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Banakhevych R, Akymova K, Pariienko K, Nechaiev V. Prevention of complications of surgical treatment of stage III-IV cystocele using light polypropylene mesh. Urologia 2024; 91:212-219. [PMID: 37606212 DOI: 10.1177/03915603231193059] [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] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The purpose of study was to report the subjective and objective results of different methods of surgical treatment of cystocele using the transvaginal Mesh-system. METHODOLOGY A prospective study was conducted from January 2017 to December 2020 comparing anterior colporrhaphy with vaginal mesh and two distinct types of vaginal wall repair sutures in the surgical treatment of cystocele. The primary endpoint was the incidence rate of vaginal wall erosion complications 12 months after surgery. Secondary endpoints were anatomic outcomes, TVM-related morbidity, and patient satisfaction measured using validated questionnaires. RESULTS In total, 102 patients with stage III-IV cystocele and the average age of 67.2 ± 3.1 years (age range of 47-79 years old) took part in the study. Of the 102 women initially enrolled, 102 (100%) were successfully followed up 12 months after primary surgery. The primary result, the objective erosion development, was radically different in the comparison groups (1.6% against 23.5%, respectively). Analysis of the improved method of operative treatment showed a prominent level of positive, uncomplicated, surgery results of 98.4% (60/61). The anatomic success rate of recovery from cystocele was 99.9% (101/102) 12 months after surgery. CONCLUSION The suggested method of restoring the anterior vaginal wall in stage III-IV isolated cystocele without signs of incomplete and complete prolapse of the uterus showed a radically positive result. The number of complications was relatively high in the comparison group, but no difference was observed in satisfaction with the anatomical results of the surgery. The percentage of the vaginal wall erosion when using a single-layer suture is 23.5%, when using a two-layer suture is 1.6.
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Affiliation(s)
- Roman Banakhevych
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, Ukraine
| | - Klavdiia Akymova
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, Ukraine
| | - Kateryna Pariienko
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, Ukraine
| | - Vsevolod Nechaiev
- Department of Obstetrics, Gynecology and Perinatology, Dnipro State Medical University, Dnipro, Ukraine
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Kim JH, Lee SY, Chae HD, Shin YK, Lee SR, Kim SH. Outcomes of vaginal hysterectomy combined with anterior and posterior colporrhaphy for pelvic organ prolapse: a single center retrospective study. Obstet Gynecol Sci 2021. [PMID: 34736315 DOI: 10.5468/ogs.21235] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the efficacy of vaginal hysterectomy combined with anterior and posterior colporrhaphy (VH APR) for the management of pelvic organ prolapse (POP). Methods A total of 610 patients with POP who underwent VH APR from January 2010 to June 2019 at Asan Medical Center were included in this study. We analyzed the patient characteristics and surgical outcomes. In addition, we compared the POP quantification system (POP-Q) pre- and postoperatively at 2 weeks, 3 months, and 1 year, and analyzed the risk factors for recurrence. Results The mean age of the patients was 65.5±7.6 years. The most common preoperative POP-Q stage was stage 2 (60.8%), followed by stage 3 (35.9%). Complications were identified during surgery in 1.6% of the patients. The most common postoperative complication (6.4%) was voiding difficulty. All POP-Q scores significantly decreased at 1 year after surgery (P<0.0001). The recurrence rate was 9.6%, and most recurrences (77.5%) occurred in the anterior compartment. An advanced stage of preoperative POP was a risk factor for recurrence (stage 3 or 4 vs. stage 1 or 2; odds ratio [OR], 5.337, 95% confidence interval [CI], 2.58–11.036, P<0.0001). Only two patients underwent surgical correction for POP recurrence, and most of the remaining patients did not undergo further treatment for prolapse. Conclusion VH APR is a safe and effective surgical procedure for POP, with a low recurrence rate. In addition, advanced preoperative stage was the only risk factor for recurrent POP.
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Schwarzman P, Samueli B, Shaco-Levy R, Baumfeld Y, Leron E, Weintraub AY. The role of hydrodissection in native tissue repair of anterior vaginal wall defects. Aust N Z J Obstet Gynaecol 2021; 62:98-103. [PMID: 34580858 DOI: 10.1111/ajo.13431] [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: 02/09/2021] [Revised: 06/24/2021] [Accepted: 08/31/2021] [Indexed: 12/01/2022]
Abstract
AIMS A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). MATERIALS Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ2 and Fisher's exact tests. RESULTS Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). CONCLUSIONS After hydrodissection, less bleeding was noted without compromise the surgical planes.
