Management Of Pelvic Organ Prolapse Research Articles

Management of Occult Urinary Incontinence with Prolapse Surgery.

The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.

Racial Differences in Pelvic Organ Prolapse Symptoms Among Women Undergoing Pelvic Reconstructive Surgery for Prolapse.

The aim of this study was to determine if there is a difference in Pelvic Floor Disability Index Questionnaire (PFDI-20) scores between black and white women seeking surgical management for pelvic organ prolapse (POP). A retrospective cohort study of 232 women who underwent pelvic reconstructive surgery with apical suspension for POP was performed. Demographic and clinical data were collected. All women completed the PFDI-20 and had a Pelvic Organ Prolapse Quantification examination at the initial consultation. Appropriate statistical tests were used to compare black and white women. Multivariable regression models adjusting for demographic and clinical variables were developed to determine the independent relationship between race and POP symptoms. In our cohort, 174 (75%) were white and 58 (25%) were black. Compared with white women, black women had higher parity, body mass index, Charlson Comorbidity Index score, and anterior POP stage. White women had higher total PFDI-20 scores corresponding to higher scores on all symptom subscales. After controlling for potential confounders, white race and prior anti-incontinence surgery remained associated with higher total PFDI scores. Higher Urogenital Distress Inventory 6 scores were significantly associated with white race, prior anti-incontinence procedures, and increasing body mass index, whereas higher CRADI-8 scores were associated with prior anti-incontinence surgery and higher POP stages. White women appeared to have more overall symptom bother from prolapse, as well as urinary symptoms, as compared with black women, when assessed by validated questionnaire tools in a cohort of patients who underwent prolapse surgery. Further research is required to determine if racial differences in symptoms translate to differences in outcomes.

Comparison of different surgical techniques for pelvic floor repair in elderly women: a multi-institutional study.

The prevalence of pelvic organ prolapse (POP) is increasing. The number of women aged 70-80years requiring surgical management for POP is also increasing. The purpose of this study was to compare the complications associated with three pelvic organ prolapse repair methods, sacrocolpopexy (SCP), native tissue repair (NTR), and vaginal mesh repair (VMR), in women aged 70-80years. We performed a multi-institutional retrospective analysis of 213 women who underwent POP surgical repairs between December 2012 and December 2017. Treatment-related complications were classified using the ClavienDindo grading system and compared among the three groups. Perioperative data, anatomical success rates, patient satisfaction, and postoperative complication data were collected during the follow-up period, which lasted up to 12months. Of 213 patients, 70 (33%) underwent SCP, 85 (40%) underwent NTR, and 58 (28%) underwent VMR. By postoperative day 30, the all-inclusive complication rate was lower in the SCP group than in the NTR or VMR group; however, there was no between-group difference in complication grade. The VMR group underwent fewer concomitant hysterectomies than the other groups, and operative time was the longest for SCP. Overall, recovery time, anatomical success rate, and patient satisfaction were comparable for all three repairs. All three surgical techniques were equivalent in patient satisfaction, anatomical success rate, and complication rate. SCP should be recommended to elderly women who meet criteria for prolonged general anesthesia, as it was associated with fewer perioperative complications than NTR and VMR.

Prolaps Organ Panggul

<p>Pelvic organ prolapse is a condition of descent or herniation of woman’s pelvic organs through the birth canal or onto birth canal space. As someone gets older, the incidence of pelvic organ prolapse increases, due to weakening of ligaments and muscles as suspensor for the pelvic organs. Prolapse may or may not show symptoms. Symptoms that occur are associated due to pressure of the pelvic area, difficulty urinating and defecation. The staging of pelvic organ prolapse utilized the Baden-Walker System and Pelvic Organ Prolapse Quantification (POP-Q). Management for pelvic organ prolapse can be done conservatively and operatively, and the decision of which approach should be taken based on the patient’s condition and choice.</p>

Methods of surgery for pelvic organ prolapse in a nationwide cohort (FINPOP 2015).

