Management Of Pelvic Organ Prolapse Research Articles

Bilateral posterior Richter sacrospinous fixation with native tissue: anatomical and functional results and quality of life assessment over 10 years.

Pelvic organ prolapse (POP) is a common condition that affects 50% of women who have given birth in their lifetime. With stop of vaginal mesh sale in 2019, the sacrospinous fixation technique according to Richter with native tissue has seen its incidence tripled in 15 years. Classically, sacrospinous fixation according to Richter is performed unilaterally, however its unilateral or bilateral character is controversial. Objective of this work is to evaluate the efficacy and safety of bilateral sacrospinous fixation according to Richter by the posterior approach with native tissue (SSB). We performed a retrospective single-center study. From March 12, 2010 to March 23, 2020, all first-time operated patients who underwent SSB in CHU Strasbourg gynecological surgery unit for symptomatic POP management were included. The main endpoint of our work is the anatomical and functional success rate at 12 and 24 months. The secondary judgment criteria of our work were based on the postoperative evaluation of patient's quality of life according to the PFDI-20 score as well as the rate of postoperative complications. 77 patients were included in our work. The anatomical success rate at 12 months is 94% and 81% at 24 months regardless of the compartment affected. The functional success rate is 94% at 12 months and 82% at 24 months. Quality of life evaluation through the PFDI-20 scale revealed a clear improvement in the symptomatology related to POP: 127/300 +/- 27.3. preoperatively and 59.8 ± 14.7 postoperatively. Bilateral sacrospinous fixation according to Richter by posterior approach with native tissue is a safe and effective surgical technique allowing a clear improvement in patients quality of life.

MP07-08 MINIMALLY INVASIVE SACROCOLPOPEXY: TRENDS AND SAFETY OF SAME-DAY DISCHARGE

You have accessJournal of UrologyCME1 Apr 2023MP07-08 MINIMALLY INVASIVE SACROCOLPOPEXY: TRENDS AND SAFETY OF SAME-DAY DISCHARGE Tal Cohen, Arshia Aalami Harandi, and Jason Kim Tal CohenTal Cohen More articles by this author , Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Laparoscopic or robotic sacrocolpopexy (SCP) has become a preferred approach in women with pelvic organ prolapse. This study aims to evaluate trends and outcomes of same day discharge (SDD) laparoscopic or robotic SCP using the American College of Surgeons National Surgical Quality Improvement Program (NSPIQ) database. METHODS: Patients were collected from the NSQIP database between 2012-2020 with the current procedural terminology code 57280. Patients with total hospital stay of 0 days were classified as SDD and compared to patients that were discharged on post-op day 1 or 2. The primary outcomes were 30-day complications and readmission rates. Demographic data and perioperative characteristics between the two groups were compared using the appropriate t-test, Chi-squared test, or Fisher’s exact test. RESULTS: A total of 17,723 SCP were included. There were 3,112 (17.6%) same day discharges. There was a significant association between SDD SCP and year of operation (p<.001), with 31.0% of SCP in 2020 discharged on the same day in contrast to 10% of SCP in 2012. SDD patients were younger (56.8 vs. 58.9 years, p<.001), and had lower prevalence of diabetes (8.2% vs. 9.9%, p<.01) and hypertension requiring medications (30.9% vs. 36.9%, p<.001). SDD SCP were more frequently performed by gynecologists than urologists (94.4% vs. 89.5%, p<.001) and had lower operative time (165.5 vs. 187.6 minutes, p<.001). There were fewer cases of readmissions following SDD (1.5% vs. 2.5%, p<.01). Post-operatively, SDD cases were associated with more superficial surgical site infections (1.5% vs. 0.8%, p<.001), but significantly fewer cases of class III-IV complications (0.7% vs. 1.2%, p<.05, Table 1). CONCLUSIONS: There has been a steady rise in SDD after minimally invasive SCP with no significant association of increased risk for serious complications. With further patient education on wound care, SDD after minimally invasive SCP may be a safe and less costly alternative in the surgical management of pelvic organ prolapse. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e87 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tal Cohen More articles by this author Arshia Aalami Harandi More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-01 MESH-FREE MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE: A COMPARATIVE STUDY OF VAGINAL SACROSPINOUS FIXATION V ROBOTIC UTEROSACRAL LIGAMENT SUSPENSION

