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Carracedo Calvo D, Pereira Rodriguez N, Moscatiello P, Jerez Izquierdo T, Meilán Hernández E, Toledo Jimenez M, Hernández Bermejo I, Gimbernat Diaz H, Sánchez Encinas M. Robotic sacrocolpopexy for the treatment of pelvic organ prolapse in elderly women: comparative analysis of safety and efficacy versus younger women. Actas Urol Esp 2024:S2173-5786(24)00072-6. [PMID: 38740262 DOI: 10.1016/j.acuroe.2024.05.012] [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: 02/06/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Pelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. METHOD A prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. RESULTS Among the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. CONCLUSION Robotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.
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Affiliation(s)
| | | | - P Moscatiello
- Hospital Universitario Rey Juan Carlos, Madrid, Spain
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Malekzadeh M, Ramirez-Caban L, Garcia-Ruiz N, Ossin DA, Hurtado EA. Effect of age in women undergoing laparoscopic sacrocolpopexy: A retrospective study. Int J Gynaecol Obstet 2024; 164:1117-1124. [PMID: 37794775 DOI: 10.1002/ijgo.15164] [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: 06/18/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To determine whether elderly women (≥65 years) have an increased risk of complications and lower success when undergoing laparoscopic sacrocolpopexy (LSC) compared with younger women (<65 years). METHODS This was a retrospective study of all LSC procedures performed from August 2014 to February 2021 by a single urogynecologic surgeon in an academic affiliated hospital system. Charts were identified through procedure codes. Patient demographics, clinical, surgical, and postoperative data were collected. The primary outcome of this study was to compare complications associated with LSC, including intraoperative and postoperative complications. Secondary outcomes included subjective, objective, and composite success. RESULTS In total, 312 participants met the criteria. The mean age of the group who were younger than 65 years was 55.7 years (±6.5) and of the group aged 65 years or older was 69.3 years (±3.5). Racial demographics revealed no differences between the two groups. Patients aged 65 years or older had a statistically significant lower body mass index (calculated as weight in kilograms divided by the square of height in meters), a higher rate of hypertension, smaller genital hiatus, and a larger anterior vaginal wall prolapse compared with the younger cohort. They also less often underwent a posterior repair. No statistically significant differences were found with regards to intraoperative and postoperative complications, including 30-day re-admission, between the two age groups. Both groups had high anatomic success rates, with no significant difference (<65 = 96.3%; ≥65 = 98.4%; P = 0.326). Those aged younger than 65 years compared with those aged 65 years or older had lower subjective success that was not significantly different (<65 = 62.8%; ≥65 = 71.0; P = 0.134). Composite success was noted to reach the threshold of a statistically significant difference in the group aged younger than 65 years compared with those aged 65 years or older (60.1% vs 71.0%; P = 0.0499). CONCLUSION In this study, elderly patients did not have increased intraoperative and postoperative complications after undergoing LSC. Similar rates of anatomic and subjective success were also found with younger patients having a lower composite success. Proper candidates for LSC should not be excluded based upon age.
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Affiliation(s)
| | | | - Nuria Garcia-Ruiz
- Department of Gynecology, Stanford Medicine, Pleasanton, California, USA
| | - David A Ossin
- Department of Gynecology, HCA Florida Women's Health Group, Orlando, Florida, USA
| | - Eric A Hurtado
- Department of Gynecology, Cleveland Clinic Florida, Weston, Florida, USA
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Khalil N, Moubarak M, Alkassis M, Kassis N, Moukarzel M, Atallah D. Long term follow-up after minimally invasive sacrocolpopexy. Int Urogynecol J 2022:10.1007/s00192-022-05430-z. [PMID: 36576540 DOI: 10.1007/s00192-022-05430-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a benign condition that can adversely affect women's quality of life. Minimally invasive mesh sacrocolpopexy is an effective surgical treatment for POP. This study aims to assess the perioperative, postoperative, and long term (10 years) outcome of a single institution cohort undergoing minimally invasive sacrocolpopexy. METHODS This retrospective study included all cases of laparoscopic sacrocolpopexy performed between 2003 and 2016. Patients were contacted by phone in 2022 for long term follow-up. Data on operative time, length of hospital stay, conversion rate, perioperative injuries, early and late postoperative complications and subjective success rates were collected. RESULTS Ninety-five patients were included aged 60±12 years. Most patients (72%) presented grade 3 POP. Grade of prolapse (3±0.4 vs 3±0.5, p<0.01) and hospital stay (3±1.1 vs 3.1±1.7; p<0.01) were significantly higher in patients who developed early postoperative complications (1st year). At long term follow-up (12±3 years), 48 patients responded. Nine subjects (19%) presented a subjective recurrence with bulge symptoms. Surgery satisfaction was of 79%. The most frequent de novo reported symptom was urge urinary incontinence followed by stress urinary incontinence. Three cases (3%) of mesh erosion were described, all occurred after the 5th postoperative year. CONCLUSIONS Laparoscopic mesh sacrocolpopexy is a safe surgical technique that shows satisfying and consistent long-term results despite the occasional onset of new urinary symptoms.
