), sal + MSC, and col + MSC groups. Two weeks after ovariectomy, rats received subepithelial injection of 0.3 ml saline, 0.3 ml collagen I gel, and 0.3 ml saline: 3 × 106 human umbilical cord mesenchymal stem cells (HUMSCs), or 0.3 ml collagen I gel: 3 × 106 HUMSCs into the anterior vaginal wall. Eight additional rats underwent in vivo bioluminescence imaging (BLI) to evaluate in vivo cell viability. The BLI signal disappeared within 1 week after MSC injection, and no in vivo MSC differentiation was found. Collagen I content was significantly lower at 4 and 12 weeks in the two MSC groups than in the sal and col groups, while collagen III was significantly higher (P < 0.001). The fraction of smooth muscle in the nonvascular muscularis increased significantly in the two MSC groups at 12 weeks (P < 0.001). ACTA2 mRNA in the col + MSC group was significantly higher than that in the sal group at 2 and 4 weeks (P = 0.042 and P = 0.040). mRNA levels of angiogenic factors (bFGF or VEGF) in the two MSC groups were significantly higher than those in the sal and col groups at different time points. HUMSCs normalized the fibromuscular structures of the vaginal wall of ovariectomized rats potentially through a paracrine effect.
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Affiliation(s)
- Meng Mao
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yaqian Li
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jia Kang
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Zhang Y, Ma Y, Chen J, Wang M, Cao Y, Li L, Yang H, Liu X, Li Y, Zhu L. Mesenchymal stem cell transplantation for vaginal repair in an ovariectomized rhesus macaque model. Stem Cell Res Ther 2021; 12:406. [PMID: 34266489 PMCID: PMC8281669 DOI: 10.1186/s13287-021-02488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/02/2021] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Current surgical therapies for pelvic organ prolapse (POP) do not repair weak vaginal tissue and just provide support; these therapies may trigger severe complications. Stem cell-based regenerative therapy, due to its ability to reconstruct damaged tissue, may be a promising therapeutic strategy for POP. The objective of this study is to evaluate whether mesenchymal stem cell (MSC) therapy can repair weak vaginal tissue in an ovariectomized rhesus macaque model. METHODS A bilateral ovariectomy model was established in rhesus macaques to induce menopause-related vaginal injury. Ten bilaterally ovariectomized rhesus macaques were divided into two groups (n=5/group): the saline group and the MSC group. Three months after ovariectomy, saline or MSCs were injected in situ into the injured vaginal wall. The vaginal tissue was harvested 12 weeks after injection for histological and biochemical analyses to evaluate changes of extracellular matrix, microvascular density, and smooth muscle in the vaginal tissue. Biomechanical properties of the vaginal tissue were assessed by uniaxial tensile testing. Data analysis was performed with unpaired Student's t test or Mann-Whitney. RESULTS Twelve weeks after MSC transplantation, histological and biochemical analyses revealed that the content of collagen I, elastin, and microvascular density in the lamina propria of the vagina increased significantly in the MSC group compared with the saline group. And the fraction of smooth muscle in the muscularis of vagina increased significantly in the MSC group. In addition, MSC transplantation improved the biomechanical properties of the vagina by enhancing the elastic modulus. CONCLUSION Vaginal MSC transplantation could repair the weak vaginal tissue by promoting extracellular matrix ingrowth, neovascularization, and smooth muscle formation and improve the biomechanical properties of the vagina, providing a new prospective treatment for POP.
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Affiliation(s)
- Ye Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yidi Ma
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Wang
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Rheumatology, Beijing Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Cao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Li
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Yang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xudong Liu
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaqian Li
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Sun ZJ, Guo T, Wang XQ, Lang JH, Xu T, Zhu L. Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study. Int Urogynecol J 2021; 32:2149-2157. [PMID: 34165615 PMCID: PMC8346404 DOI: 10.1007/s00192-021-04892-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 01/23/2023]
Abstract
Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.
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Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Tao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Xiu-Qi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China.
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The distribution of pelvic organ support defects in women undergoing pelvic organ prolapse surgery and compartment specific risk factors. Int Urogynecol J 2021; 33:405-409. [PMID: 33974095 PMCID: PMC8803792 DOI: 10.1007/s00192-021-04826-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
Introduction and hypothesis The objective of our study was to describe the distribution of pelvic organ prolapse (POP) in a population of women undergoing POP reconstructive surgery and to identify compartment-specific risk factors. Methods We conducted a retrospective observational study in a cohort of 326 women who underwent POP repair and had a standardized preoperative POP assessment using the Baden-Walker classification. The distribution of POP grade was described for each vaginal compartment. The association between the involvement of each specific compartment and predictors was evaluated with a logistic regression model. Results The frequency of significant POP (grade ≥ 2) was 79% in the anterior compartment, 49% in the middle/apical compartment and 31% in the posterior compartment. Combined significant anterior and apical defects were present in 25% of women. Increasing age was a significant risk factor for apical defect (between 60 and 70 years OR = 2.4, 95% CI 1.2–4.6; > 70 years OR = 3.4, 95% CI 1.7–6.6). Previous hysterectomy (OR = 2.2, 95% CI 1.0–4.6) was a significant risk factor for posterior defect. Conclusions In a population undergoing POP surgery, anterior compartment involvement is the most common and serious defect and can often be associated with an apical defect, especially in older women. In case of previous hysterectomy, the posterior compartment may be weakened. These findings may help surgeons to select the appropriate POP reconstructive surgery, which often should address both anterior and apical defects. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04826-7.
