Outcomes Of Pelvic Organ Prolapse Research Articles

Effects of Obesity on Urogynecologic Prolapse Surgery Outcomes: A Systematic Review and Meta-analysis.

To systematically review the literature on outcomes of pelvic organ prolapse (POP) surgery in patients from various body mass index (BMI) categories to determine the association between obesity and surgical outcomes. PubMed, EMBASE, and Cochrane databases were searched from inception to April 12, 2022; ClinicalTrials.gov was searched in September 2022 (PROSPERO 2022 CRD42022326255). Randomized and nonrandomized studies of urogynecologic POP surgery outcomes were accepted in which categories of BMI or obesity were compared. In total, 9,037 abstracts were screened; 759 abstracts were identified for full-text screening, and 31 articles were accepted for inclusion and data were extracted. Studies were extracted for participant information, intervention, comparator, and outcomes, including subjective outcomes, objective outcomes, and complications. Outcomes were compared among obesity categories (eg, BMI 30-34.9, 35-40, higher than 40), and meta-analysis was performed among different surgical approaches. Individual studies reported varying results as to whether obesity affects surgical outcomes. By meta-analysis, obesity (BMI 30 or higher) is associated with an increased odds of objective prolapse recurrence after vaginal prolapse repair (odds ratio [OR] 1.38, 95% CI, 1.14-1.67) and after prolapse repair from any surgical approach (OR 1.31, 95% CI, 1.12-1.53) and with complications such as mesh exposure after both vaginal and laparoscopic POP repair (OR 2.10, 95% CI, 1.01-4.39). Obesity is associated with increased likelihood of prolapse recurrence and mesh complications after POP repair. PROSPERO CRD42022326255.

An Improved Understanding of the Pathophysiology of Pelvic Organ Prolapse: A 3D In Vitro Model under Static and Mechanical Loading Conditions.

The suboptimal outcomes of pelvic organ prolapse (POP) surgery illustrate the demand for improved therapies. However, their development is hampered by the limited knowledge on the cellular pathophysiology of POP. Current investigations, that are limited to tissues and 2D in vitro models, provide highly inconclusive results on how the extracellular matrix (ECM) metabolism and fibroblasts are affected in POP. This study uses a physiologically relevant 3D in vitro model to investigate the cellular pathophysiology of POP by determining the differences between POP and non-POP fibroblasts on ECM metabolism, proliferation, and fibroblast-to-myofibroblast (FMT) transition. This model, based on the synthetic and biomimetic polyisocyanide hydrogel, enables the incorporation of mechanical loading, which simulates the forces exerted on the pelvic floor. Under static conditions, 3D cultured POP fibroblasts are less proliferative, undergo FMT, and exhibit lower collagen and elastin contents compared to non-POP fibroblasts. However, under mechanical loading, the differences between POP and non-POP fibroblasts are less pronounced. This study contributes to the development of more comprehensive models that can accurately mimic the POP pathophysiology, which will aid in an enhanced understanding and may contribute to improved therapies in the future.

Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery: A systematic review and meta-analysis.

Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned. To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair. MEDLINE and Embase databases were searched from inception to January 2023. We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded. A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI). Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups. No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors.

The Effect of Growth Factors on Vaginal Wound Healing: A Systematic Review and Meta-analysis.

Surgical outcomes of pelvic organ prolapse (POP) surgery are poor, resulting in a 20% recurrence risk. Following the hypothesis that impaired wound healing is the main determinant of recurrent POP, growth factors have the potential to promote wound healing and may improve surgical outcomes. In this study, we systematically reviewed the effect of growth factors on vaginal wound healing in both in vitro and animal studies. For each independent comparison, the standardized mean difference and 95% CI were calculated using the Hedges' g correction. Of the 3858 retrieved studies, seven studies were included, of which six were included in meta-analysis (three in vitro studies and four in vivo studies). In vitro, basic fibroblast growth factor (bFGF) promotes proliferation, differentiation, and collagen types I and III production. Epidermal growth factor stimulates proliferation and connective tissue growth factor promotes Tenascin-C expression. These effects, however, are less pronounced in vivo; only bFGF slightly promotes collagen production. The review shows that growth factors, particularly bFGF, are able to promote vaginal wound healing in vitro. The uncertain in vivo findings suggest that preclinical models should be improved. The ultimate goal is to develop effective growth factor-supplemented therapies that improve surgical outcomes for POP.