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Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benzion Samueli
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruth Shaco-Levy
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Jeon MJ, Suh DH, Kim CH, Cho HH, Shin JH, Lee SR, Jung YW, Kim SR, Kong MK. Non-absorbable versus absorbable sutures for anterior colporrhaphy: study protocol for a randomised controlled trial in South Korea. BMJ Open 2020; 10:e034218. [PMID: 32554735 PMCID: PMC7304798 DOI: 10.1136/bmjopen-2019-034218] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The anterior vaginal wall is the segment most commonly affected by prolapse. Traditionally, anterior vaginal wall prolapse is repaired via anterior colporrhaphy, which is known to have a high recurrence rate. Several factors might affect the outcome of anterior colporrhaphy, and the use of absorbable sutures might also be associated with the high recurrence rate because the sutures might not be able to retain adequate strength until the plicated pubocervical fascia remodels and regains maximum tensile strength. Nonetheless, no comparative data exist about the relative efficacy and safety of anterior colporrhaphy using non-absorbable versus absorbable sutures. The objective of this study is to compare the surgical outcomes of anterior colporrhaphy using non-absorbable sutures with those of anterior colporrhaphy using absorbable sutures. METHODS AND ANALYSIS This is a randomised, multicentre, superiority trial. Anterior colporrhaphy will be performed in a traditional manner with midline plication of the fibromuscular layer using either non-absorbable or absorbable sutures. The primary outcome is composite surgical success 1 year after surgery defined as the absence of all of the following: (1) anterior vaginal descent beyond the hymen, (2) the presence of vaginal bulge symptoms and (3) retreatment for recurrent anterior vaginal wall prolapse with either surgery or pessary. The secondary outcomes include the individual components of the composite primary end point, anatomical outcomes, condition-specific quality of life and adverse events related to anterior colporrhaphy. The planned number of participants is 192. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of Seoul National University Hospital (H-1810-037-977). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT03736811.
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Affiliation(s)
- Myung Jae Jeon
- Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Dong Hoon Suh
- Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
| | - Chul Hong Kim
- Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, The Republic of Korea
| | - Hyun-Hee Cho
- Obstetrics and Gynecology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, The Republic of Korea
| | - Jung-Ho Shin
- Obstetrics and Gynecology, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Sa Ra Lee
- Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, The Republic of Korea
| | - Yong Wook Jung
- Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, The Republic of Korea
| | - Soo Rim Kim
- Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, The Republic of Korea
| | - Mi Kyung Kong
- Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, The Republic of Korea
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Baser E, Ozdemirci S, Uysal D, Karahanoglu E, Sivaslioglu A. Effects of Surgical Anatomical Correction of Pelvic Anterior Compartment Defect on Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2017; 10:277-280. [PMID: 28921924 DOI: 10.1111/luts.12180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/19/2017] [Accepted: 03/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effects of surgical anatomical correction on lower urinary tract symptoms (LUTS) in patients with a pelvic anterior compartment defect (PACD). METHODS This prospective study was carried out on 30 women who had stage II-IV PACD. The women were questioned regarding LUTS symptoms such as urgency, urge incontinence, frequency, hesitancy, abnormal emptying, nocturia and dysuria pre and postoperatively. After a 7-month follow up, the comparison of LUTS symptoms with respect to their healing, existence or de novo appearance was performed using the McNemar and Bowner and Wilcoxon signed-rank tests. RESULTS For the repair of ACD, 15, 8 and 7 women were operated on using site-specific surgery, transvaginal mesh placement and anterior colporrhaphy, respectively. Surgery has significantly improved the LUTS: urgency (100 vs 26.7%, urge incontinence (70 vs 16.7%), frequency (76.7 vs 13.3%), abnormal emptying (56.7 vs 10%), hesitancy (30 vs 6.7%), nocturia (83.3 vs 60%) and dysuria (30 vs 6.7%). The differences were statistically significant (P < 0.05). CONCLUSIONS The correctional surgery on anterior compartment defects not only maintains the anatomy but also significantly heals the LUTS.
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Affiliation(s)
- Emre Baser
- Department of Obstetrics and Gynecology, Obstetrics Clinic, Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
| | - Safak Ozdemirci
- Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
| | - Dilek Uysal
- Department of Obstetrics and Gynecology, Obstetrics Clinic, Izmir Katip Celebi University Ataturk Education & Research Hospital, Izmir, Turkey
| | - Ertugrul Karahanoglu
- Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
| | - Akın Sivaslioglu
- Department of Obstetrics and Gynecology, Medical Faculty Hospital, Mugla Sitki Kocman University, Mugla, Turkey
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Huang WC, Yang SH, Yang JM. Clinical Importance and Surgical Outcomes of Green Type III Cystocele in Women With Anterior Vaginal Prolapse. J Ultrasound Med 2015; 34:2279-2285. [PMID: 26573101 DOI: 10.7863/ultra.14.11066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To explore the clinical importance and surgical outcomes of Green type III cystocele in women with anterior vaginal prolapse. METHODS A database of 336 women with a Ba point higher than -3 cm on the Pelvic Organ Prolapse Quantification system was retrospectively reviewed. Investigated data comprised those obtained from a clinical interview, the Pelvic Organ Prolapse Quantification system, and sonography. Initially, the baseline data between women with (n = 126) and without (n = 210) Green type III cystocele on sonography were compared. Subsequently, 6-month postoperative data between women who had Green type III cystocele on sonography and underwent either anterior colporrhaphy (n = 25) or a Perigee procedure (n = 76) were compared. RESULTS Women with Green type III cystocele had symptoms of voiding dysfunction more frequently, stress urinary incontinence less frequently, and more bulging (mean ± SD, 2.7 ± 1.2 versus 1.9 ± 1.5 for women with versus without Green type III cystocele; P = .001), a greater likelihood of stage II or higher cystocele (86.5% versus 60.0% for women with versus without Green type III cystocele; P < .001), as well as more caudodorsal bladder neck and genitohiatal positions and a wider genital hiatus on sonography. Women with Green type III cystocele had a greater likelihood of stage 0 cystocele (64.0% versus 89.5% for anterior colporrhaphy versus Perigee; P< .001) and more ventral bladder neck positions after Perigee procedures. CONCLUSIONS The presence of Green type III cystocele in women with anterior vaginal prolapse is associated with more functional impairments and anatomic defects. Despite comparable functional outcomes, Perigee procedures provide better anatomic outcomes for the anterior vagina in women with Green type III cystocele than anterior colporrhaphy does in the short term.
