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Ludwig S, Pfleiderer M, Püchel J, Amir-Kabirian C, Jeschke J, Ratiu D, Eichler C, Morgenstern B, Mallmann P, Radosa J, Thangarajah F. Comparison of Open Abdominal and Laparoscopic Bilateral Uterosacral Ligament Replacement: A One-Year Follow-Up Study. J Clin Med 2025; 14:1880. [PMID: 40142688 PMCID: PMC11942981 DOI: 10.3390/jcm14061880] [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: 02/07/2025] [Revised: 03/06/2025] [Accepted: 03/07/2025] [Indexed: 03/28/2025] Open
Abstract
Background: Pelvic organ prolapse significantly affects women's health, often requiring surgery. Unilateral sacrocolpopexy (SCP) is the gold standard for apical prolapse repair. However, varied SCP techniques can lead to inconsistencies in clinical outcomes, with differences in synthetic materials, mesh dimensions, placement, and apical tensioning. This variability may impact the comparability of clinical outcomes. Bilateral apical fixation has gained attention for its potential to provide effective apical support and restore anatomical integrity. Objective: To date there are not many studies on bilateral apical cervicosacropexy between the vaginal apex and the sacrum at the level of S1/promontory with one-year follow-up. Methods: This study presents a one-year follow-up comparing the clinical outcomes of open abdominal (CESA) and laparoscopic cervicosacropexy (laCESA) for bilateral apical suspension in women with pelvic floor disorders. A total of 145 women underwent either CESA (n = 75) or laCESA (n = 70) using a surgical technique with a designed polyvinylidene-fluoride (PVDF) mesh of defined shape replacing both uterosacral ligaments. Outcomes were efficacy, safety, and success rates of both surgical approaches in restoring apical vaginal support and pelvic floor functioning. Results: Both techniques demonstrated high efficacy of apical prolapse repair and a high level of safety. While comparable rates of urinary continence restoration were achieved, laCESA showed significant advantages in terms of operative time, hospital stay, and recovery time. Conclusions: These findings demonstrate the reproducibility of a surgical technique including clinical outcomes in the treatment of pelvic floor dysfunction. The standardization of mesh design and surgical methodology enhances reproducibility and may mitigate some of the variability associated with clinical outcomes in apical mesh fixation techniques.
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Affiliation(s)
- Sebastian Ludwig
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Mathieu Pfleiderer
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Jodok Püchel
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Constanze Amir-Kabirian
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Janice Jeschke
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital of Münster, University of Münster, 48149 Münster, Germany;
| | - Dominik Ratiu
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland;
| | - Christian Eichler
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Bernd Morgenstern
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Peter Mallmann
- Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany; (M.P.); (J.P.); (C.A.-K.); (C.E.); (B.M.)
| | - Julia Radosa
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany;
| | - Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, University Hospital of Essen, 45147 Essen, Germany;
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Degirmenci Y, Shehaj I, Alexa M, Klamminger GG, Schmidt MW, Hofmann K, Hasenburg A, Schwab R. Does Colpocleisis Still Hold Value? The Evolution of Apical Prolapse Surgery: A Comparative National Database Study. J Clin Med 2025; 14:1414. [PMID: 40094843 PMCID: PMC11899744 DOI: 10.3390/jcm14051414] [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: 02/05/2025] [Revised: 02/17/2025] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly affects quality of life. Obliterative surgery, such as colpocleisis, represents an alternative to reconstructive surgery with a historically established background. The trends in apical prolapse surgery have undergone substantial changes following FDA warnings. This study aims to analyze the trend of obliterative surgery within the context of apical POP surgery in the German healthcare system, considering global shifts, particularly following FDA warnings. Methods: A comprehensive analysis of in-patient data from the German Federal Statistical Office was carried out for the period between 2005 and 2021. The study included a total of 530,107 procedures, each classified by specific codes. Linear regression analysis was applied to identify and characterize trends in surgical patterns. Results: The trends in obliterative surgery showed a significant decline over the years (p < 0.001), particularly notable in older women. In contrast, a significant increasing trend was observed in the proportion of abdominal surgeries relative to the total number of procedures over time (p < 0.001), especially in the younger age group. Conclusions: Surgical trends over the specified timeframe highlight the notable evolution of POP management. Despite observed global fluctuations, obliterative surgery in Germany appeared to follow a declining trend in the changing mesh era, shaped by varying perspectives on the matter. The shifting global trend should be closely monitored and considered in urogynecological training.
