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Hwang WY, Jeon MJ, Suh DH. Minimally Invasive Sacrohysteropexy Versus Vaginal Hysterectomy With Uterosacral Ligament Suspension for Pelvic Organ Prolapse: A Prospective Randomized Non-Inferiority Trial. J Minim Invasive Gynecol 2024; 31:406-413. [PMID: 38336010 DOI: 10.1016/j.jmig.2024.01.018] [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: 04/17/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
STUDY OBJECTIVE To investigate whether minimally invasive Sacrohysteropexy (SH) is non-inferior to vaginal hysterectomy (VH) with uterosacral ligament suspension (USLS) in women with symptomatic uterovaginal prolapse. DESIGN Prospective, randomized, non-inferiority study. SETTING Tertiary university-based hospital. PATIENTS A total of 146 patients with uterovaginal prolapse between July 2016 and August 2019. INTERVENTIONS Patients were randomly assigned in a 1:1 ratio to either laparoscopic or robotic SH surgery or VH with USLS surgery. MEASUREMENTS AND MAIN RESULTS The primary outcome was prolapse recurrence at 1 year after surgery, defined as prolapse ≥ stage 2 evaluated using the pelvic organ prolapse quantification system, bothersome vaginal bulge symptoms, or retreatment for prolapse. The secondary outcomes included operation time, estimated blood loss, hospital stay, operation-related complications, pain intensity, quality of life, and activities of daily living. Of 146 women who underwent randomization, 73 in the SH group and 73 in the VH with USLS group were analyzed. SH was non-inferior for recurrence compared with VH with USLS (16.4% vs 15.8%, 95% confidence interval: -13.0% to 14.2%). Operating duration and transvaginal length were significantly longer in the SH group, while there were no significant differences in the estimated blood loss, length of hospital stay, or postoperative complication rates. Although perioperative pain intensity was greater from 1 week to 1 month in the SH group, the quality of life and activities of daily living did not differ between the groups throughout postoperative year 1. CONCLUSION Laparoscopic or robotic SH was non-inferior to VH with USLS for the recurrence of pelvic organ prolapse at the 1-year follow-up.
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Affiliation(s)
- Woo Yeon Hwang
- Department of Obstetrics and Gynecology, Kyung Hee University College of Medicine, Kyung Hee University Hospital (Dr. Hwang), Seoul
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University Hospital (Dr. Jeon), Seoul; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Jeon and Suh), Seoul
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Jeon and Suh), Seoul; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital (Dr. Suh), Seongnam, Republic of Korea.
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Vidoman M, Kalis V, Smazinka M, Havir M, Rusavy Z, Ismail KM. Pilsner Modification of Mesh Sacrohysterocolpopexy (PiMMS): An Initial Report on Safety and Efficacy. Int Urogynecol J 2024:10.1007/s00192-024-05780-w. [PMID: 38691124 DOI: 10.1007/s00192-024-05780-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/04/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS It is reported that up to 60% of women would prefer to spare their uterus during pelvic organ prolapse (POP) repair surgery. A reliable hysteropexy technique is therefore crucial. We aimed to describe the safety profile and initial core patient-reported and clinical outcomes of the Pilsner modification of laparoscopic mesh sacrohysterocolpopexy (PiMMS) in comparison with the laparoscopic sacrohysterocolpopexy technique (standard laparoscopic sacrohysterocolpopexy [sLSH]) previously used in our unit. METHODS This was a retrospective cohort study conducted in a single tertiary referral urogynecological center. All patients who underwent laparoscopic mesh sacrohysterocolpopexy between 1 January 2015, and 31 January 2022 were included in the study. Follow-up clinical, patient-reported, and imaging outcomes at the 12-month follow-up time point are presented. RESULTS A total of 87 patients were included. Of these, 49 (56.3%) and 38 (43.7%) underwent sLSH and PiMMS respectively. Low numbers of perioperative complications were found in both groups with no mesh-related complications reported following PiMMS up to 12 months postoperatively. There were no apical compartment failures in either group. There were 8 (17.0%) vs 1 (2.7%) anterior compartment failures (Ba ≤ -1) in the sLSH and PiMMS groups respectively (p = 0.07) at 12 months. At the 1-year follow-up, 42 (89.4%) patients reported a Patient Global Impression of Improvement score of ≤ 2 in the sLSH groups compared with 35 (94.6%) patients following PiMMS. CONCLUSIONS The PiMMS technique seems to have comparable safety profile and patient-reported outcomes with the sLSH technique. However, there is a trend toward reduced anterior compartment failures with this modification. The findings of this preliminary report need to be re-evaluated in a well-powered prospective study.
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Affiliation(s)
- Matej Vidoman
- Department of Gynecology and Obstetrics, Faculty Hospital, Trenčín, Slovakia
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
| | - Vladimir Kalis
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Martin Smazinka
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Martin Havir
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Zdenek Rusavy
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czechia
- Center for Pelvic-Floor Disorders, Pilsen, Czechia
| | - Khaled M Ismail
- Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 76, 304 60, Pilsen, Czechia.
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czechia.