You have accessJournal of UrologyCME1 Apr 2023MP07-01 MESH-FREE MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE: A COMPARATIVE STUDY OF VAGINAL SACROSPINOUS FIXATION V ROBOTIC UTEROSACRAL LIGAMENT SUSPENSION Sandra Elmer, Omar Salehi, Niranjan Sathianathen, Jodie McDonald, Nathan Lawrentschuk, and Caroline Dowling Sandra ElmerSandra Elmer More articles by this author , Omar SalehiOmar Salehi More articles by this author , Niranjan SathianathenNiranjan Sathianathen More articles by this author , Jodie McDonaldJodie McDonald More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , and Caroline DowlingCaroline Dowling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) significantly impacts quality of life for many women. Mesh sacral colpopexy (SCP) has a recurrence rate up to 23%, and vaginal procedures to correct apical POP up to 41%. After the FDA warnings and restrictions of transvaginal mesh, increasing concerns regarding mesh have resulted in a need for mesh-free alternatives. This study compares 2 mesh-free techniques, robotic/laparoscopic uterosacral ligament suspension (RUSL) and vaginal sacrospinous fixation (SSF) in managing apical POP. METHODS: A prospective clinical audit of 115 women with apical POP who underwent RUSL (n=61) or SSF (n=54) by a single surgeon. Demographic data included age, parity, and previous POP surgery. A pre-operative (preop) pelvic floor (PF) questionnaire was used to identify prevalence of bladder, bowel and vaginal symptoms. POP-Q was recorded at surgery and at post-operative (postop) reviews. The absolute change in POP-Q scores were recorded as objective measures of PF support. Other postop metrics used include symptomatic vaginal bulge, need for repeat POP surgery (reop) and subjective improvement in symptoms based on patient-reported outcome measures (PROMs). Postop adverse events (AE) were recorded (Clavien Dindo grading scale). Wilcoxon rank sum test, Pearson’s Chi-squared test and Fisher’s exact test were used to compare groups, and univariate analysis to predict factors for success/reop. RESULTS: Baseline demographics were similar (Table 1). Mean time from surgery was 736 (RUSL) and 565 days (SSF). Difference in postop C points was not significant (RUSL: median -8 (IQR 2), SSF: median -7cm (IQR 2), p=0.279). Procedure success rates (postop C point <0) were not different (RUSL 90.2%, SSF 92.5%, p=0.92). Reop rates for apical recurrence were SSF 1.9%, RUSL 6.6%, p=0.21; univariate odds ratio 0.26 [95% CI 0.03 to 2.43]. Univariate analysis for reop found that age, parity and surgery type were not predictors of reoperation (p=0.26, p=0.92, p=0.78). The most common postop AE was urinary tract infection (RUSL 10.2%, SSF 10.5%). CONCLUSIONS: RUSL and SSF are safe and effective mesh-free techniques for management of apical POP based on objective improvements in POP-Q score and PROMs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e84 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandra Elmer More articles by this author Omar Salehi More articles by this author Niranjan Sathianathen More articles by this author Jodie McDonald More articles by this author Nathan Lawrentschuk More articles by this author Caroline Dowling More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual function in women with pelvic organ prolapse and surgery influence on their complaints.

