Anterior Pelvic Organ Prolapse Research Articles

Lower urinary tract injury in transvaginal reconstructive pelvic surgery

Objective: To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS). Methods: A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals. Results: (1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder. Conclusions: Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

Detrusor underactivity in symptomatic anterior pelvic organ prolapse.

The aim of this study was to assess the detrusor underactivity (DUA) prevalence of females with symptomatic anterior pelvic organ prolapse (POP) and to evaluate the relationship between DUA and POP stage. This was a prospective study recruiting women with symptomatic anterior POP. Patients with symptomatic stage 2-4 POP quantification system (POP-Q) who underwent urodynamics (UD) between January 2018 and April 2021 were included. Data on 330 women (mean age 63.7 ±18.4 years old) with anterior vaginal wall defect were enrolled. Concomitant apical defect (uterine/vaginal vault) requiring surgical correction was diagnosed in 38 women (11.5%). DUA was found in 166 females (50.3%). In DUA women, POP-Q stage 2 was found in 45.2%, stage 3 in 50.9% and stage 4 in 76.5%. Only stage POP-Q stage 4 showed a statistically significant difference between DUA and non-DUA females (p 0.006). In women with symptomatic POP, regardless of the POP-Q stage, the chance of DUA occurrence was high. DUA was diagnosed in approximately half of the women undergoing UD for symptomatic POP, and it was three-fold higher in cases of POP-Q stage 4. Due to the high incidence of DUA in POP-Q 4 stage, it may be advantageous to identify and treat prolapse before they progress to stage 4.

The use of midurethral sling in the correction of low-stage cystoceles: a prospective randomized trial

Introduction and hypothesisThe objective was to assess whether midurethral slings (MUS) can improve both stress urinary incontinence (SUI) and cystoceles. MUS with anterior colporrhaphy (AC) as a treatment for SUI with cystocele is more invasive and carries greater risk than MUS alone.MethodsThis is a prospective randomized study involving women with stage 1 or 2 cystocele and SUI, who were > 21 years of age, who had had no previous surgery for SUI. Predominant SUI, symptomatic anterior pelvic organ prolapse, and informed consent were mandatory. Patients were randomized as to whether AC had been performed. The sling procedure was left to the surgeon’s discretion: pubovaginal sling, tension-free vaginal tape, or trans-obturator tape. Success was defined as a negative stress test and no evidence of cystocele upon local examination.ResultsNinety-eight patients were enrolled, 48 underwent MUS, and 50 underwent MUS and AC. Mean age ± SD was 44.96 ± 8.13 years. Baseline characteristics were similar. Operative time and blood loss were significantly higher in the MUS/AC group (p = 0.01 and 0.02 respectively). At 3 months, success was 79.1% and 77.8% in the MUS and MUS/AC groups respectively. This was maintained until 6 months (79.1% and 77.8% respectively). At 1 year, the results were comparable with success rates of 96.2% and 87.0% in the MUS and MUS and AC groups respectively. Symptom scores were comparable at 6- and 12-month evaluations.ConclusionMidurethral slings correct symptomatic stage 1 or 2 cystoceles without the need for AC, which carries the risk of a significantly longer procedure and more significant blood loss.

Modified Vaginal Mesh Procedure with DynaMesh®-PR4 for the Treatment of Anterior/Apical Vaginal Prolapse.

(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women.

Does variation of surgical technique affect native tissue anterior pelvic organ prolapse repair outcomes?