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Muche HA, Kassie FY, Biweta MA, Gelaw KA, Debele TZ. Prevalence and associated factors of pelvic organ prolapse among women attending gynecologic clinic in referral hospitals of Amhara Regional State, Ethiopia. Int Urogynecol J 2021; 32:1419-1426. [PMID: 33864474 DOI: 10.1007/s00192-021-04710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS While pelvic organ prolapse is common in clinical observation, there is a lack of evidence regarding its actual proportion and associated factors in the study area. Understanding the prevalence and risk factors could potentially help with prevention. Thus, this study aimed to determine the prevalence and associated factors related to pelvic organ prolapse in the Amhara region, northwest Ethiopia. METHODS An institutional-based cross-sectional study was conducted among 424 women, recruited by the systematic random sampling technique. Data were collected in a face-to-face interview using a structured and pre-tested questionnaire to assess the symptoms of pelvic organ prolapse and the socio-demographic, obstetric, gynecologic, medical and surgical characteristics. The stage of prolapse was determined by pelvic examination using the Simplified Pelvic Organ Prolapse Quantification staging system. Descriptive statistics and logistic regression analyses were employed. RESULTS The overall prevalence of pelvic organ prolapse (stage I-IV) was found to be 37.6% when determined by pelvic examination and 9.2% as assessed by prolapse symptoms. Age ≥ 40 years [AOR 2.46 (1.320, 5.314)], age at first delivery ≤ 20 years [AOR 4.719 (2.44, 9.11)], carrying heavy objects for ≥ 5 hours a day [AOR 12.724 (4.89, 33.07)], parity ≥ 4 [AOR 3.739 (1.693, 8.208)], prolonged labor [AOR 3.487 (1.699, 7.159)], constipation [AOR 2.835 (1.273, 6.317)] and anemia [AOR 2.22 (1.049, 4.694)] were significantly associated with pelvic organ prolapse. CONCLUSION Prevalence of pelvic organ prolapse is high in the area; thus, developing information and education programs on avoiding risk factors is advisable to reduce the problem.
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Affiliation(s)
- Haymanot Alem Muche
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Fisseha Yetwale Kassie
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Abuhay Biweta
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kelemu Abebe Gelaw
- Department of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tibeb Zena Debele
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Clinical applications of pelvic floor imaging: opinion statement endorsed by the society of abdominal radiology (SAR), American Urological Association (AUA), and American Urogynecologic Society (AUGS). Abdom Radiol (NY) 2021; 46:1451-1464. [PMID: 33772614 DOI: 10.1007/s00261-021-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).
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Medical Malpractice Litigation in Non-Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases. Female Pelvic Med Reconstr Surg 2021; 27:255-259. [PMID: 31804234 DOI: 10.1097/spv.0000000000000795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery. METHODS Westlaw (Thompson Reuters, New York, New York) is a legal research database of US court records. We identified completed POP litigations from 1987 to 2018 using the following: "pelvic organ prolapse," "enterocele," "rectocele," "cystocele," "uterine prolapse," and "vaginal wall prolapse." Mesh-related cases were excluded. Outcomes included reasons for litigation, verdict, injury, and payments. Statistical analysis was performed with nonparametric tests and χ2 independence test. RESULTS Ninety-one litigations were included. The median plaintiff age was 53 years (range, 36-85 years). The leading allegation was negligence of surgery (n = 59; 65%). The jury sided with the defendant physician in 67% of cases (n = 61). There was no association between case verdict and patient age (P = 0.781), geographic region (P = 0.824), or allegation (P = 0.904). The primary complications were urinary tract injury (n = 24; 26%), need for additional surgery (n = 22; 24%), and new postoperative urinary symptoms (n = 22; 24%). The median payout was $280,000 (interquartile range, $137,250-$1,300,000), with no difference between plaintiff awards or settlements (P = 0.659). CONCLUSION The leading allegation of malpractice litigations for nonmesh POP surgery is negligence of surgery, whereas the most common complication was urinary tract injury. A verdict in favor of the physician defendant was the most likely outcome. Plaintiff awards and settlements were not statistically different with no variation by region or time.