Sexual health is an essential component of women's wellbeing. Women with pelvic organ prolapse (POP) often suffer from sexual dysfunction. The current review focuses on the impact of POP as well as surgical POP repair on sexual function. A variety of techniques are discussed in relation to this issue, including native tissue repair (NTR), transvaginal mesh (TVM) and sacrocolpopexy (SCP). The majority of studies utilise validated questionnaires to assess sexual function in women pre- and post-POP repair and FSFI (Female Sexual Function Index) and PISQ-IR (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-IUGA revised) are among the most commonly used. According to the available data, surgical management of POP usually results in improved or unchanged scores in sexual function, regardless of the type of procedure used. SCP appears to be the preferred surgical management for women with apical vaginal prolapse that minimises the risk of dyspareunia as compared to vaginal techniques.

Nonoperative Management of Pelvic Organ Prolapse.

Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior, posterior, or apical vagina. It is a common condition, with up to 50% of women having prolapse on examination in their lifetimes. This article provides an overview of the evaluation and discussion of nonoperative management of POP for the obstetrician-gynecologist (ob-gyn), with consideration of recommendations from the American College of Obstetricians and Gynecologists, the American Urogynecologic Society, and the International Urogynecological Association. The initial evaluation of POP requires a history documenting whether the patient is experiencing symptoms and what they are, and discovery of which symptoms they believe are attributable to prolapse. Examination determines the vaginal compartment(s) and to what degree prolapse exists. In general, only patients who have symptomatic prolapse or medical indication should be offered treatment. Although surgical options exist, all patients who are symptomatic and desire treatment should be offered nonsurgical treatment first, including pelvic floor physical therapy or a pessary trial. Appropriateness, expectations, complications, and counseling points are reviewed. Educational opportunities between the patient and the ob-gyn include disentangling common beliefs that the bladder is dropping or that concomitant urinary or bowel symptoms are necessarily caused by prolapse. Improving patient education can lead to a better understanding of their condition and better alignment of treatment goals and expectations.

A Case of Recurrent Bilateral Hydronpehrosis and Pyelonephritis Due to Pelvic Organ Prolapse

Although bilateral hydronephrosis caused by pelvic organ prolapse (POP) is not rare, it does not usually cause severe pyelonephritis or acute renal failure. Recurrence of POP accompanied with hydronephrosis and pyelonephritis following curative surgery for POP has been rarely reported. We describe a case of recurrent pyelonephritis due to POP. A 79-year-old woman visited our hospital with anorexia. She was diagnosed with right pyelonephritis, acute renal failure with bilateral hydroureteronephrosis, uterine prolapse, and cystocele. She underwent right nephrostomy and received antibiotics, and her condition then improved. Two months later, she revisited us with left pyelonephritis. She underwent left nephrostomy and received antibiotics. As POP seemed to cause bilateral ureteral obstructions, laparoscopic hysterectomy and uterosacral ligament suspension was performed. Although her POP and ureteral obstructions improved temporarily cystocele and ureteral obstructions with left pyelonephritis recurred two months later. Subsequent pessary treatment managed POP and ureteral obstructions during 1-year follow-up. Pyelonephritis in patients with POP is rare. In the review of literature, all of patients undergoing nephrostomy or ureteral stent survived whereas some of patients not undergoing such interventions died. Additionally, most of patients undergoing POP management survived whereas more than half of patients not undergoing POP management died. We encountered a case of recurrent bilateral hydronephrosis and pyelonephritis caused by POP. There was a clear association of POP occurrence with ureteral obstruction and pyelonephritis, suggesting the importance of managing POP and ureteral obstruction appropriately in such case.

Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial

Importanceuterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. Objectivecompare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. Study designThis RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. ResultsHigh statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). ConclusionsUsing Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Evaluation and treatment of pelvic organ prolapse.