The management of pelvic organ prolapse (POP) varies significantly between countries. The objective of this study was to describe the methods used for POP surgery in Finland and to identify the factors that affect clinicians' choice to use either a native tissue repair (NTR) or a mesh repair method. This prospective cohort study included 3535 surgeries covering 83% of all POP operations performed in Finland in 2015. The operative details and patient characteristics, including the Pelvic Floor Distress Inventory (PFDI-20), were compared between three selected surgical methods: NTR, transvaginal mesh (TVM) and abdominal mesh (AM). The predictive factors for the use of mesh augmentation were also studied with logistic regression analysis. The most common method was NTR (n=2855, 81%), followed by TVM (n=429, 12%) and AM (n=251, 7%). Approximately 92% of the patients who underwent primary prolapse surgery underwent NTR, and mesh surgery was used mainly for recurrent prolapse. The strongest predictor of mesh surgery was previous POP surgery for the same vaginal compartment (adjusted odds ratio [OR]=56, 95% confidence interval [CI]=38-84 for TVM; adjusted OR=22, 95% CI=14-34 for AM). Other predictive factors for mesh surgery were previous hysterectomy, healthcare district, severe bulge symptoms and advanced prolapse. TVM was associated with advanced anterior prolapse and older age. AM surgery was associated with advanced apical and/or posterior compartment prolapse. PFDI-20 scores were the highest in the AM group (108 vs 103 in the TVM group and 98 in the NTR group, P=0.012), which indicates more bothersome symptoms than in the other groups. The Finnish practices follow international guidelines that advocate NTR as the principal surgical method for POP. Synthetic mesh augmentation was mainly used in patients with recurrent and advanced prolapse with severe symptoms. The variation in the rates of mesh augmentation for POP surgery in different hospitals implies a lack of sufficient evidence of the most suitable treatment method and indicates a need for national guidelines.

Uterus Preserving Prolapse Repair: How Long does it Last?

Background: The preservation of the uterus has an important role in the pelvic organ prolapse (POP) surgery. Objectives: The aim of this study is to assess the long-term anatomical and functional outcomes of abdominal hysterosacropexy. Methods: Prospective study. A series of women who underwent open abdominal hysterosacropexy for high-stage POP with a minimum 75-month follow-up were included. Results: Data on 51 patients were included. Median follow-up was 136.7 months (range 75.8–258 months). Apical prolapse cure rate was 100%. The success rate for anterior and posterior vaginal compartment was 96 and 94% respectively. Urinary and sexual symptoms significantly improved. Ninety-two percentage of the women were “extremely” or “very much improved” with the operation. Conclusion: This study confirms that abdominal hysterosacropexy is a good surgical option with durable results for the management of POP in women who wish to preserve their uterus.

Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes.

Background:Our aim was to investigate longer-term surgical and quality of life (QOL) outcomes in a cohort of women undergoing robotic-assisted laparoscopic sacrocolpopexy (RALS) for pelvic organ prolapse (POP).Methods:We performed a retrospective cohort study at a single institution of female patients undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair. Scores from the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient’s PFDI and PFIQ postoperative score by ⩾70%.Results:Clinical improvement was seen in 62.6% by the PFIQ and in 64% by the PFDI survey. Younger patient age (OR 0.92, p = 0.011) and worse preoperative American Urological Association (AUA) Quality of Life score (OR 1.42, p = 0.046) were associated with clinical improvement. Within the PFIQ, 35.6% of patients saw clinical improvement with their bowel symptoms, compared with bladder (54.1%, p < 0.001) and prolapse (45.6%, p = 0.053) symptoms. Within the PFDI, 45.5% of patients reached clinical improvement with their bowel symptoms, compared with bladder (56.7%, p = 0.035) and prolapse (62.6%, p < 0.001) symptoms. Of the patients who had a rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score, and 51% saw clinical improvement in the bowel portion of the PDFI.Conclusions:Significantly fewer patients reached clinical improvement within the portions of the surveys that focus on bowel symptoms, compared with symptoms related to urination and POP. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement with their bowel symptoms.

Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes.

There are a variety of surgical management strategies to help surgeons repair pelvic organ prolapse (POP). Surgical treatment for POP includes native tissue repair, augmentation with mesh, and minimally invasive surgeries. Currently, laparoscopic or robotic techniques for POP repair are increasing in popularity and continuing to evolve. The aim of this review is to present an up-to-date review of surgical techniques used for POP repair and to discuss ways to optimize surgical outcomes.

