Apical Sling Research Articles

Comparative analysis of methods of surgical correction of post-hysterectomy pelvic organ prolapse

BACKGROUND: The incidence of prolapse after hysterectomy requiring surgical intervention is estimated at 36 cases per 10,000 women. A universal surgical treatment method for post-hysterectomy pelvic organ prolapse is lacking, prompting the need for new approaches. AIM: To comparatively analyze the results of laparoscopic sacrocolpopexy, sacrospinous fixation, and the developed new method of surgical correction of pelvic organ prolapse after hysterectomy. MATERIAL AND METHODS: This prospective non-randomized study included 57 patients with stage II, III, or IV symptomatic post-hysterectomy prolapse of the pelvic organs who were admitted at the clinical hospital RZD-Medicine in Tula, Russia, between August 2019 and September 2023. The first group (n=18) consisted of women who underwent surgical correction of post-hysterectomy pelvic organ prolapse in a newly developed method; the second group (n=19) included women who underwent laparoscopic promontofixation according to the conventional technique; and the third group (n=20) involved patients who underwent installation of an apical sling using a UroSling-1 mesh endoprosthesis (Lintex LLC, St. Petersburg). The patients’ quality of life was assessed using specialized validated questionnaires: Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Patients were asked to complete questionnaires before surgery and 12 and 24 months after surgical correction of PGP. The patients were invited for a follow-up examination after 1, 6, 12, and 24 months. RESULTS: The duration of the operation in the second group significantly exceeded the indicators of the first and third groups. The average duration of hospital stay of patients was 4.4±0.6 (95% CI: 4.1–4.7) bed days in the first group, 4.9±1.1 (95% CI: 4.6–5.3) in the second, and 4.6±0.6 (95% CI: 4.3–4.9) in the third. The differences were insignificant (p1–2=0.437; p1–3=0.137; p2–3=0.235). The anatomical results after 24 months at points Aa and Ba showed significant differences. At point Aa, p1–3=0.007 and p2–3=0.004, and at point Ba, p1–3=0.032 and p2–3=0.041. A comparative assessment of the questionnaire data before surgery and 12 and 24 months after surgery showed a significant improvement in the quality of life of patients in the three groups. CONCLUSION: The proposed method of correction of post-hysterectomy pelvic organ prolapse provides high anatomical and functional results and reduces the posibility of repeated surgical intervention for recurrence.

The influence of simultaneous posterior colporrhaphy and perineoplasty on the efficiency and safety of mesh-augmented sacrospinal fixation (apical sling) in advanced POP repair

BackgroundPelvic organ prolapse (POP) is one of the most common pathologies of the pelvic floor, and it can be found among 40–60% of women who have given birth. Correction of the defect of the DeLancey level II without reconstruction of the apical defect is doomed to failure. Also, in the structure of pelvic floor defects, there is often an incompetency of the perineal body, as a consequence of traumatic delivery. Perineoplasty is considered to be the main method of correction for perineal body incompetency. However, it is worth mentioning that there are no randomized trials, which estimate the influence of simultaneous correction of the perineal body on the effectiveness of transvaginal apical fixation.MethodsIt is planned to include 310 patients in this trial. Patients who met the inclusion/exclusion criteria will be randomized into 2 groups: 1st group—patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy without perineoplasty, 2nd group—patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy and perineoplasty. Patients will be called to an appointment 6, 12, and 24 months after discharge.DiscussionThe aim of this trial is to evaluate the efficiency and safety of simultaneous perineoplasty on the clinical and anatomical efficacy of mesh-augmented sacrospinal fixation in advanced pelvic organ prolapse repair. Based on previous studies, it was difficult to estimate and comprehend whether colpoperinoplasty actually reduces the risk of prolapse recurrence.Trial registrationNCT05422209. Registered on 18 May 2022.

Effects of unilateral apical sling and laparoscopic sacrocolpopexy on the outcome in women with apical prolapse: randomised trial.