Pelvic organ prolapse is a common condition that can have a large impact on a patient's quality of life. Patients with prolapse may present with a vaginal bulge or pressure, bladder, bowel, or sexual symptoms. The diagnosis is confirmed on physical examination which may show descent of the anterior vaginal wall, vaginal apex (cervix/uterus or vaginal cuff in those with a prior hysterectomy), posterior vaginal wall, or a combination of these. Patients with asymptomatic prolapse can typically be reassured that it may be managed with observation, though might gradually progress with time. In patients with symptomatic prolapse, management options include conservative measures, pessary use, or surgical intervention. Pessaries can successfully be fitted for most patients that prefer this line of therapy. Surgical interventions include native tissue transvaginal surgeries or a transabdominal (laparoscopic or robotic) approach with use of polypropylene mesh. The choice of surgical procedure includes consideration of an individual's medical and surgical history, physical exam findings, differences in the risks and durability of the operations, and the patient's preference. Ultimately, the surgical plan is based on shared decision making with the patient to best achieve their treatment goals. In this article we will review pertinent clinical considerations in the diagnosis, evaluation, and management of pelvic organ prolapse.

Comparación entre el uso de malla de prolene y cinta de mersilene en la sacrohisteropexia abdominal para el prolapso apical: ensayo clínico aleatorizado

BackgroundUterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. ObjectiveCompare between using polyproline mesh and mersilene tape in abdominal sacrohysteropexy repairing apical prolapse stage ?? or more. Study designThis RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned sacrohysteropexy for uterine prolapse≥stage 2 assigned to 2 groups: Mesh group (n=38), underwent sacrohysteropexy with polyproline mesh, and tape group (n=38), underwent sacrohysteropexy using mersilene tape. ResultsHigh statistically significant difference between tape group and mesh group concerning hysteropexy time was 50.4minute in tape group vs 90.6minute in mesh group (P<.001), need for post operative analgesia was 14 in tape group vs 27 in mesh group (P<.005). The mean hospital stay was 2.8 days in tape group vs 5.2days mesh group (P<.001). ConclusionsUsing mersilene tape in sacrohysteropexy is a safe alternative to polyproline mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Pelvic Pain and Pelvic Floor Muscle Dysfunction in Women Seeking Treatment for Prolapse.

Pelvic floor muscle dysfunction (PFMD) can cause pelvic pain, but its associations with pelvic organ prolapse (POP) and POP treatment outcomes are poorly understood. The objectives of this study were to determine (1) if pelvic pain is associated with PFMD in women seeking POP treatment and (2) if baseline PFMD in women seeking management of POP is associated with improvement in pelvic pain at 12 months. This was an ambispective cohort study of women enrolled at one site of the Pelvic Floor Disorders Registry. Pelvic floor muscle dysfunction was identified if tenderness was reported on a standardized pelvic floor muscle examination at baseline. Outcomes included a pelvic pain questionnaire (score 0-70, assessed pain in the past 24 hours in 7 pelvic locations) and the Global Health-10 overall average pain rating (0-10). One hundred forty-four women planning surgery (118) or pessary (26) were included. Twenty (13.9%) had baseline PFMD. Women with PFMD versus no PFMD had greater baseline Pelvic Pain scores (median [IQR], 9.7 [4-23] vs 2.5 [0-7], P < 0.001) and overall average pain (4 [3-6] vs 1 [0-3], P < 0.001). In 107 women with 12-month treatment outcomes, those with PFMD at baseline had greater improvement in pelvic pain compared with those without PFMD (change score -6.5 [-15.2 to 0] vs 0 [-3 to 0] respectively, P = 0.03). Overall pain improved after treatment in the no PFMD group but not in the PFMD group. Patients with baseline PFMD vs none undergoing treatment for prolapse had higher baseline pelvic pain and greater improvement in pelvic pain at 12 months.

Vaginal Pessary Use and Management for Pelvic Organ Prolapse: Developed by the joint writing group of the American Urogynecologic Society and the Society of Urologic Nurses and Associates. Individual writing group members are noted in the Acknowledgments section.

