Pelvic Floor Surgery Research Articles

Prevention and management of pelvic organ prolapse.

Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery.

The effect of ascorbic acid and fluid flow stimulation on the mechanical properties of a tissue engineered pelvic floor repair material.

Synthetic non-degradable meshes used in pelvic floor surgery can cause serious complications such as tissue erosion. A repair material composed of an autologous oral fibroblast seeded degradable polylactic acid scaffold may be a viable alternative. The aims of this study were to investigate the effects of media supplementation with additives (ascorbic acid-2-phosphate, glycolic acid and 17-β-oestradiol) on the mechanical properties of these scaffolds. Oral fibroblasts were isolated from buccal mucosa. The effects of the three additives were initially compared in two-dimensional culture to select the most promising collagen stimulating additive. Sterile electrospun scaffolds were seeded with 500,000 oral fibroblasts and fixed in 6-well plates and subjected to ascorbic acid-2-phosphate (the best performing additive) and/or mechanical stimulation. Mechanical stimulation by fluid shear stress was induced by rocking scaffolds on a platform shaker for 1 h/day for 10 of 14 days of culture. In two-dimensional culture, ascorbic acid-2-phosphate (concentrations from 0.02 mM to 0.04 M) and glycolic acid (10 µM) led to significantly greater total collagen production, but ascorbic acid-2-phosphate at 0.03 mM produced the greatest stimulation (of the order of >100%). In three-dimensional culture, mechanical stimulation alone gave non-significant increases in stiffness and strength. Ascorbic acid-2-phosphate (0.03 mM) significantly increased collagen production in the order 280% in both static and mechanically stimulated scaffolds (p < 0.0001). There was no additional effect of mechanical stimulation. Dense collagen I fibres were observed with ascorbic acid-2-phosphate supplementation. Uniaxial tensiometry showed that strength (p < 0.01) and stiffness (p <0.05) both improved significantly. A combination of ascorbic acid-2-phosphate and mechanical stimulation led to further non-signficant increases in strength and stiffness. In conclusion, a pelvic floor repair material with improved mechanical properties can be developed by supplementing culture media with ascorbic acid-2-phosphate to increase collagen I production. Future studies will assess the change in mechanical properties after implantation in an animal model.

Sexual experiences of male partners before and after female pelvic floor surgery: a qualitative study

To obtain a precise idea of the partner's thoughts and experiences with regard to the effect of female pelvic floor disorders and surgery on his sexual life. Qualitative semi-structured interviews were conducted in 8 partners of women undergoing pelvic floor surgery prior to, and in 6 partners at a median of 18 weeks after surgery. The data gathered were systematically analysed using data matrices. Although most men evaluated their sex life prior to surgery in a positive way, one or more changes in the sexual life of our participants as a result of the female pelvic floor disorder were common. This was a result of changes in the man's physical sensations and behaviour during sex (direct changes), and changes in the female partner's sexual behaviour and reduced body confidence (indirect changes). The cure of the pelvic floor disorder and changes in vaginal tightness following surgery caused direct improvements in the man's physical sensations, as well as indirect improvements in his sexual experience as a result of positive changes in the woman's sexual behaviour and body confidence. As only a small group of men participated in this study, the results should be interpreted with caution. The information gathered in our study can provide guidance to clinicians on possible aspects to explore with their patients prior to and after pelvic floor surgery, and can form the basis of disease-specific male sexual function questionnaires that can be used in quantitative studies on this topic.

Vesico-cutaneous fistula: unusual complication after transobturator mid-urethral sling

The transobturator tape (TOT) procedure was described in 2001 as the safest sling technique for the treatment of stress urinary incontinence (SUI). Although routine intraoperative cystoscopy to detect bladder and urethra injuries after the TOT procedure is not usually advocated, when such perforations do occur, there is potential for further patient morbidity. We present a case report of a vesico-cutaneous fistula detected after placement of a TOT sling in a 44-year old woman, 3 months postoperatively. Cystoscopic evaluation after mid-urethral sling procedures, especially in high-risk situations such as patients with cystocele, previous pelvic floor surgery or during the learning curve of the procedure, may avoid such complications associated with unrecognized lower urinary tract injuries.