The purpose of this study was to compare the use of unilateral apical sling versus laparoscopic sacrocolpopexy in the treatment of the apical form of pelvic organ prolapse in women. M: aterial and methods:A prospective, single-center randomized trial included 100 patients who were alternately assigned to treatment. Each patient had a ≥ III stage of apical or anterior-apical prolapse determined by the POP-Q system. 45 accepted for unilateral apical sling (UAS)and 55 accepted for laparoscopic sacrocolpopexy (LS). Data were compared by the One-way ANOVA test using IBM SPSS stats 19. Mean operating time was significantly greater in the LS group versus UAS group, 194.6 vs 42.4 minutes, respectively (p < 0.05). The amount of intraoperative bleeding was significantly higher in the UAS group, compared to the LS group (p = 0.01). Within the follow-up period, 2 patients in UAS group and 3 patients in LS group (4.4% vs 5.4%, respectively; p = 0.9) had recurrent cystocoele. HRQoL and sexual outcomes did not differ significantly between the two treatment groups. s:Our data demonstrate the non-superiority one on each other of the two different approaches, except in terms of shorter operating time and higher intraoperative bleeding when UAS used. These findings raise questions about the need for long-term results of quality of life outcomes for women with genital prolapse, especially in resource-limited settings similar to Kazakhstan.

Correction of the Vault Prolapse Vaginally through Apical Sling with Fixation in the Sacrospinous Ligament with a New Device

Study Objective Evaluate the efficacy and safety of the technique for correction of the vaginal vault prolapse through the use of Apical Sling with fixation in sacrospinous ligament (AS-FSL) using a new device (SPLENTIS). Design We did a retrospective cohort and the range of follow-up was 6-42 months. Setting Patient at lithotomy position and asseptic procedures performed as usual for vaginal surgery. Patients or Participants In the national health system, our center is positionated as a reference for surgical gynecological cases receiving patients referred from basic health units on a random basis. We included the patients that we received in the period (2016-2019) that needed vault prolapse correction. A total of 20 patients were included at the study. Interventions Was performed the dissection of the vault prolapse and paravaginal spaces until the sacrospinous ligament. With the rod of the AS-FSL, the harpoons are fixed 0.5 cm from the ischial spine. Through the harpoon wires, a specific sling for vault prolapse was placed and the mucosa was closed with simple suture. Measurements and Main Results There was only one case of relapse, and with the exception of this case, all patients assessed would indicate surgery to a friend (95%) with the average satisfaction via Likert Scale of 9.25. There were no tape extrusions (100%) or complications requiring readmission (100%). Cure of 45% of the cases of urinary incontinence associated, only one case reporting sexual life worsening, only one case of defect appearance during Valsalva maneuver, total vaginal length of > 6cm at 50% of the cases. Conclusion It has been demonstrated, within the limitations of the small number of patients and single treatment center, that surgical repair of the vault prolapse can be performed vaginally through the AS-FSL safely with satisfactory objective and subjective results and reduced length of stay.

I-STOP Sling Tape: Is It Associated With Reduced Exposure Rates in Apical Prolapse and Urinary Incontinence Procedures?

Background: Type 1 polypropylene synthetic mesh has been the preferred mesh material used for reconstructive surgery in the female pelvis in the past. I-STOP is an inelastic monofilament macroporous polypropylene mesh tape with looped edges. Our primary aim was to assess the incidence of mesh complications, including exposure/erosion in women who underwent I-STOP suburethral sling or apical sling suspension procedures. Methods: This study was a retrospective review of a comprehensive urogynecological database at the Cleveland Clinic Florida of who underwent I-STOP suburethral sling procedures or apical sling suspension between 2009 and 2018. A total of 165 apical slings and 476 suburethral slings were collected at predetermined follow-up visits at 6 weeks, 6 months, and then yearly. Results: Of the apical slings, 86 (52%) had a follow-up for 6 months or longer, with the maximum patient follow-up of 99 months (mean of 19 months). Zero of the 86 patients that were followed up in the review developed mesh erosion/exposure. A total of 307 (64%) patients who underwent I-STOP suburethral slings had follow-up for 6 months or longer with the maximum patient follow-up of 158 months (mean of 36 months). Two patients developed mesh erosion/exposure with a calculated complication rate at 0.42%. No patients in either group developed clinically evident mesh contraction. Conclusions: Our study demonstrated lower mesh erosion/exposure and complication rates with the use of the I-STOP tape both in apical sling and suburethral sling procedures compared to complication rates reported with the use of other mesh products. J Clin Gynecol Obstet. 2020;9(1-2):12-16 doi: https://doi.org/10.14740/jcgo643