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Affiliation(s)
- Nour Khalil
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon.
| | - Malak Moubarak
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon.,Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen Mitte, Essen, Germany
| | - Marwan Alkassis
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon
| | - Nadine Kassis
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon
| | - Maroun Moukarzel
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon
| | - David Atallah
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon
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Comparison of first versus second line sacrocolpopexies in terms of morbidity and mid-term efficacy. Sci Rep 2022; 12:16283. [PMID: 36175515 PMCID: PMC9522651 DOI: 10.1038/s41598-022-20127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
To compare pelvic organ prolapse (POP) recurrence and morbidity between first and second line sacrocolpopexies. We conducted a retrospective chart review of all laparoscopic or robotic sacrocolpopexies for POP-Q stage ≥ 2, with or without a history of previous prolapse repair, performed with a similar technique between January 2012 and June 2019 in 3 European Gynecologic Surgery Departments. Patients were separated into two groups: first line sacrocolpopexy (FLS) and second line sacrocolpopexy (SLS). Each patient from the SLS group was age-matched with a patient from the FLS group. The primary outcome measure was reoperation procedures for recurrent POP defined as a symptomatic POP-Q stage ≥ 2 POP in at least one vaginal compartment. Secondary outcomes included operative time, intraoperative organ trauma, intraoperative blood loss, postoperative POP recurrence (operated on or not), global reoperation and mesh-related complications. During this period, 332 patients were included. After age-matching, 170 patients were analyzed: 85 patients in the FLS and SLS groups, respectively. After a mean follow-up of 3 years, there was no statistically significant difference between the two groups in terms of recurrent POP (9.4% versus 10.6%, p = 0.7), recurrent POP reoperation (3.5% versus 5.9% p = 0.7), mesh-related reoperation (0% versus 2.4%, p = 0.5), global reoperation (3.5 versus 8.2%, p = 0.3), operative time (198 ± 67 min versus 193 ± 60 min, p = 0.5), intraoperative complications such as organ injury (4.7% versus 7.1%, p = 0.7) and blood loss > 500 mL (2.4% versus 0%, p = 0.5). Patients who underwent a first or a second line sacrocolpopexy seemed to have similar rates of prolapse recurrence and complications.
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Gluck O, Rusavy Z, Grinstein E, Abdelkhalek Y, Deval B. Effect of Age on Complications Rate and Surgical Outcomes in Women Undergoing Laparoscopic Sacrohysteropexy and Sacrocolpopexy. J Minim Invasive Gynecol 2022; 29:753-758. [PMID: 35123043 DOI: 10.1016/j.jmig.2022.01.017] [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: 12/10/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To compare perioperative and long-term outcomes of laparoscopic sacrohysteropexy/sacrocolpopexy in different groups of age. DESIGN This was a retrospective cohort study. Patients were evaluated preoperatively and postoperatively (starting from 1 month after surgery, and then annually). SETTING The department of functional pelvic surgery & oncology a tertiary care center. PATIENTS All patients who underwent laparoscopic sacrohysteropexy/sacrocolpopexy, between July 2005 and December 2019 INTERVENTIONS: laparoscopic sacrohysteropexy/sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS The study population was divided into three groups, according to age at time of surgery: group 1- < 65, group 2- between 65-75, and group 3- > 75. The primary outcome was the rate of perioperative complications. The secondary outcome was the comparison of long-term results between the groups. Three hundred and thirty patients were included: 183 in group 1 (mean age 53.4±8.2), 92 patients in group 2 (mean age 69.2±2.9), and 55 patients in group 3 (mean age 79.3±.5). The overall perioperative complications rate (up to 30 days after surgery) was 5.7%. No differences between the groups in operative details and rates of perioperative complications were observed. During follow up period, 37 patients (11.2%) presented with prolapse recurrence (objective and/or subjective), the rates of prolapse recurrence, as well as long-term complications, were similar between the groups. Similarly, the groups did not differ in postoperative functional results except for postoperative stress urinary incontinence. A surgery for stress urinary incontinence was more common among patients in group 3 (group 1- 13.4%, group 2- 11.9%, group 3- 31.3%, p=.008). CONCLUSION Laparoscopic sacrohysteropexy/sacrocolpopexy is associated with low rates of perioperative and long- term complications. We did not find a difference in rates of complications and/ or long-term outcomes, between different age groups.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France.