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Kikuchi JY, Muñiz KS, Handa VL. Surgical Repair of the Genital Hiatus: A Narrative Review. Int Urogynecol J 2021; 32:2111-2117. [PMID: 33606054 DOI: 10.1007/s00192-021-04680-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An enlarged genital hiatus (GH) is associated with the development of prolapse and may be associated with prolapse recurrence following surgery; however, there is insufficient evidence to support surgical reduction of the GH as prophylaxis against future prolapse. The objective of this review is (1) to review the association between GH size and pelvic organ prolapse and (2) to discuss the existing literature on surgical procedures that narrow the GH. METHODS A literature search was performed in the PubMed search engine, using the keyword "genital hiatus." Articles were included if they addressed any of the following topics: (1) normative GH values; (2) associations between the GH and prolapse development or recurrence; (3) surgical alteration of the GH; (4) indications, risks or benefits of surgical alteration of the GH. RESULTS An enlarging GH has been observed prior to the development of prolapse. Multiple studies show that an enlarged pre- and/or postoperative GH is associated with an increased risk of recurrent prolapse following prolapse repair surgery. There are limited data on the specific risks of GH alteration related to bowel and sexual function. CONCLUSIONS GH size and prolapse appear to be strongly associated. Because GH size appears to be a risk factor for pelvic organ prolapse, the GH size should be carefully considered at the time of surgery. Surgeons should discuss with their patients the risks and potential benefits of additional procedures designed to reduce GH size.
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Affiliation(s)
- Jacqueline Y Kikuchi
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
| | - Keila S Muñiz
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA
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Predictors for Pelvic Organ Prolapse Recurrence After Sacrocolpopexy: A Matched Case-Control Study. Female Pelvic Med Reconstr Surg 2021; 27:e165-e170. [DOI: 10.1097/spv.0000000000000874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lamblin G, Courtieu C, Bensouda-Miguet C, Panel L, Moret S, Chabert P, Chene G, Nohuz E. Outpatient vaginal surgery for pelvic organ prolapse: a prospective feasibility study. ACTA ACUST UNITED AC 2020; 72:19-24. [PMID: 32153159 DOI: 10.23736/s0026-4784.20.04510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the light of recent progress in pelvic organ prolapse surgery, the modalities of hospital admission need reconsidering. This work aims to assess success rate of outpatient (ambulatory) vaginal mesh surgery for genital prolapse. METHODS A prospective observational study was conducted between January 2015 and July 2017, including all patients presenting with POP-Q stage ≥3 anterior and/or apical prolapse. RESULTS Sixty-nine of the 89 eligible patients were treated on an ambulatory basis (group A); 20 required overnight admission (group B): i.e., ambulatory success rate, 77.5%. Mean operative time was 44.9±2.5 min in group A and 62±6.5 min in group B. Reasons for ineligibility for ambulatory management comprised organizational issues at home (10.5%) and excessive home-to-hospital distance (5.7%). The postoperative urinary retention rate was 4.5%. Rates for successful cystocele correction (POP-Q <2) at 2 months were similar in the two groups: 94.2% in group A and 94.4% in group B (P=ns). Mean satisfaction score was 8.6±0.3/10. CONCLUSIONS Outpatient anterior vaginal mesh surgery for prolapse is safe and effective. The current medical-economic context favors ambulatory management. Patient selection, prior information and continuity of care seem primordial.
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Affiliation(s)
- Géry Lamblin
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Christophe Courtieu
- Department of Gynecological Surgery, Beau Soleil Clinic, Montpellier, France
| | - Chloé Bensouda-Miguet
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Laure Panel
- Department of Gynecological Surgery, Beau Soleil Clinic, Montpellier, France
| | - Stéphanie Moret
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Philippe Chabert
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Gautier Chene
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Erdogan Nohuz
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France -
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Ten years' follow-up after iliococcygeus fixation for the treatment of apical vaginal prolapse. Int Urogynecol J 2020; 32:1533-1538. [PMID: 33237354 DOI: 10.1007/s00192-020-04598-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Various surgical techniques have been described for vaginal vault prolapse repair, but the best surgical approach is still to be proven. The aim of this study is to report the long-term objective and subjective outcomes of women who underwent iliococcygeus fixation for the treatment of vaginal vault prolapse with a minimum follow-up of 10 years. METHODS Women with symptomatic vaginal vault prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage ≥ 2) who had previously undergone hysterectomy for any reason were prospectively enrolled and treated with iliococcygeus fixation. Subjective success was defined as Patient Global Impression of Improvement (PGI-I) ≤ 2 and an absence of bulging symptoms. Objective success was defined as stage of prolapse < 2 in all compartments. Overall success rate was defined as women without prolapse symptoms, PGI-I ≤ 2, stage of prolapse < 2, and no need for other surgery. Prolpase Quality of Life (P-QOL) questionnaires were completed at the preoperative visit and at every follow-up visit. Multiple logistic regression was performed to identify factors involved in the risk of recurrent POP. RESULTS After a median (range) follow-up of 120 (120-132) months, the subjective, objective, and overall cure rates were 82% (32/39), 74.4% (29/39), and 74.4% (29/39), respectively. Only stage IV vault descensus independently predicted POP recurrence after ICG (OR: 7.66 [95% CI: 1.21-9.02]; p < 0.001). CONCLUSION Iliococcygeus fixation seems to be a safe and effective option for the treatment of vaginal vault prolapse at 10 years' follow-up.