V13-09 THE THREE-LEVEL UTERUS-SPARING REPAIR OF ADVANCED PELVIC ORGAN PROLAPSE WITH THE USE OF ULTRAMINIMESH

You have accessJournal of UrologyFemale Pelvic Surgery (V13)1 Apr 2020V13-09 THE THREE-LEVEL UTERUS-SPARING REPAIR OF ADVANCED PELVIC ORGAN PROLAPSE WITH THE USE OF ULTRAMINIMESH Dmitry Shkarupa*, Nikita Kubin, Olga Staroseltseva, Ekaterina Shapovalova, Anastasia Zaytseva, and Alexander Petrov Dmitry Shkarupa*Dmitry Shkarupa* More articles by this author , Nikita KubinNikita Kubin More articles by this author , Olga StaroseltsevaOlga Staroseltseva More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , Anastasia ZaytsevaAnastasia Zaytseva More articles by this author , and Alexander PetrovAlexander Petrov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000970.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to J.O. DeLancey, the structures that support the pelvic floor are divided into three levels. The majority of existing treatment methods of pelvic organ prolapse (POP) is aimed at 1 and 2 levels. At the same time according to the modern data the structures of the 3 level allow to break the excessive tension from the ligaments/fascias and is a kind of the basis of the above located levels of support. Besides, the minimizing of synthetic materials use in vaginal surgery is very actual issue. The purpose of this study was to evaluate the efficiency and safety of the three-level uterus-sparing repair of advanced POP using ultraminimesh. METHODS: This prospective study involved 209 women suffering from POP (stage III-IV, POP-Q), who underwent transvaginal reconstruction of all levels of support (according to J.O. DeLancey): unilateral sacrospinal fixation using apical sling (level 1), anterior and posterior subfascial colporrhaphy (level 2) and perineorrhaphy (level3) (fig. 1). The patients were examined 12 months after the surgery, including vaginal examination, assessment of POP according to the POP-Q system and completion of validated questionnaires (PFDI-20, PISQ-12, VAS). RESULTS: Mean operation time was 58.2 ± 9.7 minutes. No intraoperative bladder injuries or clinically significant bleeding were observed. Postoperative data were obtained in 185 (88.2%) patients. The anatomical success rate (stage ≤ I, POP-Q) of follow-up was 95.1%. Anatomical recurrence at the apical level (C> -1) was detected in 1 (0.5%) patient, and in the anterior compartment (Ba≥-1) in 8 (4.3%) patients. During the observation period only one case of suture material extrusion was recorded. None of the patients complained of pain in the area of surgery. However, one woman noted de novo dyspareunia. SUI de novo developed in 6 (3.2%) patients. Most of the patients reported a significant improvement in the quality of life after treatment. Satisfaction with the treatment outcome according to questionnaires was 94.7%. CONCLUSIONS: The reconstruction of the all levels of support of the pelvic floor allows to distribute the load between compartments and therefore, to reduce the amount of used synthetic material while maintaining high efficiency and safety of the surgery. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1213-e1213 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Shkarupa* More articles by this author Nikita Kubin More articles by this author Olga Staroseltseva More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Alexander Petrov More articles by this author Expand All Advertisement PDF downloadLoading ...