| | - Zdenek Rusavy
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
| | - Ehud Grinstein
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
| | - Yara Abdelkhalek
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
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Salman S, Kumbasar S, Yeniocak AS. Uterine preserving technique in the treatment of pelvic organ prolapse: Laparoscopic pectopexy. J Obstet Gynaecol Res 2022; 48:850-856. [PMID: 35001452 DOI: 10.1111/jog.15146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/28/2021] [Accepted: 12/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Apical prolapse constitutes an important part of pelvic organ prolapse. In this study, our aim was to investigate the effectiveness of laparoscopic pectopexy that we made by preserving the uterus in the surgical treatment of apical prolapse. METHODS A total of 36 patients with apical prolapse who wanted to preserve their uterus underwent laparoscopic rectopexy. Apical prolapse and sexual function of the patients were evaluated preoperatively and 12 months after surgery using the Pelvic Organ Prolapse Quantification (POP-Q) scale and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) sexual questionnaire form. Preoperative medical records and postoperative clinical results were recorded. RESULTS There were no intraoperative or postoperative complications in the patients who underwent laparoscopic pectopexy. The average duration of surgery was 48.7 ± 9.8 min. Two patients had a recurrence of apical prolapse. In the Aa, Ba, C, and D points in the POP-Q staging, significant changes were observed. Postoperative PISQ-12 scores improved significantly (p < 0.05). CONCLUSION Uterine-preserving laparoscopic pectopexy is a safe, feasible, and effective method for treating pelvic organ prolapse. It also improved the PISQ-12 and POP-Q scores in POP patients. Laparoscopic pectopexy may increase a surgeon's technical perspective for pelvic organ prolapse surgery.
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Affiliation(s)
- Süleyman Salman
- Department of Obstetrics and Gynecology, Gazi Osman Paşa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Serkan Kumbasar
- Department of Obstetrics and Gynecology, Gazi Osman Paşa Taksim Research and Education Hospital, Istanbul, Turkey
| | - Ali S Yeniocak
- Department of Obstetrics and Gynecology, Başakşehir Çam ve Sakura Research and Education Hospital, Istanbul, Turkey
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Sato H, Abe H, Ikeda A, Miyagawa T, Sato K, Tsukada S. Laparoscopic sacrocolpopexy for pelvic organ prolapse in the elderly: safety and outcomes. J OBSTET GYNAECOL 2022; 42:110-115. [PMID: 33890540 DOI: 10.1080/01443615.2020.1867968] [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: 12/14/2022]
Abstract
Due to its low postoperative complication rate, vaginal surgery is the preferred intervention for pelvic organ prolapse (POP) in elderly patients. We aimed to assess outcomes and perioperative complication rates associated with laparoscopic sacrocolpopexy (LSC) in elderly women. We retrospectively reviewed the medical records of 74 consecutive patients [52 (70.3%) aged <75 years; 22 (29.7%) aged ≥75 years] with POP who underwent LSC between August 2015 and December 2017. We evaluated preoperative risks using the Charlson Comorbidity Index (CCI) and complications, using the Clavien-Dindo grading (CDG). No between-group differences were observed in CCI. CDG indicated fewer perioperative complications in patients aged >75 years. Anatomical success rates at 15 months were 95.5% and 90.4% in patients aged ≥75 and <75 years, respectively. LSC has a high anatomical correction rate and few perioperative complications regardless of age. Thus, the appropriate surgical intervention method would depend on the patient's health and comorbidities.IMPACT STATEMENTWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) is a superior method to vaginal surgery because of its anatomical and functional outcomes, particularly regarding