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Marriott J, Pedofsky L, Smalldridge J, Hayward L, Budgett D, Nielsen PMF, Kruger J. Assessing vaginal pressure profiles before and after prolapse surgery using an intravaginal pressure sensor (femfit®). Int Urogynecol J 2020; 32:3037-3044. [PMID: 33196880 DOI: 10.1007/s00192-020-04576-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of surgery on pelvic floor muscle (PFM) function remains uncertain. There is a pressure differential along the length of the vagina, influenced by surrounding active and passive tissue structures, giving rise to a pressure profile. The aim of this study is to determine if an intravaginal pressure sensor, femfit®, can measure differences in pressure profiles before and after surgery for pelvic organ prolapse (POP). METHODS This pilot study includes 22 women undergoing POP surgery. Intravaginal pressure profiles were measured with femfit® pre- and post-surgery and differences tested using paired Student's t-tests. Patients completed validated questionnaires for vaginal, bowel, and urinary incontinence symptoms pre- and post-POP surgery and a femfit® usability questionnaire. RESULTS Sixteen sets of vaginal pressure data were analysed. The highest pressure generated was identified as the peak PFM pressure, whilst all sensor measurements provided a pressure profile. Intra-abdominal pressure (IAP) was measured by the most distal sensor, 8. On average, the difference between peak PFM pressure and IAP was significantly greater post-surgery (p < 0.01). Urinary and vaginal symptom questionnaire scores were significantly improved after POP surgery. Femfit® usability questionnaires demonstrated high levels of patient acceptability. CONCLUSIONS Women generate higher peak PFM pressures compared to IAP post-POP surgery, with pressure profiles that are comparable to women without POP. This metric might be useful to assess the outcome of POP surgery and encourage women to maintain this profile via PFM training, potentially reducing POP recurrence risk.
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Affiliation(s)
- Joy Marriott
- Department of Obstetrics & Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, 92019, New Zealand.
| | - Laura Pedofsky
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Lynsey Hayward
- Middlemore Hospital CMDHB, University of Auckland, Auckland, New Zealand
| | - David Budgett
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Poul M F Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Malacarne Pape D, Escobar CM, Agrawal S, Rosenblum N, Brucker B. The impact of concomitant mid-urethral sling surgery on patients undergoing vaginal prolapse repair. Int Urogynecol J 2020; 32:681-685. [PMID: 33048178 DOI: 10.1007/s00192-020-04544-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/21/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess whether mid-urethral sling (MUS) placement at the time of vaginal prolapse repair compared to vaginal prolapse repair alone is associated with an increase in 30-day postoperative complications. METHODS Using the American College of Surgeons National Surgical Quality Improvement Database, Current Procedural Terminology codes were used to identify cases of vaginal prolapse repair with and without concomitant MUS from 2012 to 2017. Student's t-test and chi-square test were used to compare differences between the groups. RESULTS A total of 1469 cases of vaginal prolapse repair with sling were compared to 4566 cases without sling. There was no difference between prolapse repair with sling compared to without sling in mean hospital length of stay (LOS) (1.42 versus 1.32 days, p = 0.65), postoperative urinary tract infection (UTI) (6.1% versus 5.8%, p = 0.670), perioperative blood transfusion (1.1% versus 1.2%, p = 0.673), readmission (2.7% versus 2.6%, p = 0.884) and postoperative wound infection (0.5% versus 0.7%, p = 0.51). There was a higher rate of reoperation (2.2% versus 1.5%, p = 0.049) and venous thromboembolism (VTE) (0.4% versus 0.1%, p = 0.030) in patients undergoing concomitant MUS compared to those undergoing prolapse repair alone. CONCLUSIONS Compared to prolapse repair alone, the addition of a sling did not increase hospital LOS, UTI, perioperative blood transfusions, readmission or postoperative wound infections. However, concomitant sling was found to be associated with a higher risk of reoperation and VTE.