483 Increasing elastin fibre production in a tissue engineered mesh for pelvic floor surgery

483 Increasing elastin fibre production in a tissue engineered mesh for pelvic floor surgery

MP4-16 CAN HIGHLY PURIFIED COLLAGEN COATING MODULATE POLYPROPILENE MESH IMMUNE-INFLAMMATORY AND FIBROBLASTIC REACTIONS? IMMUNOHISTOCHEMICAL ANALYSIS IN RAT MODEL

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Basic Research II1 Apr 2014MP4-16 CAN HIGHLY PURIFIED COLLAGEN COATING MODULATE POLYPROPILENE MESH IMMUNE-INFLAMMATORY AND FIBROBLASTIC REACTIONS? IMMUNOHISTOCHEMICAL ANALYSIS IN RAT MODEL Fernando Dias, Alessandro Dos Santos, Rodrigo Siniscalchi, Benedicto Vidal, and Cassio Riccetto Fernando DiasFernando Dias More articles by this author , Alessandro Dos SantosAlessandro Dos Santos More articles by this author , Rodrigo SiniscalchiRodrigo Siniscalchi More articles by this author , Benedicto VidalBenedicto Vidal More articles by this author , and Cassio RiccettoCassio Riccetto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.216AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of monofilament polypropylene (PP) mesh as slings has become the standard treatment of urinary incontinence with low risk of extrusion, erosion or vaginal exposure. However, the complications related to vaginal prolapse treatment with PP meshes kits cannot be neglected and had led to regulatory agencies warnings around the World. Collagen is an important immune and inflammatory modulator and has been proposed as a useful biomaterial to increase healing process efficiency. Previous attempts to combine meshes and collagen were based on covering the mesh with a nonporous collagen membrane, which resulted in mesh encapsulation and failure. The aim of this study is to verify the effect of high-purified collagen gel coating in the immune-inflammatory response, host collagen metabolism and angiogenesis around PP mesh. METHODS In twenty female Wistar rats were randomly implanted, at one side of abdominal wall, a 20x10 mm monofilament polypropylene mesh (PP), and, on the other side, the same mesh, but coated with a new highly purified collagen gel prepared at our institution (PPC). Gama irradiation was used to sterilize both meshes preparations. The animals were divided into four sub-groups and were euthanized at 7, 14, 21 and 90 days after implantation. Immunohistochemical analysis was done using specific antibodies: interleukin 1 (IL-1), metalloproteinases 2 and 3 (MMP-2, MMP-3), surface antigen CD-31 and tumor necrosis factor (TNF-α). Objective analysis (percent reactive area, average density and vessels concentration) was performed with AxioVision Microscope Software (Karl Zeiss-Germany). RESULTS Comparative analysis among the four periods and between the 2 groups showed: higher vessel density in the PPC group after 14 days (p=0.002) with significant reduction after 90 days (p=0.002) in this group; decrease of MMP-2 average density in PPC group after 21 and 90 days (p=0.046); more stability in MMP-3’s behavior in PPC group among periods, with MMP-3 percent reactive area showing significant decrease just in PP group after 14 and 90 days (p=0.017) and also for MMP-3 average density, in which reduction was significant after 21 days in PP group, but just after 90 days in PPC (p<0.001). CONCLUSIONS Highly purified collagen coating causes significant changes in angiogenesis and in metalloproteinase's (2 and 3) immune reaction around PP meshes implants in rats. These findings can be useful for improving PP mesh biocompatibility for pelvic floor surgery if such effects could be properly controlled. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e49 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Fernando Dias More articles by this author Alessandro Dos Santos More articles by this author Rodrigo Siniscalchi More articles by this author Benedicto Vidal More articles by this author Cassio Riccetto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP4-17 IN VITRO COMPARISON OF DIFFERENT ANCHORING SYSTEMS USED IN PELVIC FLOOR SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Basic Research II1 Apr 2014MP4-17 IN VITRO COMPARISON OF DIFFERENT ANCHORING SYSTEMS USED IN PELVIC FLOOR SURGERY Ralf Anding, Ruth Tabaza, and Ruth Kirschner-Hermanns Ralf AndingRalf Anding More articles by this author , Ruth TabazaRuth Tabaza More articles by this author , and Ruth Kirschner-HermannsRuth Kirschner-Hermanns More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.217AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Study to evaluate in vitro tests for comparison of different intra-corporeal anchoring systems used e.g. in single incision slings or vaginal meshes. Comparing pull-out forces of different fixation systems with regard to shape, size, and material. Finding conclusions especially with regard to the reliability of anchors to prevent dislocation during surgery and in the early postoperative period. Up to now the impact of the design of current anchor systems and their capability to provide sufficient retention forces is not known. METHODS Four anchoring systems (‘PelFix’ - FEG, ‘Surelift’ - Neomedic, ‘TFS’ - TFS Surgical, ‘MiniArc’ - AMS) were evaluated in different tissues in a pig model as well as in a ballistic gelatine model with 10 pull-out tests each. The extraction forces were measured in Newton (N) and the measurements were limited to a maximum of 50 N as this value is far above the range assumed to be physiologically relevant. For comparison we performed ANOVA with post-hoc Bonferroni. Results were presented as mean values whereby a significance level of p < 0.05 was considered significant. RESULTS The four systems showed significantly different pull-out forces. Depending on textile structure, size, and form of the anchoring systems, mechanical strain resulted in considerable deformation with local peak stresses. Relative differences of pull-out forces did not change in different tissues tested, as long as the anchors remained stable in their form. Overall the 'PelFix' anchor showed the best performance in the various tissues. CONCLUSIONS Our testing revealed significant differences between different anchoring systems in their ability to keep mesh implants in place. Testing different anchoring systems in an animal model led to reproducible data even if tested in different anatomic structures. With testing in both animal models and especially designed ballistic gelatine, we present a comprehensive model for testing different anchoring systems. The methods of testing introduced here will help to modify anchoring systems in novel pelvic floor implants. Anchoring System Gelatine Pelvic floor tissue Rectus fascia F [N] (mean) F [N] (range) F / F(PelFix) [/] F [N] (mean) F [N] (range) F / F(PelFix) [/] F [N] (mean) F [N] (range) F / F(PelFix) [/] MiniArc 4.18 3.6 - 4.7 0.53 4.73 3.9 - 5.8 0.37 20.65 5.7 - = 50.0 0.41 Surelift 7.20 6.2 - 8.2 0.92 10.86 6.6 - 15.2 0.85 39.67 21 - = 50.0 0.79 TFS 8.17 7.0 - 9.3 1.04 11.80 8.3 - 14.8 0.93 18.74 10.8 - 27.4 0.37 PelFix 7.86 6.7 - 9.0 1.00 12.73 8.4 - 15.6 1.00 50.00 > 50.0 1.00 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e49-e50 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ralf Anding More articles by this author Ruth Tabaza More articles by this author Ruth Kirschner-Hermanns More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Male sexual function and pelvic floor surgery of their female partner: A one-year follow-up study.