Outcome of Sacrospinous Ligament Fixation of the Vault during Repair of Pelvic Organ Prolapse

Pelvic organ prolapse includes descent of anterior/ posterior wall and apical (vault) prolapse with significant morbidity. In this study we evaluated the outcome of sacrospinous ligament fixation of vault through vaginal approach as part of the repair for massive uterovaginal (pelvic organ prolapse stage III and stage IV) and vault prolapse. This study on sacrospinous ligament fixation along with repair for Pelvic organ prolapse at Kathmandu Model Hospital from November 2016 to April 2018 was done to assess the outcome in terms of early (during hospital stay) and delayed (six months) post-operative complications and need of removal of sacrospinous fixation suture and recurrence of vault prolapse. Out of 95 Pelvic organ prolapse patients, 80 (84%) were post-menopausal, 28 (29.4%) were in the age group of 70-79 years. There were 61 (64%) POPQ stage III. The post-operative complications during post-operative hospital stay were pain over right buttock in 42 (44%), urinary retention in 7 (7%) and UTI in7 (7%). Sacrospinous suture was released in two patients for severe pain over right buttock. At one-week follow-up, 35 (36%) had right buttock pain of moderate severity and 8 (8%) had vaginal cuff infection. Sacrospinous suture was removed in one patient for neuropraxia two weeks following surgery. At four weeks follow-up, 25 (26%) patients had mild right buttock pain relieved by oral NSAIDs on need. At six months follow-up, five had occasional buttock pain, six had some recurrences and two had some vault prolapse and one each had short vagina and stress incontinence. Sacrospinous ligament fixation is a good procedure for the management of Pelvic organ prolapse with better long-term outcome if performed with good surgical expertise.

Outcome of Sacrospinous Ligament Fixation of the Vault during Repair of Pelvic Organ Prolapse

Background: Pelvic organ prolapse includes descent of anterior/ posterior wall and apical (vault) prolapse with significant morbidity. In this study we evaluated the outcome of sacrospinous ligament fixation of vault through vaginal approach as part of the repair for massive uterovaginal (pelvic organ prolapse stage III and stage IV) and vault prolapse. Methods: This study on sacrospinous ligament fixation along with repair for pelvic organ prolapse at Kathmandu Model Hospital from November 2016 to April 2018 was done to assess the outcome in terms of early (during hospital stay) and delayed (six months) post-operative complications, need of removal of sacrospinous fixation suture and recurrence of prolapse. Results: Out of 95 pelvic organ prolapse patients, 80 (84%) were post-menopausal, 28 (29.4%) were in the age group of 70-79 years. There were 61 (64%) POPQ stage III. The post-operative complications during post-operative hospital stay were pain over right buttock in 42 (44%), urinary retention in 7 (7%) and UTI in 7 (7%). Sacrospinous suture was released in two patients for severe pain over right buttock. At one-week follow-up, 35 (36%) had right buttock pain of moderate severity and 8 (8%) had vaginal cuff infection. Sacrospinous suture was removed in one patient for neuropraxia two weeks following surgery. At four weeks follow-up, 25 (26%) patients had mild right buttock pain relieved by oral NSAIDs on need. At six months follow-up, five had occasional buttock pain, six had some recurrences and two had some vault prolapse and one each had short vagina and stress incontinence. Conclusions: Sacrospinous ligament fixation is a good procedure for the management of pelvic organ prolapse with better long-term outcome if performed with good surgical expertise. Keywords: Prolapse; repair; sacrospinous fixation; vaginal hysterectomy.