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Affiliation(s)
| | | | - Surbhi Agrawal
- New York University Langone Medical Center, New York, NY, USA
| | - Nirit Rosenblum
- New York University Langone Medical Center, New York, NY, USA
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Kilic GS, Lee T, Lewis K, Demirkiran C, Dursun F, Unlu BS. Perioperative, postoperative and anatomical outcomes of robotic sacrocolpopexy. J OBSTET GYNAECOL 2020; 41:651-654. [PMID: 33045854 DOI: 10.1080/01443615.2020.1789958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study aimed to analyse the anatomical, perioperative and postoperative outcomes of the robotic-assisted sacrocolpopexy (RSCP). After obtaining Institutional Review Board (IRB #19-0167) approval, our retrospective case series included 144 consecutive patients that underwent an RSCP for symptomatic stage II pelvic organ prolapse (POP) or symptomatic/asymptomatic stage III/IV POP. Patient information included operative parameters, perioperative and postoperative complications, readmissions and reoperation. Demographics and baseline characteristics were summarised by frequencies and percentages for categorical variables, and by mean/median, standard deviation, and ranges for continuous variables. In our study, concomitant surgeries with sacrocolpopexy consisted of hysterectomy, Burch colposuspension and midurethral sling. The anatomical success rate was 87.5% and the reoperation rate was 10.4%. The mean follow-up time was 12.5 (±8.7) months. Intraoperative complications 13 (9%) were bowel serosal abrasion, bladder wall injuries, trochar site bleeds, subcutaneous emphysema and a retroperitoneal haematoma. Our results suggest that RSCP is a feasible and safe approach for the treatment of POP with a low complication rate and favourable medium-term outcomes regarding anatomical and symptomatic results.Impact statementWhat is already known on this subject? Pelvic organ prolapse affects more than 25% of women in the United States. Apical and anterior compartment defects are challenging cases and sacrocolpopexy is considered the gold standard treatment option for apical and anterior compartment defects. As technology has advanced, minimally invasive approaches have been popular with their pros.What the results of this study add? We present the highest volume case series in the literature from our tertiary care centre for robotic-assisted sacrocolpopexy (RSCP). Our results suggest that RSCP is a feasible and safe approach for the treatment of POP with a low complication rate and favourable 1-year outcomes regarding anatomical and subjective results.What the implications are of these findings for clinical practice and/or further research? Robotic-assisted sacrocolpopexy has the potential to gain more popularity in the near future based on accumulating data on its feasibility and safety results.
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Affiliation(s)
| | - Toy Lee
- University of Texas Medical Branch, Galveston, TX, USA
| | - Kelsey Lewis
- University of Texas Medical Branch, Galveston, TX, USA
| | | | - Furkan Dursun
- University of Texas Medical Branch, Galveston, TX, USA
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Traditional McCall culdoplasty compared to a modified McCall technique with double ligament suspension: anatomical and clinical outcomes. Int Urogynecol J 2020; 31:2147-2153. [PMID: 32594190 DOI: 10.1007/s00192-020-04403-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study compared anatomical and clinical outcomes of traditional McCall culdoplasty versus a modified McCall technique with double ligament suspension (DLS). METHODS This retrospective study presents outcomes of 68 patients who underwent vaginal hysterectomy and vaginal suspension for apical prolapse ≥ stage II according to the POP-Q score system, at, between January 2016 and February 2018. In 34 women vaginal cuff suspension was obtained with traditional McCall culdoplasty (McCall group), while in 34 women we performed a modified McCall, which consists of a double ligament suspension (DLS group), suspending the vaginal cuff to uterosacral ligaments and also to adnexal peduncles. Primary outcome was prolapse recurrence ≥ stage II according to the POP-Q system. Fisher's, Mann-Whitney U and Student's t tests were used for statistical analysis. RESULTS There were no statistical differences among patients' preoperative characteristics, operative time, blood loss or postoperative complications. Follow-up mean duration was 23.2 ± 6.7 and 22.4 ± 8.7 months in the McCall and DLS group, respectively. Prolapse recurrence occurred in 11 (32.3%) women in the McCall group versus 2 (5.9%) women in the DLS group (p < 0.05): among them, 2 patients (5.9%) in the McCall group and 1 (2.9%) in the DLS group required further treatment. Total vaginal length was 6.1 ± 0.9 cm in the McCall group versus 6.9 ± 0.7 cm in the DLS group (p < 0.001). No statistical difference in quality of life assessment was observed. CONCLUSIONS DLS group patients had better anatomical outcomes and lower recurrence rates than McCall group patients, without increasing operative time or complications. A prospective study with more cases is needed to confirm our data.
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Duarte TB, Bø K, Brito LGO, Bueno SM, Barcelos TM, Bonacin MA, Ferreira CH. Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial. J Physiother 2020; 66:27-32. [PMID: 31843420 DOI: 10.1016/j.jphys.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
QUESTION In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery? DESIGN Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS Ninety-six women with an indication for POP surgery. INTERVENTION The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only. OUTCOME MEASURES Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 'unaffected' to 300 'worst affected'. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 'very much better' to 7 'very much worse'. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery. RESULTS There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference -6, 95% CI -25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference -4, 95% CI -23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference -0.4 (95% CI -0.8 to -0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes. CONCLUSION In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function. TRIAL REGISTRATION ReBEC, RBR-29kgz5.