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Affiliation(s)
- Yaman Degirmenci
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
| | - Ina Shehaj
- Department of Obstetrics and Gynecology, University of Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Matthias Alexa
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
| | - Gilbert Georg Klamminger
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
| | - Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
| | - Konstantin Hofmann
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (M.A.); (G.G.K.); (M.W.S.); (K.H.); (A.H.); (R.S.)
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Wilczak M, Chmaj-Wierzchowska K, Wójtowicz M, Kądziołka P, Paul P, Gajdzicka A, Jezierska K, Sujka W. Safety and Effectiveness of G-Mesh ® Gynecological Meshes Intended for Surgical Treatment of Pelvic Organ Prolapse-A Retrospective Analysis. J Clin Med 2024; 13:7421. [PMID: 39685878 DOI: 10.3390/jcm13237421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 11/08/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
Background: The prevalence of POP in women ranges from 30-40%, with 10-20% requiring surgical intervention. Annually, over 225,000 surgical procedures for POP are performed in the United States. The severity of prolapse is assessed using the four-stage POP-Q system, which facilitates clinical research by providing a standardized measure of defect severity. Surgical intervention is indicated for more severe cases, with various techniques available through vaginal or abdominal access. Synthetic meshes, primarily made of polypropylene (PP), are commonly used in POP surgeries due to their biocompatibility and mechanical support. This research aims to evaluate the effectiveness and safety of a non-resorbable, light polypropylene gynecological mesh (G-Mesh®, Tricomed S.A., Łódź, Poland) in the surgical treatment of pelvic floor prolapse in women. Methods: The meshes were implanted via laparoscopy (Dubuisson method) and laparotomy or transvaginally. A multicenter, retrospective study was conducted involving 81 patients aged 28-83. Results: The results collected at three follow-up visits indicated a high level of patient satisfaction, minimal discomfort, and no significant pain. Many patients emphasized significant improvement in quality of life and the lack of any adverse events associated with the presence of the implant. Conclusions: The G-Mesh® gynecological mesh has emerged as an effective and safe intervention for treating pelvic floor dysfunction in women, addressing conditions such as cystocele, rectocele, uterine prolapse, and ureterocele.
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Affiliation(s)
- Maciej Wilczak
- Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland
| | - Karolina Chmaj-Wierzchowska
- Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 60-701 Poznan, Poland
| | | | - Przemysław Kądziołka
- UROFEM Estetica Specialist Medical Practice, Kanclerska 2, 60-327 Poznan, Poland
| | - Paulina Paul
- Tricomed S.A., Świętojańska 5/9, 93-493 Lodz, Poland
| | | | | | - Witold Sujka
- Tricomed S.A., Świętojańska 5/9, 93-493 Lodz, Poland
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Degirmenci Y, Stewen K, Dionysopoulou A, Schiestl LJ, Hofmann K, Skala C, Hasenburg A, Schwab R. Trends in Urogynecology-Transvaginal Mesh Surgery in Germany. J Clin Med 2024; 13:987. [PMID: 38398300 PMCID: PMC10889587 DOI: 10.3390/jcm13040987] [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: 12/19/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Pelvic organ prolapse constitutes a prevalent condition associated with a considerable impact on the quality of life. The utilization of transvaginal mesh surgery for managing POP has been a subject of extensive debate. Globally, trends in TVM surgery experienced significant shifts subsequent to warnings issued by the FDA. METHODS This study aims to explore temporal patterns in transvaginal mesh surgery in the German healthcare system. A comprehensive analysis was conducted on in-patient data from the German Federal Statistical Office spanning 2006 to 2021. A total of 1,150,811 operations, each associated with specific codes, were incorporated into the study. Linear regression analysis was employed to delineate discernible trends. RESULTS The trends in transvaginal mesh surgery within the anterior compartment exhibited relative stability (p = 0.147); however, a significant decline was noted in all other compartments (posterior: p < 0.001, enterocele surgery: p < 0.001). A subtle increasing trend was observed for uterine-preserving transvaginal mesh surgery (p = 0.045). CONCLUSION Surgical trends over the specified timeframe demonstrate how POP management has evolved globally. Notably, despite observed fluctuations, transvaginal mesh surgery remains a viable option, particularly for specific cases with a high risk of relapse and contraindications to alternative surgical approaches.
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Affiliation(s)
- Yaman Degirmenci
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (K.S.); (A.D.); (L.J.S.); (K.H.); (C.S.); (A.H.); (R.S.)
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