PD32-10 RACIAL AND ETHNIC DISPARITIES IN PELVIC ORGAN PROLAPSE SURGERY IN THE UNITED STATES: AN ANALYSIS OF THE ACS-NSQIP CLINICAL REGISTRY

INTRODUCTION AND OBJECTIVE:Racial and ethnic factors may influence the management and outcomes of pelvic organ prolapse (POP). The objective of the study was to assess the types of POP surgery perf...

Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery.

IntroductionDespite ample research regarding the impact of reconstructive surgery on anatomic/functional outcomes of pelvic organ prolapse (POP), including incidence of dyspareunia, evidence regarding sexual outcomes is equivocal.AimTo assess changes in sexual function in women followed up for at least 12 months after transvaginal mesh surgery for POP.MethodsWe conducted a retrospective review of women who underwent surgery for POP using different mesh products between 2008 and 2019. Baseline demographics were compiled along with intraoperative and postoperative information. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) was used to assess sexual function.Main Outcome MeasuresWomen sexually active before and after surgery were assessed to determine changes in overall and question-specific PISQ-12 responses and potential factors to explain sexual function after surgery.Results622 women underwent surgery using mesh at our center. 360 (58%) attended at least one visit at a median of 12 months (IQR 11–23 months), with 113 (31%) sexually active at baseline and 247 (69%) sexually inactive. 97 had complete PISQ-12 responses before and after surgery. There was an overall improvement in the median PISQ-12 scores of 2 points (P < .001); improvements persisted when scores were stratified by various factors. Specific improvements were noted in climax (P = .046) and orgasm intensity (P = .002), fear (P < .001) or actual incontinence during intercourse (P = .004), avoidance of intercourse due to prolapse (P < .001), and negative emotions (P < .001). There was a slight positive effect of the baseline PISQ-12 score on the postoperative PISQ-12 score (regression coefficient 0.24, 95% CI: 0.09-0.39), and a stronger negative effect of having a concomitant anal sphincteroplasty (−4.84, 95% CI: −8.42 to −1.25). Preoperative prolapse stage was not associated with postoperative sexual outcomes. There was a weak negative association between the postoperative PISQ-12 and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores [rs(95) = −0.27, P = .008] and a moderate negative association between postoperative PISQ-12 and total Pelvic Floor Distress Inventory short form [rs(94) = −0.42, P < .001].ConclusionTransvaginal mesh surgery appears to positively impact sexual function, and improvements were independent of mesh or baseline prolapse severity.Khandwala S, Cruff J, Williams C. Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery. Sex Med 2021;9:100281.

Change over time in the surgical management of pelvic organ prolapse between 2008 and 2014 in France: patient profiles, surgical approaches, and outcomes

Pelvic organ prolapse (POP) is a common pathological condition that may require surgical management. Several surgical treatment options are possible, and practice varies from one center to another. The objective of the present study was to describe the surgical management and outcomes of POP in France from 2008 to 2014. We performed a retrospective cohort study of all patients operated on for POP from 2008 to 2014, according to the French national hospital discharge summary database. Patient characteristics, surgical approaches, concomitant hysterectomy and/or incontinence surgery, the length of stay, the proportion of day-case operations, and patient outcomes were analyzed. We analyzed 310,938 hospital stays with POP surgery between 2008 and 2014; 130,908 (42%) of the operations took place in hospitals performing more than 100 prolapse surgical procedures per year. The proportion of day-case operations was low, but rose significantly from 1.2% to 4.6% during the study period. More than half of the operations featured a vaginal approach. The proportions of operations with concomitant hysterectomy or urinary incontinence surgery fell from 41.0% to 36.1% and from 33.0% to 25.8% respectively. The proportions of laparoscopic procedures increased. The mortality rate was stable (0.07% for all years). The number of patients undergoing POP surgery remained stable from 2008 to 2014. The proportion of laparoscopic procedures increased (in parallel with the rising proportion of day-case operations) and the proportion of procedures with concomitant hysterectomy or incontinence treatment decreased.

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. Retrospective cohort study. Tertiary-care university hospital. Patients with symptomatic anterior or apical POP stage III and above. All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre- and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery.

Management of Pelvic Organ Prolapse After Radical Cystectomy.