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Affiliation(s)
- Thaiana B Duarte
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences and Department of Obstetrics and Gynecology, University Hospital, Lørenskog, Norway
| | - Luiz Gustavo O Brito
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sabrina M Bueno
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Thays Mr Barcelos
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marília Ap Bonacin
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Cristine Hj Ferreira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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Veit-Rubin N, De Tayrac R, Cartwright R, Franklin-Revill L, Warembourg S, Dunyach-Remy C, Lavigne JP, Khullar V. Abnormal vaginal microbiome associated with vaginal mesh complications. Neurourol Urodyn 2019; 38:2255-2263. [PMID: 31402478 PMCID: PMC6852108 DOI: 10.1002/nau.24129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022]
Abstract
Aims To identify differences in the vaginal microbiomes of women after transvaginal mesh (TVM) surgery for pelvic organ prolapse with and without mesh‐associated complications. Methods Patients with complications were eligible as cases, patients without as controls. DNA was isolated and the V1‐2 region of the 16S ribosomal RNA gene was amplified and sequenced. Overall richness was quantified using Chao1. Overall diversity was expressed as Shannon diversity and screened for group differences using analysis of variance. Multivariate differences among groups were evaluated with functions from R. Results We recruited 14 patients after mesh exposure, 5 after contraction, and 21 as controls. The average number of operational taxonomic unit was 74.79 (SD ± 63.91) for controls, 57.13 (SD ± 58.74) after exposures, and 92.42 (SD ± 50.01) after contractions. Total 89.6% of bacteria in controls, 86.4% in previous exposures, and 81.3% in contractions were classified as either Firmicutes, Proteobacteria, or Actinobacteria (P < .001). Veillonella spp. was more abundant in patients after contraction (P = .045). The individual microbiomes varied, and we did not detect any significant differences in richness but a trend towards higher diversity with complications. Conclusions The presence of Veillonella spp. could be associated with mesh contraction. Our study did not identify vaginal microbiotic dysbiosis as a factor associated with exposure. Larger cohort studies would be needed to distinguish the vaginal microbiome of women predisposed to mesh‐related complications for targeted phenotyping of patients who could benefit from TVM surgery.
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Affiliation(s)
- Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Renaud De Tayrac
- Department of Gynecology and Obstetrics, Caremeau University Hospital, Nîmes, France
| | - Rufus Cartwright
- Department of Urogynaecology, Oxford University Hospitals, Oxford, United Kingdom
| | - Larissa Franklin-Revill
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - Sophie Warembourg
- Department of Gynecology and Obstetrics, CHU La Croix-Rousse University Hospital Lyon, Lyon, France
| | - Catherine Dunyach-Remy
- Department of Microbiology, CHU Caremeau University Hospital, Montpellier University, Nîmes, France
| | - Jean-Philippe Lavigne
- Department of Microbiology, CHU Caremeau University Hospital, Montpellier University, Nîmes, France
| | - Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
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Sohlberg EM, Dallas KB, Weeks BT, Elliott CS, Rogo-Gupta L. Reoperation rates for pelvic organ prolapse repairs with biologic and synthetic grafts in a large population-based cohort. Int Urogynecol J 2019; 31:291-301. [DOI: 10.1007/s00192-019-04035-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
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Komemushi Y, Komemushi A, Morimoto K, Yoneda Y, Yoshimura R, Tanaka T, Katou T, Nakatani T. Quantitative evaluation of age-related changes to pelvic floor muscles in magnetic resonance images from 369 patients. Geriatr Gerontol Int 2019; 19:834-837. [PMID: 31270946 DOI: 10.1111/ggi.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to establish and validate a quantitative evaluation method for pelvic floor muscles using magnetic resonance images (MRI) and to examine the morphological change of pelvic floor muscles with aging. METHODS Data from 369 consecutive patients (163 men, 206 women; median age 58 years; range 17-92 years) who underwent coronal T2-weighted pelvic MRI at Osaka General Hospital between January 2016 and December 2016 were retrospectively examined. MRI of the levator ani muscle was evaluated. The MRI image blinded the patient information and was evaluated by a radiology specialist with 22 years of experience. In coronal T2-weighted MRI of the pelvis, the levator ani muscle was evaluated using the slice; it showed the most upward and downward convexity. We measured the thickness of the levator ani muscle, and the distance at the most convex part from a straight line connecting the origin and insertion of the levator ani muscle on both the left and right sides. Upward and downward convexity was recorded in positive and negative values, respectively. RESULTS The levator ani muscle was able to be evaluated quantitatively in all cases. Both men and women showed thinning (men: mean 3.316 mm, r = -0.388, P < 0.0001; women: mean 3.947 mm, r = -0.359, P < 0.0001) and concavity (men: mean 1.412 mm, r = -0.362, P < 0.0001; women: mean 4.979 mm, r = -0.630, P < 0.0001) of the levator ani muscle with aging. CONCLUSIONS A quantitative evaluation method for pelvic floor muscles using MRI was established. Aging was associated with morphological changes in the pelvic floor muscles in both men and women. Geriatr Gerontol Int 2019; 19: 834-837.