sexual activity.What do the results of this study add? In this single-center study with a 15-month follow-up, we demonstrated that LSC has a high anatomical correction rate and few perioperative complications regardless of age at the time of surgery. Furthermore, there was no significant difference in the rate of complications between the ≥75 and <75 years groups. Thus, LSC may be considered for women aged >75 years. However, in these elderly patients, the surgical method should be determined according to their health status and medical comorbidities.What the implications are of these findings for clinical practice and/or further research? Age should not be the basis for exclusion from laparoscopic procedures. Moreover, LSC is a suitable and valid option for elderly women with POP. As the study population consisted of a homogenous group of Japanese women, it lacks generalisability. Studies evaluating these outcomes are required in other populations.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi, Medical University Saitama Medical Center, Saitama, Japan
| | - Katsuhiko Sato
- Department of Urology, Eastern Oomiya Medical Center, Saitama, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Rebahi C, Cardaillac C, Cosson M, Fernandez H, Hermieu JF, Estrade JP, Winer N, Dochez V, Thubert T. National survey of surgical practices: Sacropexy in France in 2019. Int Urogynecol J 2020; 32:975-991. [PMID: 32918592 DOI: 10.1007/s00192-020-04526-8] [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: 06/19/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sacropexy is a reference surgical treatment for pelvic organ prolapse in women. The great variability in surgical techniques for this procedure is a source of bias that complicates analysis of the results of trials assessing it. Using the French guidelines issued in 2016 by the SCGP, AFU, SIFUD-PP, and CNGOF as a reference, we sought to inventory the surgical practices of the surgeons who perform these procedures. METHODS In November 2018, a questionnaire about the technical aspects of this procedure was distributed by email to the French physicians performing it. It was distributed to members of several professional societies (CNGOF, SCGP, and SIFUD) and to gynecologists practicing in clinics owned by the ELSAN group. RESULTS Of the 273 responders, 92% reported that they perform most operations laparoscopically. Overall, 83% of gynecologic surgeons used polypropylene prostheses (mesh); 38% routinely placed a posterior mesh, while the rest did so only in cases of clinical rectocele with anorectal symptoms. A concomitant hysterectomy was performed by 51% of respondents when the uterus was bulky and/or associated with substantial uterine prolapse. Finally, half the surgeons suggested the placement of a suburethral sling for women with stress urinary incontinence. CONCLUSIONS Although practices are largely consistent with the most recent guidelines, surgical techniques vary widely between surgeons, both in France and internationally.
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Affiliation(s)
- Christie Rebahi
- Service de gynécologie et d'obstétrique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Claire Cardaillac
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France
| | - Michel Cosson
- Service de chirurgie gynécologique de Lille, Hopital Jeanne De Flandre, Lille, France
| | - Hervé Fernandez
- Département de gynécologie et d'obstétrique, AP-HP, GHU-Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Jean-Francois Hermieu
- Service d'urologie, Hôpital Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot, 46, rue Henri Huchard, 75018, Paris, France
| | - Jean-Philippe Estrade
- Service de gynécologie obstétrique, Gyneco Marseille Saint-Giniez, Marseille, France
| | - Norbert Winer
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France
| | - Vincent Dochez
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France
| | - Thibault Thubert
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France.