This article explores the anatomy, management options, and outcomes of pelvic organ prolapse with a female cystectomy patient. There is a lack of data on surgical management outcomes for prolapse following radical cystectomy. However, most case series from tertiary referral centers show reasonable results irrespective of route of repair. As expected, the surgical planes and the reorientation of the bowel loop for urinary diversion makes any pelvic reconstruction a potential hazard and requires a high level of expertise and counseling to the patient in regard to the management of expectations. Pelvic organ prolapse following radical cystectomy is uncommon but presents a significant challenge to the reconstructive surgeon.

Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines.

We aimed to systematically review the literature on pelvic organ prolapse (POP) surgery with uterine preservation (hysteropexy). We hypothesized that different hysteropexy surgeries would have similar POP outcomes but varying adverse event (AE) rates. MEDLINE, Cochrane, and clinicaltrials.gov databases were reviewed from inception to January 2018 for comparative (any size) and single-arm studies (n ≥ 50) involving hysteropexy. Studies were extracted for participant characteristics, interventions, comparators, outcomes, and AEs and assessed for methodological quality. We identified 99 eligible studies: 53 comparing hysteropexy to POP surgery with hysterectomy, 42 single-arm studies on hysteropexy, and four studies comparing stage ≥2 hysteropexy types. Data on POP outcomes were heterogeneous and usually from <3years of follow-up. Repeat surgery prevalence for POP after hysteropexy varied widely (0-29%) but was similar among hysteropexy types. When comparing sacrohysteropexy routes, the laparoscopic approach had lower recurrent prolapse symptoms [odds ratio (OR) 0.18, 95% confidence interval (CI) 0.07-0.46), urinary retention (OR 0.05, 95% CI 0.003-0.83), and blood loss (difference -104ml, 95% CI -145 to -63ml) than open sacrohysteropexy. Laparoscopic sacrohysteropexy had longer operative times than vaginal mesh hysteropexy (difference 119min, 95% CI 102-136min). Most commonly reported AEs included mesh exposure (0-39%), urinary retention (0-80%), and sexual dysfunction (0-48%). Hysteropexies have a wide range of POP recurrence and AEs; little data exist directly comparing different hysteropexy types. Therefore, for women choosing uterine preservation, surgeons should counsel them on outcomes and risks particular to the specific hysteropexy type planned.

Long-Term Outcomes of Pelvic Organ Prolapse by Laparoscopic Butterfly Suspension

Aim The study aimed to investigate the long clinic value of laparoscopic colpo-uterine butterfly suspension for pelvic organ prolapse. Methods Ninety -three patients who underwent the laparoscopic colpo-uterine butterfly suspension from December 2012 to May 2018 at the first affiliated hospital of zhengzhou university were analyzed in a retrospective study. Baseline characteristics and perioperative data were recorded. The POP quantification (POP-Q) system indicates the pre- and post-operative data. Respectively，the symptoms, health-related quality of life (HRQL) and Sexual function were evaluated by the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12). Results In 5 years’ follow-up, the objective cure ratio reached 97.8%, and the subjective success rate of the laparoscopic colpo-uterine butterfly suspension was 93.5%. Two cases was identified as clinical relapse. There was only one abdominal erosion during the long-term follow-up. The quality of life had improved significantly without any genital symptoms. No patients abstained from sex due to the operation or postoperative sexual discomfort. Conclusions The laparoscopic colpo-uterine butterfly suspension is a safe, feasible and highly effective technique that offers a good long-term results for the treatment of pelvic organ prolapse, also a good option for sexually active women.

Tenascin-C expression and its associated pathway in BMSCs following co-culture with mechanically stretched ligament fibroblasts.

