Anterior Vaginal Wall Suspension Research Articles

The Anterior Vaginal Wall Suspension Procedure: Mid-Term Follow-Up of a Native Tissue Vaginal Repair for Stress Urinary Incontinence

The Anterior Vaginal Wall Suspension Procedure: Mid-Term Follow-Up of a Native Tissue Vaginal Repair for Stress Urinary Incontinence

PD44-04 NATIVE TISSUE REPAIR OF ANTERIOR COMPARTMENT PROLAPSE FROM MULTIPLE INSTITUTIONS IS DURABLE OVER 3 YEARS

You have accessJournal of UrologyCME1 May 2022PD44-04 NATIVE TISSUE REPAIR OF ANTERIOR COMPARTMENT PROLAPSE FROM MULTIPLE INSTITUTIONS IS DURABLE OVER 3 YEARS Ramzy Burns, Leo Song, Feras Alhalabi, Lauren Snodgrass, Philippe Zimmern, and CR Powell Ramzy BurnsRamzy Burns More articles by this author , Leo SongLeo Song More articles by this author , Feras AlhalabiFeras Alhalabi More articles by this author , Lauren SnodgrassLauren Snodgrass More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and CR PowellCR Powell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The US Food and Drug Association has recommended removal of all transvaginal mesh kits from the market for anterior compartment pelvic organ prolapse (POP) repair, stimulating renewed interest in native tissue POP repair. Specifically, anterior vaginal wall suspension (AVWS) has emerged as a reproducible option for stage 2-3 isolated anterior compartment prolapse repair using native tissue. Zimmern et al. (2016) found a 7.4% rate of failure after AVWS in 121 patients over a follow-up of 5.8 years. We sought to update this experience in multiple institutions. The hypothesis is that well selected patients will have durable results supported by validated patient reported outcome measures and pelvic organ prolapse - quantification (POP-Q) exam. METHODS: We reviewed an institutional review board approved prospectively maintained database of women undergoing anterior vaginal wall suspension without concomitant apical support procedures across multiple institutions. The primary outcome was prolapse recurrence in the anterior compartment. Secondary outcomes included preoperative and postoperative POPQ values, Urinary Distress Inventory-6 (UDI6), and Incontinence Impact Questionnaire-7 (IIQ7) scores. Statistical analysis was performed using STATA 17.0. Significance for continuous variables was by 2-tailed T-test. Predictive modeling was logistic regression. RESULTS: 651 patients underwent AVWS at participating institutions. Table 1 displays preoperative and postoperative POP-Q and validated patient reported outcomes. Failure as defined by Aa>=0 was seen in 8% of patients at 38.3 months follow up. Logistic regression revealed that preoperative POP-Q “Aa” severity was predictive of failure in the anterior compartment (OR 2.6, p<0.05). Preoperative POP-Q “C” severity also weakly predicted failure (OR 1.1, p<0.05). UDI6 item 5 “difficulty emptying your bladder” score was predictive of failure (OR 1.6, p<0.05), however there were no parameters that predicted failure using IIQ7. CONCLUSIONS: AVWS is durable and re-producible. Validated questionnaires are sensitive to improvement in POP-Q measurements and failures in the anterior compartment. Source of Funding: This project was supported by a Project Development Team within the ICTSI NIH/NCRR Grant Number RR025761 SUBAWARD (Powell, PI) and NIDDK DiaComp Pilot & Feasibility project, sub-award DK076169 (Powell, PI) and Indiana University CTSI MedSTAR program (Song). Indiana Clinical and Translational Sciences Institute is funded in part by Award Number UL1TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Awtard © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e709 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ramzy Burns More articles by this author Leo Song More articles by this author Feras Alhalabi More articles by this author Lauren Snodgrass More articles by this author Philippe Zimmern More articles by this author CR Powell More articles by this author Expand All Advertisement PDF DownloadLoading ...

A standardized telephone interview with validated questionnaires for very long-term evaluation of women lost to follow-up after a stress urinary incontinence procedure.