An Unusual Delayed Complication of Urogynecologic Surgical Mesh Placement: Perirectal Abscess 10 Years After Initial Placement Treated by Endoscopic Removal and Transrectal Drain Placement: ACG Case Reports Journal Award: Presidential Poster Award

INTRODUCTION: More than 500,000 surgical procedures are done annually for management of symptomatic pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Surgical mesh has been used in these surgeries for more than 20 years. However, an increasing number of reports of adverse effects have been described, particularly with transvaginal route of mesh insertion, which has led to issuance of FDA guidelines regarding the use of mesh in urogynecological procedures. Here we describe an uncommon complication of perirectal fistula and abscess associated with surgical mesh that was successfully managed with endoscopic therapy. CASE DETAILS: A 63-year old diabetic woman with urinary incontinence underwent robotic-assisted laparoscopic sacrocolpopexy (Burch procedure) along with polypropylene mesh placement in 2008. She did well until rectal bleeding 7 years later. Sigmoidoscopy showed protrusion of the mesh from the anterior wall of the rectum. During anoscopy under anesthesia, a 2cm length of mesh was cut out. She did well for 18 months before experiencing worsening low back and groin pain. CT scan revealed a 3 x 3 x 8cm fluid collection anterior to the rectum. Percutaneous drainage was attempted but a suitable window could not be found for drain placement. Long term antibiotics were given for several months, but she was readmitted for fevers. CT showed that the abscess now contained air. The patient was then referred for EUS-guided abscess drainage. Flexible endoscopy revealed purulent drainage through a pinpoint low rectal fistula. A through the scope balloon dilator was used to enlarge the fistula to 12 mm. After entry into the cavity a large piece of coiled surgical mesh was seen. The proximal margin was released using an endoscopic scissors, and a 9cm length of mesh removed. Two 7Fr x 5 cm double pigtail stents were placed in the cavity. CT 3 weeks later showed near complete resolution of the abscess and spontaneous extrusion of the stents. DISCUSSION: The use of surgical plastic mesh is common for management of POP and SUI, although increasing reports of adverse effects are being seen. The occurrence of a perirectal abscess is uncommon. This is the first reported case of endoscopic management of an abscess and removal of retained mesh. With increasing use of flexible endoscopic transrectal abscess drainage (usually under EUS guidance), this approach should be considered earlier in the management of perirectal abscesses.2164_A Figure 1. Coronal CT shows a large perirectal abscess.2164_B Figure 2. A through-the-scope dilation balloon is introduced through the fistula; purulent drainage is seen.2164_C Figure 3. After entry into the abscess cavity, a coiled piece of polypropylene surgical mesh is encountered.

Women's experiences of managing digitation: do we ask enough in primary care?

The aim of this paper was to consider the available evidence for the current management of pelvic organ prolapse, which is a common presentation in primary care. However, not all women will present, only presenting when symptoms become bothersome. Particular attention was paid to understanding the problem of rectocele and its influence on obstructive defaecation symptoms. The burden of rectocele and its consequences are not truly known. Furthermore, healthcare professionals may not always enquire about bowel symptoms and patients may not disclose them. Complex emotions around coping and managing stress add to the challenges with seeking healthcare. Therefore, the impact on the lived experience of women who have difficulty with rectal emptying can be significant. The review identified a dearth of knowledge about women living with the problem of obstructive defaecation resulting in the use of digitation. Improving the management of digitation, an under-reported problem, is necessary to improve the quality of life for women. Primary care needs to increase access to conservative measures for women struggling with bothersome symptoms, such as constipation, the need to digitate or anxiety.

Pattern of body mass index among women with pelvic organ prolapse

BACKGROUND: Overweight and obesity are usually regarded as risk factors for pelvic organ prolapse. This may not be the case in Sub-Saharan Africa where there is chronic malnutrition, physical stress and underweight.OBJECTIVE: To determine the pattern of body mass index in women with pelvic organ prolapse.METHODS: This was a retrospective study which involved the review of medical records of patients between June 2012 and May 2016. Data of 917 women who presented for management of pelvic organ prolapse met the inclusion criteria. Ethical clearance for the study was obtained from Research and Ethics committee of the National Obstetric Fistula Centre, Abakaliki.RESULTS: The mean age was 49.46±13.2 years. The mean weight was 52.04±11.96 kg. The mean body mass index was 21.37±4.73kg/m2. Two hundred and thirty four (25.5%) were underweight and 540 (58.9%) had normal weight. Overall, 15.7% of the study population had obesity and overweight. In women that had first degree uterovaginal prolapse, 20% had obesity and overweight. For women that had second and third degree uterovaginal prolapse, obesity and overweight occurred in 17.7% and 10.6% respectively.CONCLUSION: Most women with pelvic organ prolapse in our setting tend to have normal body mass index or are underweight. Increasing severity of prolapse does not appear to correspond with increasing body mass index in our setting.

