Urogynecology

Abstract

Journal of Obstetrics and Gynaecology ResearchVolume 46, Issue S1 p. 64-68 Oral AbstractFree Access Urogynecology First published: 27 August 2020 https://doi.org/10.1111/jog.14290AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat A retrospective review on the outcomes of abdominal apical suspension using mesh in a Philippine Tertiary Training Hospital Mary Rani M. Cadiz, MD, Joanne Karen S Aguinaldo MD, Almira J Amin-Ong MD, Lisa T Prodigalidad-Jabson MD Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital, Manila, Philippines Introduction: The cornerstone of successful prolapse repair is a strong apical support. Objective: This is the first study in the Philippines which determines the outcomes of abdominal sacrocolpopexy (ASC) and abdominal sacrohysteropexy (ASH), two procedures which address apical prolapse. Methodology: A retrospective cohort design was utilized to compare the pre-operative and post-operative Pelvic Organ Prolapse Quantification Score (POP-Q Score), presence of mesh complications, and urinary/bowel symptoms in patients admitted within 2010-2016 by the Section of Urogynecology and Pelvic Reconstructive Surgery. Thirty-four patients met the inclusion criteria out of the fifty who underwent abdominal apical suspension. McNemar's test was used to compare the incidence of urinary/bowel symptoms. Univariate logistic regression was used to determine variables associated with operative failure. Results: For sole apical support, the overall success rate is 97%. When descent of the anterior or posterior compartment is also considered, the success rate of ASC is 73.7% and 56.3% at 6th and 12th month, while that of ASH is 81.6% and 71.4% at the same time frame. The anterior wall was the most common site of descent. Posterior descent was seen in 2 cases. Objective descent did not necessarily translate to symptomatic prolapse. Variables such as age, gravidity, parity have no significant contribution in prolapse recurrence. Vaginal estrogen use for vulvovaginal atrophy was the only significant factor associated with 17.14 higher odds for postoperative failure. This risk for prolapse recurrence may be due to poor tissue quality baseline. There was lower incidence of urinary symptoms postoperatively. There was no mesh erosion during the first 2 years of follow-up. Only one incidence of incisional hernia was reported. Conclusion: ASC and ASH have good success rate in apical support; however, descent of the anterior or posterior compartment diminishes the overall success rate in terms of objective POP-Q score. Both resulted to improvement in symptoms with minimal complications. An evaluation of the long term outcome of vaginal mesh for treatment of pelvic organ prolapse Symphorosa Shing Chee Chan, MD, Rachel Yau Kar Cheung MD, Osanna Yi Kee Wan MD The Chinese University of Hong Kong, Hong Kong Introduction: There is limited information on long term outcome of vaginal mesh surgery Objective: To evaluate the outcome of vaginal mesh surgery for women with pelvic organ prolapse (POP) in one tertiary referral center Methodology: This was an analysis of a prospectively collected surgical database from 2007. Generally, only women who had stage III/IV prolapse or recurrence of prolapse would receive vaginal mesh. Vaginal mesh repair was performed by urogynaecologists or subspecialty trainees. Women were followed-up at 3 months, then annually till 5 years. Data on demographics, peri-operative data, outcome and complications of surgery were collected. Objective recurrence was defined by POP-Q assessment with any compartment reaching hymen. Subjective recurrence was defined as women reported symptoms of prolapse. Subjective satisfaction was also asked. Results: A total of 183 women received vaginal mesh surgery; 20% had history of pelvic floor repair surgery. The mean age at surgery was 71.9 ± 8.4 years and mean vaginal parity was 3.6 ± 1.9. Majority of them are sexually inactive. In all, 83% received concomitant surgery, such as vaginal hysterectomy, sacrospinous fixation or TVTO during same operation. Operative time was 122.9 ± 40.6 minutes and blood loss was 192.4 ± 155.3 ml. Hospital stay was 3.8 ± 2.9 days. Overall, 4 defaulted follow-up or died of medical conditions within 1 year, leaving 179 women. Out of 179 women, 87%, 63% and 43% had reached one, three and 5 years of follow up. The objective recurrence rate was 10.6%. Subjective recurrence rate was 5.6% (n=8). Among them, 5, 1 and 2 had conservative treatment, vaginal