Telephone interviews including questionnaires have been used to obtain very long-term (>10-year) follow-up after stress urinary incontinence (SUI) procedures in women otherwise lost to follow-up (LTF). For questionnaires validated for office use, our goal was to evaluate recent telephone vs last clinic scores in a long-term study. For women with >10 years of follow-up after anterior vaginal wall suspension (AVWS) for bothersome SUI associated with an anterior compartment prolapse, questionnaire scores from their last clinic encounter were compared with their scores from a standardized telephone interview at long-term follow-up. The validated questionnaires were Urinary Distress Inventory 6-Short Form (UDI-6), International Incontinence Questionnaire 7-Short Form (IIQ-7), and Quality of Life (QoL). Eighty-four women underwent a telephone interview (median follow-up: 13.8 years, interquartile range [IQR]: 12.2-17) after AVWS. The median difference between telephone and clinic visit was 10.2 years (IQR: 6.1-12.2). The clinic UDI-6 total score remained low but was higher than the phone score (mean difference 1.2, P= .0023). The UDI-6 Q2, Q3, Q5, IIQ-7, and QoL scores did not significantly differ between clinic and phone. For "incontinent" AVWS patients (UDI-6 Q3 ≥ 2), there was a larger difference between clinic and phone UDI-6 total score (P< .0001), while "dry" patients (UDI-6 Q3 ≤ 1) responded similarly. In women who would otherwise be LTF after anti-incontinence native tissue repair AVWS, UDI-6 total score varied slightly between last clinic and long-term follow-up phone interviews, but QoL and IIQ-7 remained similar.

Cost Analysis of Vaginal Anti-incontinence Procedures at a Tertiary Care Center

ObjectiveTo compare the cost of 3 vaginal procedures used in the surgical management of stress urinary incontinence (SUI) at 1 tertiary institution. MethodsThe costs of autologous fascial sling (AFS), synthetic mid-urethral sling (MUS), and anterior vaginal wall suspension (AVWS) were analyzed from a prospective long-term database, with follow-up to 5 years after these procedures. Original costing data were obtained for operating room, medical and surgical supplies, pharmacy, anesthesia supplies, and room and bed over 2 consecutive years. Included were complete cost data provided by our institution from Medicare (2012) and private payer insurance. ResultsFor the year 2013, the AVWS, AFS, and MUS had total median costs of $4513, $5721, and $3311, respectively. Total cost and all subcosts except for pharmacy costs were significantly different for each procedure. AVWS and MUS placement differed from each other regarding the cost of anesthesia and hospital stay, which was higher for AVWS. Compared to AFS, AVWS had significantly lower total costs due to decreased costs associated with operating time, hospital stay, and surgical supplies (P <.0001). At 5 years after these procedures, synthetic slings had less frequent follow-up visits. The most common revision for SUI failure was a bulking agent injection. ConclusionInitial costs of vaginal SUI procedures at our institution fared favorably compared to SUI procedures reported in the contemporary US literature. Long-term costs can vary based on physician preference in follow-up routine and etiology of SUI.

Very long-term follow-up of the anterior vaginal wall suspension procedure for incontinence and/or prolapse repair.

To report outcomes of the anterior vaginal wall suspension (AVWS) procedure for stress urinary incontinence (SUI) and/or anterior compartment prolapse (POP), with minimum 10-year follow-up. Following institutional review board approval, a database of patients with > 10-year follow-up after AVWS for bothersome SUI with early stage anterior compartment prolapse (stage ≤ 2) or symptomatic anterior compartment prolapse (stage > 2) was reviewed. Preoperative evaluation included validated questionnaires [Urogenital Distress Inventory-Short Form (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), quality of life (QoL)], Pelvic Organ Prolapse Quantification (POP-Q), and voiding cystourethrography. Follow-up data was based on clinic visits or telephone interviews for patients not seen in the past 2years. Telephone interviews used validated questionnaires and were conducted by a third party not involved in patient care. Failure was defined as reoperation for SUI or POP. The influence of lost to follow-up (LTF) was also analyzed. Between 1996 and 2008, 161 of 328 patients met study criteria, with follow-up from phone interviews (103) or clinic visits (58). The LTF patients were deceased (52), mentally disabled (5), or unreachable by telephone (110). Median follow-up was 13.5years (IQR 11.5-17). Type of follow-up (clinic vs. phone) and uterine status (concomitant/prior/no hysterectomy) did not impact reoperation rates. Reoperation occurred in 23/161 (14%) and consisted of sacrocolpopexy (8), anterior colporrhaphy (5), injectable agents (8), fascial sling (2). The AVWS procedure to restore anterior vaginal support to the bladder neck and bladder base to correct SUI/POP can provide satisfactory and durable results.

Reliability of Patient Reported "Dry" Status to Define Success after an Anti-Incontinence Surgery.