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Togo M, Kitta T, Kanno Y, Ouchi M, Tokiwa S, Huang T, Moriyama S, Nomura J, Moriya K, Shinohara N. Lower urinary tract function improves after laparoscopic sacrocolpopexy for elderly patients with pelvic organ prolapse. Low Urin Tract Symptoms 2020; 12:260-265. [DOI: 10.1111/luts.12313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine Hokkaido University Sapporo Japan
- Urogynaecology Unit Kameda Medical Center Kamogawa Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Shino Tokiwa
- Urogynaecology Unit Kameda Medical Center Kamogawa Japan
| | - Tingwen Huang
- Urogynaecology Unit Kameda Medical Center Kamogawa Japan
| | | | - Jimmy Nomura
- Urogynaecology Unit Kameda Medical Center Kamogawa Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine Hokkaido University Sapporo Japan
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Sato H, Abe H, Ikeda A, Miyagawa T, Sato K. Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse. J OBSTET GYNAECOL 2020; 41:128-132. [PMID: 32148120 DOI: 10.1080/01443615.2020.1724914] [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] [Indexed: 10/24/2022]
Abstract
Evidence on laparoscopic sacrocolpopexy (LSC) is lacking. Herein, we describe the complications and outcomes of LSC. This single-centre, retrospective cohort study included women with pelvic organ prolapse (POP) who underwent LSC between 2015 and 2017. Preoperative, intraoperative, postoperative, and demographic data were collected. We evaluated patients using the Pelvic Organ Prolapse Quantification system and questionnaires. The primary outcomes were operative characteristics, perioperative complications, early postoperative complications, and anatomical results at 12 months. Forty-six patients (median age: 71 years) underwent LSC. The median follow-up period was 12.0 ± 5.0 (range: 11-26) months. The perioperative complications were bladder perforation and vaginal injury (2.2%). Two (4.3%) patients required reoperation for port-site hernia. One (2.2%) patient developed a retroperitoneal abscess, and one (2.2%) had worsened stress urinary incontinence after LSC. Three (6.5%) patients presented with recurrence of prolapse. LSC is safe and effective for POP.IMPACT STATEMENTWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) has become a widely used intervention strategy during the last decade; nevertheless, few studies have reported its outcomes and complications.What do the results of this study add? We demonstrate that LSC for pelvic organ prolapse (POP) has favourable anatomical and voiding functional results, and few perioperative complications. However, it is important to preoperatively inform patients regarding the incidence of mesh-related postoperative complications, although they are not life-threatening, and secure their informed consent.What are the implications of these findings for clinical practice and/or further research? We believe that the LSC procedure, because of its short-term and functional outcomes in the lower urinary tract discussed here, will be more commonly available in clinical practice as a feasible and safe surgical option for POP. However, prospective, large-sample studies should be performed to verify the efficacy of LSC, as further evaluation of the procedure is required.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi, Medical University Saitama Medical Center, Saitama, Japan
| | - Katsuhiko Sato
- Department of Urology, Eastern Oomiya Medical Center, Saitama, Japan
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Kalis V, Smazinka M, Rusavy Z, Blaganje M, Havir M, Havelkova L, Ismail K. Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study. Eur J Obstet Gynecol Reprod Biol 2019; 244:60-65. [PMID: 31747633 DOI: 10.1016/j.ejogrb.2019.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES The primary aim of this study was to assess the clinical feasibility of a policy where laparoscopic sacrocolpopexy (LSC) is the default procedure for the management of a significant apical pelvic organ prolapse (a-POP). As a secondary aim, we wanted to evaluate LSC outcomes in relation to women's preoperative assessment of their surgical fitness using the American Society of Anesthesiologists physical status (ASA-PS) categorization. DESIGN Retrospective cohort study. SETTING A university affiliated urogynecology center. METHODS All women with symptomatic a-POP (C ≥ -1) who attended the urogynecology clinic between the 1st of January and the 31st of December 2016 and had their surgery by the 31st of May 2017 were included in the study. In our unit, routine follow-up appointments are arranged at 3 and 12 months post LSC. INTERVENTIONS Perioperative and mesh-related complications were assessed based on the Dindo-Clavien and IUGA/ICS classifications respectively. The preoperative outcome measures included Pelvic Organ Prolapse Quantification (POP-Q) stage, Pelvic Floor Distress Inventory (PFDI) and ASA-PS score. At follow-up women were asked to complete a PFDI, Patient Global Impression of Improvement (PGI-I), had their POP-Q staging and ultrasonographic assessment of mesh position and placement. The above measures are routinely collected as part of our standard practice. A preoperative ASA-PS score of <3 was used as a cut-off to dichotomies participants into low and high risk. MAIN RESULTS A total of 220 women attended our center during the study period because of POP. Of these, 146 women were diagnosed with a significant a-POP and 142 (97.2 %) women opted for a surgical repair. Of the 142 women, 128 (90.1 %) were deemed suitable for a type of LSC and 121 had their surgery before the 31st of May 2017. There were no statistically significant differences in any of our collected perioperative, clinical, patient reported or ultrasonographic outcome measures when comparing women with ASA-PS scores of <3 or ≥3. CONCLUSION In a specialized urogynecology healthcare setting, it is feasible and safe to rely on LSC as the mainstay surgical procedure for the repair of a significant a-POP. However, it is imperative to ensure that technical skills and equipment requirements are fulfilled and maintained.