Introduction and hypothesisThe Variation in Surgical Technique study (VaST), demonstrated the large variation in surgical techniques used in native tissue (NT) anterior pelvic organ prolapse (POP) repairs. However, there are few comparative studies of different surgical techniques. This study was aimed at exploring whether surgical technique influenced the outcomes of NT anterior POP repairs.MethodsThe surgical techniques of 22 consultant surgeons performing NT anterior POP repairs were filmed and categorised. These surgeons performed 809 anterior repairs within the PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial (PROSPECT). Logistical regression models were used to determine the influence of the different surgical techniques on subjective and objective outcomes, using data collected during PROSPECT.ResultsIn adjusted multivariate linear regression models, fascial-flap repair was associated with an improved subjective outcome (POP-SS) compared with midline plication (β = −2.50 [−4.42 to −0.57]; p = 0.01). At 12 months, separate fascial defect repair was associated with a poorer objective outcome than midline plication (OR 6.06 [1.82–3.52], p = 0.006). At 24 months, deep dissection was associated with a poorer POP-SS than superficial dissection (0.32–2.60, p = 0.0). Continuous-locking closure of the skin was also associated with improved POP-SS compared with continuous non-locking closure (12 months: β = −1.94 [−3.42 to −0.45], p = 0.01).ConclusionSurgical technique may influence the outcome of native tissue anterior POP repairs. Our results should not change practice but inform future research; to develop methods of explicitly recording surgical techniques and allow confirmation of the effect of these aspects of technique on outcome.

Retracted: Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women.

[This retracts the article DOI: 10.1155/2022/4818011.].

Anatomic outcomes of sacrohysteropexy without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles: Is a rectouterine mesh really necessary?

To present the anatomic outcomes of sacrohysteropexy surgery without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles. The patients who underwent abdominal sacrohysteropexy without posterior mesh placement for the treatment of symptomatic grade 3 and 4 anterior/apical prolapse + asymptomatic grade 1 and 2 rectocele between May 2015 and January 2021 were evaluated retrospectively. The success rate, the anatomic outcomes (for anterior, apical, and posterior pelvic organ prolapse [POP]), and perioperative data of the surgical procedure were assessed. The objective failure criteria after surgery included the presence of grade 1 or higher in any compartment (anatomical criteria), recurrent POP requiring an operation, and/or usage of pessaries. Perioperative adverse events were categorized according to the Clavien-Dindo classification. Fifty-one patients underwent sacrohysteropexy without posterior mesh. The mean age of the patients was 56.8 ± 10 years. The success rates (anatomical outcomes) for the anterior/apical and posterior POP in the study group were 60.7%, 54.9%, and 58.8%, respectively, at a median follow-up time of 40.24 (24-71) months. The median hospital stay was 3.1 (2-6) days. The mean estimated blood loss was 127.6 (80-150) mL. The mean operation time was 114 (90-156) min. The mean urethral and catheter removal times were 1.3 (1, 2) and 2.1 (2-4) days, respectively. The mean recovery time of gastrointestinal motility was 14.4 h (11-35). Sacrohysteropexy without posterior mesh placement might be associated with less pain, shorter operative time, and shorter recovery time of gastrointestinal motility, without compromising the anatomic success.

Comparison of the anterior pelvis and levator ani muscle on MRI in women with and without anterior pelvic organ prolapse.

The objective was to compare the differences in pelvic and levator ani muscle diameters in women with and without anterior pelvic organ prolapse. Three groups were included, including 50 nulliparous women (nulliparous group), 50 women with stage III-IV anterior vaginal prolapse (prolapse group), and 50 women of the same age as the prolapse group but without prolapse (nonprolapse control group). The ischial interspinous diameter (ISD), anterior pelvic area (APA), levator defect score (LDS), levator ani hiatus width (LH-W), H-line, M-line, levator ani plate length, levator ani plate angle, and cervix length (CL) were measured. There were no significant differences in ISD (10.6±0.8 vs 10.6±0.9cm), LH-W (3.0±0.4 vs 3.3±0.4cm), or CL (2.9±0.6 vs 3.0±0.5cm) between the nulliparous group and the nonprolapse control group (p>0.05). However, there were significant differences between them and the prolapsed group (11.2±0.6cm, 3.6±0.4cm, 4.2±1.5cm; p<0.05). There were no significant differences in LDS (0.70±0.61 vs 0.70±0.65) or APA (58.4±8.4 vs 60.1±7.4 cm2) between the nonprolapse control group and the prolapse group (p>0.05), but they were significantly different from those of the nulliparous group (0.08±0.34, 55.1±6.0 cm2) (p<0.05). The area under the receiver-operating characteristic curve for the ISD of nonprolapse control and prolapse groups was 0.713, and the cutoff value was 10.95cm. The levator ani hiatus width and cervix length were larger in patients with anterior vaginal prolapse than in those without prolapse. An ischial ISD greater than 10.95cm was associated with prolapse.