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Doğan O, Yassa M, Eren E, Birol İlter P, Tuğ N. A randomized, prospective, controlled study comparing uterine preserving laparoscopic lateral suspension with mesh versus laparoscopic sacrohysteropexy in the treatment of uterine prolapse. Eur J Obstet Gynecol Reprod Biol 2024; 297:120-125. [PMID: 38608354 DOI: 10.1016/j.ejogrb.2024.03.042] [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: 08/31/2023] [Revised: 11/11/2023] [Accepted: 03/30/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Pelvic organ prolapse (POP) significantly affects women's quality of life, occurring in 20-30% of females aged over 20 globally. With aging populations, demand for pelvic reconstructive surgery is rising. Patients seek anatomical restoration while preserving uterus and sexual function. Sacrohysteropexy is the gold standard for apical prolapse, but carries risks. Lateral suspension, offers safer apical and anterior correction especially for obese, sexually active women. Our prospective study compares laparoscopic sacrohysteropexy and lateral suspension objectively and subjectively. STUDY DESIGN The study included patients who had laparoscopic lateral suspension (n = 22) or laparoscopic sacrohysteropexy (n = 22) for symptomatic stage 2 apical prolapse. Groups randomized with using block design. Anatomical cure was based on measurements taken by the same physician, unaware of intervention, before and at 12 months using POP-Q score. Pelvic floor ultrasound also used for objective rates. Subjective comparison used Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse-Symptom Score (POP-SS), Female Sexual Function Index (FSFI), Visual Analog Score (VAS), and Michigan Incontinence Severity Index (M-ISI). RESULTS Age, BMI, parity, menopause, sexual activity, complications, showed no significant difference between groups (p > 0.05). Surgical procedure duration significantly varied between groups lateral suspension group was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups. CONCLUSION Both methods effectively managed apical prolapse with similar outcomes. Objective measurements showed lateral suspension's superiority in reducing bladder descent.
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Affiliation(s)
- Ozan Doğan
- Private Clinic, Istanbul, Turkey; Pelvic Floor and Cosmetic Gynecology Association (PET-KOZ), Turkey
| | - Murat Yassa
- Bahçeşehir University, VM Medical Park Maltepe Hospital, Clinic of Obstetrics and Gynecology, Istanbul, Turkey; Pelvic Floor and Cosmetic Gynecology Association (PET-KOZ), Turkey
| | - Ecem Eren
- Memorial Hospital, Clinic of Obstetrics and Gynecology, Istanbul 34034, Turkey; Pelvic Floor and Cosmetic Gynecology Association (PET-KOZ), Turkey.
| | - Pınar Birol İlter
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey; Pelvic Floor and Cosmetic Gynecology Association (PET-KOZ), Turkey
| | - Niyazi Tuğ
- Department of Obstetrics and Gynecology, University of Health Sciences, Sehit Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey; Pelvic Floor and Cosmetic Gynecology Association (PET-KOZ), Turkey
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Arab W, Lukanović D, Matjašič M, Blaganje M, Deval B. Determinants of Dissatisfaction After Laparoscopic Cure of Vaginal and/or Rectal Prolapse using Mesh: a Comprehensive Retrospective Cohort Study. Int Urogynecol J 2024; 35:457-465. [PMID: 38206336 DOI: 10.1007/s00192-023-05701-3] [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: 07/18/2023] [Accepted: 11/15/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The primary objective is to identify determinants of dissatisfaction after surgical treatment of vaginal prolapse ± rectal prolapse, using laparoscopic mesh sacrohysteropexy (LSH) or sacrocolpopexy (LSC) ± ventral mesh rectopexy (VMR). The secondary objective is the evaluation of complications and objective/subjective recurrence rates. METHODS The study performed was a single-surgeon retrospective review of prospectively collected data. LSH/LSC ± VMR were performed between July 2005 and September 2022. Primary investigated outcome was patients' satisfaction, assessed using the Patient Global Impression of Improvement (PGI-I) score and the bother visual analog scale (VAS) obtained postoperatively (at a 1-month interval and on a 6-month/yearly basis thereafter). We looked for a correlation between the level of satisfaction (as reflected by the VAS) and potential determinants. RESULTS There were 355 patients with a mean age of 62 ±12 years. Nearly all the patients (94.3%) had a stage 3 or 4 prolapse according to the POP-Q classification. The mean postoperative bother VAS was 1.8, with only 12.7% of patients reporting a bother VAS score ≥ 3/10, indicating a dissatisfaction. PGI-I showed improvement in the vast majority of patients (96.4% scoring 1 to 3). Patients with anal incontinence preoperatively scored higher on the bother VAS postoperatively (r=0.175, p < 0.05). The use of a posterior arm mesh (for posterior vaginal prolapse) correlated with better satisfaction overall (r= -0.178, p = 0.001), whereas the performance of VMR was associated with a bothering sensation (r = 0.232, p < 0.001). A regression analysis confirmed the impact of posterior mesh and VMR on satisfaction levels, with odds of dissatisfaction being 2.18 higher when VMR was combined with LSH/LSC. CONCLUSIONS Posterior mesh use improves patient satisfaction when the posterior compartment is affected. In patients with concomitant vaginal and rectal prolapse, combining VMR with anterior LSC/LSH appears to negatively impact patients' satisfaction. Preoperative anal incontinence was demonstrated to be a risk factor for postoperative dissatisfaction.