Over the past 50 years, pessary use has increased in popularity and has become an essential pelvic organ prolapse (POP) management tool. However, evidence is lacking to define care standardization, including pessary fitting, routine maintenance, and management of pessary-related complications. This clinical consensus statement (CCS) on vaginal pessary use and management for POP reflects statements drafted by content experts from the American Urogynecologic Society and Society of Urologic Nurses and Associates. The purpose of this CCS is to identify areas of expert consensus and nonconsensus regarding pessary fitting, follow-up, and management of pessary complications to improve the safety and quality of care where evidence is currently limited. The American Urogynecologic Society and Society of Urologic Nurses and Associates' vaginal pessary for POP writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 31 statements were assessed and divided into 3 categories: (1) fitting and follow-up, (2) complications, and 3) quality of life. Of the 31 statements that were assessed, all statements reached consensus after 2 rounds of the Delphi survey. This CCS document hopefully serves as a first step toward standardization of pessary care, but the writing group acknowledges that improved research will grow the base of knowledge and evidence providing clinicians a foundation to manage pessary care effectively and confidently.

Development of a conceptual framework for a new patient-reported outcome measure for pain in women following mesh surgery for pelvic floor disorders: a qualitative study

Introduction and hypothesisThe Australasian Pelvic Floor Procedure Registry (APFPR) collects both clinical and health-related quality of life (HRQoL) data on women undergoing surgery using a prosthesis such as mesh for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The registry lacks a suitable instrument to assess pain in women following mesh surgery for SUI and POP. This qualitative study describes the views on pain following mesh surgery in women and clinicians through the development of a conceptual framework, which may inform the development of a new instrument for the APFPR.MethodsWe conducted semi-structured interviews with women following mesh surgery for POP and SUI (n=17) and clinicians (n=6) in Victoria, Australia. We sought to reveal aspects of any sort of pain after a pelvic floor procedure. Interviews covered sensation, region, continuity of pain, triggers, and the mode and method of administration for a new pain-specific patient-reported outcome measure. Data were analysed using thematic analysis.ResultsWe identified the important components of pain felt by women with POP and SUI after surgery using mesh. From the seven themes outlined, a conceptual framework was developed compiling related components of pain into six specific domains.ConclusionsThis study identifies the important components of pain felt by women following mesh surgery. It is hoped that the development of a pain-specific PROM, as supported by clinicians, will assist in the timely and appropriate diagnosis and management of POP and SUI.

Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis.

Introduction: Quality of life (QoL) improvement is one of the main outcomes in the management of pelvic organ prolapse as a chronic illness in women. This systematic review aimed to investigate the impact of surgical or pessary treatment for pelvic organ prolapse (POP) on quality of life. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied. Electronic databases, including PubMed, Scopus, and Web of Science, were searched for original articles that evaluated the QoL before and after surgical interventions or pessary in pelvic organ prolapse from 1 January 2012 until 30 June 2022 with a combination of proper keywords. Included studies were categorized based on interventions, and they were tabulated to summarize the results. Results: Overall, 587 citations were retrieved. Of these, 76 articles were found eligible for final review. Overall, three categories of intervention were identified: vaginal surgeries (47 studies), abdominal surgeries (18 studies), and pessary intervention (11 studies). Almost all interventions were associated with improved quality of life. The results of the meta-analysis showed a significant association between the employment of surgical approach techniques (including vaginal and abdominal surgeries) and the quality of life (Pelvic Floor Distress Inventory (PFDI) (MD: −48.08, 95% CI: −62.34 to −33.77, p-value < 0.01), Pelvic Floor Impact Questionnaire (PFIQ) (MD: −33.41, 95% CI: −43.48 to −23.34, p < 0.01)) and sexual activity of patients with pelvic organ prolapse (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) (MD: 4.84, 95% CI: 1.75 to 7.92, p < 0.01)). Furthermore, narrative synthesis for studies investigating the effect of the pessary approach showed a positive association between the use of this instrument and improvement in the quality of life and sexual activity. Conclusions: The results of our study revealed a significant improvement in the women’s quality of life following abdominal and vaginal reconstructive surgery. The use of pessary was also associated with increased patient quality of life.