We compared the patient self reported assessment of dryness after an anti-incontinence procedure in women with 3 simple, office based questionnaire items. Following institutional review board approval electronic medical records of non-neurogenic women who underwent anterior vaginal wall suspension alone for stress urinary incontinence associated with early stage anterior compartment prolapse were reviewed. Using last visit assessment, responses to Urogenital Distress Inventory-short form question 3 related to stress urinary incontinence, global quality of life score using visual analog scale and Incontinence Impact Questionnaire-short form question 7 related to frustration were compared to self reported dry (no/rare leakage) status. Success (dry status) was specifically compared to Urogenital Distress Inventory-short form question 3 response 0 (none) or 1 (rarely), quality of life score of 3 or lower (scale 0-10) and Incontinence Impact Questionnaire-short form question 7 response 0 (not at all) or 1 (slightly). From 1996 to 2017, 193 of 397 women were included. Of those self reported dry 160 (83%) replied no/rare urine leakage, 148 (77%) reported quality of life of 3 or lower and 178 (92%) replied no or slight frustration. Urogenital Distress Inventory-short form question 3 score 0 was significantly associated with Incontinence Impact Questionnaire-short form #7 scores 0-1 (p=0.0145) and quality of life scores 0-3 (p <0.0001). In this study using native tissue repair to correct stress urinary incontinence self-reported dry status compared adequately to responses to relevant questions of validated questionnaires. These easily queried outcome measures via phone or office visits could strengthen the quality of stress outcome measure data in our literature.

Posterior Compartment Prolapse Occurrence After Anterior Vaginal Wall Suspension

ObjectiveTo determine the long-term rate of posterior compartment prolapse (PCP) occurrence after native tissue repair of the anterior compartment with anterior vaginal wall suspension (AVWS) procedure. MethodsAn institutional review board approved surgical prolapse database was reviewed for women who underwent AVWS for any degree of anterior compartment prolapse with minimum of 6-month follow-up and no history of apical or posterior compartment repair. Demographic data, smoking status, parity, and uterine status were collected. The primary outcome was need for secondary PCP repair. ResultsA total of 300 women met inclusion criteria with a mean age of 63.8 ± 10.8 years, mean BMI of 26.1 ± 6.2 kg/m2, and a mean parity of 2.5 ± 1.4. At the time of AVWS 46 women (15%) had uterine-sparing AVWS, 74 (25%) had concomitant hysterectomy, and 180 (60%) had prior hysterectomy. Forty-eight women (16%) had secondary posterior compartment repair for PCP (60% abdominal route, 40% done vaginally) over a mean follow-up of 7.1 ± 4.4 years. ConclusionAt long-term follow-up, less than 20% of women undergoing AVWS underwent PCP repair.

Bladder Prolapse Configuration on Baseline Standing Cystogram Can Predict Anterior Vaginal Wall Suspension Procedure Outcomes

To evaluate whether bladder prolapse shape on lateral voiding cystourethrogram (VCUG) is an accurate predictor of anterior vaginal wall suspension (AVWS) procedure outcomes. Following an institutional review board approval, preoperative lateral standing VCUG views from a prospectively maintained database of women who underwent AVWS for stage ≥2 cystocele were reviewed retrospectively by 3 reviewers. Patients with no retrievable preoperative VCUG imaging were excluded. Only the straining view with a fixed bladder volume of 125 cc was used for this project. Cystocele shape on imaging was scored as either (1) "round," (2) "crescent," or (3) not readable (suboptimal image quality or excessive artifact from prosthesis). A subset of cases was rescored by each reviewer for intra-rater reliability analysis. Intra- and inter-rater reliability was calculated using the weighted kappa coefficient (κ). Cystocele shape was correlated with the published long-term clinical outcomes after AVWS of these same women, with failure defined as prolapse recurrence stage >2 clinically or reoperation for prolapse (Kaplan-Meier). Between 1997 and 2013, 79 women met the study criteria. All 3 reviewers had moderate to high intra-rater reliability (κ = 1.00, 0.82, and 0.79). Inter-rater reliability among the 3 reviewers was significant (κ = 0.76), with 81% (64 out of 79) ratings in perfect concordance and 19% (15 out of 79) with 1 reviewer discordance. Prolapse recurrence-free probability between round- and crescent-shaped cystoceles was statistically significant (P = .0304). Bladder prolapse shape on baseline standing VCUG can be used to predict AVWS outcomes, with round-shaped cystoceles faring better with this vaginal native tissue repair procedure.