The aim of this study was to examine if sexual function of male partners changed after surgery for pelvic floor disorders and to explore associated factors. This was an observational follow-up study at the Gynecological Department at the St Olavs University Hospital, Trondheim. The sample consisted of 35 male partners of women scheduled for pelvic organ prolapse or stress urinary incontinence surgery. Self-administered questionnaires, containing validated instruments as well as exploratory questions, were sent to women and their partners before and one year after pelvic floor surgery. Vaginal dimensions were measured in all women according to the Pelvic Organ Prolapse Quantification System, both before and after the surgery. The Brief Sexual Function Instrument and the presence of erectile dysfunction. One year after pelvic floor surgery, scores for sexual drive, erection and overall satisfaction from the Brief Sexual Function Instrument were unchanged; the ejaculation score (range 0-4) had mildly improved from a range of 4 (median 4) to a range of 3.5 (median 4), (p = 0.014). The proportion of men with erectile dysfunction was unchanged, while the proportion of men reporting vaginal wind had significantly decreased (p = 0.016). None of the baseline factors, subjective experiences or vaginal dimensions at baseline or follow-up were associated with the improved ejaculation score; only a reduction in the proportion of men reporting their partners with dyspareunia (ns) was significantly correlated (Spearman's rho 0.42, p = 0.019). Sexual function of male partners was unchanged or mildly improved after pelvic floor surgery.