pessary or surgery for the recurrence of prolapse. Mesh exposure rate was 8.9% (n=16). In all, 125 (70%) and 52 (29%) reported satisfy and very satisfy with the vaginal mesh repair surgery. Conclusion: Vaginal mesh repair can be one of the surgical options for women with advanced stage of POP. Five years vesicovaginal fistula's experience in Tertiary Hospital Surabaya Tri Hastono Setyo Hadi, Azami Denas Azinar, Eighty Mardiyan Kurniawati, Gatut Hardianto, Hari Paraton Department of Obstetrics Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia Introduction: Vesicovaginal fistulas cause high morbidity in women, affecting psychological conditions and quality of life. Currently surgery is still a challenge in providing healing and reducing the recurrence rate. Objectives: To review the epidemiological factor, causes and surgery outcome of vesicovaginal fistula Methods: This study is descriptive retrospective study. A total of 48 medical records of vesicovaginal fistula patients of Urogynecology outpatient clinic of Dr. Soetomo Academic General Hospital, tertiary hospital in Indonesia. Data managed over a 5 year period (2014-2018) were studied. Relevant information pertaining to epidemiological factor, causes and surgery outcome of vesicovaginal fistula were retrieved. Results: Forty-eight medical records of patient with diagnosis of vesicovaginal fistula were evaluated. Most of the patient (56.3%) with age of 40-49 years old. We found 5 (10.4%) cases of vesicovaginal fistula caused by obstetric procedure, 24 (50%) cases were caused by benign gynecology surgery and 19 (39.6%) cases were caused by malignancy, in which 8 patients were treated surgically and 11 patients underwent radiation. There were 20 patients (83.3%) with benign gynecology cases who underwent surgical management at Dr. Soetomo Academic General Hospital and had vesicovaginal fistula. From all the patients, 25 patients underwent transvaginal vesicovaginal fistula surgical procedure. Fifty-four percent were successfully treated with their first surgery, 46% encountered recurrences and needed re-surgery. From these patients who underwent another operation, one patient had a successful operation, while 2 patients needed additional surgical procedures. Conclusion: In our study, vesicovaginal fistula was mostly caused by benign gynecological procedure, which is contrary to some references in developing countries. There is still a high number of recurrences, thus we need to evaluate the complexity of fistula repair and surgical methods. Keywords: vesicovaginal fistula, surabaya Laparoscopic Davydov procedure: A laparoscopic peritoneal neovaginoplasty in 24 year-old girl with primary amenorrhea due to Mayer-Rokitansky-Küster-Hauser (MRKH) type I syndrome: A rare case report Monika Lijuwardi, MD, Azami Denas MD, Hari Paraton MD, Gatut Hardianto MD, Eighty Mardiyan Kurniawati MD, Tri Hastono Setyo Hadi MD Department of Obstetrics Gynecology, Faculty Of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is one of the causes of primary amenorrhea. The exact incidence is unknown, although recent study estimated it to be of 1:1500 to 1:4000. Several surgical techniques done in our hospital, such as using amnion and sigmoid in creating neovagina. Among other techniques, laparoscopic Davydov procedure, in which the vesicorectal space is coated by the peritoneum, is the simplest, safest, and quickest method for this case. Objective: To learn more about Laparoscopic Davydov as a minimally invasive yet effective procedure in creating neovagina. Method and Results: A case report of a 24-year-old girl referred from Endocrine to Urogynecology outpatient department with Vaginal Agenesis-MRKH Syndrome for neovagina procedure. On examination she was found to have well developed secondary sexual characteristics, normal external genitalia and a small blind vaginal dimple. Ultrasonography and MRI revealed the absence of uterus but ovaries were reported to be present. The karyotyping was 46XX. She will get married; hence the surgery was done 3 months before the date to provide an intercourse for her future husband. The laparoscopic Davydov procedure was selected with considerations of less complication, excellent esthetically and length of the neovagina is long enough. The procedure was performed with no major complications. Neovagina had been created in this patient and made her feel more confident. She had no complaints on her follow-up. Conclusions: The laparoscopic Davydov procedure can be done