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Affiliation(s)
- Wissam Arab
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - David Lukanović
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Matjašič
- Department of Education Studies, Faculty of Education, University of Ljubljana, Ljubljana, Slovenia
| | - Mija Blaganje
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
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van Oudheusden AMJ, Weemhoff M, Menge LF, Essers BAB. Gynecologists' perspectives on surgical treatment for apical prolapse: a qualitative study. Int Urogynecol J 2023; 34:2705-2712. [PMID: 37392227 PMCID: PMC10682281 DOI: 10.1007/s00192-023-05587-1] [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: 03/31/2023] [Accepted: 05/21/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal sacrospinous fixation (VSF) without mesh and sacrocolpopexy (SCP) with mesh are the most frequently performed surgical procedures for apical prolapse in the Netherlands. There is no long-term evidence suggesting the optimal technique, however. The aim was to identify which factors play a role in the choice between these surgical treatment options. METHODS A qualitative study using semi-structured interviews amongst Dutch gynecologists was carried out. An inductive content analysis was performed with Atlas.ti. RESULTS Ten interviews were analyzed. All gynecologists performed vaginal surgeries for apical prolapse, six gynecologists perform SCP themselves. Six gynecologists would perform VSF for a primary vaginal vault prolapse (VVP); three gynecologists preferred a SCP. All participants prefer a SCP for recurrent VVP. All participants have stated that multiple comorbidities could be a reason for choosing VSF, as this procedure is considered less invasive. Most participants choose a VSF in the case of older age (6 out of 10) or higher body mass index (7 out of 10). All treat primary uterine prolapse with vaginal, uterine-preserving surgery. CONCLUSIONS Recurrent apical prolapse is the most important factor in advising patients which treatment they should undergo for VVP or uterine descent. Also, the patient's health status and the patient's own preference are important factors. Gynecologists who do not perform the SCP in their own clinic are more likely to perform a VSF and find more reasons not to advise a SCP. All participants prefer a vaginal surgery for a primary uterine prolapse.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynecology and Obstetrics, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Mirjam Weemhoff
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Leah F Menge
- Department of Gynecology and Obstetrics, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA, Delft, The Netherlands
| | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Alsahabi JA, Alsary S, Abolfotouh MA. The Outcome of Sacrocolpopexy/ Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure. Int J Womens Health 2023; 15:1093-1105. [PMID: 37483888 PMCID: PMC10362893 DOI: 10.2147/ijwh.s413729] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Background Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women's quality of life. Unfortunately, the literature lacks long-term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting. Methods In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009-2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05. Results Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01‒1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33‒18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure. Conclusion The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long-term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.
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Affiliation(s)
- Jawaher A Alsahabi
- Department Urogynecology & Reconstructive Female Pelvic Surgery, King Abdul-Aziz Medical City, King Saud Ben Abdu Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 22490, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 11481, Saudi Arabia
| | - Saeed Alsary
- Department Urogynecology & Reconstructive Female Pelvic Surgery, King Abdul-Aziz Medical City, King Saud Ben Abdu Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 22490, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 11481, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 11481, Saudi Arabia
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Elsibai Anter M, Elsayed Ellakwa H, Fouad Sanad Z, Abd-Elhameed Nasr-Eldin M, Ramzy Rashid M. Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial. Actas Urol Esp 2023:S2173-5786(23)00013-6. [PMID: 36750158 DOI: 10.1016/j.acuroe.2023.02.004] [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: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/07/2023]
Abstract
IMPORTANCE uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. OBJECTIVE compare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. STUDY DESIGN This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. RESULTS High statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). CONCLUSIONS Using Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.
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Affiliation(s)
| | | | - Z Fouad Sanad
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - M Ramzy Rashid
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Rusavy Z, Najib B, Abdelkhalek Y, Grinstein E, Gluck O, Deval B. Outcomes of sacrocolpopexy/ sacrohysteropexy with mesh placement targeted to affected compartment. Eur J Obstet Gynecol Reprod Biol 2022; 272:188-192. [PMID: 35364554 DOI: 10.1016/j.ejogrb.2022.03.037] [Citation(s) in RCA: 3] [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: 11/23/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE No recommendation regarding the number of meshes to be implanted in laparoscopic genital prolapse surgery exists. Is it necessary to implant a mesh into a compartment that is not affected to prevent its prolapse in the follow-up? Our objective was to compare the long-term outcomes of laparoscopic sacrocolpopexy according to compartments where mesh was implanted. STUDY DESIGN This is a retrospective cohort study of 328 patients after laparoscopic sacrocolpopexy at our centre in 7/2005 - 3/2021. 294 patients with perioperative data and POP-Q and/or prolapse symptoms in mean follow-up of 42.8 months was available for the outcome analysis. Surgical failure was defined as prolapse beyond hymen, subjective recurrence or retreatment. The women were divided into four groups depending on compartments, where the mesh was implanted. Group A - anterior, group P - posterior, Group AP - compound of patients with anterior or posterior single arm mesh placement and (B), with anterior and posterior arm placement. Groups AP and B were compared for feasibility of single compartment mesh implantation. Comparison of groups A and P allowed assessment of non-inferiority of single anterior vs. posterior compartment placement. The data were compared using Wilcoxon Two Sample test, Chi-square test or Fisheŕs Exact test, p-value < 0.05 was considered statistically significant. RESULTS A single compartment mesh implantation was associated with shorter operating time and hospital stay and comparable incidence of complications. A statistically significant difference in all POP-Q points in favour of group B was observed, however, with comparable rate of prolapse beyond hymen(6.3%AP vs. 7.8%B). Similar frequency of surgical failure (17.5%AP vs. 13.8%B) and incidence of de novo pelvic floor disorders or pain was observed. Comparison of groups A and P showed higher suspension of point C in group P(-2.6 vs. -4.0, p < 0.05) with no difference in points Ba, Bp, surgical failure rate and de novo pelvic floor disorders. CONCLUSION Implantation of a single sheet of mesh was not associated with inferior outcome to implantation of mesh to both compartments. Laparoscopic sacrocolpopexy with a single mesh arm placed into the affected compartment along with apical suspension does not induce a de novo prolapse in unoperated compartment.
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Affiliation(s)
- 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, Générale de Santé, Paris, France.
| | - Bernard Najib
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Yara Abdelkhalek
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Ehud Grinstein
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
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Rusavy Z, Abdelkhalek Y, Najib B, Deval B. Laparoscopic synthetic mesh explantation after sacrohysteropexy. Int Urogynecol J 2022; 33:2049-2051. [PMID: 35254472 DOI: 10.1007/s00192-022-05141-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/03/2021] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In this video, we present a case of rectal and bladder injury, which occurred during laparoscopic mesh removal following sacrohysteropexy treated 6 months later with a laparoscopic pectopexy. METHODS We present the case of a 66-year-old woman with a prolapse recurrence after sacrohysteropexy. During the laparoscopic explantation of the mesh, we detected a fixation of the mesh to the bladder and the rectum rather than a fixation to the vaginal walls. Consequently, bladder and rectal injuries occurred during the dissection and were diagnosed and repaired immediately. Due to bowel injury, the treatment of the prolapse was postponed. Six months later, a laparoscopic pectopexy was performed to avoid complications during the repeated dissection of the promontory. The postoperative recovery after the pectopexy was uncomplicated with no short-term prolapse recurrence or postoperative complications. CONCLUSION Laparoscopy appears to be an efficient approach to mesh explantation. Futhermore, laparoscopic pectopexy seems to be a good approach to secondary prolapse reconstruction after sacrohysteropexy mesh explantation avoiding complications during repeated dissection of the promontory.