The Value of Vaginal Packing in Pelvic Floor Surgery

The objective of this study was to evaluate the effect of vaginal packing following pelvic floor surgery with regard to post-operative pain, bleeding and infection. This was a double-blind randomised study of women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynaecology unit. The primary outcome of day 1 post-operative pain was assessed using the short-form McGill Pain score. Secondary outcomes were haematological and infective morbidity, evaluated using changes in full blood count, and cultures of midstream urine and high vaginal swabs. A transvaginal ultrasound scan to exclude pelvic haematoma was performed at 6 weeks in all women who underwent vaginal hysterectomy with or without a pelvic floor repair. In total, 190 women were recruited: mean age 58.3 years (27–91 years), mean body mass index 27.4 kg/m2 and median parity 3. Women were randomised into the ‘pack’ (n = 86) and ‘no pack’ (n = 87) arms with no demographic differences between the groups. No statistically significant differences in the post-operative pain scores or secondary outcome measures were demonstrated. Incidence of haematoma formation (14.8 % no pack, 7.3 % pack, p = 0.204) was not statistically significant. There were three clinically significant complications in the no pack group and none in the pack group. This is the first study to examine pain in association with post-operative vaginal packing. There is no evidence to suggest that packing increases pain scores or post-operative morbidity. A trend towards increased haematoma and significant complications was seen in the no pack group. As vaginal packing does no harm and may be of some benefit it may be argued that packing should be recommended as routine clinical practice.

Pelvic Floor Dysfunction: Women’s Sexual Concerns Unraveled

Sexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem. To gain a more in-depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study. Qualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings. The impact of POP and/or UI on female sexual function. Only 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: "drive" and "motivation." Although "drive," i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in "motivation" or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned. Body image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's "motivation."

Sexual function in older women with pelvic floor symptoms: a cross-sectional study in general practice

Pelvic floor symptoms are common and are negatively associated with sexual function which, in turn, is an important aspect of quality of life. The majority of older women with pelvic floor symptoms are treated in general practice but evidence from studies in general practice on the sexual functioning of these women is scarce. This study examined predictors of sexual inactivity in older women with pelvic floor symptoms in general practice and of sexual functioning in those women who are sexually active. Cross-sectional study in women (aged ≥55 years) from 20 general practices who screened positive on a pelvic floor symptom questionnaire. Logistic and linear regression analyses were used to determine predictors of sexual inactivity and sexual functioning (PISQ-12) by assessing their association with patient characteristics, symptoms (PFDI-20) and degree of prolapse (POP-Q). A total of 639 women were included (sexually active n = 393, sexually inactive n = 246). Predictors of sexual inactivity were increasing age (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10 to 1.17) and lower education (OR = 2.31; 95% CI = 1.50 to 3.54; Nagelkerke R(2) = 0.208). In sexually active women, sexual functioning was associated with pelvic floor symptom distress (P<0.001) and pelvic floor surgery (P = 0.018; R(2) = 0.138). In older women with pelvic floor symptoms, increasing age and lower educational level are predictors of sexual inactivity. Many of these older women are sexually active and pelvic floor symptom distress is negatively associated with sexual functioning. These results may encourage GPs to ask about sexual problems in women with pelvic floor symptoms.

Customised Mesh

Aim of the review: Initial use of synthetic mesh in pelvic organ prolapse surgery involved use of custom made meshes. Custom made mesh involves cutting of a synthetic mesh into appropriate size and shape, and anchoring the mesh to the supporting structures using sutures. On the other hand, there are varieties of pre-designed commercially available mesh kits attached with trocars for insertion of mesh. This review aims to analyze the success rates, complications, and viability of custom made meshes and compare them with pre-designed mesh kits. Methods of literature search and analysis: A Pubmed search for the term “Vaginal mesh” revealed 1421 articles. Further narrowing the search using filters “Last 10 years”, “Humans” and excluding “Review articles”, we obtained 850 papers on vaginal mesh. Searching through these 850 papers, we found that 89 papers dealt with customised mesh in pelvic floor surgery. Papers are analyzed under the sub-headings efficacy in anterior and apical compartment, complications, comparison of custom mesh with predesigned mesh kits, and abdominal mesh repairs. Results: In the anterior compartment, anatomical failure rate for custom mesh is around 17%, and that of subjective failure rate is around 4.4%. In the Apical compartment repair, anatomic failure rate for customized mesh for apical compartment ranges from 0% to 7%. The risk of vaginal exposure for custom mesh ranges from 5 to 17%. New onset of dyspareunia was noted in 4.5% to 16.7% of patients. In terms of efficacy, custom mesh gives equally good success comparable to that of pre-designed mesh kits. Complication rates are similar between custom meshes and pre-designed mesh kits, with the exception of reduced blood loss in custom meshes. Customised meshes are relatively inexpensive compared to predesigned mesh kits. Conclusion: In terms of efficacy, customised mesh gives equally good success rates for pelvic organ prolapse surgery as compared to pre-designed mesh kits, with an added advantage of reduced cost. This is particularly relevant in developing countries where cost of surgery is of paramount importance for patients. Other advantage of custom made mesh kits is reduced blood loss.