as an alternative procedure in creating neovagina because it is a safe and effective surgical treatment which offers sexual intercourse in MRKH syndrome patients. It is not a life-threatening disease, but has a significant influence on patients' life. With adequate treatment, sexual relations are possible, and fertility options are available. Keywords: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, Laparoscopic Davydov, neovagina Clinical outcomes on tension-releasing suture appendage on single-incision sling devices for postoperative voiding dysfunction involving undue tape tension Tsia-Shu Lo 1,2, Sandy Chua3, Shih Yin Huang1, Chuan-Chi Kao1, Wu-Chiao Hsieh1, Ahlam Al-Kharabsheh4 1Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou/Keelung/Taipei, Taiwan, 2Chang Gung University, School of Medicine, Taoyuan, Taiwan, 3Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines, 4Obstetrics and Gynecology, King Abdullah University Hospital/University of Science and Technology, Irbid, Jordan Objective: To determine the clinical outcomes of adding tension releasing suture (TRS) appendage [1] for manipulation of over-tensioned single-incision slings (SIS) as a means to relieve post-operative voiding dysfunction Materials and Methods: A retrospective observational study conducted from January 2010 to July 2017. The records of patients with urodynamic stress incontinence (USI) without needing concurrent procedures that underwent anti-incontinence surgery using MiniArc, Solyx, and Ajust with voiding dysfunction were collated and analyzed. The TRS was prepared by appending a 1-0 absorbable polyglactin suture to one end of the mini-sling fiber attached to the anchoring tip. Precaution was taken to exteriorize the free end of the TRS suture through the anterior vaginal surface epithelium incision. To facilitate subsequent postoperative manipulation if sling tension release was indicated, approximately 2 cm of the TRS was left protruding on the vaginal wall. The primary outcome measure was having a post-void residual (PVR) urine volume within the normal defined range of <150 mL or <20% the bladder volume on bladder scan after TRS manipulation. The secondary outcome measures were the pain intensity noted during manipulation (quantified through Visual Analog Scale), and the continence rate (assessed through 1. Objective cure- 1-hour pad test weight <2 g and absence of USI; and 2. Subjective cure- index score of <1 on question #3 on UDI-6: “Urine leakage related to physical activity, coughing, or sneezing?”). Results: There were 443 consecutive patients diagnosed with USI offered with SIS surgery. Of these, 73(17%) patients had high PVR urine volume on the first post-operative day and underwent introital ultrasonography. From the 73 patients, 42(9.5%) had over-tensioned sling and managed with TRS manipulation while 31(7%) patients with no sling over-tension but had high PVR were managed with intermittent catheterization. Baseline demographics amongst the patients were comparable. Pain experienced during TRS manipulation significantly increased with the Ajust system (p=0.018). Post-operative urodynamic evaluation showed significant improvement of USI. The TRS manipulated group demonstrated an objective cure of 92.9%(39/42) and subjective cure of 91%(38/42). Three patients had persistence of USI, 2 from MiniArc and 1 from Solyx. Conclusion: The TRS manipulation is a well-tolerated procedure that can effectively relieve voiding dysfunction for over-tensioned SIS without affecting continence cure rates. Prophylactic mid-urethral sling insertion during transvaginal pelvic reconstructive surgery for advanced prolapse patients with high-risk predictors of post-operative de novo stress urinary incontinence Tsia-Shu Lo1,2, Sandy Chua3, Chuan Chi Kao1, Hun-Shan Pan4, Ma. Clarissa Patrimonio5, Eileen Feliz M. Cortes6 1Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou/Keelung/Taipei, Taiwan, 2Chang Gung University, School of Medicine, Taoyuan, Taiwan, 3Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines, 4Obstetrics and Gynecology, Shin Kong Hospital, Taipei, Taiwan, 5Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippine, 6Obstetrics and Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines Objective: To evaluate the clinical outcome of continent women with high-risk predictors for de novo stress urinary incontinence (SUI) offered with prophylactic mid-urethral sling (MUS) insertion during vaginal pelvic reconstructive surgery (PRS) for