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is the descent of one of more aspects of the vagina and/or uterus. Evaluation of POP always begins with a thorough history and physical examination. Management choices include observation, conservative options, and surgical options. Surgical management is divided into two categories, which are restorative and obliterative. It is important to counsel patients that although POP may affect quality of life, it is not life-threatening. This chapter is designed to guide the healthcare provider with a review of epidemiology, anatomy, evaluation, and management of POP. The chapter contains 14 figures that illustrate examples of common examination findings, devices, and treatment options. Also, there are 5 tables that provide concise reference materials to help guide the healthcare provider. This review contains 91 references, 14 figures, and 6 tables. Key Words: constipation, mesh, pain, pelvic floor, pessary, POP-Q, risk factors, surgery, vaginal wall

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is the descent of one of more aspects of the vagina and/or uterus. Evaluation of POP always begins with a thorough history and physical examination. Management choices include observation, conservative options, and surgical options. Surgical management is divided into two categories, which are restorative and obliterative. It is important to counsel patients that although POP may affect quality of life, it is not life-threatening. This chapter is designed to guide the healthcare provider with a review of epidemiology, anatomy, evaluation, and management of POP. The chapter contains 14 figures that illustrate examples of common examination findings, devices, and treatment options. Also, there are 5 tables that provide concise reference materials to help guide the healthcare provider. This review contains 91 references, 14 figures, and 6 tables. Key Words: constipation, mesh, pain, pelvic floor, pessary, POP-Q, risk factors, surgery, vaginal wall

Évolution des pratiques dans la chirurgie du prolapsus au sein d’une école vaginaliste sur la période 2010–2015

ObjectivesTo determine whether the 2011 FDA alert and French Guidelines have impacted the routine surgical practice in the management of pelvic organ prolapse in a “vaginalist” team over the period 2010–2015. MethodsRetrospective study involving all patients undergoing surgical management of anterior and/or apical symptomatic pelvic organ prolapse during the civil years 2010 and 2015. Both naive and relapsed prolapses were eligible. ResultsOverall, 338 patients were included: 187 in 2010 and 151 in 2015. Among patients with naive prolapse, we observed a significant increase in the number of laparoscopic sacrocolpopexies (11.1% in 2010 versus 34.4% in 2015, P=0.001) and a significant decline in the use of native tissue repair (67.6% in 2010 versus 39% in 2015, P=0.001). While the number of transvaginal meshes did not decline over the study period, their indications displayed a significant evolution towards a restricted use to advanced stages. We did not observe any difference regarding the treatment of recurred pelvic organ prolapse. Vaginal route remained the preferred approach in this indication. ConclusionIn our “vaginalist” team, routine practice has significantly evolved over the period 2010–2015, resulting in a diversification of the healthcare offer. This paradigm shift towards pluripotency is mandatory, since patients’ preference should also drive the choice of both surgical route and technique.

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse.

To (1) determine the proportion of hysterectomy cases with documentation of pessary counseling prior to prolapse surgery and (2) identify variables associated with women offered a pessary. The Michigan Surgical Quality Collaborative (MSQC) is a hysterectomy improvement initiative. Hysterectomies from 2013 to 2015 in which prolapse was the principal diagnosis were included. "Pessary offer" was defined as documentation showing the patient declined, could not tolerate, or failed a pessary trial. Bivariate analyses were used to compare demographics, medical history, surgical route, concomitant procedures (colpopexy or colporrhaphy), and intra- and postoperative complications between women with and without pessary offer. Hierarchical logistic regression was used to determine factors independently associated with pessary offer. Risk-adjusted pessary offer rates by hospital were calculated. The adjusted rate of pessary offer was 25.2%, ranging from 3 to 76% per hospital. Bivariate comparisons showed differences between women with and without pessary offer in age, tobacco use, prior pelvic surgery, insurance status, surgical approach, secondary indication for surgery, concomitant prolapse procedure, teaching hospital status and hospital bed size. In logistic regression, odds of pessary offer increased with age > 55 years (OR 1.45, 95% CI 1.12-1.88, p = 0.006), Medicare insurance (OR 1.65, 95% CI 1.30-2.10, p < 0.0001), and a concomitant procedure (OR 1.5, 95% CI 1.16-1.93, p = 0.002). Postoperative urinary tract infections were more common in patients offered a pessary (6.4% vs. 2.5%, p < 0.0001), but other complications were similar. Overall, only one-quarter of hysterectomies for prolapse in MSQC hospitals had documentation of pessary counseling-suggesting an opportunity to improve documentation, counseling regarding pessary use, or both.