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Affiliation(s)
- 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, Générale de Santé, Paris, France.
| | - Yara Abdelkhalek
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Bernard Najib
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
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de Tayrac R, Cosson M, Panel L, Compan C, Zemmache MZ, Bouvet S, Wagner L, Fatton B, Lamblin G. Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial. Int Urogynecol J 2022. [PMID: 35044477 DOI: 10.1007/s00192-021-05071-8] [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: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The main objective of the study was to evaluate the rates of de novo stress urinary (SUI) and postoperative dyspareunia after both sacrocolpopexy/hysteropexy (SCP) and vaginal mesh surgery. METHODS A prospective, multicenter, randomized, open-label study with two parallel groups treated by either SCP or Uphold Lite vaginal mesh was carried out. Study participants were ≥ 50 and < 80 years old patients with Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 who were considered eligible for reconstructive surgery and who were sexually active with no dyspareunia and free from bothersome SUI at presentation. Women were assessed before surgery and at 4-8 weeks and 11-13 months after using validated measures including POP-Q, Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Patient Global Impression of Improvement (PGI-I). Data were also collected for health economics evaluation. RESULTS Of the required sample of 156 women, 42 women (19 SCP and 23 vaginal mesh) were only recruited owing to the discontinuation of vaginal mesh worldwide. The median follow-up was 376 days. The rates of bothersome de novo SUI were similar in the SCP and Uphold vaginal mesh groups (15.79 vs 15.00%, OR 0.95 [95% CI 0.22-4.14]). Among 30 sexually active patients at follow-up, the rates of women reporting de novo dyspareunia "usually or always" were 6.7% after SCP vs 13.3% after vaginal mesh (p = 1). Health economics evaluation showed a cost saving of 280€ in favor of the Uphold vaginal mesh technique, but no significant difference in the total cost (2,934.97€ for SCP vs 3,053.26€ for Uphold vaginal mesh). CONCLUSIONS Bothersome de novo SUI and de novo dyspareunia occurred in approximately 15% and 23% of our study cohorts, with no significant difference between sacrocolpopexy/hysteropexy and anterior/apical vaginal mesh surgery. However, these results should be interpreted with caution owing to the small sample size.
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Grinstein E, Abdelkhalek Y, Veit-Rubin N, Gluck O, Deval B. Long term outcomes of laparoscopic sacro/colpo-hysteropexy with and without rectopexy for the treatment of prolapse. Int Urogynecol J 2021; 33:343-350. [PMID: 34125240 DOI: 10.1007/s00192-021-04868-x] [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: 03/13/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic sacrohysteropexy (LSH), sacrocolpopexy (LSC) and ventral rectopexy (LVR) with mesh are advocated for surgical treatment of pelvic and rectal prolapse. Our study aims at showing the feasibility of concomitant laparoscopic prolapse repair by comparing perioperative and long-term outcomes of LSH or LSC with and without LVR. METHODS This is a retrospective study carried out on 348 women operated on between July 2009 and July 2019. Patients were divided into four groups: (1) LSH only, (2) LSC only, (3) LSH + LVR and (4) LSC + LVR. POP-Q scores and satisfaction questionnaires were recorded at baseline and then annually. Outcomes were defined as subjective failure (vaginal/rectal prolapse symptoms), objective failure (prolapse to/beyond the hymen, full thickness rectal prolapse) or retreatment for prolapse. Complications were collected and graded according to the Clavien-Dindo classification. RESULTS Three hundred forty-eight women underwent laparoscopic repair for pelvic and rectal prolapse (219, 44, 66 and 19 in group 1, 2, 3 and 4, respectively). Median follow-up was 24 (4-174) months. Success rate for both rectal and pelvic prolapse was 90.2%. Recurrence rates were not significantly different between the groups (12.3%, 6.8%, 9.1% and 10.5% for groups 1, 2, 3 and 4, respectively). Significant improvement was noticed in satisfaction questionnaires in all groups. There was no difference in perioperative and late complications. CONCLUSION The combined laparoscopic procedure appears to be safe and efficient in treating pelvic and rectal prolapse. Appropriate patient selection and available surgical expertise should determine whether to perform these procedures combined or separately.
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Affiliation(s)
- 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
| | - Yara Abdelkhalek
- Department of Obstetrics and Gynecology. Hôtel-Dieu de France University Hospital, St Joseph University, Beirut, Lebanon. .,, Paris, France.
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - 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
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
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Tsilanizara A, Karila L, Sallee C, Denys P, Fechner A, Benistan K, Cardot V, Deffieux X. Obsessive-compulsive disorder and pelvic organ prolapse. Prog Urol 2021; 31:445-446. [PMID: 33648828 DOI: 10.1016/j.purol.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Affiliation(s)
- A Tsilanizara
- Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de gynécologie obstétrique, 92140 Clamart, France; Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - L Karila
- Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Paul-Brousse, UR PSYCOMADD, 94800 Villejuif, France
| | - C Sallee
- Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de gynécologie obstétrique, 92140 Clamart, France; Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - P Denys
- Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital R.-Poincaré, Service de neurourologie, 92380 Garches, France
| | - A Fechner
- Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de radiologie, 92140 Clamart, France
| | - K Benistan
- Centre de référence des syndromes d'Ehlers-Danlos non vasculaires, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital R.-Poincaré, 92380 Garches, France; Université Paris Saclay, UMR 1179 Inserm-Université de Versailles-Saint-Quentin, France
| | - V Cardot
- Pôle de santé du plateau-Meudon, service d'urologie, clinique de Meudon, 3, avenue de Villacoublay, 92360 Meudon-La-Forêt, France
| | - X Deffieux
- Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de gynécologie obstétrique, 92140 Clamart, France; Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France.