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Affiliation(s)
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kazuya Morimoto
- Department of Urology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Yukio Yoneda
- Department of Urology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Rikio Yoshimura
- Department of Urology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Tomoaki Tanaka
- Department of Urology, Osaka City University, Osaka, Japan
| | - Takeharu Katou
- Department of Radiology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
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Imamura M, Hudson J, Wallace SA, MacLennan G, Shimonovich M, Omar MI, Javanbakht M, Moloney E, Becker F, Ternent L, Montgomery I, Mackie P, Saraswat L, Monga A, Vale L, Craig D, Brazzelli M. Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials. BMJ 2019; 365:l1842. [PMID: 31167796 PMCID: PMC6549286 DOI: 10.1136/bmj.l1842] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To compare the effectiveness and safety of surgical interventions for women with stress urinary incontinence. DESIGN Systematic review and network meta-analysis. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials evaluating surgical interventions for the treatment of stress urinary incontinence in women. METHODS Identification of relevant randomised controlled trials from Cochrane reviews and the Cochrane Incontinence Specialised Register (searched May 2017), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Medline In-Process, Medline Epub Ahead of Print, CINAHL, ClinicalTrials.gov, and WHO ICTRP. The reference lists of relevant articles were also searched. Primary outcomes were "cure" and "improvement" at 12 months, analysed by means of network meta-analyses, with results presented as the surface under the cumulative ranking curve (SUCRA). Adverse events were analysed using pairwise meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool. The quality of evidence for network meta-analysis was assessed using the GRADE approach. RESULTS 175 randomised controlled trials assessing a total of 21 598 women were included. Most studies had high or unclear risk across all risk of bias domains. Network meta-analyses were based on data from 105 trials that reported cure and 120 trials that reported improvement of incontinence symptoms. Results showed that the interventions with highest cure rates were traditional sling, retropubic midurethral sling (MUS), open colposuspension, and transobturator MUS, with rankings of 89.4%, 89.1%, 76.7%, and 64.1%, respectively. Compared with retropubic MUS, the odds ratio of cure for traditional sling was 1.06 (95% credible interval 0.62 to 1.85), for open colposuspension was 0.85 (0.54 to 1.33), and for transobtrurator MUS was 0.74 (0.59 to 0.92). Women were also more likely to experience an improvement in their incontinence symptoms after receiving retropubic MUS or transobturator MUS compared with other surgical procedures. In particular, compared with retropubic MUS, the odds ratio of improvement for transobturator MUS was 0.76 (95% credible interval 0.59 to 0.98), for traditional sling was 0.69 (0.39 to 1.26), and for open colposuspension was 0.65 (0.41 to 1.02). Quality of evidence was moderate for retropubic MUS versus transobturator MUS and low or very low for retropubic MUS versus the other two interventions. Data on adverse events were available mainly for mesh procedures, indicating a higher rate of repeat surgery and groin pain but a lower rate of suprapubic pain, vascular complications, bladder or urethral perforation, and voiding difficulties after transobturator MUS compared with retropubic MUS. Data on adverse events for non-MUS procedures were sparse and showed wide confidence intervals. Long term data were limited. CONCLUSIONS Retropubic MUS, transobturator MUS, traditional sling, and open colposuspension are more effective than other procedures for stress urinary incontinence in the short to medium term. Data on long term effectiveness and adverse events are, however, limited, especially around the comparative adverse events profiles of MUS and non-MUS procedures. A better understanding of complications after surgery for stress urinary incontinence is imperative. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049339.
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Affiliation(s)
- Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sheila A Wallace
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Health Care Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mehdi Javanbakht
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Frauke Becker
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Laura Ternent
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Ash Monga
- University Hospitals Southampton Foundation Trust, Southampton, UK
| | - Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Mastwyk S, McClelland J, Rosamilia A, Frawley H. The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review. Neurourol Urodyn 2019; 38:1467-1481. [DOI: 10.1002/nau.24025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Sally Mastwyk
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourne Victoria Australia
| | - Jodie McClelland
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourne Victoria Australia
| | - Anna Rosamilia
- Department of Obstetrics and GynaecologyMonash UniversityClayton Victoria Australia
- Monash HealthClayton Victoria Australia
| | - Helena Frawley
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourne Victoria Australia
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The challenge of stress incontinence and pelvic organ prolapse: revisiting biologic mesh materials. Curr Opin Urol 2019; 29:437-442. [PMID: 31083010 DOI: 10.1097/mou.0000000000000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The present article reviews the history of mesh-related complications and regulations in SUI and POP repair settings, clinical outcomes associated with the use of biologic and synthetic mesh materials, and novel approaches using modified mesh materials. RECENT FINDINGS Treatment of pelvic floor disorders, such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) commonly involves implantation of synthetic surgical mesh materials like polypropylene. Many synthetic mesh materials, however, are associated with a foreign body response upon implantation, which is characterized by fibrotic encapsulation. Complications, including erosion, infections, bleeding, and chronic pain, have led to warnings by regulatory agencies and the recall of several mesh products. To mitigate such complications, biologic mesh materials have been proposed as alternatives for SUI and POP repair. SUMMARY Clinical outcomes of surgical repair of POP/SUI are similar between biologic and synthetic meshes, but biologic meshes have a lower incidence of adverse effects. Several strategies for modifying or functionalizing biological and synthetic meshes have shown promising results in preclinical studies.