Recent trends in the management of pelvic organ prolapse in Australia and New Zealand.

To compare current practice in the management of female pelvic organ prolapse in Australia and New Zealand with that in 2007, and assess the impact on practice of the withdrawal of Prolift® and Prosima® mesh kits in 2015. In early 2015, two invitations to participate in a survey, including a link to Surveymonkey, were emailed to 2506 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and fellows. The online survey closely resembled a printed survey that was posted to RANZCOG trainees and fellows in 2007 and had additional questions relating to the impact of withdrawal of Prolift® and Prosima® products. Four-hundred-and-three doctors participated, giving a response rate of 16%. Native tissue repair was the procedure of choice for primary and recurrent prolapse of the anterior and posterior vaginal wall. An implant was used to treat 45% of anterior recurrences and 25% of posterior recurrences. Vaginal hysterectomy and repair were the procedures of choice for uterovaginal prolapse. Sacrospinous hysteropexy was the uterine preservation procedure of choice, preferred by 41%. For post-hysterectomy vault prolapse, sacrospinous colpopexy and vaginal repair was preferred by 65% of respondents. Between 2007 and 2015, there was a substantial decrease in respondents' usage of implants across all indications except for midurethral slings and sacrocolpo/hysteropexy. Forty-two percent of respondents changed their practice as a result of Prolift® and Prosima® being withdrawn. There is a trend toward increasing use of various native tissue prolapse repair procedures and midurethral slings, and less utilisation of transvaginal mesh for prolapse.

Long-term outcomes of transvaginal mesh (TVM) In patients with pelvic organ prolapse: A 5-year follow-up

ObjectiveThe objective of this study was to evaluate the overall outcomes and complication rates of the transvaginal mesh (TVM) placed for the management of pelvic organ prolapse (POP) at 5-years follow up. Study designRetrospective cohort study in Urogynecology section in a single center in Argentina. Patients with prolapse stage II or higher were included. Seventy-six patients had TVM surgery for POP and 72 (95%) were available for the 5-year follow-up period. ResultsThe cure rate using the combined criteria (leading edge ≤0 according to Pelvic Organ Prolapse Quantification System (POP-Q), no bulge symptoms and no new treatment for prolapse) was 79.2% (57/72) (95% CI 68–88%). Only 5.5% (4/72) (95% CI 1.5–13.6) were re-operated for prolapse recurrence. Mesh exposure occurred in 16.6% of cases (n = 12; 95%CI 8.9–27.3). The incidence of de-novo dyspareunia was 13.3% (2/15) (95%CI 1–40) ConclusionsWe observed that TVM is a durable treatment for prolapse and that adverse events were acceptable without severe complications at 5-year follow-up.

Management of Urinary Incontinence before and after Total Pelvic Reconstruction for Advanced Pelvic Organ Prolapse with and without Incontinence.

Background:The effectiveness of an anti-incontinence procedure concomitant with prolapse reconstruction for pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for pelvic reconstructive surgery and evaluate the management of POP associated with UI.Methods:A total of 329 patients who underwent total pelvic reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift reconstruction]: n = 190 and Group B [modified total pelvic reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student's t-tests were used for two independent samples.Results:A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total pelvic reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ2= 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ2= 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ2= 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of reconstructions (P > 0.05).Conclusions:No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions.