V675 OUR MEDIUM-TERM RESULTS WITH A NOVEL APPROACH FOR ADVANCED UTERINE/VAGINAL VAULT PROLAPSE: RETROPERITONEAL SACROCOLPOPEXY

Abstract

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2011V675 OUR MEDIUM-TERM RESULTS WITH A NOVEL APPROACH FOR ADVANCED UTERINE/VAGINAL VAULT PROLAPSE: RETROPERITONEAL SACROCOLPOPEXY Fikret Fatih Onol, Erdal Kaya, Osman Kose, and Sinasi Yavuz Onol Fikret Fatih OnolFikret Fatih Onol Sakarya, Turkey More articles by this author , Erdal KayaErdal Kaya Istanbul, Turkey More articles by this author , Osman KoseOsman Kose Istanbul, Turkey More articles by this author , and Sinasi Yavuz OnolSinasi Yavuz Onol Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1627AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abdominal sacrocolpopexy is the gold standard for advanced pelvic organ prolapse repair; however, bowel complications are a reported concern. Our aim is to report our preliminary results with extraperitoneal sacrocolpopexy (ESCP). METHODS Twenty-three patients underwent ESCP for advanced (grade 3/4) uterovaginal/vaginal vault prolapse between July 2007 and July 2010. Preoperative assessment included Pelvic Floor Distress Inventory (PFDI-SF 20) and Pelvic Floor Impact (PFIQ-7) questionnaires, and pelvic examination according to Pelvic Organ Prolapse Quantification (POP-Q) system. Uterus was preserved in 10 patients. Through a 10 cm pfannenstiel incision, peritoneum over the bladder was retracted medially and cranially on the right side to facilitate the dissection of plane between the posterior bladder and anterior vaginal wall including cuff/cervix, then a 10×3 cm. Polypropylene mesh was fixed to the anterior vaginal wall. Retroperitoneal tissues were bluntly dissected to expose the common iliac vessels, right ureter, and sacral promontorium, followed by lateralization of right ureter which could otherwise be compressed by the sacrocolpopexy mesh at the end of the procedure. Posterior vaginal mesh was not used in any case in this series. Post-operative follow-up was scheduled at 7th day, 1,3,6, and 12th months, and yearly thereafter with pelvic examination, PDFI-SF 20 and PFIQ-7 questionnaires, and PVR measurement. Failure was defined as any prolapse of grade idegÝ 2 in the anterior, posterior or apical compartments. Pre operative PFDI-20 and PFIQ-7 scores and POP-Q measurements were compared with values obtained at the last follow-up using Wilcoxon sign test. RESULTS Mean operation time was 86 iÀ 20 minutes. Twenty (87%) patients were discharged within 24 hours. Urethral catheter was removed within 12 hours in all but one who had bladder perforation during dissection. With a median follow-up of 24 months (range: 3–36), objective and subjective cure rates were 91.3% and 86.9% respectively. Post-operative intestinal complications or mesh erosion were not evident. All patients showed significant improvement in POP-Q measurements, and PFDI-SF 20 and PFIQ-7 scores assessed postoperatively. CONCLUSIONS This is the first report to describe a retroperitoneal approach for sacrocolpopexy. ESCP seems as a safe and effective option that may potentially eliminate the serious gastrointestinal complications of trans-peritoneal sacrocolpopexy without compromising its success. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e273 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fikret Fatih Onol Sakarya, Turkey More articles by this author Erdal Kaya Istanbul, Turkey More articles by this author Osman Kose Istanbul, Turkey More articles by this author Sinasi Yavuz Onol Istanbul, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...