The occurrence of pelvic organ prolapse (POP) is closely associated with alterations in the extracellular matrix proteins of the supporting ligament. Bone marrow mesenchymal stem cells (BMSCs) have the potential to differentiate into a variety of cell types, including osteoblasts, chondroblasts and adipocytes. Therefore, BMSCs have the potential to improve the clinical outcomes of POP. Tenascin-C is a large glycoprotein that is present in the ECM and is involved in morphogenetic movements, and tissue patterning and repair. The aim of the present study was to investigate the effect of mechanical stretching on tenascin-C expression during the differentiation of BMSCs induced by pelvic ligament fibroblasts. BMSCs were isolated from 7-day-old Sprague Dawley rats. Fibroblasts were obtained from rat pelvic ligaments and, at the fourth passage, were subjected to 10% deformation with 1 Hz, periodic one-way mechanical stretch stimulation, followed by co-culture with BMSCs. The co-culture with stretched fibroblasts increased tenascin-C and transforming growth factor (TGF)-β expression levels, compared with groups without mechanical stimulation. Neutralizing anti-TGF-β1 antibodies, and inhibitors of TGF-β receptor, mitogen-activated protein kinase (MAPK) kinase and MAPK, decreased tenascin-C expression levels induced by TGF-β and mechanical stretching. The results of the present study suggested that the regulation of tenascin-C expression levels in BMSCs co-cultured with mechanically stretched pelvic ligament fibroblasts is mediated via the soluble growth factor TGF-β and the MAPK signaling pathway. In addition, these results indicated that in an indirect co-culture system, pelvic ligament fibroblasts with mechanical stretch stimulation may promote the synthesis of tenascin-C and BMSC differentiation into pelvic ligament fibroblasts.

PD50-08 PREDICTORS OF REGRET AFTER COLPOCLEISIS FOR PELVIC ORGAN PROLAPSE: A SYSTEMATIC REVIEW

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 2015PD50-08 PREDICTORS OF REGRET AFTER COLPOCLEISIS FOR PELVIC ORGAN PROLAPSE: A SYSTEMATIC REVIEW Juzar Jamnagerwalla, Karyn Eilber, Samantha Jagannathan, Niv Hakami-Majd, Eugene Shkolyar, and Jennifer Anger Juzar JamnagerwallaJuzar Jamnagerwalla More articles by this author , Karyn EilberKaryn Eilber More articles by this author , Samantha JagannathanSamantha Jagannathan More articles by this author , Niv Hakami-MajdNiv Hakami-Majd More articles by this author , Eugene ShkolyarEugene Shkolyar More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Colpocleisis is a safe and effective procedure to alleviate the symptoms of pelvic organ prolapse (POP) in women who are not sexually active (Fitzgerald et al). With the goal of determining factors associated with regret after colpocleisis, we synthesized the available literature examining satisfaction and reasons for regret among women undergoing colpocleisis. METHODS The review was conducted according to the recommendations of the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) group. We performed a systematic review of PubMed and Medline to identify articles published between 1948 and 2013 using search terms “colpocleisis, obliterative and vaginal”. RESULTS Our literature search identified 182 titles, of which 42 were ultimately included in the review. Twenty-nine studies reported objective POP outcomes data with a pooled patient population of 1,714 patients. Objective POP success ranged from 89% to 100%. Seventeen studies included satisfaction in their analysis, with a pooled patient population of 1,077 patients. The individual satisfaction reported in these studies ranged from 86.4% to 96%. Twenty-four studies included data on urinary outcomes after colpocleisis. The rate of de novo stress urinary incontinence (SUI) in women who did not undergo concomitant sling ranged from 0-13%. In women who had preoperative SUI with concurrent placement of midurethral sling, SUI was persistent in between 6-17% of women. Ten studies included regret in their analysis, with a pooled patient population of 415 patients. Thirty-one out of 415 women (7.5%) at least partially regretted their decision. Frequent causes of regret included loss of sexual function (41%) and worsening pre-operative urinary incontinence (31%). CONCLUSIONS Though colpocleisis is associated with a high success and satisfaction rate overall, few studies exist that examine sources of regret. The data available suggests that regret is often due to worsening urinary incontinence or remorse about loss of sexual function. Careful patient selection for colpocleisis may help predict who may be more likely to become sexually active again. In addition, patient age alone should not deter providers from placing a concomitant prophylactic sling at the time of colpocleisis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1048 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juzar Jamnagerwalla More articles by this author Karyn Eilber More articles by this author Samantha Jagannathan More articles by this author Niv Hakami-Majd More articles by this author Eugene Shkolyar More articles by this author Jennifer Anger More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

[Study on reductive surgery for pelvic organ prolapse concomitant with anti-incontinence sling for treatment of occult stress urinary incontinence].