S&T-49 HOW TO DEFINE STRESS URINARY INCONTINENCE SUCCESS AFTER AN ANTI-INCONTINENCE PROCEDURE IN REAL LIFE PRACTICE: DO YOU TRUST THE PATIENT OR THE QUESTIONNAIRES/PAD USAGE?

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-49 HOW TO DEFINE STRESS URINARY INCONTINENCE SUCCESS AFTER AN ANTI-INCONTINENCE PROCEDURE IN REAL LIFE PRACTICE: DO YOU TRUST THE PATIENT OR THE QUESTIONNAIRES/PAD USAGE? Philippe Zimmern, Carlos Finsterbusch, Feras Alhalabi, and Alana Christie Philippe ZimmernPhilippe Zimmern More articles by this author , Carlos FinsterbuschCarlos Finsterbusch More articles by this author , Feras AlhalabiFeras Alhalabi More articles by this author , and Alana ChristieAlana Christie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2878AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Defining success after an anti-incontinence procedure remains a challenge. Since objective outcome measures (OM) are desirable (stress test, Urodynamic, diary) but beyond reach for most practitioners, we focused on subjective OMs which may be more compatible with the demands of a busy real life practice. METHODS Two physicians (CF and FA) not involved in patient care reviewed independently the electronic medical records of women who underwent an anterior vaginal wall suspension (AVWS) alone for stress urinary incontinence (SUI) with associated early grade cystocele. Women with neurogenic bladder, those requiring additional surgeries like hysterectomy or other concomitant procedures, needing an anti-incontinence reoperation, incomplete questionnaires, or ongoing urinary tract infections were excluded. Their last complete visit assessment was used for this study. Three subjective OMs (UDI-6 Q3 related to SUI, a global quality of life score (QoL), pad usage) were compared to patient's self-reported SUI dry (no or rare SUI) status. For the OMS, SUI success or “dry” was defined as UDI-6 Q3: 0 (none) or 1 (rarely), QoL ≤ 3 (scale 0 to 10 with 0 being pleased and 10 terrible), 0-1 pad usage on a daily basis. RESULTS Out 319 women who underwent AVWS between 2004-2014, 73 met our inclusion criteria. Only 1 patient had a discrepancy between reviewers for whether the patient had self-reported SUI. Mean age was 60.2 ± 10.9 (range: 35-81) with a BMI of 25.2 ± 6.8, average parity at 2.3 ± 1.2, and 66 (90%) Caucasian. Mean follow-up was 3.9 ± 4.2 years. Of the women dry by self-report, 54 (74%) of women replied 0 or 1 on UDI-6 Q3, 55 (75%) reported QoL ≤ 3, and 72 (99%) used 0-1 pads daily. Out of the 54 women with 0 or 1 on UDI-6 Q3, 47 (87%) also scored QoL ≤ 3, while 11/19 (58%) with 2 or 3 on UDI-6 Q3 scored QoL > 3. CONCLUSIONS The nearly perfect correlation between patient self-reported dry status after an AVWS and subjective OM criteria was for pad usage. These OM criteria which can be easily extracted during a phone interview or a face-to-face office visit could help strengthen the quality of outcome data in the field of SUI. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e328 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Philippe Zimmern More articles by this author Carlos Finsterbusch More articles by this author Feras Alhalabi More articles by this author Alana Christie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup

We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse. We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4%, isolated apical 10.7%, isolated posterior 8.3% and multiple compartments 19%. Surgery for recurrent prolapse included anterior compartment 3.3% at 1.4± 1.0 years, apical 9.9% at 2.8 ± 3.0 years, posterior compartment 5.8% at 2.0± 1.0 years and multiple compartments 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and a 5.7% rate of 30-day complications (all Clavien I). Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33% ofpatients required secondary prolapse compartment procedures from 0.6 to 13years later, highlighting the importance of long-term followup.