advanced pelvic organ prolapse (POP) Materials and Methods: A prospective cohort study done in a tertiary referral center on patients with POP >stage 3 who were continent and possess high risk predictors for de novo SUI determined through maximum urethral closure pressure (MUCP) <60cmH20 and functional urethral length (FUL) <2cm. Patients were divided two groups: PRS and PRS+MUS groups. Surgery commenced with vaginal hysterectomy, application of Uphold® and insertion of MUS to PRS+MUS group. Main outcome measures the incidence of de novo urodynamic stress incontinence (USI), lower urinary tract symptoms, quality of life, and topographic and anatomical relationship of implanted mesh. The sample size of 20 patients was required for each study arm to detect a 40% difference in postoperative USI with 95% confidence interval (CI); statistical power of 80% was computed based on the incidence of postoperative USI in the study by Lo et al. [1]. Results: Based on sample size calculation, 40 patients were recruited-20 in each group. Rate of de novo USI in PRS+MUS was 5% objectively and 10% subjectively while in the PRS, rate was 50% objectively and 60% subjectively. No significant difference was noted in patient demographics. Intra-operative blood loss was greater for PRS+MUS but was not statistically significant. No organ injuries, mesh exposure nor infections occurred. Post-operatively, MUCP significantly increased from 43.3+8.9 to 58.5+19.2cmH20; and FUL from 17.2+1.9 to 20.3+3.1mm in the PRS+MUS group. Residual urine significantly decreased. No patient had bladder outlet obstruction. Sonographic assessment showed no difference in mesh mobility with urethral kinking observed in 11(55%) patients with MUS. Conclusion: Based on validated small sample, prophylactic MUS to continent women at high-risk for post-operative USI with advanced POP lowers its incidence to 5%. Continence is achieved in 95%. Concern for complications, lower urinary tract symptoms and quality of life did not significantly differ. Reference 1Karim N, Cortes EM et al. Comparison between elevate anterior/apical system and perigee system in pelvic organ prolapse surgery: clinical and sonographic outcomes. Int Urogynecol J. 2015; 26: 391– 400. Outcome of laparoscopic sacrocolpopexy for pelvic organ prolapse: A single center experience in a series of 1235 patients Jimmy Nomura, MD Purpose: To assess safety and outcomes of laparoscopic sacrocolpopexy (LSC) for the treatment of pelvic organ prolapse (POP). Methods: This was retrospective study of 1235 patients who underwent LSC. All patients were diagnosed with at least POP-Q Stage 2. Two separate meshes were used for the procedure. The posterior mesh end was fixed on the levator ani muscles and the anterior mesh end was fixed on the vaginal wall at the level of the bladder neck. In this study, no concomitant surgery was performed. Objective success, subjective success, subjective failure, complication, and reoperation rate were evaluated. Objective success was defined as POP-Q Stage 0 or 1 in all compartments and objective failure as Stage 2 or more in any compartment. Subjective success was defined as having no symptomatic bulge not protruding beyond the hymen based on the questionnaire. Subjective failure was defined as a recurrence of symptoms with no objective prolapse. Results: The objective success rate was 94.3%. The subjective success rate based on patient's questionnaire was 91.4%. Among the recurrent cases (5.7%), 5.0% were diagnosed to have Stage 2 and 0.7% of them with Stage 3 POP. The complication rate was 1.9%. Perioperative complications were 2 cases of bladder injury and 6 cases of vaginal injury. Postoperative complications were port site hernia and ileus. During the follow-up, no vaginal mesh exposure and no chronic pelvic pain were identified. The overall reoperation rate was 6.0%. However, re-operation rate for POP was only 0.7% and re-operation for mid-urethral sling was 5.3%. Conclusions: The present study provided the findings that LSC with anterior and posterior mesh had an over 90% objective and subjective success rate and only 0.7% re-operation rate for POP. These findings suggest the effectiveness of LSC using anterior and posterior mesh on the support for multiple compartment prolapses. Volume46, IssueS1Supplement: 26th Asia and Oceania Federation of Obstetrics and Gynecology Congress, 10–14 November 2019, Philippine International Convention Center, Pasay, PhilippinesAugust 2020Pages 64-68 ReferencesRelatedInformation