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Shekhar S, Goyal S, Goel M, Sharma C, Jhirwal M. Medium-Term Anatomical and Functional Results of Isolated Laparoscopic Sacrocolpopexy for Female Pelvic Organ Prolapse during the Early Learning Curve. J Obstet Gynaecol India 2021; 71:91-94. [PMID: 33814807 PMCID: PMC7960832 DOI: 10.1007/s13224-020-01373-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: 04/21/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Laparoscopic repair of female pelvic organ prolapse is a technically challenging surgery, especially for the beginners. METHODS We performed a follow-up study of women who underwent laparoscopic sacrocolpopexy or sacrohysteropexy (LSCP/LSHP) for pelvic organ prolapse between January 2015 and October 2019. We analysed anatomical and subjective success rates, peri-operative complications and medium-term complications. RESULTS Twenty women underwent LSCP/LSHP with average follow-up of 16 months. Anatomical success rate was 95%, and subjective success rate was 90%. Blood loss averaged at 24 ml. Majority of women (90%) reported improvement in their symptoms and 10% reported no change in symptoms. There were no mesh complications. CONCLUSION Laparoscopic sacrocolpopexy is an effective and safe surgery for female pelvic organ prolapse even by beginners.
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Affiliation(s)
- Shashank Shekhar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Shuchita Goyal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Manu Goel
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Charu Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Manisha Jhirwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
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Bertolo R, Maiorino F, Petta F, Vittori M, Cipriani C, La Barbera L, Masci B, Bove P. Robot-assisted re-do sacrohysteropexy after anterior abdominal wall hysteropexy. Int Urogynecol J 2020; 32:1589-1590. [PMID: 33034679 DOI: 10.1007/s00192-020-04549-1] [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: 07/07/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We report the case of a 49-year-old woman who came to our institution complaining of bowel constipation and bladder outlet obstruction due to the recurrence of a pelvic prolapse after anterior abdominal wall hysteropexy performed 1 year before. METHODS The patient was counseled to undergo robot-assisted re-do sacrohysteropexy performed using the da Vinci Xi surgical system. The step-by-step technique used for the herein reported clinical case of robot-assisted re-do sacrohysteropexy is shown in the accompanying video. RESULTS Operative time was 120 min. There was virtually no blood loss. No intraoperative complications occurred. Use of analgesic drugs was stopped on the 1st postoperative day. The patient was mobilized on postoperative day 2. The catheter was removed on the 3rd postoperative day, and the patient got back to spontaneous micturition with no post-voiding residual. On the same day, the patient was discharged. At 3-month follow-up, the patient was well with neither bowel nor bladder symptoms. Uroflowmetry was normal. CONCLUSION We demonstrated the feasibility of robot-assisted re-do sacrohysteropexy. In the surgical technique herein reported, we showed how we were able to partially re-use a previously implanted mesh together with a new one to ensure fixation of a multi-compartment pelvic organ prolapse.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165, Rome, Italy.
| | - Francesco Maiorino
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165, Rome, Italy
| | - Filomena Petta
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165, Rome, Italy
| | - Matteo Vittori
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165, Rome, Italy
| | - Chiara Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165, Rome, Italy
| | - Laura La Barbera
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - Bruno Masci
- Department of General Surgery, San Carlo di Nancy Hospital, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165, Rome, Italy.,Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy
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Cucinella G, Culmone S, Guastella E, Gentile F, De Maria F, Granà R, Carlisi B, Rotolo S, Calagna G. Uterine preservation in pelvic organ prolapse and urinary stress incontinence using robot-assisted laparoscopic surgery. Case report. Int J Surg Case Rep 2020; 77S:S143-6. [PMID: 32962958 DOI: 10.1016/j.ijscr.2020.08.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To report a case of uterine preservation in pelvic organ prolapse robot-assisted laparoscopic surgery. PRESENTATION OF CASE The patient is a 42-year old Caucasian woman with pelvic organ prolapse. She previously had undergone a pelvic floor reconstruction with vaginal surgical approach, she had suffered from anorexia nervosa and she had two childbirths with vaginal deliveries. The woman was treated with robotic-assisted laparoscopic sacrohysteropexy and retropubic colposuspension. DISCUSSION Data suggest that abdominal surgery, typically with an abdominal sacralcolpopexy, provides better objective anatomic outcomes, than vaginal procedures, despite the longer operating times and grater delay in the resumption of activities which can be mitigated by the use of laparoscopic or robotic surgery. Several studies about vaginal approaches suggest that uterus-preserving surgery with vaginal procedures have similar success rates, less blood loss and shorter surgical time compared with hysterectomy. A multicenter study compared laparoscopic sacrohysteropexy with vaginal mesh hysteropexy reported similar one-year cure rates, improvement in pelvic floor symptoms, improvement in sexual function, and satisfaction rates. CONCLUSION We found robotic-assisted laparoscopic sacrohysteropexy to be a feasible and successful procedure. Combining robotic retropubic colposuspension to sacrohysteropexy is a safe and efficient approach for the treatment of stress urinary incontinence. Further studies are needed to define the standard surgical steps and confirm the efficacy and the advantages of this procedure.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nightingale G, Phillips C. Long-term safety and efficacy of laparoscopically placed mesh for apical prolapse. Int Urogynecol J 2021; 32:871-7. [PMID: 32524157 DOI: 10.1007/s00192-020-04374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Concerns regarding the use of vaginal mesh for prolapse have led to questions about the safety and efficacy of abdominally placed mesh. Mesh procedures for treating apical prolapse have become popular, either a laparoscopic hysteropexy (LSH) for uterine prolapse or a sacrocolpopexy (LSC) for vaginal vault prolapse. Robust long-term safety and efficacy data for these procedures are essential. METHODS All patients who had LSH or LSC since 2010 were invited back for face-to-face review and examination. Case notes were reviewed for surgical morbidities and patients were questioned about short- and long-term complications. The Patient Global Impression of Improvement (PGI-I) scale was used to assess prolapse, bladder and bowel symptoms postoperatively. RESULTS One hundred twelve patients were included in the review, 93 of whom were examined. The median time since surgery was 6 years (range 1-9 years); 2.7% cases had an intraoperative complication, two conversions to laparotomy and one bladder injury. Overall, 17.3% patients sought medical review postoperatively, with 10.7% having problems with their skin incisions. With regard to mesh safety, there was one case of bowel obstruction requiring resection following LSH and two vaginal mesh exposures following LSC; 97% had stage 1 or less apical prolapse at long-term follow-up and 79.6% reported symptoms of prolapse to be 'much better' or 'very much better' on the PGI-I scale. CONCLUSIONS This study shows excellent long-term results from LSC and LSH with comprehensive follow-up, demonstrating a very low and acceptable level of intraoperative, short- and long-term complications.