Total hysterectomy and anterior vaginal wall suspension for concurrent uterine and bladder prolapses: Long-term anatomical results of additional vault and/or posterior compartment prolapse repair

ObjectiveTo review the long-term results of an intraoperative decision to repair or not repair associated vault and posterior compartment defects after total hysterectomy (TH) and anterior vaginal wall suspension (AVWS) for uterine and bladder prolapses. MethodsAfter gaining Institutional Review Board approval, the operative records of women receiving TH and AVWS concurrently with a minimum follow-up period of 6 months were reviewed. Two groups were identified: Group 1 (G1) underwent TH + AVWS and intraoperative apical and/or posterior repairs, and Group 2 (G2) had TH + AVWS alone. The definition of prolapse recurrence was Pelvic Organ Prolapse—Quantification ≥ Stage 2 and/or any reoperation for prolapse. ResultsFrom 1998 to 2009, a total of 94 women were evaluated. At the mean 3 years follow-up, the rates of overall prolapse recurrence following initial surgeries between G1 and G2 were 30% and 24%, respectively. Additional operative repair for G1 and G2 was 18.5% and 16%, respectively. The progression rate for both groups was < 8%. The overall success for G1 and G2 was 70% and 76%, respectively. ConclusionAt long-term follow-up, nearly one in five apical recurrences in these two surgical groups was observed with stable results in the anterior compartment. The posterior compartment required the least surgical intervention.

Anterior Vaginal Wall Suspension Procedure for Moderate Bladder and Uterine Prolapse as a Method of Uterine Preservation

We report our experience with anterior vaginal wall suspension for moderate anterior vaginal compartment prolapse and uterine descent less than stage 2. Data on patients who underwent anterior vaginal wall suspension with uterine preservation by hysteropexy and had a 1-year minimum followup were extracted from a long-term, prospective, institutional review board approved, surgical prolapse database. The indication for uterine preservation was uterine descent not beyond the distal third of the vagina with traction with the patient under anesthesia, and negative Pap smear and pelvic ultrasound preoperatively. The upper suture of the anterior vaginal wall suspension secures the cardinal ligament complex, allowing for uterine suspension once the suture is transferred suprapubically. Failure was defined as prolapse recurrence greater than stage 2 on physical examination or the need for reoperation for uterine descent. Outcome measures at serial intervals included validated questionnaires, physical examination, standing voiding cystourethrogram at 6 months postoperatively and complications. From May 1996 to March 2012, 52 of 739 patients met inclusion criteria. Mean followup was 55 months (range 12 to 175, median 44). Mean patient age was 62 years (range 38 to 81), mean body mass index was 26.7 kg/m(2) (range 18.3 to 49.4) and mean parity was 2.7. There were no transfusions or intraoperative complications. Overall 7 (13%) patients underwent subsequent hysterectomy foruterine prolapse recurrence at 7 months to 6 years postoperatively. The anterior vaginal wall suspension procedure offers a simple, mesh-free surgical alternative with acceptable long-term followup in patients with moderate uterine prolapse who wish for uterine preservation. However, patients should be appropriately counseled about the low risk of subsequent hysterectomy.

MP3-16 DISMEMBERED PYELOPLASTY IN SYMPTOMATIC PATIENTS WITH EQUIVOCAL OBSTRUCTION: DOES IT MAKE A DIFFERENCE?

INTRODUCTION AND OBJECTIVES: To report on the midand long-term outcome for the anterior vaginal wall suspension (AVWS) procedure (1) for correction of stage II-IV anterior compartment prolapse (ACP). METHODS: Following IRB approval, the long-term prospective Access database of non-neurogenic women who underwent AVWS for ACP, with a minimum 1 year follow-up and complete pre and postoperative records, was reviewed. Preoperative evaluation included detailed history, validated questionnaires (UDI-6, QoL), physical examination, and standing lateral voiding cystourethrogram (VCUG) with rest (UAR)/strain(UAS) views to evaluate urethral hypermobility and degree of cystocele (Lateral height). Follow-up included examination, questionnaires, and one VCUG around 6-12 months post-operatively. Success was measured by Kaplan-Meier curves using time to reoperation for ACP recurrence. Mixed-effects model least square means were used for baseline versus post-AVWS and follow-up period mean score comparisons. RESULTS: Between 1996 and 2012, 169 women met inclusion criteria. Mean Sd were: age 67.7 (9.3), BMI 26.5 (4.5), parity 2.7 (1.5). 78 (46%) patients underwent AVWS alone and 28 (17%) had prior POP procedures. Aa and Ba points increased slightly over time (p1⁄40.01, p1⁄40.02, respectively) (Table 1). VCUG findings also improved significantly for urethral support and cystocele reduction. Recurrence rate based on reoperation using mesh sacrocolpopexy or anterior colporrhaphy was 13/169 (8%) at a median of 1.4 (0.6-7.0) years. CONCLUSIONS: The AVWS procedure can durably correct ACP by restoration of the anatomical support to the bladder neck and bladder base.