MP05-15 8 YEARS PROSTHETIC VAGINAL PELVIC ORGAN PROLAPSE REPAIR IN ULTRA-HIGH-VOLUME CENTER: 4487 PATIENTS, 250 CASES PER SURGEON ANNUALLY AND NO EVIDENCE FOR MESH BAN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-15 8 YEARS PROSTHETIC VAGINAL PELVIC ORGAN PROLAPSE REPAIR IN ULTRA-HIGH-VOLUME CENTER: 4487 PATIENTS, 250 CASES PER SURGEON ANNUALLY AND NO EVIDENCE FOR MESH BAN Shkarupa Dmitry*, Shkarupa Andrey, Kubin Nikita, Shulgin Andrey, Staroseltseva Olga, Vostrikova Evgenia, and Ustinova Anna Shkarupa Dmitry*Shkarupa Dmitry* More articles by this author , Shkarupa AndreyShkarupa Andrey More articles by this author , Kubin NikitaKubin Nikita More articles by this author , Shulgin AndreyShulgin Andrey More articles by this author , Staroseltseva OlgaStaroseltseva Olga More articles by this author , Vostrikova EvgeniaVostrikova Evgenia More articles by this author , and Ustinova AnnaUstinova Anna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: At the moment, there is no universal approach to the treatment of patients with pelvic organ prolapse (POP). Native tissue repair is characterized with the lack of effectiveness in advanced cases however the use of synthetic materials can lead to a number of specific complications. The objective was to assess the evolution in POP-mesh surgery based on tertiary center experience. METHODS: The database of 4487 patients operated for POP with the use of mesh implants during 2012-2019 was analysed retrospectively. The type of performed surgery and indicators characterizing its safety and effectiveness were evaluated. RESULTS: According to the results, it was possible to retrace distinctly how the techniques for pelvic floor reconstruction have been changed basing on clinical experience and global trends. First, there were two “big” meshes: one for each compartment. Then, there was a total exclusion of mesh implantation in posterior compartment in favor of native tissue repair. Further, the fixation of implant to arcus tendinius was replaced for sacrospinous. Meanwhile, the transition from trocar technique to anchor fixation took place. Subsequently, the anchor fixation was changed again for trocar and a “big” implant was replaced by apical sling which was put bilaterally in sacrospinous ligaments and the anterior compartment was repaired via original subfascial colporrhaphy. Then the bilateral fixation was replaced by the unilateral apical sling. Finally, the technique described above was combined with posterior colpoperineoplasty for the hybrid three-level reconstruction of the pelvic floor. The results of all listed techniques are presented in the table. It is important that with the decrease of the implanted mesh material amount and decrease of fixation points, the technique’s safety rises while retaining its high effectiveness. CONCLUSIONS: The keystone of the improvement of technologies in vaginal reconstruction of the pelvic floor for 8 years was to reduce the amount of synthetic material and the number of fixation points of mesh implant together with pathogenetically substantiated native tissue repair. In high-volume center where every doctor performs at least 250 surgeries annually, the number of complications is more than acceptable. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e47-e47 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shkarupa Dmitry* More articles by this author Shkarupa Andrey More articles by this author Kubin Nikita More articles by this author Shulgin Andrey More articles by this author Staroseltseva Olga More articles by this author Vostrikova Evgenia More articles by this author Ustinova Anna More articles by this author Expand All Advertisement PDF downloadLoading ...

Cure of Underactive and Overactive Bladder Symptoms in Women by 1,671 Apical Sling Operations Gives Fresh Insights into Pathogenesis and Need for Definition Change

Introduction:To check evidence that symptoms identical with those constituting “underactive bladder” (UAB) and “overactive bladder” (OAB) are caused by apical prolapse and cured by repair thereof. Material and Methods: After repair of apical prolapse by mesh tape reinforcement of lax uterosacral ligaments (USL) data form 1,671 women were retrospectively examined to determine the presence of OAB and UAB symptoms and to check, how many were cured surgically. Thereby 3 different techniques were performed: elevate (n = 277), “Posterior IVS” (n = 1,049), and TFS cardinal (CL)/USL (n = 345). Results: Symptoms identical with those comprising UAB and OAB were cured in up to 80% of cases following surgical repair of the CL/USL complex. Conclusions: These symptoms may be consistent with symptoms of the posterior fornix syndrome, which comprises 4 main symptoms: micturition difficulties, urge/frequency, nocturia, chronic pelvic pain, all consequent on USL laxity. Surgical cure of OAB and UAB is inconsistent with existing definitions, which imply pathogenesis of the detrusor muscle itself. A reconsideration and reformulation of existing definitions may be required. Altering UAB definition to “bladder emptying difficulties” and return to former definitions for OAB such as “detrusor” or “bladder instability” may help to restore compatibility with surgical cure of these conditions.