Conservative management of pelvic organ prolapse

Pelvic organ prolapse is the descent of one or more pelvic organs, (including the bladder, uterus and rectum) from their normal anatomical position into the vaginal canal. Many patients with pelvic organ prolapse can be managed conservatively in the community with the use of supervised pelvic floor muscle training and/or vaginal pessaries. This article explains how to assess and conservatively treat pelvic organ prolapse, with particular focus on how to fit and manage vaginal pessaries.

Novel, disposable, self-inserted, vaginal device for the non-surgical management of pelvic organ prolapse: efficacy, safety, and quality of life

BackgroundWe evaluated a novel disposable, collapsible, ring-shaped vaginal device that is self-inserted within an applicator and removed with a string. The device was developed to overcome the drawbacks of existing ring pessaries for non-surgical pelvic organ prolapse management (POP).MethodsThe primary objective efficacy endpoint of this prospective, interventional, multicenter, self-controlled, and home-use study was the proportion of subjects with improved staging on the Pelvic Organ Prolapse Quantification (POP-Q) scale. Subjective efficacy was assessed using the POP symptoms alleviation score. Safety was evaluated by recording the rate and incidence of adverse events (AEs) in a daily diary, and quality of life (QoL) was evaluated using the modified Pelvic Floor Impact (PFIQ-7) and Pelvic Floor Disability Index (PFDI-20) questionnaires.ResultsA total of 94 usage cycles were observed in a group of 52 participants (mean age 60.2 ± 10.5 years, 81.1% postmenopausal) who used the device for 3558 days. Of these, 24 participants completed one usage cycle, 14 completed two usage cycles, and 14 completed three usage cycles with 28–45 days of ProVate use in each usage cycle. All patients experienced greater than two POP-Q stage reductions. The descent was completely reduced to POP-Q stage 0 in 97.8% of participants. The POP symptom alleviation questionnaire showed significant subjective efficacy (P < 0.0001). The modified PFDI-20 and PFIQ-7 scores also improved substantially (P < 0.0001 for both). There were 91 nonserious device-related AEs: 98.9% were mild and 87.9% anticipated, with no vaginal infection, and one case of urinary tract infection.ConclusionThe novel device substantially reduces prolapse and provides significant subjective POP symptom relief and QoL improvement, with minimal AEs. The device may enable women to self-manage their prolapse with a small, disposable device that minimizes self-touching and frequent dependency on the clinic.Trial registrationClinical.Trials.gov, NCT02239133, posted September 12, 2014 (retrospectively registered).

8681 Complications Among Patients Undergoing Mesh Graft Revision Surgery: A Retrospective Cohort Study of the NSQIP Database

<h3>Study Objective</h3> To compare complication rates among patients having urogynecology surgery for revision of a mesh graft placed for management of pelvic organ prolapse. <h3>Design</h3> A retrospective, population-based cohort study was conducted using the American College of Surgeons National Quality Improvement Program (NSQIP) database. A multivariable logistic regression analysis adjusting for age, race, smoking status, ASA category and concomitant procedures was completed. The outcomes were a composite of complications excluding urinary tract infections (UTI), and hospital readmission within 30 days. <h3>Setting</h3> Inpatient and outpatient mesh revision surgeries performed at community and academic hospitals captured in the NSQIP database from 2012 to 2019. <h3>Patients or Participants</h3> Patients undergoing mesh graft revision by urology or gynecology were classified into vaginal, abdominal or laparoscopic approach using Common Procedural Technology (CPT) codes. Patients having revision of a mid-urethral sling were excluded. <h3>Interventions</h3> Mesh graft revision surgery by vaginal, abdominal or laparoscopic approach <h3>Measurements and Main Results</h3> Of 1692 eligible patients, 1561 underwent vaginal, 74 underwent abdominal, and 57 underwent laparoscopic approach graft revision. The complication rate, excluding UTI, was 4.6% in the vaginal approach group, 12.2% in the abdominal approach group and 12.3% in the laparoscopic approach group (p<0.001). Compared to a vaginal approach, the abdominal approach group had higher odds of complications (abdominal: adjusted OR 2.76, 95% CI 1.30 – 5.83; laparoscopic: adjusted OR 1.86, 95% CI 0.73 – 4.72). The abdominal and laparoscopic groups had higher odds of readmission compared to the vaginal approach group (abdominal: adjusted OR 3.11, 95% CI 1.15 – 8.40; laparoscopic: adjusted OR 6.57, 95% CI 2.22 – 19.40). Clavien-Dindo IV complications were rare and only seen after vaginal surgery (0.4%, n=6). <h3>Conclusion</h3> Short term complications were uncommon after vaginal mesh graft revision surgery, and less common than following an abdominal approach.