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Şükür YE, Dökmeci F, Çetinkaya ŞE, Seval MM. Comparison of patient reported outcomes, pelvic floor function and recurrence after laparoscopic sacrohysteropexy versus vaginal hysterectomy with McCall suspension for advanced uterine prolapse. Eur J Obstet Gynecol Reprod Biol 2020; 247:127-31. [PMID: 32092668 DOI: 10.1016/j.ejogrb.2020.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare medium/long-term outcomes in terms of pelvic floor function, patient reported prolapse recurrence and repeat prolapse surgery after laparoscopic sacrohysteropexy (LSHP) and vaginal hysterectomy with McCall suspension (VH&McCall) which is the most commonly performed surgical option for severe uterine prolapse from past to present. STUDY DESIGN Files of patients who underwent LSHP and VH&McCall for advanced utero-vaginal prolapse (stage 3 & 4) at the Department of Gynecology in Ankara University School of Medicine between 2008 and 2018 were reviewed (n = 517). Data of women who were followed up for at least 1-year and containing both the full-filled Patient Global Impression of Improvement (PGI-I) survey and Turkish validated Pelvic Floor Distress Inventory-20 (PFDI-20), were included. RESULTS A total of 132 women were included in the study; 46 women who underwent LSHP and 86 women who underwent VH&McCall. Even though the median age of the LSHP group was significantly lower than the median age of VH&McCall group (42 vs. 67 years; P<;0.001), recurrence and repeat surgery rates were found to be similar after both surgical approaches as well as the scores of PGI-I and PFDI-20. However, in women who were operated before their sixties, symptomatic recurrence was found to be significantly lower after LSHP than VH&McCall (16.2 % vs. 47.4 %, respectively; P = 0.024) as well as repeat prolapse surgery (2.7 % vs. 26.3 %, respectively; P = 0.014). PGI-I and PFDI-20 scores also suggested better pelvic floor function after LSHP significantly (p = 0.004 & p = 0.003 respectively). When adjusted for age, VH&McCall significantly increased the risk of symptomatic prolapse recurrence compared to LSHP (OR: 4.65; 95 % CI: 1.326-16.312; P = 0.016). CONCLUSION LSHP and VH&McCall might seem to be surgical options for individualized management with similar pelvic floor function & recurrence in the medium/long-term follow-up, but the age adjusted risk analysis showed higher rates of symptomatic recurrence after VH&McCall. Moreover, the better outcomes after LSHP in the younger subset, revealed the need of further clarification with well-designed prospective studies.
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Mahoney C, Hindle A, Rajashanker B, Kearney R. MR scan evaluation of pelvic organ prolapse mesh complications and agreement with intra-operative findings. Int Urogynecol J 2019; 31:1559-1566. [PMID: 31853599 PMCID: PMC7363669 DOI: 10.1007/s00192-019-04182-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
Introduction An increasing number of women are presenting with symptoms after the placement of mesh implants for prolapse which may be attributable to a mesh implant complication. MRI imaging can be used to evaluate abdominally placed mesh but there is no published research evaluating the use of MRI in this group of women. The objective of our study was to report our experience as a tertiary centre in evaluating abdominal mesh with MR imaging and the agreement of MR reports with surgical findings. Study design A retrospective observational cohort study (Canadian Task Force classification II-2) of all women referred to our tertiary unit who underwent an MR scan for investigation of symptoms of mesh complication following an abdominally placed mesh implant between June 2006 and September 2018 was performed. The reports of MR images were compared with the findings at surgery. Results MR scan was performed in 87 with suspected mesh complications. MR scan detected mesh failure in 42.1% of women (37/87), infection in 12.6% (11/87), compression in 2.3% (2/87), exposure in 12.6% (11/88), bowel extrusion in 2.3% (2/87) and inflammation in 11.5% (10/87). Agreement between MR scan report and surgical diagnosis was almost perfect for mesh failure, infection and compression, whilst agreement was only moderate for mesh erosion and signs of inflammation (failure κ = 0.97, infection κ = 0.94, compression κ = 1.0, exposure κ = 0.58 and inflammation κ = 0.24). Conclusion These data provide information on the role of MR imaging in the investigation of women presenting with suspected intra-abdominal POP mesh complications including recurrence.
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Affiliation(s)
- Charlotte Mahoney
- The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Adam Hindle
- Fairfield General Hospital, Pennine Acute NHS Trust, Bury, BL9 7TD, UK
| | - Balashanmugam Rajashanker
- Department of Radiology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Rohna Kearney
- The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK.
