Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison

Sacrospinous fixation versus uterosacral ligament suspension in managing apical prolapse

PURPOSE

To compare and assess the safety of two mesh-free surgical techniques in managing apical pelvic organ prolapse (POP); robot assisted/laparoscopic uterosacral ligament suspension (USLS) and vaginal sacrospinous ligament fixation (SSLF).

METHODS

We performed a retrospective review of 116 women with apical POP who underwent USLS (n = 61) or SSLF (n = 55) by a single surgeon. Demographic data including age, parity, previous POP surgery was recorded. A pre-operative pelvic floor questionnaire was used to identify prevalence of bladder, bowel and vaginal symptoms. POP Quantification system (POP-Q) scores were recorded at surgery and at post-operative reviews. The absolute change in POP-Q scores were recorded as objective measures of pelvic floor support. Other post-operative metrics used include the presence of vaginal bulge, need for repeat POP surgery (re-operation) and subjective improvement in symptoms based on a patient-reported outcome measures survey. Post-operative adverse events were recorded using the Clavien-Dindo grading scale. Multivariable logistical regression analysis was performed to predict factors for failure, re-operation and adverse events.

RESULTS

Baseline demographics were similar. Mean post-operative follow-up time was 24 months (USLS) and 18.5 months (SSLF). The difference in post-operative C point was not significant (USLS: median - 8 (IQR 2), SSLF: median - 7 cm (IQR 2)). Procedure success rates (post-operative C point < 0) were not different (USLS 90.2%, SSLF 92.5%). Re-operation rates for apical recurrence were similar between groups (SSLF 1.9%, USLS 6.6%). Univariate analysis for re-operation found that age, parity, and surgery type were not predictors of re-operation. The most common post-operative adverse event was urinary tract infection (USLS 10.2%, SSLF 10.5%).

CONCLUSION

Robot assisted/laparoscopic uterosacral ligament suspension and vaginal sacrospinous ligament fixation are safe and effective mesh-free techniques for management of apical pelvic organ prolapse based on objective improvements in POP-Q score and patient-reported outcome measures.

Erroneous and Incomplete Reporting of the Pelvic Organ Prolapse Quantification System

INTRODUCTION AND HYPOTHESIS

Accurate and complete reporting of the Pelvic Organ Prolapse Quantification (POP-Q) system is essential for reporting research outcomes in POP. We aimed to assess the accuracy and completeness of POP-Q reporting in studies published from selected journals in 2023 and evaluate the validity of available POP-Q calculators.

METHODS

A systematic search of Medline and Embase was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify eligible studies from selected journals in 2023 that utilised the POP-Q system. An assessment of available POP-Q calculators was also performed.

RESULTS

Of the 134 studies identified, 18 (13.4%) met the inclusion criteria. Twelve studies reported complete quantitative POP-Q data of which 9 (75%) contained identifiable POP-Q reporting errors. These included 5 studies reporting mean Aa > Ba, 2 reporting mean Ap > Bp, 6 reporting C > Bp, 5 reporting mean C > Ba, 1 reporting mean Aa > + 3, and 1 reporting mean D > C. The remaining 6 of the 18 studies reported incomplete POP-Q measurements, which restricted our ability to identify further reporting errors, except for 2 studies reporting C > Ba and C > Bp respectively. The evaluated POP-Q calculator permitted the input of inaccurate POP-Q data.

CONCLUSIONS

Erroneous and/or incomplete quantitative POP-Q data were identified in 15 of the 18 studies reviewed (83.3%). Our findings highlight the need for improved POP-Q data reporting. Journal editors and reviewers should ensure that publications provide complete and accurate quantitative POP-Q data. POP-Q calculators should be based on algorithms that ensure complete and accurate data inputs and outputs.

To mesh or not mesh "apical prolapse," that is the question!

AIMS

The management of pelvic organ prolapse (POP) involves both nonsurgical and surgical management. Views on best surgical approach for apical prolapse is an evolving field based on recent evidence and events related to transvaginal mesh.

METHODS

At the 97th Annual Meeting of the North Central Section of the American Urological Association (Scottsdale, AZ, USA), this topic was discussed and debated. The following article summarizes the concepts presented that day as well as the interactive debate with three perspectives on apical prolapse surgeries. The authors were asked to support their approach in various scenarios including: extremes of age, prior hysterectomy and intact uterus, desire to avoid mesh, sexual activity, and presence of comorbidities.

RESULTS

Surgical approaches for POP have evolved and is a popular topic for debate, particularly when discussing apical prolapse. Transvaginal native tissue repairs remain the mainstay of POP surgeries; however, transabdominal approaches continue to evolve. Use of interposition material, such as synthetic polypropylene mesh, is the standard when performing an abdominal sacrocolpopexy, however, use of autologous fascia can be considered. Small series have demonstrated the safety and efficacy of autologous fascia-based repairs; however, larger studies with longer follow-up are needed.

CONCLUSIONS

There are a variety of surgical strategies to repair POP. Ultimate decision making on specific surgeries should be determined by patient preference and goals after appropriate counseling on all options.

Modified Oxford technique of colpopexy for the treatment of uterine and vaginal vault prolapse: a retrospective pilot cohort study

INTRODUCTION

Pelvic organ prolapse is a common health issue that affects 30.8% of women. Laparoscopic sacrocolpopexy and colpopectopexy are two of the most common procedures to restore the pelvic anatomy. Mesh application on the other hand carries an increased complications risk over the short and long terms. The aim of this study is to provide a basis for meshless sacrocolpopexy and colpopectopexy.

METHODS

This study is a retrospective cohort pilot study that analyzed the data of patients with a pelvic organ prolapse according to the pelvic organ prolapse quantification system and underwent the modified technique for sacrocolpopexy and colpopectopexy. Descriptive statistics were used to express the different variables.

RESULTS

A total of 36 patients met the inclusion criteria and provided consent for the participation in this study. The majority of patients were postmenopausal. 22 out of 36 patients received a previous prolapse surgery. All patients presented with reducible vaginal lump. Dyspareunia and sexual dysfunction were the most commonly reported symptoms. The intraoperative complications rate was 0%. Only one patient had a postoperative persistent urinary retention that was managed medically.

DISCUSSION

Sacrocolpopexy and colpopectopexy seems to be a safe alternative to the mesh-based pelvic surgeries with a very low rate of intraoperative complications and favorable follow up outcomes.