To evaluate the clinical outcome of anti-incontinence sling in the treatment of occult stress urinary incontinence (OSUI) during reductive surgery for advanced pelvic organ prolapse (POP). From Jun. 2003 to Dec. 2012, 78 patients with OSUI underwent reductive surgery for advanced POP such as high uterosacral ligament suspension, sacrospinous ligament suspension and sacral colpopexy in the First Affiliated Hospital, General Hospital of People's Liberation Army. Among them, 41 patients received reductive surgery alone was enrolled in non-concomitant anti-incontinence group and the other 37 patients who underwent same surgery with tension-free vaginal tape (TVT) or tension-free vaginal tape-obturator technique (TVT-O) was in anti-incontinence group. The patient's demography, objective and subjective outcomes, as well as complications and injures were compared between the two groups. The pelvic organ prolapse quantitation (POP-Q) was used to evaluate the objective outcomes of POP. Urinary distress inventory (UDI-6) and incontinence impact questionnaire short form (IIQ-7) were used to evaluate the subjective outcomes of stress urinary incontinence (SUI). Compared with the non-concomitant anti-incontinence group, the objective outcomes of reductive surgery exhibited no significant differences (100%, 78/78), and only the operation time of anti-incontinence group slightly increased 16 minutes. The occurrence rate of postoperative SUI was 12% (5/41), 15% (6/41), 17% (7/41) respectively after the operation at 2-month, 6-month and 12-month follow up in the non-concomitant anti-incontinence group; and the occurrence rate of the anti-incontinence group was 3% (1/37), 3% (1/37), 3% (1/37); but none of patients in the two groups require further surgery for stress urinary incontinence. Mean score of UDI-6 and IIQ-7 in all the patients decreased significantly after operation at 2-month, 6-month and 12-month follow up (all P < 0.01). However, there was no statistic difference between the two groups (P > 0.05). It is still difficult to make decision for concomitant anti-incontinence procedure in those patients with OSUI, who are undergoing reductive surgery because of advanced POP. Whether the patients will benefit more from anti-incontinence sling depends largely on strict preoperative evaluation for the severity of SUI. The patients with severe SUI are supposed to benefit most from anti-incontinence sling. However, a two-step approach to correct the postoperative stress urinary incontinence is also reasonable.

Determinants and management outcomes of pelvic organ prolapse in a low resource setting.

Background:The last decade has seen significant progress in understanding of the pathophysiology, anatomy and management modalities of pelvic organ prolapse. A review of the way we manage this entity in a low resource setting has become necessary.Aim:The aim of the study is to determine the incidence, risk factors and management modalities of pelvic organ prolapse.Materials and Methods:A 5-year cross-sectional study with retrospective data collection of women who attended the gynecologic clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria and were diagnosed of pelvic organ prolapse was made. Proforma was initially used for data collection before transfer to Epi-info 2008 (v 3.5.1; Epi Info, Centers for Disease Control and Prevention, Atlanta, GA) software.Results:There were 199 cases of pelvic organ prolapse, out of a total gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean age was 55.5 (15.9) years with a significant association between prolapse and advanced age (P < 0.001). The age range was 22-80 years. The leading determinants were menopause, advanced age, multiparity, chronic increase in intra-abdominal pressure (IAP) and prolonged labor. Out of the 147 patients with uterine prolapse, majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic floor repair was the most common surgery performed. The average duration of hospital stay following surgery was 6.8 (2.9) days and the most common complication was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199). Most of the patients who presented initially with pelvic organ prolapse were lost to follow-up.Conclusion:The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were - multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women is necessary so that conservative management could be offered if feasible.

Transischioanal trans-sacrospinous ligament rectocele repair with polypropylene mesh: a prospective study with assessment of rectoanal function