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Affiliation(s)
- Wen-Chen Huang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan (W.-C.H.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine (W.-C.H., J.-M.Y.), School of Nutrition and Health Sciences, College of Public Health and Nutrition (S.-H.Y.), and Department of Obstetrics and Gynecology, Shuang Ho Hospital (J-M.Y.), Taipei Medical University, Taipei, Taiwan; and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (W.-C.H.)
| | - Shwu-Huey Yang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan (W.-C.H.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine (W.-C.H., J.-M.Y.), School of Nutrition and Health Sciences, College of Public Health and Nutrition (S.-H.Y.), and Department of Obstetrics and Gynecology, Shuang Ho Hospital (J-M.Y.), Taipei Medical University, Taipei, Taiwan; and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (W.-C.H.)
| | - Jenn-Ming Yang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan (W.-C.H.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine (W.-C.H., J.-M.Y.), School of Nutrition and Health Sciences, College of Public Health and Nutrition (S.-H.Y.), and Department of Obstetrics and Gynecology, Shuang Ho Hospital (J-M.Y.), Taipei Medical University, Taipei, Taiwan; and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (W.-C.H.).
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Aydın S, Arıoğlu Aydın Ç. Effect of concomitant single incision vaginal surgery on mid urethral sling success. Neurourol Urodyn 2015; 35:995-999. [PMID: 26250780 DOI: 10.1002/nau.22847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 11/08/2022]
Abstract
AIMS The aim of this study was to assess medium-term outcomes of the single anterior vaginal wall incision technique with concomitant mid-urethral sling (MUS) procedure. METHODS Patients suffering from stress urinary incontinence and who desired surgical correction for their incontinence were divided into two groups according to MUS surgery alone or MUS surgery with anterior vaginal wall surgery. Concomitant surgery was performed via single large anterior vaginal wall incision. Primary outcome was treatment success 12 months after surgery. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. RESULTS Single incision anterior colporrhaphy with MUS was performed in 180 patients, 62 patients underwent only MUS procedure. Success rate was 87.1% in sling surgery alone and 83.9% in single incision concomitant surgery group (P = 0.5). Detrusor overactivity (DO) was present on UDS in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). Total continence rate in patients who underwent vaginal hysterectomy was 60.6% (P < 0.001). CONCLUSION Concurrent cystocele repair with MUS operations through a single anterior wall incision is a safe and effective method for SUI. This study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse. Neurourol. Urodynam. 35:995-999, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Serdar Aydın
- Department of Obstetric and Gynecology, Bezmialem Vakif University, İstanbul, Turkey.
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Wong V, Shek K, Rane A, Goh J, Krause H, Dietz HP. Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement? Ultrasound Obstet Gynecol 2013; 42:230-234. [PMID: 23404827 DOI: 10.1002/uog.12433] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 01/31/2013] [Accepted: 02/01/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh. METHODS This was a retrospective analysis of data obtained from three surgical audits for subjective and objective outcomes following anterior colporrhaphy with mesh. Recurrence was defined as cystocele ≥ Stage 2 on the prolapse quantification system of the International Continence Society; symptoms of vaginal lump/bulge; or cystocele on ultrasound, defined as maximum bladder descent to ≥ 10 mm below the symphysis pubis. Levator avulsion was diagnosed using tomographic ultrasound imaging. RESULTS Two hundred and nine patients were followed up at a mean of 2.2 years (range, 3 months to 5.6 years) after anterior vaginal mesh placement. 24% (51/209) had recurrent prolapse symptoms, 33% (68/209) clinical cystocele recurrence ≥ Stage 2, and 26% (54/209) a recurrent cystocele on ultrasound. Twenty-eight out of 80 (35%) women with levator avulsion had significant sonographic cystocele recurrence (odds ratio (OR), 2.24 (95% confidence interval (CI), 1.13-4.43)). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression (OR, 2.13 (95% CI, 1.04-4.39); P = 0.04). CONCLUSION Levator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh.
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Affiliation(s)
- V Wong
- Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia.
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