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Nüssler E, Granåsen G, Nüssler EK, Bixo M, Löfgren M. Repair of recurrent rectocele with posterior colporrhaphy or non-absorbable polypropylene mesh-patient-reported outcomes at 1-year follow-up. Int Urogynecol J 2019; 30:1679-1687. [PMID: 30627830 PMCID: PMC6795632 DOI: 10.1007/s00192-018-03856-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022]
Abstract
Introduction and hypothesis The aim of this study was to compare the results of repair of isolated, recurrent, posterior vaginal wall prolapse using standard posterior colporrhaphy versus non-absorbable polypropylene mesh in a routine health care setting. Methods This cohort study was based on prospectively collected data from the Swedish National Register for Gynaecological Surgery. All patients operated for recurrent, posterior vaginal wall prolapse in Sweden between 1 January 2006 and 30 October 2016 were included. A total of 433 women underwent posterior colporrhaphy, and 193 were operated using non-absorbable mesh. Data up to 1 year were collected. Results The 1-year patient-reported cure rate was higher for the mesh group compared with the colporrhaphy group, with an odds ratio (OR) of 2.06 [95% confidence interval (CI) 1.03–4.35], corresponding to a number needed to treat of 9.7. Patient satisfaction (OR = 2.38; CI 1.2–4.97) and improvement (OR = 2.13; CI 1.02–3.82) were higher in the mesh group. However, minor surgeon-reported complications were more frequent with mesh (OR = 2.74; CI 1.51–5.01). Patient-reported complications and re-operations within 12 months were comparable in the two groups. Conclusions For patients with isolated rectocele relapse, mesh reinforcement enhances the likelihood of success compared with colporrhaphy at 1-year follow-up. Also, in our study, mesh repair was associated with greater patient satisfaction and improvement of symptoms, but an increase in minor complications. Our study indicates that the benefits of mesh reinforcement may outweigh the risks of this procedure for women with isolated recurrent posterior prolapse.
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Affiliation(s)
- Emil Nüssler
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, 90187, Umeå, Sweden.
| | - Gabriel Granåsen
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, 90187, Umeå, Sweden
| | - Emil Karl Nüssler
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, 90187, Umeå, Sweden
| | - Marie Bixo
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, 90187, Umeå, Sweden
| | - Mats Löfgren
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, 90187, Umeå, Sweden
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Abstract
Sexual dysfunction in women with prolapse and incontinence is well documented in the literature, but the impact of treatment, particularly surgical correction, remains very limited and confusing. Age, on the other hand, has been shown to be an independent risk factor for deteriorating sexual function, with all aspects of the sexual function (i.e. desire, arousal, penetration, and orgasm) being affected. When combined with surgical correction of prolapse or incontinence there is potential for further worsening of sexual function, and hence this should be assessed before any pelvic floor surgery and patient expectations established. In this article the current evidence will be reviewed looking at the impact of pelvic floor dysfunction on sexual function and the effect of commonly performed surgery for these problems. Ways and means of preserving sexual function in women undergoing corrective surgery will also be investigated.
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Affiliation(s)
- S Jha
- a Department of Urogynaecology , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
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Decisions to use surgical mesh in operations for pelvic organ prolapse: a question of geography? Int Urogynecol J 2018; 30:1533-1539. [PMID: 30343378 PMCID: PMC6706359 DOI: 10.1007/s00192-018-3788-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022]
Abstract
Introduction and hypothesis Surgical mesh can reinforce damaged biological structures in operations for genital organ prolapse. When a method is new, scientific information is often contradictory. Individual surgeons may accept different observations as useful, resulting in conflicting treatment strategies. Additional scientific information should lead to increasing convergence. Methods Based on data from the Swedish National Quality Register of Gynecological Surgery, all patients who underwent their first recurrent anterior compartment prolapse operation between 2006 and 2017 were included (2758 patients). Surgical mesh was used in 56.5%. We analyzed inter-county disparities in and patterns of mesh use over 12 years. To minimize confounding, we selected a group of highly comparable patients where similar decision patterns could be expected. Results The use of mesh differed between counties by a factor of 11 (8.6–95.3%). Counties with low use of mesh continued with low use and counties with high use continued with high use. Conclusions Decisions regarding how to interpret existing scientific information about mesh implants in the early years of mesh use have led to “communities of practice” highly influenced by geographical factors. For 12 years, these groups have made disparate decisions and upheld them without measurable change toward consensus. The scientific learning process has stopped—despite the abundance of new publications and the steady supply of new types of mesh. Ongoing disparity in surgeons’ choices in comparable patients has an adverse effect on clinical care. For the patient, this represents 12 years of a geographical lottery concerning whether mesh is used or not.
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A Hypothesis Generating the Mechanical Systems Underlying Posterior Vaginal Prolapse Based on Observed Displacements by Dynamic Magnetic Resonance Imaging. Female Pelvic Med Reconstr Surg 2018; 26:585-590. [PMID: 30239346 PMCID: PMC7458084 DOI: 10.1097/spv.0000000000000637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to analyze quantified displacements of the posterior vaginal wall (PVW) on dynamic magnetic resonance imaging (MRI), which may generate hypotheses for the detailed mechanisms that underlie the development of posterior vaginal prolapse.
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