Urinary Biomarkers and Overactive Bladder Symptoms Before and After Prolapse Surgery.

Women with pelvic organ prolapse (POP) have increased prevalence of overactive bladder (OAB) and the evaluation of urinary biomarkers associated with OAB in the setting of POP is limited. The objective is to determine whether associations exist between urinary biomarkers measured before POP surgery with postoperative OAB symptoms. In this prospective cohort study, women with anterior and/or apical POP beyond the hymen undergoing POP surgery were assessed using the OAB Questionnaire Short Form (OAB-q SF) and the Urogenital Distress Inventory 6 (UDI-6) preoperatively and 3 months postoperatively. A first morning voided urine specimen was collected preoperatively and 3 months postoperatively. Urinary biomarkers for inflammation, neuroinflammation, and tissue remodeling were measured. Univariate generalized linear models measured the relationship between biomarkers and symptoms. Between- and within-cohort assessments were made using 2-sample paired and unpaired t tests, respectively. Seventy-seven participants with OAB (n = 67, 87.0%) and without OAB (n = 10, 13.0%) were enrolled. Seventy-four participants (96%) completed 3-month follow up. The OAB-q SF and UDI-6 scores significantly improved between preoperative and postoperative measures. Preoperative urinary biomarkers did not demonstrate significant correlations with postoperative OAB-q SF or UDI-6 scores. No significant differences were measured in preoperative biomarkers between patients with and without OAB or when comparing preoperative and postoperative biomarkers in patients with OAB. Urinary biomarkers for tissue remodeling, inflammation, and neuroinflammation were not significantly correlated with OAB symptoms in a population of patients with OAB and POP.

Medium- to long-term outcomes of vaginally assisted laparoscopic sacrocolpopexy in the treatment of stage III–IV pelvic organ prolapse

BackgroundVaginally assisted laparoscopic sacrocolpopexy (VALS) refers to the placement of synthetic meshes through the vagina in addition to traditional laparoscopic sacrocolpopexy. In this study, we aimed to investigate the medium- to long-term efficacy and safety of VALS for treating stage III–IV pelvic organ prolapse (POP).MethodsThe study was designed as a case series at a single center. Patients with stage III–IV POP in our hospital from January 2010 to December 2018 were included. Perioperative parameters, objective and subjective outcomes, and complications were assessed.ResultsA total of 106 patients completed the follow-up and were included in our study. Within a median follow-up duration of 35.4 months, the objective cure ratio of VALS reached 92.45% (98/106), and the subjective success rate was 99.06% (105/106). Patients reported significant improvements in subjective symptoms. In eight patients suffering anatomic prolapse recurrence, two posterior POP cases were treated by posterior pelvic reconstruction surgery, while six anterior POP cases did not need surgical therapies. The reoperation rate was 1.89% (2/106). No intraoperative complications occurred. Three patients (2.83%) had postoperative fever, and one (0.94%) had wound infection during hospitalization. Six patients (5.66%) had mesh exposure on the vaginal wall, and de novo urinary incontinence occurred in two patients (1.89%) during the follow-up period.ConclusionVALS is an effective and safe surgical method for treating severe POP. Therefore, VALS should be considered in the treatment of severe POP due to its favorable subjective and objective outcomes, relatively low rate of infection and acceptable rate of mesh exposure.