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Affiliation(s)
- Vladimir Kalis
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Martin Smazinka
- Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Zdenek Rusavy
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Mija Blaganje
- Divison of Gynecology, University Medical Centre Ljubljana, Slovenia
| | - Martin Havir
- Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Linda Havelkova
- New Technologies - Research Centre, University of West Bohemia, Czech Republic
| | - Khaled Ismail
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
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Szymczak P, Grzybowska ME, Wydra DG. Comparison of laparoscopic techniques for apical organ prolapse repair - a systematic review of the literature. Neurourol Urodyn 2019; 38:2031-2050. [PMID: 31452267 DOI: 10.1002/nau.24115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/05/2019] [Indexed: 11/10/2022]
Abstract
AIMS Apical defect is a pelvic organ prolapse disorder, with 5%-15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). METHODS A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. RESULTS A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP-Q < II stage) was 77%-100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%-97.6%, 71.0%-100%, 66.7%-87.8%, and 95%-95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%-12.8%. CONCLUSIONS Most studies reported anatomical and subjective outcomes, with follow-up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery.
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Affiliation(s)
- Paulina Szymczak
- Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
| | - Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
| | - Dariusz Grzegorz Wydra
- Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
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Vossaert K, Housmans S, Pacquée S, Callewaert G, Cattani L, Van der Aa F, Wolthuis A, D’hoore A, Roelandt P, Deprest J. Laparoscopic sacrocolpopexy is as safe in septuagenarians or elder as in younger women. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s10397-018-1043-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Data concerning laparoscopic sacrocolpopexy (LSCP) in elder women are scarce. We compared intra-operative and early-postoperative complications associated with laparoscopic colpo-, cervico-, or hysteropexy in women under and above 70 years.
Methods
Retrospective assessment by an independent investigator of a prospective cohort of 571 consecutive women undergoing LSCP in a tertiary unit over an 18-year period. Data included were patient demographics, operative variables, intra-operative, and early (≤ 3 months) postoperative complications. Complications were graded according to the Clavien-Dindo classification and mesh complications categorized using the International Urogynaecological Association (IUGA)-classification.
Findings
Median age was 66 (IQR 15, range 27-91) and 204 (35.7%) patients were older than 70 years. There were no deaths. Strategic conversion rate was 2.3% (13/571), the majority because of extensive adhesions yet early in our experience. Reactive conversion rate was 0.7% (4/571). Among 554 patients who had a completed LSCP, there were 20 intra-operative complications (3.6%), mostly bladder (1.3%) and vaginal (1.1%) injuries. Eighty-four patients had a total of 95 early-postoperative Dindo ≥ II complications (15.1%). Most common complications were infectious and treated medically (Dindo II). Clinically major complications are rare (III = 3.1% and IV = 0.2%). Reoperation for suspected bleeding (IIIb = 0.7%) was the most common reintervention, typically without demonstrable cause. Most mesh complications were vaginal exposures. Septuagenarians were not more likely to have an intra-operative (4.0 vs 3.3% < 70 years, p = 0.686) or early-postoperative complication (13.6 vs 16.0% < 70 years, p = 0.455) than younger patients. Mesh complications were also equally uncommon.
Conclusions
LSCP is as well-tolerated by women above 70 years as by younger women.
