1
|
Meyer I, Blanchard CT, Szychowski JM, Richter HE. Five-year surgical outcomes of transvaginal apical approaches in women with advanced pelvic organ prolapse. Int Urogynecol J 2023; 34:2171-2181. [PMID: 37039859 DOI: 10.1007/s00192-023-05501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/30/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In women with advanced prolapse, differences in vaginal apex anchoring sites may impact surgical outcomes over time. The primary aim was to compare 5-year surgical outcomes of uterosacral ligament suspension (ULS) versus sacrospinous ligament fixation (SSLF) in women with advanced (stage III-IV) prolapse. METHODS A secondary analysis was conducted in a subset of women with advanced prolapse from a multicenter randomized trial comparing ULS versus SSLF and its extended follow-up, using publicly accessible de-identified datasets. The primary outcome was time to failure, defined as any one of (1) apical descent > 1/3 into the vaginal canal or anterior/posterior compartment beyond the hymen, (2) bothersome vaginal bulge symptoms, or (3) re-treatment. Secondary outcomes include symptom severity measured by the Pelvic Organ Prolapse Distress Inventory (POPDI) and adverse events. RESULTS Of 285 women, 90/147 (61.2%) in ULS and 88/138 (63.8%) in SSLF had advanced prolapse. Baseline characteristics did not differ between groups except for median-vaginal deliveries (3.0 [2.0, 5.0] versus 3.0 [2.0, 4.0], p < 0.01). The median time to failure was 1.7 years ULS versus 2.0 years SSLF (p = 0.42). Surgical failure increased over time in both groups with no intergroup difference; by year 5, the estimated failure rate was 67.7% ULS versus 71.5% SSLF (adjusted difference -3.8; 95%CI [-21.9, 14.2]). No differences were noted in individual failure components (p > 0.05). POPDI scores improved over 5 years without intergroup difference (ULS -68.0 ± 61.1 versus SSLF -69.9 ± 60.3, adjusted difference -0.1 [-20.0, 19.9]). No difference in adverse events were observed (p > 0.05). CONCLUSION In women with advanced prolapse, surgical failure, symptom severity, and adverse events did not differ between ULS and SSLF over 5 years.
Collapse
Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M Szychowski
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
| |
Collapse
|
2
|
Gupta A, Bretschneider CE, Rhodes S, Shoag J, McBride C, Sheyn D. Evaluation of gastrointestinal tract injury within 1 year of surgery for pelvic organ prolapse. Int Urogynecol J 2023; 34:2061-2065. [PMID: 36918419 DOI: 10.1007/s00192-023-05503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To identify the incidence and risk factors of gastrointestinal injury (GITI) related to pelvic organ prolapse (POP) surgery. METHODS Women who underwent POP surgery between 2000 and 2020 were identified in the Premier Healthcare Database. The primary outcome was GITI, defined as small or large bowel injury or repair, and fistula or fistula repair. Differences between patients with and without GITI were evaluated, and a multivariable regression was performed to determine independent predictors of GITI. RESULTS We identified 563,661 index POP surgeries in female patients aged 18 years and older. Of these, 4582 (0.8%) had a bowel injury code within 1 year of index POP surgery. Patients who experienced GITI were more likely to be younger (49.9 ± 12.8 vs 50.9 ± 13.7), and receive surgery with a surgeon who performed less than 12 surgeries per year (48% vs 42%). Most GITI was diagnosed in the same month (73.4%) and same hospital encounter (54%) as index POP surgery. After adjusting for confounders, lysis of adhesions (aOR = 2.03, 95% CI: 1.48-2.72) and perioperative hematoma/hemorrhage (aOR = 2.87, 95%C I: 1.70-4.59) were strongly associated with GITI, while having surgery with a surgeon performing > 50 POP surgeries per year (aOR = 0.66, 95%C I: 0.59-0.75 and concomitant obliterative procedures (aOR = 0.48, 95% CI: 0.34-0.65) were associated with a lower probability of GITI. CONCLUSIONS The rate of GITI after POP surgery is less than 1%, and injuries are commonly diagnosed and treated in the same month as index surgery. High-volume surgeons and obliterative procedures may be protective against GITI.
Collapse
Affiliation(s)
- Ankita Gupta
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville Health, 4331 Churchman Avenue, Louisville, KY, 40215, USA.
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals, Cleveland, OH, USA
| | - Jonathan Shoag
- Division of Urologic Oncology, Urology Institute, University Hospitals, Cleveland, OH, USA
| | - Cathrine McBride
- Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, OH, USA
| |
Collapse
|
3
|
OuYang Y, Xu W, Li F, Wang R, Zhao X. Anatomic identification of laparoscopic uterosacral ligament suspension: A step-by-step procedure. Int Urogynecol J 2022; 33:3587-90. [PMID: 35723712 DOI: 10.1007/s00192-022-05257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOSTHESIS The uterosacral ligament (USL) is the main structure of physiological apical support, and USL suspension is one of the most commonly used methods for native tissue apical suspension. Structures surrounding the USL are complex, and the USL itself is difficult to identify, especially the sacral portion of the USL. Laparoscopy improves visualization, but exposure of the USL is still unsatisfactory. METHODS In this study, we report a simple method for exposing and suturing the USL laparoscopically, with step-by-step instructions, well-presented figures and videos. The key techniques are shown as follows: keeping tension on the USL with a uterine manipulator, dissecting the space medial to the USL, exposing the portion of the USL near the sacrum through the natural space, and then suturing it medially and connecting it directly to the posterior cervix. RESULTS 95 consecutive patients have undergone this modified USLS and none had serious perioperative complication. CONCLUSION In this way, the USL anatomy is exposed well, which may make placement of sutures in USL suspension safe and effective.
Collapse
|
4
|
Campagna G, Panico G, Lombisani A, Vacca L, Caramazza D, Scambia G, Ercoli A. Laparoscopic uterosacral ligament suspension: a comprehensive, systematic literature review. Eur J Obstet Gynecol Reprod Biol 2022; 277:57-70. [PMID: 36007356 DOI: 10.1016/j.ejogrb.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Laparoscopic uterosacral ligament suspension (LUSLS) of the vaginal apex for the treatment of pelvic organ prolapse (POP) has gained popularity. The aim of this systematic review is to investigate perioperative outcomes and complications, subjective and objective success rates and recurrence rates in women undergoing this surgical procedure. STUDY DESIGN A systematic literature search was performed in December 2021. The critical appraisal skills program (CASP) was used to assess the methodological quality of the selected studies. The Clavien-Dindo (CD) scale and the Satava scale were used to classify periprocedural complications. Continuous variables were described as means and standard deviations while categorical were expressed as percentages of the whole group. Statistical significance was set at p < 0.05. RESULTS 26 articles were selected and analysed, with a total population of 1401 patients. Anatomical and subjective success rates after LUSLS ranged from 79% and 100% and from 76.2% to 100% respectively. The re-operation rate varied from 2% to 4.5% in the largest cohorts. The overall complication rate was 13.6%, however grade III CD complications occurred only in 1% of patients. Ureteral complications were described in only 2 cases. CONCLUSIONS LUSLS represent a safe and effective technique for vaginal apex resuspension in women with POP. Further larger prospective randomized studies are required to confirm these data.
Collapse
Affiliation(s)
- Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
| |
Collapse
|
5
|
Ha B, Gordon T, Merchant M, Ramm O. Healthcare utilization following minimally invasive apical prolapse repair in a large integrated healthcare system. Int Urogynecol J 2021; 33:351-358. [PMID: 34132866 DOI: 10.1007/s00192-021-04884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to describe healthcare utilization (HU) following minimally invasive apical prolapse repair (MIAR) and its association with duration of hospital stay, patient characteristics, and perioperative factors. METHODS This retrospective study included women undergoing MIAR within a large managed care organization between January 1, 2011, and June 30, 2018, and aimed to quantify HU within 30 days of surgery. HU was dichotomized into two groups: normal and high, based on typical postoperative utilization of healthcare resources. The primary outcome was the rate of normal versus high HU overall and by duration of hospital stay [discharge home on day of surgery versus postoperative day (POD) 1-2]. Multivariable logistic regression was performed to identify factors predictive of high HU. A p value of < 0.05 was considered statistically significant. RESULTS Of the 4208 patients in our final cohort, 17% had high HU, while 83% were normal utilizers. High utilizers were more likely to have multiple comorbidities (p < 0.01) and a diagnosis of chronic pelvic pain (p = 0.02) and were less likely to be discharged on day of surgery (p < 0.01). A higher burden of disease, a concurrent mid-urethral sling or posterior colporrhaphy, and discharge on POD 1-2 were independently predictive of high HU. Within the high HU cohort, the most common type of unanticipated healthcare encounter was emergency department visit for urinary retention or pain. CONCLUSIONS Same-day discharge after MIAR does not result in increased HU, even after adjusting for relevant demographic and clinical characteristics. Pre-existing chronic pain diagnoses, multiple comorbidities, and concurrent mid-urethral sling are associated with high HU in this population.