Summary: 2021 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse.

(1) Background: There is wide variation in the reported prevalence rates for pelvic organ prolapse (POP). There is also wide variation in the rate at which surgical interventions for pelvic organ prolapse are performed, as well as the type of interventions undertaken. As part of the International Consultation on Incontinence (ICI), our committee was tasked to produce evidence-based pathways for the surgical management of POP, any associated stress urinary incontinence (SUI), and bowel dysfunction. (2) Methods: To enable us to generate such evidence, we undertook a thorough search for the POP surgery-related, English-language scientific literature published up to April 2021. (3) Results: The committee evaluated the literature and made recommendations based on the Oxford grading system. (4) Conclusions: This review serves to provide a summary of the 2021 ICI surgical management of an evidence-based prolapse pathway and outline the evidence used to inform this guidance.

Surgical Management of Pelvic Organ Prolapse in a Woman with Right Pelvic Kidney

A thorough knowledge of both normal and variant abdominopelvic anatomy is important to the surgeon treating patients with pelvic organ prolapse and pathology in the pelvis. Knowledge of the location of the kidney and ureters is mandatory in treating women with pelvic organ prolapse and a pelvic kidney. This case report describes surgical management for a woman with the right pelvic kidney and symptomatic pelvic organ prolapse.

EP48.05: Ultrasound‐based triage in the management of pelvic organ prolapse: long‐term surgical outcome

EP48.05: Ultrasound‐based triage in the management of pelvic organ prolapse: long‐term surgical outcome

Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse.

Reliable risk factors for persistent urgency following pelvic organ prolapse (POP) surgery are still unclear. We aimed to identify preoperative parameters related to persistent postoperative urgency in a cohort of women following surgery for POP stage 3-4 with concomitant overactive bladder (OAB). In this retrospective analysis, women with POP stage 3-4 and OAB who underwent POP repair during November 2012-December 2020 were included. Preoperative evaluation included history, Pelvic Organ Prolapse Quantification (POP-Q), multi-channel urodynamic studies and Pelvic Floor Distress Inventory (PFDI-20). Surgical procedures included: anterior and posterior colporrhaphy, sacrospinous ligament suspension, anterior vaginal wall mesh repair and robotic-assisted laparoscopic sacrocolpopexy. At the 12-month follow-up, urogynecological history, POP-Q evaluation, cough stress test and the PFDI-20 questionnaire were repeated. One hundred seventy-three patients were included in the analysis. Resolution of urgency was observed in 56% of women. Variables associated with persistent postoperative urgency included body mass index (BMI) (27 kg/m2 vs 25.7 kg/m2, p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), urgency urinary incontinence (UUI) (51.46% vs 80.26%, p = 0.0001), detrusor overactivity (DO) (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate on UDS (13.9 ml/s vs 15 ml/s, p = 0.04). Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4-16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3-11.0]; p = 0.008) and BMI > 25 kg/m2 (OR 1.8 [95% CI: 1.1-7.2]; p = 0.04) as predictive factor for persistent urgency. In women with advanced POP and OAB, being overweight, preoperative UUI and DO are related to persistent postoperative urgency. These findings will guide our future preoperative counseling and reinforce the role of UDS in POP management.