Despite good anatomical outcomes of pelvic organ prolapse (POP) repair by the vaginal route using synthetic mesh, complications limit their use. Clinical data are needed to generalize prolapse mesh repair by the vaginal route. The current study aims to evaluate midterm rectoanal function and clinical outcomes after transischioanal rectocele repair using a medium weight polypropylene mesh. Between March 2003 and June 2004, 230 patients with stage II-IV anterior and/or posterior POP were included in a prospective multicenter study. The current study is based on the analysis of the 116 patients who underwent a rectocele repair via the infracoccygeal route through the sacrospinous ligament. Anatomical cure was defined when rectocele was at stage <II in the Pelvic Organ Prolapse Quantification (POP-Q) system. Postoperative functional results were evaluated using the self-administered Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ). Of the 116 patients who received a posterior mesh with two arms via the infracoccygeal route through the sacrospinous ligament, midterm anatomical results were available for 78 women representing 67 % (78/116) of the operated patients. The mean follow-up was 36 (± 8.1) months. No rectal injury occurred during surgery. The objective success rate was 94.8 % and subjective (by patient satisfaction) was 93.23 %. Colorectal-Anal Impact (CRAI) and Colorectal-Anal Distress Inventory (CRADI) scores were both significantly decreased at midterm follow-up in comparison with baseline (42.7 at baseline vs 11.4 at 24- or 36-month follow-up, p = 0.001 for CRAI, and 81.1 vs 34.4, p < 0.001 for CRADI) highlighting the benefits of rectocele repair on colorectal-anal function. Polypropylene mesh with two arms via the infracoccygeal route through the sacrospinous ligament has good anatomical results at midterm follow-up with significant improvement in symptoms and quality of life and is associated with few complications. Obstructive symptoms reported in cases of rectocele can be improved by transvaginal mesh repair.

Treatment strategies for pelvic organ prolapse: a cost-effectiveness analysis

To compare the relative cost effectiveness of treatment decision alternatives for post-hysterectomy pelvic organ prolapse (POP). A Markov decision analysis model was used to assess and compare the relative cost effectiveness of expectant management, use of a pessary, and surgery for obtaining months of quality-adjusted life over 1 year. Sensitivity analysis was conducted to determine whether the results depended on specific estimates of patient utilities for pessary use, probabilities for complications and other events, and estimated costs. Only two treatment alternatives were found to be efficient choices: initial pessary use and vaginal reconstructive surgery (VRS). Pessary use (including patients that eventually transitioned to surgery) achieved 10.4 quality-adjusted months, at a cost of $10,000 per patient, while VRS obtained 11.4 quality-adjusted months, at $15,000 per patient. Sensitivity analysis demonstrated that these baseline results depended on several key estimates in the model. This analysis indicates that pessary use and VRS are the most cost-effective treatment alternatives for treating post-hysterectomy vaginal prolapse. Additional research is needed to standardize POP outcomes and complications, so that healthcare providers can best utilize cost information in balancing the risks and benefits of their treatment decisions.

The Kelly Technique of Bladder Exstrophy Repair: Continence, Cosmesis and Pelvic Organ Prolapse Outcomes

The Kelly technique of radical soft tissue mobilization, an alternative to osteotomy and modern staged repair, has been used extensively at our tertiary referral center for bladder exstrophy in the last 2 decades. We present what is to our knowledge the first long-term followup of the Kelly technique in 31 patients treated at our institution. Patients admitted for bladder exstrophy at our institution since 1980 were identified and the medical charts were reviewed. Continence questionnaires were completed during followup appointments or by mail. Continence was defined as complete-dry greater than 3 hours during the day and night with 2 or fewer night wets per month and partial-dry 2 hours or more during the day and 3 or greater night wets per month, and/or stress incontinence. The degree of pelvic organ prolapse was assessed in females older than 12 years. Data were available on 31 Kelly patients, including 14 females, 4 to 25 years old and 13 patients, including 4 females, 2 to 29 years old treated with another staged technique. Of 30 Kelly patients without urinary diversion 21 (70%) were completely or partially continent. Of the 30 patients 17 voided spontaneously without clean intermittent catheterization or augmentation, of whom 12 (71%) were continent. Lower abdominal appearance was graded as abnormal in 11 of 12 male Kelly patients vs in 2 of 7 nonKelly males with pubic approximation (p = 0.01). Of the 12 females assessed none of 9 Kelly patients had prolapse, whereas 2 of 3 nonKelly patients had prolapse (p <0.05). The continence rate after the Kelly operation compares favorably with that in recent series. The abnormal appearance of the lower abdomen and bony pelvis in Kelly males may result from a lack of pubic approximation. Importantly pelvic organ prolapse may be decreased in women after the Kelly technique.

Genitourinary, Cosmetic and Pelvic Organ Prolapse Outcomes in Women with Bladder Exstrophy: The Melbourne Experience

Genitourinary, Cosmetic and Pelvic Organ Prolapse Outcomes in Women with Bladder Exstrophy: The Melbourne Experience