Collapse
Affiliation(s)
- Barbara Ha
- Obstetrics & Gynecology, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Toya Gordon
- Female Pelvic Medicine & Reconstructive Surgery, Tower Health-Reading Hospital, West Reading, PA, USA
| | - Maqdooda Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Olga Ramm
- Female Pelvic Medicine & Reconstructive Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
| |
Collapse
|
6
|
Lee J, Oh S, Jeon MJ. Suture Complication Rates and Surgical Outcomes According to the Nonabsorbable Suture Materials Used in Vaginal Uterosacral Ligament Suspension: Polyester versus Polypropylene. J Minim Invasive Gynecol 2020; 28:1503-1507. [PMID: 33310165 DOI: 10.1016/j.jmig.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/17/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To evaluate suture complication rates and surgical outcomes according to the nonabsorbable suture materials used in vaginal uterosacral ligament suspension (USLS) surgery. Multifilament polyester (polyethylene terephthalate [PET]) and monofilament polypropylene (PP) sutures were compared. DESIGN Retrospective cohort study. SETTING Single teaching hospital. PATIENTS Total of 229 patients who underwent transvaginal USLS and completed a 1-year follow-up. INTERVENTIONS Use of PET and PP sutures for transvaginal USLS procedures. MEASUREMENTS AND MAIN RESULTS PP sutures were used in 149 patients, and PET sutures were used in 80 patients. The suture-related complication rates, including granulation tissue and suture erosion at the vaginal apex, were significantly higher in the PET suture group than in the PP suture group (46.3% vs 20.1%, p <.01). However, there was no significant difference in the rates of surgical failure (defined as the presence of vaginal bulging symptoms, apical descent ≥ half of the total vaginal length, anterior or posterior vaginal wall descent beyond the hymen, or retreatment for prolapse) between the 2 groups (p = .84). CONCLUSION Compared with the use of multifilament PET sutures, the use of monofilament PP sutures in transvaginal USLS may reduce suture-related complications without increasing surgical failure rates.
Collapse
Affiliation(s)
- Jeesun Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital (all authors)
| | - Sumin Oh
- Department of Obstetrics and Gynecology, Seoul National University Hospital (all authors)
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University Hospital (all authors); Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Dr. Jeon), Seoul, Republic of Korea.
| |
Collapse
|
7
|
Chapman GC, Slopnick EA, Roberts K, Sheyn D, Wherley S, Mahajan ST, Pollard RR. National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at the Time of Uterosacral Ligament Suspension. J Minim Invasive Gynecol 2020; 28:275-281. [PMID: 32450226 DOI: 10.1016/j.jmig.2020.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension. DESIGN Retrospective propensity-score matched cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS We included all patients who had undergone uterosacral ligament suspension and concurrent total vaginal hysterectomy (TVH-USLS) or total laparoscopic hysterectomy (TLH-USLS) from 2010 to 2015. We excluded those who underwent laparoscopic-assisted vaginal hysterectomy, abdominal hysterectomy, other surgical procedures for apical pelvic organ prolapse, or had gynecologic malignancy. INTERVENTIONS We compared 30-day complication rates in patients who underwent TVH-USLS versus TLH-USLS in both the total study population and a propensity score matched cohort. MEASUREMENTS AND MAIN RESULTS The study population consisted of 3,349 patients who underwent TVH-USLS and 484 who underwent TLH-USLS. Patients who underwent TVH-USLS had a significantly higher composite complication rate (11.4% vs 6.4%, odds ratio [OR] 1.9, 1.3-2.8; p <.01) and a higher serious complication rate (5.6% vs 3.1%, OR 1.8, 1.1-3.1; p = .02), which excluded urinary tract infection and superficial surgical site infection. The propensity score analysis was performed, and patients were matched in a 1:1 ratio between the TVH-USLS group and the TLH-USLS group. In the matched cohort, patients who underwent TVH-USLS had a higher composite complication rate than those who underwent TLH-USLS (10.3% vs 6.4%, OR 1.7, 95% confidence interval [CI], 1.1-2.7; p = .04), whereas the rate of serious complications did not differ between the groups (4.3% vs 3.1%, OR 1.4, 95% CI, 0.7-2.8; p = .4). On multivariate logistic regression, TVH-USLS remained an independent predictor of composite complications (adjusted OR 1.6, 95% CI, 1.0-2.6; p = .04) but not serious complications (adjusted OR 1.4, 95% CI, 0.7-2.8; p = .3). CONCLUSION In this large national cohort, TVH-USLS was associated with a higher composite complication rate than TLH-USLS, largely secondary to an increased rate of urinary tract infection. After matching, the groups had similar rates of serious complications. These data suggest that TLH-USLS should be viewed as a safe alternative to TVH-USLS.