MP75-10 FIFTEEN YEARS EXPERIENCE WITH THE ANTERIOR VAGINAL WALL SUSPENSION PROCEDURE, A NATIVE TISSUE VAGINAL REPAIR FOR STRESS URINARY INCONTINENCE WITH EARLY STAGE ANTERIOR COMPARTMENT PROLAPSE.

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-10 FIFTEEN YEARS EXPERIENCE WITH THE ANTERIOR VAGINAL WALL SUSPENSION PROCEDURE, A NATIVE TISSUE VAGINAL REPAIR FOR STRESS URINARY INCONTINENCE WITH EARLY STAGE ANTERIOR COMPARTMENT PROLAPSE. Philippe Zimmern, Alana Christie, Xian-Jin Xie, Chasta Bacsu, Dominic Lee, Benjamin Dillon, Jack Hou, and Feras Alhalabi Philippe ZimmernPhilippe Zimmern More articles by this author , Alana ChristieAlana Christie More articles by this author , Xian-Jin XieXian-Jin Xie More articles by this author , Chasta BacsuChasta Bacsu More articles by this author , Dominic LeeDominic Lee More articles by this author , Benjamin DillonBenjamin Dillon More articles by this author , Jack HouJack Hou More articles by this author , and Feras AlhalabiFeras Alhalabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report on the mid- and long-term outcome for the anterior vaginal wall suspension (AVWS) procedure (1) for stress urinary incontinence (SUI) with early stage anterior compartment prolapse. METHODS Following IRB approval, the long-term prospective Access database of non-neurogenic women who underwent AVWS for SUI, with a minimum 1 year follow-up, was reviewed in women with complete pre and post-operative records. Preoperative evaluation included detailed history, validated questionnaires, (UDI-6, QoL), physical examination, and standing lateral voiding cystourethrogram (VCUG) with rest (UAR)/strain (UAS) views to evaluate urethral hypermobility and degree of cystocele (Lateral height). Follow-up included examination, questionnaires, and one VCUG around 6-12 months post-operatively. Success was measured by Kaplan-Meier curves using time to reoperation for incontinence. Mixed-effects model least square means were used for baseline versus post-AVWS mean score comparison and for follow-up period mean score comparison (2). RESULTS Between 1996 and 2011, 213 women met inclusion criteria. Mean ± Sd were: age 62.2 (11.0), BMI 26.8 (5.7), parity 2.4 (1.3). 88 (41%) patients underwent AVWS alone and 51 (24%) had prior anti-incontinence procedures. Aa and Ba points, questionnaire results, and QoL consistently improved post-operatively, and remained stable over time (Table 1). VCUG findings also improved for urethral support and cystocele reduction. Additional therapy with sling (4) or injectable agents (8) was required in 12 (6%) women at a median of 3.8 (1.2-10.3) years. CONCLUSIONS The AVWS procedure can durably correct SUI by restoration of anatomical support to the bladder neck and bladder base. Reference: 1. Wilson TS, Zimmern PE: Anterior Vaginal Wall Suspension, Female Urology, Urogynecology, and Voiding Dysfunction, Vasavada, Appell, Sand, and Raz, Section I, Chapter 17, 283-290, Marcel Dekker, 2005 Table 1. Mixed Model Least Square Means for Follow-up Period Mean Score Comparison Patients Baseline Follow-up Period Mean Mean p-value 1-3 Years 3-5 Years >5 Years p-value Physical Exam (n=197/213) (n=80/177) (n=73/147) Aa (-3,+3) 213 -1.0 0.0003 -2.8 -2.8 -2.7 0.1913 Ba (-3,+8) 213 -2.8 0.0003 -2.8 -2.7 -2.7 0.3462 Questionnaires (n=113/122) (n=45/99) (n=41/88) UDI 6 Total (0-18) 122 8.2 0.0045 4.0 4.6 5.1 0.0936 UDI Q2 (UUI) (0-3) 122 1.6 0.0251 0.8 0.9 1.3 0.1112 No OAB Treatment 107 1.6 0.1248 0.8 0.9 1.2 0.2223 OAB Treatment 15 1.5 0.0092 1.0 1.5 1.7 0.2174 UDI Q3 (SUI) (0-3) 122 1.7 0.0023 0.6 0.7 0.9 0.03961 UDI Q5 (Empty) (0-3) 122 1.0 0.0008 0.5 0.6 0.5 0.6151 (n=113/120) (n=45/97) (n=41/87) QoL (0-10) 120 6.2 0.0005 2.2 2.7 2.8 0.2182 UUI = Urge Urinary Incontinence; SUI = Stress Urinary Incontinence; OAB = Overactive bladder 1 1-3 years follow-up and >5 years follow-up is significantly different, p < 0.05 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e876-e877 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Philippe Zimmern More articles by this author Alana Christie More articles by this author Xian-Jin Xie More articles by this author Chasta Bacsu More articles by this author Dominic Lee More articles by this author Benjamin Dillon More articles by this author Jack Hou More articles by this author Feras Alhalabi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP3-15 LARGE CYSTOCELE REPAIR WITH THE ANTERIOR VAGINAL WALL SUSPENSION PROCEDURE