- Institute of Human Development, Faculty of Medical & Human Sciences, University of Manchester, Manchester, UK.
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Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic sacrocolpopexy is the preferred contemporary procedure for the surgical management of a significant apical pelvic organ prolapse. In the presence of a uterus it is possible for the patient to have subtotal hysterectomy and cervicopexy, total hysterectomy with colpopexy or uterine conservation and hysteropexy. However, hysteropexy seems to be associated with a higher risk of anterior compartment failure compared with cervicopexy or colpopexy. It is not uncommon for an asymmetrically large anterior compartment defect to co-exist with a symptomatic apical pelvic organ prolapse. In a cervicopexy or colpopexy, this asymmetry can be balanced by creating a de novo vaginal apex from the superior part of the anterior vaginal wall. However in a hysteropexy the attachment of the base of the anterior mesh to the vagina and cervical isthmus limits the ability to do this. METHODS In this video we present a solution where the shape of the posterior mesh is modified to include two horizontal arms that are passed through openings in the broad ligament and attached to the cervical isthmus anteriorly. RESULTS This frees the anterior Y-shaped mesh to be fixed to the anterior vaginal wall only and hence provides the required tension to create the de novo apex. CONCLUSION Prior to wide adoption, this technique should be further investigated in the context of robustly designed comparative studies.
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Affiliation(s)
- Vladimir Kalis
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic
| | - Zdenek Rusavy
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic
| | - Khaled M Ismail
- Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic.
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Sanverdi İ, Kılıççı Ç, Polat M, Özkaya E, Kılıç SG, Dizdar M, Karateke A. A new operation technique for uterine prolapse: Vaginally-assisted laparoscopic sacrohysteropexy. Turk J Obstet Gynecol 2017; 14:181-186. [PMID: 29085709 PMCID: PMC5651894 DOI: 10.4274/tjod.96641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/30/2017] [Indexed: 12/01/2022] Open
Abstract
Objective: To describe the new surgical technique and report the safety and feasibility of vaginally-assisted laparoscopic sacrohysteropexy (VALSH). Materials and Methods: Thirty-three women with stage 3 or more uterine prolapse underwent VALSH operation. Patients were followed up for 12 months for mesh-related complications and improvements of symptoms. The operation had three sections; 1st laparoscopic, 2nd vaginal, 3rd laparoscopic. Results: The mean age, gravidity, and parity of the study population were 46.5 years (range, 25-68 years), 4.3 (1-9), and 2.9 (1-6), respectively. The mean duration of operation was 59.5 min (range, 20-120 min). There were significant differences between the pre- and post-operative values of pelvic organ prolapse quantification parameters, which were favorable in the latter evaluation (p<0.001); total vaginal length was preserved after surgery (p>0.05). Conclusion: VALSH is a safe and minimally-invasive procedure in uterovaginal prolapse, with favorable anatomic and functional outcomes at 12 months post-operatively.
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Affiliation(s)
- İlhan Sanverdi
- University of Health Sciences, Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Çetin Kılıççı
- University of Health Sciences, Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mesut Polat
- University of Health Sciences, Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Enis Özkaya
- University of Health Sciences, Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sami Gökhan Kılıç
- The University of Texas Medical Branch, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery/Urogynecology, Texas, USA
| | - Merve Dizdar
- University of Health Sciences, Ümraniye Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- University of Health Sciences, Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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22
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Chen Y, Hua K. Medium-term outcomes of laparoscopic sacrocolpopexy or sacrohysteropexy versus vaginal sacrospinous ligament fixation for middle compartment prolapse. Int J Gynaecol Obstet 2017; 137:164-169. [PMID: 28099748 DOI: 10.1002/ijgo.12097] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/17/2016] [Revised: 11/18/2016] [Accepted: 01/04/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare laparoscopic sacrocolpopexy (LSC) or sacrohysteropexy (LSH) with vaginal sacrospinous ligament fixation (VSSLF) for middle compartment pelvic organ prolapse (POP). METHODS Data were retrospectively reviewed from patients with POP (stage 3 or worse) who underwent LSC, LSH, or VSSLF at a center in Shanghai between January 2009 and March 2014. POP quantification (POP-Q) and Pelvic Floor Distress Inventory scores were compared at the 2-year follow-up. RESULTS Data were available for the 2-year follow-up for 102 LSC, 11 LSH, and 94 VSSLF procedures. Compared with patients who had undergone VSSLF, those who had undergone LSC/LSH had better POP-Q C values (P<0.001), longer total vaginal length (TVL) (P<0.001), and lower Aa and Ba scores (P=0.003 and P=0.002, respectively). Apical compartment and overall success rates of LSC/LSH and VSSLF did not differ significantly. Quality of life was improved in both groups (P<0.001). Both groups achieved symptomatic relief, although bowel and urinary functions were significantly improved only in the VSSLF group (P<0.001 for both). More patients in the LSC/LSH group were sexually active at 2 years (P<0.001); improvement in sex life was similar between the groups. CONCLUSION Although LSC/LSH achieved longer TVL, both groups achieved the same success rate and improvement in quality of life. Specifically, VSSLF yielded a significant improvement in bowel and urinary function.