Collapse
Affiliation(s)
- Graham C Chapman
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio.
| | - Emily A Slopnick
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| | - Kasey Roberts
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| | - David Sheyn
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| | - Susan Wherley
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan)
| | - Sangeeta T Mahajan
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan)
| | - Robert R Pollard
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| |
Collapse
|
8
|
Lin KL, Tang FH, Chou SH, Loo ZX, Liu YY, Juan YS, Long CY. Evaluation of single-incision apical vaginal suspension for treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2020; 247:198-202. [PMID: 32146224 DOI: 10.1016/j.ejogrb.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/01/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present a comprehensive evaluation of anterior/apical and/or posterior prolapse repair systems with a focus on safety and surgical efficacy. METHODS Two hundred and twenty women with pelvic organ prolapse (POP) stage II-IV were referred for single-incision transvaginal mesh procedures in a single institution. Pre- and postoperative assessments included pelvic examination, urodynamic studies, and personal interviews about patients' quality of life and urinary symptoms. RESULTS The anatomical success rate was 92.3 % (203/220), regardless of primary or de-novo POP, at 12-38 month follow-up. The POP quantification parameters, except total vaginal length, improved significantly after surgery (p < 0.05). Complications included bladder injury (one case), mesh exposure (six cases) and urinary retention that required intermittent catheterization (five cases). There were no cases of bowel injury during surgery. The results indicated that 29 % of patients had de-novo stress urinary incontinence and 7.7 % of patients had de-novo POP after surgery. CONCLUSION The apical vaginal suspension system is a safe and effective procedure, creating good anatomical restoration and significant improvement in quality of life. However, the rate of de-novo POP in the anterior compartment of the vagina (31.8 %) seems high after treatment with apical and posterior prolapse repair systems.
Collapse
Affiliation(s)
- Kun-Ling Lin
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Hsiang Tang
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zi-Xi Loo
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Yin Liu
- Department of Obstetrics and Gynaecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynaecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
9
|
Bazi T. The underutilization of obliterative and constrictive surgery in the surgical treatment of pelvic organ prolapse. Int Urogynecol J 2019; 30:1221-1224. [PMID: 31183534 DOI: 10.1007/s00192-019-03994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
Vaginal length and caliber are necessary for satisfactory vaginal coitus. Surgical treatment of pelvic organ prolapse (POP) can include preservation of vaginal length and caliber, or shortening and narrowing of the vagina (constrictive and obliterative surgery). The latter option is proven to have fewer complications and a lower risk of recurrence of POP. Women undergoing surgical intervention for POP who are not coitally active and choose not to be coitally active for the rest of their lives should be offered constrictive and obliterative surgery.