Unilateral apical sling: a new look at the sacrospinous fixation

Hypothesis/aims of study. Nowadays a sacrospinous ligament fixation is one of the most studied and popular methods of colpo- and hysteropexy. Despite the high effectiveness against apical compartment defect, this technique has a number of specific side effects: chronic pain syndrome, dyspareunia, and а high rate of postoperative cystocele de novo. This study aimed to evaluate the efficacy and safety of unilateral sacrospinous ligament fixation with use of a modern synthetic monofilament mesh combined with the original technique of pubocervical fascia reconstruction using subfascial colporrhaphy.&#x0D; Study design, materials and methods. This study involved 174 women suffering from anterior/apical prolapse. All patients were operated with the proposed method. Postoperative assessment was performed at 1, 6 and 12 months after surgery and included vaginal examination with evaluation of pelvic organ prolapse by standardized POP-Q system, uroflowmetry, bladder ultrasound with post-void residual urine volume measurement, and filling in validated questionnaires (PFDI-20, PFIQ-7, PISQ-12).&#x0D; Results. Mean operation time was 26 ± 7.8 min. No cases of damage to the bladder or intraoperative clinically significant bleeding were noted. During a postoperative period, most of the patients showed a significant improvement in POP-Q points while maintaining the total vaginal length. Within 12 months of follow-up, the recurrence was observed in 1 (0.7%) patient in the apical compartment and in 10 (6.8%) patients in the anterior compartment. It should be mentioned that only in 3 cases of cystocele recurrence did the vaginal wall descend beyond the hymen. There were no cases of mesh erosion and pelvic pain syndrome through 12 months postoperatively. In the postoperative period, an improvement in urination was observed in all women. Most of the patients after the treatment showed a significant improvement in the quality of life. Only one patient complained of dyspareunia de novo. According to the questionnaires, satisfaction with the result of treatment was 96.5%.&#x0D; Conclusion. A unilateral sacrospinous fixation using a synthetic mesh combined with pubocervical fascia reconstruction (subfascial colporrhaphy) provides a high efficiency, while significantly reducing the rate of complications related to the traditional sacrospinous fixation.

The novel technique of post-hysterectomy vaginal vault prolapse repair: Apical sling and “neocervix” formation

ObjectiveWe primarily aimed to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling combined with “neocervix” formation in surgical treatment of post − hysterectomy vaginal vault prolapse. The secondary objective was to estimate the impact of the surgery on voiding function and quality of life. Study designThis prospective study involved 61 women suffering from post-hysterectomy prolapse. We used the following criteria to evaluate the results of surgical treatment: results of vaginal examination (POP-Q system), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment. ResultsMean operation time was 35min. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted.At 12-month follow-up anatomical cure rate (≤stage I, POP-Q) was 100%, 94,4% and 100% for vaginal apex, anterior and posterior vaginal walls, respectively. The following long-term complications were noted stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4,9%, respectively. Statistically significant (P<0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. ConclusionThe novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with vaginal vault prolapse. The technique improves voiding function and quality of life.

V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2017V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION Dmitry Shkarupa, Alexey Pisarev, Ekaterina Shapovalova, Anastasia Zaytseva, and Nikita Kubin Dmitry ShkarupaDmitry Shkarupa More articles by this author , Alexey PisarevAlexey Pisarev More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , Anastasia ZaytsevaAnastasia Zaytseva More articles by this author , and Nikita KubinNikita Kubin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6% in patients with prior hysterectomy for uterine prolapse. Sacrocolpopexy is considered the gold standard procedure for VVP correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The objective of this study was to evaluate effectiveness of novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling-1, Lintex) combined with neocervix formation (purse-string suture on the internal surface of the cervical fascia fixed to the tape) in surgical treatment of post - hysterectomy vaginal vault prolapse. Secondary aim was to estimate the impact of the surgery on urinary function and patient′s quality of life. METHODS This prospective study involved 54 women suffering from post-hysterectomy prolapse. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, ultrasound measurement of post-voiding residual volume were used, determined before the surgery and at control examinations after treatment. Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires. RESULTS Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. Median follow-up time was 12 (min-8, max-18) months. There was noted statistically significant improvement in POP-Q points, especially, Ba and C (p<0,001) in all patients. Also statistically significant improvement was found in peak and average flow rate according to uroflowmetry (p<0,05). Recurrent prolapse was noted in anterior compartment in 3.7% (2/54). After 6 months of follow-up stress urinary incontinence de novo was noted in 7.4% (4/54). Most of the patients reported a significant improvement in quality of life after treatment. CONCLUSIONS The novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with post-hysterectomy prolapse. This technique also provides high functional results and improves quality of life. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e134 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dmitry Shkarupa More articles by this author Alexey Pisarev More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Nikita Kubin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V81 - The novel technique of pelvic organ prolapse treatment: Apical sling and subfascial colporrhaphy

Introduction and hypothesis The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy.

The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.

The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy. This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12months after the treatment. At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%. The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.

Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE

Introduction. Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6-45% in patients with prior hysterectomy for uterine prolapse. Reported recurrence rate of VVP following different techniques of surgical correction is up to 10%.Objective: to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling (Urosling 1; Lintex, Saint Petersburg, Russia) in surgical treatment of VVP.Methods. This prospective study involved 61 women suffering from post-hysterectomy prolapse. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment.Results. Mean operation time was 35 minutes. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted. 12-months anatomical cure rate (≤ stage I, POP-Q) was 100%, 94.4% and 100% for apical, anterior and posterior vaginal compartments, respectively. At 1 month of follow-up stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4.9%, respectively. Statistically significant (p &lt; 0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.Conclusion. Bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling appears to be effective and safe method for treatment patients with vaginal vault prolapse.

Apical sling: an approach to posthysterectomy vault prolapse.

This video demonstrates a transvaginal technique for vaginal vault suspension using an apical sling suspended from the sacrospinous ligaments. This was a retrospective review of apical sling procedures performed from July 2013 to November 2014. The technique is started by marking the vaginal apex. A posterior dissection is performed and the sacrospinous ligaments are identified after dissection into the pararectal space. A 10-cm piece of monofilament, inelastic polypropylene tape is attached to the underside of the vaginal apex. Polypropylene sutures are placed into the sacrospinous ligament and threaded though the lateral edges of the apical sling and tied down, restoring apical support. Finally, the vaginal epithelium is closed. A total of 67 women underwent an apical sling procedure with 70% (47/67) completing 6months follow-up. The subjective cure rate ("cured" or "greatly improved") was 78.7% and the objective cure rate (anatomical success, defined as apical prolapse stage ≤1) was 100% (47 patients). Our apical sling sacrospinous ligament fixation approach is a unique, minimal mesh approach using a tape commonly used for midurethral slings to suspend the vaginal apex. We achieved high anatomical success and patient satisfaction.

V63 Apical sling for site specific pelvic organ prolapse repair

V63 Apical sling for site specific pelvic organ prolapse repair

V1-05 APICAL SLING FOR FOR SITE SPECIFIC PELVIC ORGAN PROLAPSE REPAIR

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-05 APICAL SLING FOR FOR SITE SPECIFIC PELVIC ORGAN PROLAPSE REPAIR Paulo Palma, Cassio Riccetto, Tiago Aguiar, and Wilmar Azal Neto Paulo PalmaPaulo Palma More articles by this author , Cassio RiccettoCassio Riccetto More articles by this author , Tiago AguiarTiago Aguiar More articles by this author , and Wilmar Azal NetoWilmar Azal Neto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.599AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral colpopexy has become a widely used procedure for apical vaginal prolapse repair, but the risk of bleeding, injury of the rectum, as well as other abdominal viscera still represents a major concern. Posterior transcoccigeal mesh brings the risks of the transgluteal route, mostly pudendal neurovascular bundle injury. A new procedure for colpopexy was developed in order to allow for a single incision apical transvaginal level I repair, using a small amount of synthetic material. The kit contains a macro porous polypropylene 8 x 1,2 cm tape and two polypropylene self anchoring system attached to polypropylene threads and a disposable retractable insertion guide for placement of the anchoring system into the sacrospinous ligaments. This video highlights the technical details of the procedure. METHODS It is presented the surgical treatment of a patient with a vaginal apical (uterine) prolapse stage 3 according to the POP-Q system. A vertical incision is done in the anterior vaginal. Blunt dissection is performed towards the ischial spine, and coccigeous muscle and sacrospinous ligaments are identified bilaterally. Then, the retractable insertion guide is primed with the multipoint anchoring system and introduced toward the ischial spine guided by surgeon’s index finger and implanted into the sacrospinous ligament, 1.5 cm medial to ischial spine. The tissue anchoring system is delivered and the retractable insertion guide is gently retracted. Next reconstruction of the pericervical ring is performed then, both sides of the sling are attached to the polypropylene threads and knots are tied in order to elevate the cervix and the vaginal apex to DeLancey’s level one. Finally, the vaginal incision is closed in the usual manner. RESULTS This procedure was performed in 10 patients (mean age 65 years-old) with POP-Q stage 3 apical prolapse. No intra-operative complications or postoperative significant adverse events were observed. None presented post-operative vaginal mesh exposure. Mean follow up was 12 months (6 to 18 months). In this short term follow up, all of the patients were considered cured (POP-Q apical stage was 0 or 1). CONCLUSIONS Apical sling kit adds the advantages of single incision transvaginal approach, safety and level I correction of apical defect, without the mesh related complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e292-e293 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Paulo Palma More articles by this author Cassio Riccetto More articles by this author Tiago Aguiar More articles by this author Wilmar Azal Neto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...