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Affiliation(s)
- Yisong Chen
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Abstract
OBJECTIVE To assess the outcome and safety of sacrohysteropexy as uterus conserving surgery for pelvic organ prolapse in young women and to assess patients' satisfaction with the procedure. METHODS This is a case series of patients operated at Sind Government Lyari General Hospital and Civil Hospital Karachi, between January, 2007 to October, 2015. Data of the patients who had sacrohysteropexy were reviewed. Complications during surgery and post-operative period including haemorrhage, visceral injury, paralytic ileus and peritonitis were studied. Success of procedure, need of blood transfusion, hospital stay and condition on discharge and six weeks follow-up were noted. Data were analyzed using SPSS version 16. Mean ± SD was calculated for numerical, while frequencies were computed for categorical variables. RESULTS Data of 60 patients were reviewed. Early post-operative success was 100%. Duration of surgery was less than two hours in 57 (95%) patients. Blood loss was negligible in majority of cases. Out of all 60 cases, 52 (86.7%) did not suffer any complication. One patient had ureteric injury, while one patient sustained bowel injury. Two patients had paralytic ileus. Four patients suffered from abdominal wound infection. All patients were managed satisfactorily. Mean duration of stay in hospital was four days. Upon follow up 96.7% patients were satisfied with results of operative procedure. Sixteen (26.7%) patients complained of backache on follow-up visit. CONCLUSION This review concludes that sacrohysteropexy was successful in all cases in early post-operative period. It is a safe procedure and should be considered as an option for the treatment of pelvic organ prolapse in young women, in whom uterine conservation is required.
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Affiliation(s)
- Ayesha Khan
- Prof. Ayesha Khan, FRCOG. Professor & Head of Department, Department of Obstetrics & Gynaecology, Unit I, Dow University of Health Sciences, Karachi, Pakistan
| | - Riffat Jaleel
- Dr. Riffat Jaleel, FCPS. Associate Professor, Dow Medical College & Civil Hospital Karachi, Department of Obstetrics & Gynaecology, Unit I, Dow University of Health Sciences, Karachi, Pakistan
| | - Farah Deeba Nasrullah
- Dr. Farah Deeba Nasrullah, MCPS, FCPS. Assistant Professor, Dow Medical College & Civil Hospital Karachi, Department of Obstetrics & Gynaecology, Unit I, Dow University of Health Sciences, Karachi, Pakistan
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Grimminck K, Mourik SL, Tjin-Asjoe F, Martens J, Aktas M. Long-term follow-up and quality of life after robot assisted sacrohysteropexy. Eur J Obstet Gynecol Reprod Biol 2016; 206:27-31. [PMID: 27614268 DOI: 10.1016/j.ejogrb.2016.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/12/2016] [Revised: 05/14/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effect of robot assisted laparoscopic sacrohysteropexy (RALS), with preservation of the uterus, in patients with pelvic organ prolapse on short and long term outcome. We report on (anatomical) status of the prolaps and the associated health related quality of life of women treated with RALS before and five years after surgery. STUDY DESIGN A prospective cohort study in a teaching hospital in The Netherlands was performed. Quality of life was assessed pre-operative, post-operative and five years after RALS using the UDI/IIQ validated self-questionnaire designed for Dutch-speaking patients. Clinical and operative data were prospectively collected up to five years. Statistical analysis of categorical data was performed with the paired T-test. Descriptive statistics were computed with the use of standard methods for means, median and proportions. RESULTS Hundred women with utero vaginal prolapse were treated with RALS with preservation of the uterus. The overall success rate of pelvic organ prolapse (POP) was 89.2%. After surgery the quality of life improved (P<0.05) Overall health status, based on a 0-100% visual analogue scale (VAS), improved from 72.6% pre-operative to 82.2% six weeks postoperative (P<0.05). Postoperative patients experienced less feelings of nervousness (P=0.01), shame (P<0.05) and frustration (P<0.05). The positive effects on these feelings remained present after five years. The learning curve shows a decrease in operating time with gained experience. CONCLUSION RALS has proven to be a safe and effective treatment for uterine preserving surgery in cases of pelvic organ prolapse. The long term anatomical outcomes and quality of life after RALS compare favorably with laparoscopic and open hysteropexy.
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Affiliation(s)
- K Grimminck
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands.
| | - S L Mourik
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
| | - F Tjin-Asjoe
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
| | - J Martens
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
| | - M Aktas
- The Maasstad Hospital, Obstetrics and Gynecology, Maasstadweg 21, Rotterdam, Netherlands
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Kupelian AS, Vashisht A, Sambandan N, Cutner A. Laparoscopic wrap round mesh sacrohysteropexy for the management of apical prolapse. Int Urogynecol J 2016; 27:1889-97. [PMID: 27250829 DOI: 10.1007/s00192-016-3054-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Interest in uterine-conserving surgery for apical prolapse is growing. Laparoscopic sacrohysteropexy is one of the conservative surgical options, although different surgical approaches have been described. We report medium-term outcome data using a bifurcated mesh implant, employing 'wrap round' uterine attachment. METHODS All procedures undertaken at our unit were reviewed. Study inclusion was contingent on the collection of baseline and 3-month anatomical and symptomatic outcome data. Medium-term follow-up data were collected by telephone review. Anatomical outcome was reported using the Pelvic Organ Prolapse Quantification scale. Symptom prevalence and treatment response were assessed using validated instruments including the Patient Global Impression of Improvement scale (PGI-I), and the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI) and Vaginal Symptoms (ICIQ-VS) questionnaires. Patient satisfaction was reported using Kaplan-Meier survival analysis. RESULTS Data were available for 110 patients. Of 80 patients providing PGI-I data at 3 months, 75 (94 %) described their prolapse symptoms as 'much better' or 'very much better'. Anatomical success in the apical compartment was 98 %. ICIQ-UI and ICIQ-VS responses demonstrated significant improvement. Despite a concurrent vaginal repair in only 11 % of patients, satisfaction at a mean follow-up of 2.6 years was 96 %. Repeat surgery for vaginal wall prolapse was required in only 5 % of patients. No safety concerns or graft complications were recorded. CONCLUSIONS This surgical variant of laparoscopic sacrohysteropexy is safe and highly effective. These data also cast doubt on the need for correction of modest vaginal wall prolapse at the time of surgery, and imply that apical prolapse may play a dominant role in the generation of symptoms.
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