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2014MP3-15 LARGE CYSTOCELE REPAIR WITH THE ANTERIOR VAGINAL WALL SUSPENSION PROCEDURE Philippe Zimmern, Alana Christie, Xian-Jin Xie, Chasta D. Bacsu, Dominic Lee, Benjamin Dillon, Jack C. Hou, and Feras Alhalabi Philippe ZimmernPhilippe Zimmern More articles by this author , Alana ChristieAlana Christie More articles by this author , Xian-Jin XieXian-Jin Xie More articles by this author , Chasta D. BacsuChasta D. Bacsu More articles by this author , Dominic LeeDominic Lee More articles by this author , Benjamin DillonBenjamin Dillon More articles by this author , Jack C. HouJack C. Hou More articles by this author , and Feras AlhalabiFeras Alhalabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.194AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report on the mid- and long-term outcome for the anterior vaginal wall suspension (AVWS) procedure (1) for correction of stage II-IV anterior compartment prolapse (ACP). METHODS Following IRB approval, the long-term prospective Access database of non-neurogenic women who underwent AVWS for ACP, with a minimum 1 year follow-up and complete pre and post-operative records, was reviewed. Preoperative evaluation included detailed history, validated questionnaires (UDI-6, QoL), physical examination, and standing lateral voiding cystourethrogram (VCUG) with rest (UAR)/strain(UAS) views to evaluate urethral hypermobility and degree of cystocele (Lateral height). Follow-up included examination, questionnaires, and one VCUG around 6-12 months post-operatively. Success was measured by Kaplan-Meier curves using time to reoperation for ACP recurrence. Mixed-effects model least square means were used for baseline versus post-AVWS and follow-up period mean score comparisons. RESULTS Between 1996 and 2012, 169 women met inclusion criteria. Mean ± Sd were: age 67.7 (9.3), BMI 26.5 (4.5), parity 2.7 (1.5). 78 (46%) patients underwent AVWS alone and 28 (17%) had prior POP procedures. Aa and Ba points increased slightly over time (p=0.01, p=0.02, respectively) (Table 1). VCUG findings also improved significantly for urethral support and cystocele reduction. Recurrence rate based on reoperation using mesh sacrocolpopexy or anterior colporrhaphy was 13/169 (8%) at a median of 1.4 (0.6-7.0) years. CONCLUSIONS The AVWS procedure can durably correct ACP by restoration of the anatomical support to the bladder neck and bladder base. Table 1. Mixed Model Least Square Means for Follow-up Period Mean Score Comparison Patients Baseline Follow-up Period Mean (95% CI) Mean p-value 1-3 Years 3-5 Years >5 Years p-value Physical Exam (n=164/169) (n=57/138) (n=44/109) Aa (-3,+3) 169 0.14 0.0003 -2.65 -2.41 -2.42 0.012112 Ba (-3,+8) 169 0.22 0.1054 -2.59 -2.37 -2.30 0.01992 Questionnaires (n=93/97) (n=42/82) (n=29/75) UDI6 Total (0-18) 97 7.87 <0.0001 4.03 4.63 4.33 0.3581 UDI Q2 (UUI)(0-3) 97 1.65 <0.0001 0.93 1.08 0.91 0.4228 No OAB treatment 91 1.61 <0.0001 0.90 1.04 0.89 0.5040 OAB treatment 6 2.23 0.0199 1.61 2.00 1.40 0.8218 UDI Q3 (SUI)(0-3) 97 1.21 <0.0001 0.66 0.74 0.79 0.6173 UDI Q5 (Empty)(0-3) 97 1.17 <0.0001 0.40 0.46 0.72 0.043223 (n=95/98) (n=42/84) (n=30/76) QoL (0-10) 98 6.15 0.0206 1.92 2.10 2.59 0.2513 11-3 years follow-up and 3-5 years follow-up is significantly different, p < 0.05 21-3 years follow-up and >5 years follow-up is significantly different, p < 0.05 33-5 years follow-up and >5 years follow-up is significantly different, p < 0.05 UUI = Urge Urinary Incontinence; SUI = Stress Urinary Incontinence OAB = Overactive Bladder © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e40 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Philippe Zimmern More articles by this author Alana Christie More articles by this author Xian-Jin Xie More articles by this author Chasta D. Bacsu More articles by this author Dominic Lee More articles by this author Benjamin Dillon More articles by this author Jack C. Hou More articles by this author Feras Alhalabi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP75-11 LONG-TERM OUTCOME OF UTERINE SPARING PROCEDURE AS PART OF ANTERIOR VAGINAL WALL SUSPENSION.