Collapse
Affiliation(s)
- Tony Bazi
- American University of Beirut Medical Center, PO box 11-0236, Riyad El-Solh, Beirut, 11072020, Lebanon.
| |
Collapse
|
10
|
Lamblin G, Cerruto E, Chabert P, Lebail Carval K, Nohuz E, Chene G. [How I do… utero-vaginal suspension using a bilateral vaginal anterior sacrospinous fixation with mesh]. ACTA ACUST UNITED AC 2019; 47:535-9. [PMID: 31003011 DOI: 10.1016/j.gofs.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Indexed: 11/23/2022]
|
11
|
Panico G, Campagna G, Caramazza D, Amato N, Ercoli A, Scambia G, Cervigni M, Zaccoletti R. Laparoscopic high uterosacral ligament suspension: an alternative route for a traditional technique. Int Urogynecol J 2018; 29:1227-1229. [PMID: 29500517 DOI: 10.1007/s00192-018-3588-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/31/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Uterovaginal prolapse treatment is a challenge for the urogynecologist. Surgical management for apical prolapse can be successful with native tissue and uterosacral ligament (USL) fixation. However, some complications have been described, especially with use of the vaginal approach. The aim of this video is to describe an alternative laparoscopic approach to a traditional vaginal procedure to reduce nerve injury and ureteral complications. METHODS A 75-year-old woman was referred to our unit for symptomatic stage III apical prolapse and underwent laparoscopic USL fixation, according to the technique described herein. RESULTS This surgical technique was successful in correcting apical prolapse. CONCLUSIONS This video tutorial may be useful to urogynecologists for improving surgical technique, thus leading to a reduction in the risk of nerve and ureteral complications. The technique offers the possibility of a correct under-vision suture positioning. Laparoscopic USL fixation can be safely performed to treat apical prolapse.
Collapse
Affiliation(s)
- Giovanni Panico
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Campagna
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Daniela Caramazza
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Nicola Amato
- Obstetrics and Gynecology Unit, P. Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Maggiore Hospital, Novara, Italy
| | - Giovanni Scambia
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Mauro Cervigni
- Department of Woman And Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Zaccoletti
- Obstetrics and Gynecology Unit, P. Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| |
Collapse
|
12
|
Northington GM, Hudson CO, Karp DR, Huber SA. Concomitant apical suspensory procedures in women with anterior vaginal wall prolapse in the United States in 2011. Int Urogynecol J 2015; 27:613-9. [PMID: 26630948 DOI: 10.1007/s00192-015-2894-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/15/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although the surgical restoration of apical support has been shown to decrease reoperation rates, it is unclear whether this has been incorporated into current practice. The aims of this study were to determine the rate of concomitant apical suspensory procedures in women with anterior vaginal wall prolapse undergoing surgical repair in 2011 and to identify associated factors. METHODS This cross-sectional study queried the Nationwide Inpatient Sample for women with a primary diagnosis of cystocele who underwent prolapse repair in 2011. The study cohort was analyzed for demographics, concomitant procedures, and hospital characteristics. The rate of apical suspensory procedures was determined. Factors potentially associated with receiving concomitant apical suspensory procedure were evaluated using univariate analysis and multivariate logistic regression. RESULTS A total of 2,900 women in the database had a primary diagnosis of cystocele and underwent surgical prolapse repair in 2011. 925 (31.9 %) subjects underwent a concomitant apical suspensory procedure. The mean age in the study cohort was 61.9 ± 12.8 years. Hysterectomies were performed in 11.1 % of subjects. 61.1 % were performed vaginally, 26.5 % laparoscopically, and 12.5 % abdominally. On multivariate analysis, age greater than 50 years, Caucasian race, concomitant hysterectomy, and an urban teaching hospital setting were independently associated with receiving concomitant apical suspensory procedure in 2011. CONCLUSIONS Despite evidence that the restoration of apical support is important for optimal anterior support, the overall rate of concomitant apical suspensory procedures is low. Several factors may play a role in whether or not women receive an apical suspensory procedure. This study highlights opportunities to improve the quality of surgical care provided to women with anterior vaginal prolapse.
Collapse
Affiliation(s)
- Gina M Northington
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 1639 Pierce Drive, Room 4208 WMB, Atlanta, GA, 30322, USA.
| | - Catherine O Hudson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 1639 Pierce Drive, Room 4208 WMB, Atlanta, GA, 30322, USA
| | - Deborah R Karp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 1639 Pierce Drive, Room 4208 WMB, Atlanta, GA, 30322, USA
| | - Sarah A Huber
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 1639 Pierce Drive, Room 4208 WMB, Atlanta, GA, 30322, USA
| |
Collapse
|