Does menopausal status impact urinary continence outcomes following abdominal sacrocolpopexy without anti-incontinence procedures in continent women?

Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital

Objectives

To evaluate the complications of apical prolapse correction with abdominally placed mesh and to assess the long-term efficacy of Sacrohysteropexy and Sacrocolpopexy.

Method

A retrospective cohort study was conducted at the Department of Gynecology and Obstetrics, Aga Khan University Hospital. All women who underwent apical prolapse surgery using abdominal mesh from January 2010 to December 2019 at AKUH were included. Patients with missing routine follow up visits and incomplete data up to one year post op were excluded. Patient notes were reviewed, and subjective and objective success and complications were analyzed. Safety was measured by incidence of intra, early and late postoperative complications and mesh-related complications of both procedures at two weeks, six months, twelve months, postoperatively.

Results

A total of 69 cases were retrieved from the database with a mean age of 46.97 ± 13.86 years. It was found that 14 (20.3%) patients had wound infection while six (8.7%) patients developed urinary tract infections. In a median follow-up of 12 months, three patients developed mesh erosion as a complication, with an incidence of 4.3%. Two required surgical excision of the mesh and the third was successfully managed conservatively with topical estrogen and oral antibiotics. Extremely significant improvements were observed in POPDI-six scores six months postoperatively (p=0.0001).

Conclusion

The present study signifies the use of abdominally placed mesh in patients with pelvic organ prolapse indicating significant improvement in Pelvic Organ Prolapse-associated symptoms postoperatively.

A web-based fuzzy risk predictive-decision model of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery

Background:

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions affecting women's health and quality of life. In 50% of cases, SUI occurs after POP surgery, which is called de novo SUI. Predicting the risk of de novo SUI is a complex multi-attribute decision-making process. The current study made available a Decision Support System in the form of a fuzzy calculator web-based application to help surgeons predict the risk of de novo SUI.

Materials and methods:

We first identified 12 risk factors and the diagnostic criteria for de novo SUI by means of a systematic review of the literature. Then based upon an expert panel, all risk factors were prioritized. A set of 232 fuzzy rules for the prediction of de novo SUI was determined. A fuzzy expert system was developed using MATLAB software and Mamdani Inference System. The risk prediction model was then evaluated using retrospective data extracted from 30 randomly selected medical records of female patients over the age of 50 without symptoms of urinary incontinence who had undergone POP surgery. Finally, the proposed results of the predictive system were compared with the results of retrospective medical record data review.

Results:

The results of this online calculator show that the accuracy of this risk prediction model, at more than 90%, compared favorably to other SUI risk prediction models.

Conclusions:

A fuzzy logic-based clinical Decision Support System in the form of an online calculator for calculating SUI prognosis after POP surgery in women can be helpful in predicting de novo SUI.

Experience in application of modified sling in treatment of Moderate Stress Urinary Incontinence

Objective

To observe the clinical significance of modified sling in the treatment of moderate stress urinary incontinence (SUI).

Methods

From January 2016 to January 2019, eighty patients with moderate urinary incontinence who were hospitalized in our hospital were randomly divided into two groups. 40 patients in the experimental group underwent modified sling transvaginal tension-free mid-urethral suspension. Modification method of the sling: cut the sling to a remaining length of about 6~7cm, properly connect the barbed sutures (V-LOCK) on both sides of the sling, and insert the urinary incontinence sling from the urethra to the obturator membrane, from the obturator membrane to the thigh. The inner skin area is replaced by the V-LOCK line. The 40 patients in the control group were unmodified ordinary slings. The operation time, the local pain of the inner thigh after the operation, and the improvement of postoperative urinary incontinence symptoms were compared and analyzed between the two groups.

Results

Both groups of patients were successfully operated. The operation time was 16.36 minutes in the experimental group and 27.18 minutes in the control group. The difference in operation time between the two groups was statistically significant (p=0.00); the catheter was pulled out on the third day after the operation. One patient in the group had urinary effort, four patients still had urinary incontinence symptoms, the remaining 35 patients had good urinary control (effective rate 87.5%), five patients in the control group still had urinary incontinence, two patients had urinary effort, and the remaining 33 patients had urinary control Good, (effective rate 87.5%), there was no significant difference in surgical effectiveness between the two groups (p=0.53); follow-up for 12 to 36 months, no significant long-term complications occurred, the pain score of the inner thigh of the experimental group was significantly lower than that of the control group ,statistically significant (p=0.04).

Conclusion

The efficacy of the modified sling in the treatment of moderate SUI is the same as that of the traditional sling, but the operation time is shorter, the operation is simpler, and the local pain is significantly reduced.

Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: A systematic review

OBJECTIVE

Stress urinary incontinence (SUI) is a common problem in women that affects their quality of life. According to the current evidence, 15%-50% of severe pelvic organ prolapse (POP) surgeries lead to de novo urinary incontinence (UI). This study aimed at determining the risk factors and characteristics of de novo SUI after POP surgeries in a systematic review.

MATERIAL AND METHODS

We conducted a systematic search of articles in English related to the risk of UI after POP surgery published until December 2019 in the selected bibliographic databases, including PubMed, EMBASE, Scopus, Cochrane Library, and ProQuest.

RESULTS

The initial search resulted in 2,363 studies, and after reviewing the titles and abstracts, 146 studies were identified. Moreover, 2 independent reviewers, using the Joanna Briggs Institute checklists, evaluated the risk of biases in the selected studies. Finally, 40 studies met the inclusion criteria. The most important predictors of UI after POP surgery were positive pessary testing, age >50 years, and maximum urethral closure pressure (MUCP) <60 cmH₂O.

CONCLUSION

Positive pessary testing, older age, and low MUCP were the most important risk factors for de novo incontinence after POP surgeries.

Evaluation of patients undergoing abdominal sacrocolpopexy due to symptomatic pelvic organ prolapse in terms of gastrointestinal complications

OBJECTIVES

To evaluate the intra- and postoperative gastrointestinal complications following abdominal sacrocolpopexy and determine the possible causes.

METHODS

A total of 86 patients who underwent abdominal sacrocolpopexy due to symptomatic pelvic organ prolapse between January 2014 and January 2016 at İzmir Tepecik Training and Research Hospital Obstetrics and Gynecology Clinic were retrospectively reviewed using the hospital information system. Patients were divided into two groups: those with and without prolonged length of hospital stay. They were evaluated in terms of gastrointestinal complications and risk factors.

RESULTS

The reason for prolonged hospitalization was nausea and vomiting in 24 (88%) of 27 patients. The symptoms in these patients were recovered with hydration, stopping of oral intake, and administration of antiemetics. Nasogastric decompression and parenteral nutrition were required in three (11%) patients due to clinical and radiological evidence of ileus. The parameter that significantly prolonged the length of hospital stay was prior abdominal surgery (p < 0.05).

CONCLUSION

There were obvious gastrointestinal complications in three out of 27 patients with prolonged length of hospital stay. These findings may be beneficial for preoperative patient counselling.