7419 Vaginally Assisted Laparoscopic Sacrocolpopexy

<h3>Study Objective</h3> The objective of this video is to demonstrate the surgical technique for attaching sacrocolpopexy mesh using a vaginal approach. We will highlight the steps of the procedure and discuss findings in the literature to support this approach. <h3>Design</h3> Surgical video recording of vaginal and laparoscopic procedures to demonstrate the steps of this technique for prolapse repair. <h3>Setting</h3> Operating Room <h3>Patients or Participants</h3> 69-year-old female with stage III anterior and apical pelvic organ prolapse who desired surgical management. <h3>Interventions</h3> Total vaginal hysterectomy, followed by mesh attachment via a vaginal approach for stage III pelvic organ prolapse. Laparoscopic sacrocolpopexy was then performed in the routine fashion. Excellent apical support was noted at completion of the procedure. <h3>Measurements and Main Results</h3> Vaginal mesh attachment after hysterectomy and prior to laparoscopic sacrocolpopexy has shorter mean operating room times with no significant difference in complication rates or anatomic outcomes. Mesh exposure is not significantly higher in those who have vaginal mesh attachment vs. laparoscopic mesh attachment. <h3>Conclusion</h3> Vaginally attached mesh prior to laparoscopic sacrocolpopexy is an efficient way to perform minimally invasive sacrocolpopexy in patients with stage 3 or greater pelvic organ prolapse, and with the appropriately selected patient, allows for same day discharge.

Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women.

The aim of the study was to determine effects of adding transperineal ultrasound (TPUS) biofeedback to individualized pelvic floor muscle training (PFMT) on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse (POP) in postmenopausal women. A total of 77 patients with POP at stage I or stage II were admitted to Beijing Shijitan Hospital, China, from January 2017 to October 2018. They were randomly divided into a control group (CG) (n = 37) or a study group (SG) (n = 40). Both SG and CG received a 12-week PFMT including health education, verbal instruction, and home training. However, the SG, but not the CG, received additional TPUS biofeedback. Data of these patients were retrospectively reviewed. The distance from the lowest point of the bladder to the inferior-posterior margin of the symphysis pubis (BSP) and the levator hiatus area (LHA) were measured on maximal Valsalva via TPUS before and after the 12-week PFMT. Correct pelvic floor muscle contraction (PFMC) rates before and after PFMT were compared between the two groups. The correct PFMC rate was higher in the SG than that in the CG (92.5% vs. 73%; x2 = 5.223, p=0.022). The BSP was increased but the LHA was reduced after the 12-week PFMT in both groups compared to those before PFMT (all p < 0.05). However, after the PFMT, the SG showed greater improvement than the CG for both BSP (0.77 ± 0.71 cm vs. 0.11 ± 0.66 cm, p < 0.05) and LHA (20.69 ± 2.77 cm2 vs. 22.85 ± 3.98 cm2, p < 0.05). TPUS might be an effective biofeedback tool for PFMT in clinical practice. Individualized PFMT with TPUS biofeedback could significantly attenuate POP severity and strengthen the extensibility of pelvic floor muscle in postmenopausal women when they are under increased intraabdominal pressure.

Thirty-six-month Prospective Study of Transvaginal Bovine Graft vs Native Tissue Repair for the Treatment of Pelvic Organ Prolapse

Objective(s)To compare the safety and effectiveness of dermal bovine transvaginal graft, Xenform, to native tissue in the surgical treatment of anterior and/or apical pelvic organ prolapse. This study was designed in conjunction with Food and Drug Administration requirements. MethodsThis was a prospective, non-randomized, parallel cohort, multi-center trial. The primary objective was to demonstrate noninferiority between transvaginal graft and native tissue repair at 36 months compared to baseline. Treatment success was based on a composite of objective and subjective measures. The co-primary outcome was the rate of serious device- or procedure-related adverse events. A total of 228 patients at 25 sites were included in the study arm and 485 patients underwent native tissue repair. Propensity score stratification was applied to achieve balance between treatment groups. Study outcomes were compared in per protocol and intent-to-treat analysis. ResultsThe primary outcome, treatment success at 36 months, was 83.6% (191/228) for transvaginal graft and 80.5% (390/485) native tissue repair (0.2%, 90% confidence interval [–5.6% to 5.9%]), demonstrating noninferiority at a preset margin of -12%. The overall rate of severe adverse events was 5.3% (12/228) in transvaginal graft vs 2.7% (13/485) in native tissue repair groups. The study group demonstrated noninferiority in serious adverse events at the preset margin of 11.6% (2.0%, 90% confidence interval [–0.8% to 4.7%]). There were no reports of graft erosion, and graft exposure rates were low (0.9% [2/228]). ConclusionsTransvaginal repair of anterior and/or apical prolapse with a biological graft is noninferior to traditional native tissue repair in effectiveness and safety at 36 months.