and QoL consistently improved post-operatively, and remained stable over time (Table 1). VCUG findings also improved for urethral support and cystocele reduction. Additional therapy with sling (4) or injectable agents (8) was required in 12 (6%) women at a median of 3.8 (1.2-10.3) years. CONCLUSIONS: The AVWS procedure can durably correct SUI by restoration of anatomical support to the bladder neck and bladder base. Reference: 1. Wilson TS, Zimmern PE: Anterior Vaginal Wall Suspension, Female Urology, Urogynecology, and Voiding Dysfunction, Vasavada, Appell, Sand, and Raz, Section I, Chapter 17, 283-290, Marcel Dekker, 2005

114 Quality of life after an anterior vaginal wall suspension procedure to correct urinary incontinence with concomitant anterior compartment prolapse based on type of incontinence at baseline

114 Quality of life after an anterior vaginal wall suspension procedure to correct urinary incontinence with concomitant anterior compartment prolapse based on type of incontinence at baseline

531 Apical and posterior compartment recurrence after concurrent total hysterectomy and anterior vaginal wall suspension for bladder with uterine prolapses

531 Apical and posterior compartment recurrence after concurrent total hysterectomy and anterior vaginal wall suspension for bladder with uterine prolapses

Do Biomechanical Properties of Anterior Vaginal Wall Prolapse Tissue Predict Outcome of Surgical Repair?

We determined the relevance of the biomechanical properties of freshly harvested vaginal tissue during large cystocele repair on clinical outcome at a minimum 1-year followup. With institutional review board approval we prospectively studied the biomechanical properties of full thickness vaginal wall tissue from postmenopausal women with symptomatic Baden-Walker prolapse undergoing anterior vaginal wall suspension with cystocele repair from 2002 to 2005. A standardized biomechanical protocol was applied with stress-strain curves for Young's modulus obtained by blinded investigators. Failed repair was defined as recurrence on examination or reoperation for recurrent anterior prolapse. A total of 32 patients (median age 72 years) had a median followup of 34 months (range 12 to 62). Median Young's modulus was statistically different in tissue samples transported in immersed vs moistened media (median 3.8 vs 7.6, p = 0.008). Associations between Young's modulus and clinical variables were described. On followup 7 patients experienced failure of the repair. After controlling for tissue transport protocol no association was seen between Young's modulus and failures (HR 1.1, p = 0.34). This study found no association between Young's modulus and clinical results at long-term followup. This finding suggests that retropubic scarring and pelvic floor muscle properties may be more important for a successful reparative outcome than the intrinsic properties of the vaginal wall.

V1676: Repair of Moderate-To-Large Cystocele with the Anterior Vaginal wall Suspension Procedure

You have accessJournal of UrologyVideo Session, Wednesday, May 24, 2006, 1:00 - 3:00 pm1 Apr 2006V1676: Repair of Moderate-To-Large Cystocele with the Anterior Vaginal wall Suspension Procedure Jason P. Gilleran, Darren M. Chapman, and Philippe E. Zimmern Jason P. GilleranJason P. Gilleran More articles by this author , Darren M. ChapmanDarren M. Chapman More articles by this author , and Philippe E. ZimmernPhilippe E. Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33991-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "V1676: Repair of Moderate-To-Large Cystocele with the Anterior Vaginal wall Suspension Procedure." The Journal of Urology, 175(4S), p. 540 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 540 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Jason P. Gilleran More articles by this author Darren M. Chapman More articles by this author Philippe E. Zimmern More articles by this author Expand All Advertisement PDF downloadLoading ...