Abstract
ABSTRACTPurpose:To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI).Materials and Methods:Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled “rinary Distress Inventory-6(UDI-6)”, “Incontinence Impact Questionnaire 7(IIQ-7)” and “Index of Female Sexual Function(IFSI)” questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted.Results:There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively.Conclusions:Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.
Highlights
Pelvic organ prolapse (POP) is a common problem that occurs in half of multiparous women, and surgical treatment is required in one tenth of the patients [1,2,3,4]
Urinary incontinence is detected in 20-90% of women with POP, POP is found in 30-70% of women with UI, and sexual dysfunction is reported in 31-44% in women with POP and UI [16]
The improvement rates of VHTOT surgeries are superior to conventional methods for stress urinary incontinence (SUI), and quality of life, the negative effects on sexual function are notable
Summary
Pelvic organ prolapse (POP) is a common problem that occurs in half of multiparous women, and surgical treatment is required in one tenth of the patients [1,2,3,4]. SUI accompanying POP may be treated using conventional methods or other methods that require the use of mesh, such as the mid-urethral slings (MUS). Anterior / posterior colporrhaphy with Kelly’s plication (CA-KP) is one of the conventional methods performed in the treatment of SUI. It is an old method and the success rate is lower in the long term, it has been a popular method in some clinics among gynecologists and urologists [10]. After the description of transoburator tape (TOT) procedure in the treatment of SUI in 2001 by Delorme, TOT has been the gold standard in many centers as a minimally invasive method [11]
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