Clinical and Urodynamic Findings Before and After Surgical Repair of Pelvic Organ Prolapse in Women With Lower Urinary Tract Symptoms. A Prospective Observational Study

ObjectiveTo investigate the association between urodynamic findings and lower urinary tract symptoms (LUTS) before and after surgical treatment of pelvic organ prolapse (POP). Patients and MethodsSeventy-four patients with stage II or more anterior POP associated with LUTS and eligible for surgical repair of POP were included in this prospective study. All cases had clinical evaluation and urodynamic testing (UDS) before and 6 months after surgical repair of POP. ResultsMean age was 45 ± 9 years. Mean BMI was 28 ± 6 kg/m2. Most cases were multiparous, had stage III cystocele (50/74, 68%), and an associating apical prolapse (37/74, 50%). Native tissue repair was done in 53/74 (72%) cases with a concomitant anti-incontinence procedure in 41/74 (55%) for overt (26/74, 35%) or occult (15/74, 20%) stress urinary incontinence (SUI). Preoperative UDS revealed detrusor overactivity (DO) in 19/56 (34%) patients of those presenting with storage LUTS and an obstructed detrusor pressure at maximum flow rate in 20/26 (77%) patients presenting with voiding LUTS. At the 6-month postoperative follow-up, 61/74 (82%) patients had marked improvement of their LUTS, SUI resolved in 39/41 (95%) patients and 1/33 (3%) patient developed de novo SUI. Preoperative DO and post-void residual urine volume were not related to the postoperative improvement, or persistence of LUTS. Meanwhile, detrusor underactivity was detected both on preoperative and postoperative UDS of 4 patients with persistent voiding LUTS. ConclusionPatients had significant improvement in LUTS after POP surgery with or without an anti-incontinence procedure. Detrusor underactivity was associated with persistence of voiding LUTS. Meanwhile, preoperative DO and post-void residual urine volume were of limited prognostic value.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Meshless Anterior Repair for the Treatment of Pelvic Organ Prolapse

To demonstrate the feasibility of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) meshless anterior repair for the treatment of pelvic organ prolapse (POP). Stepwise demonstration of the technique with narrated video footage. The vNOTES approach is a recent and rapidly developing technique that allows safe endoscopic transvaginal treatment of benign uterine pathologies [1]. Its use in the treatment of POP is still in its early stages; however, the first results are encouraging in terms of anatomy, functionality, and safety [2]. We describe the vNOTES technique of meshless anterior POP repair using a vaginal plastron [3]. The "vaginal plastron" technique uses an autologous vaginal strip that is left attached to the bladder and suspended from the arcus tendineus. After the delimitation of a 6 cm square vaginal strip, a lateral dissection is performed on each side between the bladder and the vaginal fascia to enter the paravesical space. The vaginal strip is left attached to the bladder wall and will later be fixed laterally to the arcus tendineus with 6 nonabsorbable monofilament sutures, caliber 0 (3 on each side of the plastron). The fixation points on the arcus tendineus concern the internal obturator fascia ventrally and the iliococcygeus fascia dorsally. The sutures are placed under endoscopic view using a transvaginal access platform (GelPOINT V-Path, Applied Medical, Rancho Santa Margarita, CA). After deflation and removal of the platform, the sutures are attached to the vaginal strip. Once the vaginal plastron is secured, the anterior vaginal wall is closed. The vNOTES approach offers an endoscopic anatomic view of the paravesical space, thus reducing any blind surgical procedure. It provides an alternative route in the performance of meshless anterior POP repair.