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Vidal F, Léonard F, André B, Guerby P, Jourdain O. Comparative mid-term anatomical and functional outcomes following laparoscopic sacrocolpopexy in women under and over 65: results from a prospective study. Arch Gynecol Obstet 2018; 297:1465-1472. [PMID: 29546565 DOI: 10.1007/s00404-018-4738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/04/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare mid-term anatomical and functional outcomes following laparoscopic sacrocolpopexy (LS) between women under and over 65. METHODS Prospective and observational study involving patients with symptomatic pelvic organ prolapse (POP) undergoing LS. Study population was stratified according to patients' age at the time of surgery. POP symptoms and impact on quality of life were assessed by PFIQ-7 and PFDI-20 questionnaires at baseline and during follow-up. RESULTS Among our study population (n = 72), 26 women were over 65 and 46 under 65. Mean follow-up duration was 17.6 months, and complete follow-up was available in 90% of patients. No differences between study groups were observed regarding surgery duration, length of stay, and peri-operative complications. Recurrence rate was 1.4% at 18 months of follow-up. Questionnaires analysis revealed a significant improvement in PFIQ-7 and PFDI-20 scores. We found no differences in post-operative scores between control and elderly groups. Sixteen patients experienced de novo stress urinary incontinence (22.2%), with no difference between groups (p = 0.7). Among them, seven required surgical management. CONCLUSIONS LS was associated with high anatomical success rate and good functional outcomes, regardless of age at the time of surgery. LS should thus be considered in women over 65. Beyond age, the route of surgery should be driven by patient's choice and medical condition.
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Affiliation(s)
- Fabien Vidal
- CHU Purpan, hôpital Paule de Vigiuier, 330 avenue de Grande bretagne, 31059, Toulouse, France.
- Université Paul Sabatier, 118 route de Narbonne, 31062, Toulouse, France.
| | - Franck Léonard
- Centre Hospitalier de Cahors, 335 rue Président Wilson, 46000, Cahors, France
| | - Benoit André
- Université Paul Sabatier, 118 route de Narbonne, 31062, Toulouse, France
- CHU Rangueil, service de chirurgie générale et gynécologique, 1 avenue du professeur Jean Poulhès, 31059, Toulouse, France
| | - Paul Guerby
- CHU Purpan, hôpital Paule de Vigiuier, 330 avenue de Grande bretagne, 31059, Toulouse, France
- Université Paul Sabatier, 118 route de Narbonne, 31062, Toulouse, France
| | - Olivier Jourdain
- Polyclinique Jean Villar, 28 avenue Maryse Bastié, 33523, Bruges, France
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15
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Allègre L, Abdirahman S, Hedde A, Fatton B, de Tayrac R. [Could we perform vaginal mesh surgery for treatment of pelvic organ prolapse in elderly women?]. Prog Urol 2018; 28:221-229. [PMID: 29339140 DOI: 10.1016/j.purol.2017.12.010] [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: 10/08/2017] [Revised: 12/10/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Prevalence of pelvic organ prolapse will increase with the aging of the population. Concerning the treatment of pelvic organ prolapse, transvaginal route is often preferred for elderly women. However few data are available concerning transvaginal mesh surgery in this population. The aim of this study was to compare efficiency and complications of transvaginal mesh surgery between women aged over 75 and younger women. MATERIALS AND METHODS A monocentric, retrospective study included all women who underwent anterior sacrospinous suspension with mesh for treatment of pelvic organ prolapse. The primary endpoint was anatomical success at the last follow-up, defined by a pelvic organ prolapse stage 0 or 1 of POP-Q classification. The secondary endpoints were rate of complications and urinary, colorectal and sexual functional results. RESULTS We included 329 patients, 69 were under 75 years old and 260 were aged over 75. The median of follow-up was 12 months (IQR: 6). The rate of anatomical success was significantly higher in patients aged over 75: 92% versus 85% in younger patients (P=0.02). However this difference was no more significant in multivariate analysis after inclusion of confusions factors (P=0.82). The rate of perioperative complications was low and similar in the 2 groups even in multivariate analysis. CONCLUSION Utero-vaginal suspension using bilateral vaginal anterior sacrospinous fixation with mesh seems to achieve at least similar results between women aged more than 75 years and younger women. There is no excess risk of complications in elderly women. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- L Allègre
- Service de gynécologie obstétrique, CHU de Nîmes, place du Professeur-Robert-Debré, 30900 Nîmes, France.
| | - S Abdirahman
- Service de gynécologie obstétrique, CHU de Nîmes, place du Professeur-Robert-Debré, 30900 Nîmes, France
| | - A Hedde
- Service de gynécologie obstétrique, CHU de Nîmes, place du Professeur-Robert-Debré, 30900 Nîmes, France
| | - B Fatton
- Service de gynécologie obstétrique, CHU de Nîmes, place du Professeur-Robert-Debré, 30900 Nîmes, France
| | - R de Tayrac
- Service de gynécologie obstétrique, CHU de Nîmes, place du Professeur-Robert-Debré, 30900 Nîmes, France
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