171 Efficacy and safety of mesh-augmented transvaginal repair with calistar s in non-fertile women with recurrent or complex anterior pelvic organ prolapse according to the scenihr-recommendations on urogynecological surgical meshes

Introduction and Aim of the Study: To evaluate transvaginal mesh-augmented repair with the ultra-lightweight mesh Calistar S (Promedon, Argentina) in women with recurrent or complex anterior POP prolapse with or without apical vaginal wall involvement. Methods: Women who underwent transvaginal POP repair with Calistar S for either recurrent or complex anterior POP have been included in this multicenter cohort trial. Baseline characteristics and perioperative assessment have been evaluated retrospectively.

Surgical treatment of advanced anterior wall and apical vaginal prolapse using the anchorless self-retaining support implant: long-term follow-up

Introduction and hypothesisFollowing health notification by the FDA in 2008 of serious complications with transvaginal mesh for anterior pelvic organ prolapse, there has been a return to native tissue repairs. Earlier work with a self-retaining support (SRS) implant showed a high anatomical success rate with minimal implant-related complications over a medium-term follow-up. It is proposed that post-implant complications are more a consequence of the method of mesh anchoring rather than the implant itself. Our system incorporates an ultralight mesh with a frame that provides level I, II, and III support without the need for fixation. The first long-term outcomes of SRS implantation are presented.MethodsA prospective multicenter trial was conducted using two consecutive identical protocols of the use of the SRS implant in women with symptomatic anterior compartment prolapse extending their follow-up to 36 months. Anatomical success (Pelvic Organ Prolapse Quantification stage 0 or 1 or a Ba ≤ −2) was recorded along with subjective success as defined by regular quality-of-life (PFDI-20 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire) assessments.ResultsSixty-seven patients completed 36 months of follow-up. Mean Ba measurements improved from 3.1 (−1 to 6) cm to −2.8 (−1 to −3) cm and C point from 0.4 (−8 to 6) cm to −6.9 (−10 cm to 1) cm. accumulating to a significant anatomical success rate of 94.3%. Subjective success based on question #3 of the PFDI-20, analyzed for the index surgical compartment, reached 95.7%. Post-operative complications included 2 cases of urinary retention, 1 minor frame exposure, 1 case of delayed voiding dysfunction, and 2 cases of de novo stress urinary incontinence. Untreated pre-operative second-degree Bp measurements had increased in 27% at follow-up.ConclusionThe long-term outcome of the SRS implant shows an excellent subjective and objective success with minimal risk of complications or need for reintervention.

Are Two Meshes Better than One in Sacrocolpopexy for Pelvic Organ Prolapse? Comparison of Single Anterior versus Anterior and Posterior Vaginal Mesh Procedures

Introduction: Sacrocolpopexy (SC) is the main treatment option for the repair of anterior and apical pelvic organ prolapse (POP). Indications and technical aspects are not standardized, and the question remains whether it is necessary to place a mesh on both anterior and posterior vaginal walls, particularly in cases with only minor or no posterior compartment prolapse. The present study aimed to compare the anatomical and functional outcomes of single anterior mesh only versus anterior and posterior mesh procedures in SC. Materials and Methods: Our prospectively maintained database on POP was used to identify patients who had undergone either abdominal or mini-invasive SC from January 2006 to October 2019. Patients with symptomatic or unmasked stress urinary incontinence (SUI) were not included in the study and were treated using the pubo-vaginal cystocele sling procedure. Objective outcomes included clinical evaluation of pre-existing or de novo POP by the halfway system and POP-q classifications, as well as the development of de novo SUI. Subjective outcomes were assessed using the Pelvic Floor Impact Questionnaire (PFIQ-7) with questions on bladder, bowel, and vaginal functions. Persistent or de novo constipation and overactive bladder were defined as bowel symptoms and urinary urgency/frequency/urinary incontinence after surgery. Results: Ninety-five women with symptomatic anterior and apical POP underwent SC. Forty-one patients were treated with only anterior vaginal mesh (group A), and 54 with anterior and posterior mesh (group B). There were no differences between the pre- and post-operative characteristics of the 2 groups. In group B, there were 2 blood transfusions, 1 wound dehiscence, and 3 mesh erosions/extrusion after abdominal SC (Clavien-Dindo II), and in group A, there was 1 ileal lesion after laparoscopic SC (Clavien-Dindo III). There were no differences between the 2 groups in either anatomical or functional outcomes during 3 years of follow-up. Conclusions: SC with single anterior vaginal mesh has similar results to SC with combined anterior/posterior mesh, regardless of the surgical approach. The single anterior mesh may reduce the risk of complications (mesh erosion/extrusion), and offers better subjective outcomes with improved quality of life. Anterior/posterior mesh may be justified in the presence of clinically significant posterior POP.

Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases.

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

PD66-07 LOWER URINARY TRACT SYMPTOMS IN WOMEN FOLLOWING BIOLOGIC TRANSVAGINAL GRAFT VS. NATIVE TISSUE REPAIR FOR PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III (PD66)1 Sep 2021PD66-07 LOWER URINARY TRACT SYMPTOMS IN WOMEN FOLLOWING BIOLOGIC TRANSVAGINAL GRAFT VS. NATIVE TISSUE REPAIR FOR PELVIC ORGAN PROLAPSE Gina Northington, Ricardo Gonzalez, Jennifer Wu, Felicia Lane, Benjamin Brucker, and Peter Rosenblatt Gina NorthingtonGina Northington More articles by this author , Ricardo GonzalezRicardo Gonzalez More articles by this author , Jennifer WuJennifer Wu More articles by this author , Felicia LaneFelicia Lane More articles by this author , Benjamin BruckerBenjamin Brucker More articles by this author , and Peter RosenblattPeter Rosenblatt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002110.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare postoperative lower urinary tract symptoms in women surgically treated for pelvic organ prolapse (POP) with a biologic transvaginal graft (TVG) vs. traditional native tissue repair (NTR). METHODS: This is a secondary analysis of a prospective, non-randomized, parallel cohort, multi-center trial where subjects received TVG or NTR to repair anterior and/or apical POP. The primary endpoint was non-inferiority (NI) of TVG repair to NTR in treatment success and SAE rate at 36 months compared to baseline. The primary objective of this study was to compare the occurrence of de novo or worsening urinary symptoms. Symptoms were recorded using validated questionnaires (Urinary Distress Inventory (UDI-6) and Urinary Impact Questionnaire (UIQ-7)). Baseline and post-operative urinary symptoms for each treatment group were compared using two sample t-test. Adverse event rate was compared between TVG and NTR using log-rank test. RESULTS: Baseline urinary symptoms from UIQ-7 and UDI-6 were significantly higher in the TVG group (n=228) compared to NTR (n=485) (Table 1). There were no other significant differences in baseline characteristics after propensity score stratification, and treatment success at 36 months was similar between both groups. The overall SAE rate of TVG (5.3%) was NI to NTR (2.7%) (group difference of 2.0%, 90% CI [0.8%, 4.7%]) at the pre-specified margin of 11.6%; however de novo voiding dysfunction was significantly greater in TVG (15.4%) vs. NTR (4.7%) (p<0.001). De novo stress urinary incontinence (SUI) was also significantly higher in TVG compared to NTR (3.1% vs. 0.8%, p=0.02). Conversely, worsening SUI occurred more frequently in the NTR group compared to TVG (3.9% vs. 0.9%, p=0.003). Postoperatively, there were no significant differences in urinary symptoms on UIQ-7 and UDI-6 at each time point. CONCLUSIONS: Biologic transvaginal graft for the treatment of anterior and/or apical vaginal prolapse was overall safe and effective but led to significantly more de novo voiding dysfunction compared to native tissue repair; this may be related to higher baseline urinary symptoms in the transvaginal graft group noted on UIQ-7 and UDI-6. Postoperatively, lower urinary tract symptoms were similar between both groups. Source of Funding: Boston Scientific Corporation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1161-e1161 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gina Northington More articles by this author Ricardo Gonzalez More articles by this author Jennifer Wu More articles by this author Felicia Lane More articles by this author Benjamin Brucker More articles by this author Peter Rosenblatt More articles by this author Expand All Advertisement Loading ...