Climbing a long hill: pelvic floor surgery and the need for geriatric urogynecology

The topic of geriatric urogynecology is receiving much attention lately as a public health priority because of the global increase in female life expectancy and the significant risk of associated pelvic floor dysfunctions. Statistics from the USA project that in 2050, 25 % of the population will be >60 years and that those >85 will increase from a population of 1.9 % in 2010 to 4.3 % in 2050 [1]. The urogynecological community should thus expect to face a worldwide and progressively growing demand from patients seeking care for pelvic floor dysfunctions. One study predicted >50 % increased demand for urogynecological services over the next 40 years [2]. The changing female demographics is accompanied by a considerable interest in the contemporary literature to standardize the indications, techniques, and outcomes of surgical treatment of pelvic floor dysfunctions. Only a few reports appreciate that increasing age of our female population is an intrinsic biological variable interfering with the standardization process [3]. Women aged >80 years undergoing urogynecological surgery have a 13.6 higher risk of postoperative death than their younger counterparts. In the majority of cases, the cause of death is not directly related to the procedure [4]. Despite the obvious need for operative intervention among these elderly women and the strong evidence for the inherent morbidity and mortality of this treatment option, there is scarce urogynecological data on the risks and specific perioperative management in this patient group. Ageing influences lower urinary tract symptoms (LUTS), pelvic floor function, and perioperative and postoperative courses. The higher postoperative morbidity rate is also an important factor that is often overlooked in most surgical studies. Main concerns when treating elderly women are:

Satisfaction in Patients Undergoing Concurrent Pelvic Floor Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse

Simultaneous repair of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) is common. In these cases, determinants of patient satisfaction are complicated given that surgical success may be achieved in one component but not the other. We sought to assess satisfaction in patients undergoing multiple pelvic surgeries. We performed a review of 89 women undergoing concomitant POP repair and midurethral sling (MUS) placement. Focus was placed on patient-reported satisfaction rates. Validated measures were used to evaluate outcomes after MUS [International Consultation on Incontinence Questionnaire (ICIQ)-Female Lower Urinary Tract Symptoms, SUI item; pad use] and POP repair (ICIQ-Vaginal Symptoms; POPQ stage). At 1-year evaluation, 78 (88%) women reported satisfaction. Assessment identified combined cure of both POP/SUI in 64 (72%) patients, in contrast to failure of MUS, POP repair, and both repairs in 15 (17%) patients, 9 (10%) patients, and 1 (1%) patient, respectively. Subset analysis revealed dissatisfaction in 5% (3/64) of patients achieving complete cure of both SUI and POP. In contrast, 40% (6/15) were dissatisfied if there was failure to cure SUI, 22% (2/9) if failure to cure POP, and the patient with failure of both was not dissatisfied. The ICIQ-Vaginal Symptoms domain score for vaginal bulge was the only assessed outcome demonstrating a statistical relationship with patient-reported satisfaction. Among women achieving cure of both SUI and POP via concurrent surgical repair, 95% reported satisfaction. Interestingly, a variety of outcomes measures fail to correlate with satisfaction. Further, in patients with complete cure of concurrent pelvic surgeries, a percentage still report dissatisfaction, highlighting the complicated nature of patient satisfaction.

The value of vaginal packing in pelvic floor surgery: a randomised double-blind study

The objective of this study was to evaluate the effect of vaginal packing following pelvic floor surgery with regard to post-operative pain, bleeding and infection. This was a double-blind randomised study of women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynaecology unit. The primary outcome of day 1 post-operative pain was assessed using the short-form McGill Pain score. Secondary outcomes were haematological and infective morbidity, evaluated using changes in full blood count, and cultures of midstream urine and high vaginal swabs. A transvaginal ultrasound scan to exclude pelvic haematoma was performed at 6 weeks in all women who underwent vaginal hysterectomy with or without a pelvic floor repair. In total, 190 women were recruited: mean age 58.3 years (27-91 years), mean body mass index 27.4 kg/m(2) and median parity 3. Women were randomised into the 'pack' (n = 86) and 'no pack' (n = 87) arms with no demographic differences between the groups. No statistically significant differences in the post-operative pain scores or secondary outcome measures were demonstrated. Incidence of haematoma formation (14.8 % no pack, 7.3 % pack, p = 0.204) was not statistically significant. There were three clinically significant complications in the no pack group and none in the pack group. This is the first study to examine pain in association with post-operative vaginal packing. There is no evidence to suggest that packing increases pain scores or post-operative morbidity. A trend towards increased haematoma and significant complications was seen in the no pack group. As vaginal packing does no harm and may be of some benefit it may be argued that packing should be recommended as routine clinical practice.

Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh

In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0% and 30% of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions.

What predicts improvement of sexual function after pelvic floor surgery? A follow‐up study

To analyze factors predictive for changes in sexual function after pelvic floor surgery and explore differences between stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery. Prospective observational study. St Olav Hospital, Trondheim University Hospital, Norway. Of 346 mailed questionnaires for women scheduled for SUI and POP surgery, 65 questionnaires were available for analysis together with examination findings before and 1year after surgery. Postal questionnaires including Prolapse and Incontinence Sexual Function Questionnaire (PISQ 12), Hopkins Symptom Checklist 5 for psychological distress, questions from the validated Body Image Questionnaire, a general health question, questions addressing goals for improvement after surgery, clinical findings based on the Pelvic Organ Prolapse Quantification System and Brief Sexual Function Index for partners. Uni- and multivariate linear regressions adjusting for age were performed. Change in PISQ 12 score at follow-up. Sexual function significantly improved in the total group (p=0.000). After stratification into SUI and POP surgery, improvement only remained significant after SUI surgery (p=0.001). Improvement for the total group was predicted by good health or coital incontinence, whereas psychological distress or the goal of improved defecation predicted deterioration. For women undergoing SUI surgery, increasing age, parity or the goal of improving sexuality or body image predicted improvement, while for women undergoing POP surgery, menopausal status or anterior colporrhaphy predicted improvement. Significantly improved sexuality was observed after pelvic floor surgery. Predictive factors for change differed for women undergoing SUI surgery and and those undergoing POP surgery.

Which Works Better for Stress Urinary Incontinence — Surgery or Physiotherapy?

Treatment options for stress urinary incontinence consist of pelvic-floor muscle training (physiotherapy) and/or surgery; however, success rates vary for both approaches and direct comparisons have been limited. Dutch investigators conducted a 12-month, multicenter, randomized trial to compare physiotherapy with midurethral-sling surgery (retropubic or transobturator polypropylene tape) for moderate-to-severe stress-predominant urinary incontinence in 417 women. Crossing over between groups was permitted. Among women in …

OC19.06: The latency between pelvic floor trauma and presentation for prolapse surgery

Levator avulsion, the traumatic disconnection of the levator ani from the pelvic sidewall during childbirth, is common and associated with female pelvic organ prolapse (FPOP). Such trauma is likely an etiological factor for FPOP. However, most women present decades after the traumatic event, and the reasons for this long latency are unknown. We performed this study to determine range and average values for the time latency between pelvic floor trauma and presentation for prolapse surgery. This is a retrospective observational study utilising data sets of 681 women seen for assessment at a tertiary urogynecological unit between June 2011 and December 2012. They all underwent an interview, clinical assessment (ICS POPQ) and 4D translabial pelvic floor ultrasound in preparation for surgery. Postprocessing analysis of ultrasound volumes was performed blinded against all clinical data. Of 681 women, 354 (52%) presented with symptoms of prolapse at a mean bother of 5.8/10. 115 (17%) were found to have a full avulsion of the levator ani muscle. All 115 showed significant prolapse on ultrasound and/ or ICS POPQ staging. Mean latency between the first vaginal delivery and presentation was 34.3 years (3–66.3 years). There were no meaningful associations between latency and any potential predictors except for Forceps delivery (P= 0.03) and age at first delivery: the older someone was at the birth of her first child, the shorter the latency (r= −0.505, P<0.001). There seems to be a very substantial latency of 34 years on average between childbirth-related trauma in the form of an avulsion of the levator ani muscle and subsequent presentation for pelvic floor surgery. Latency ranged from 3–66 years, with markers of more severe trauma being associated with shorter time to presentation.

E.07.02 Clinical use of psychotropic drugs in youth – interests and pitfalls

Stress urinary incontinence (SUI) is a highly prevalent dysfunction in middle-aged and elderly women. One recent technique places a sub-urethral tape passed through the transobturator foramen. Efficacy and quality of life were assessed after five years of treatment with the transobturator technique in women suffering SUI. This evaluation followed a previous control at the first year post-intervention.Sixty-three women were assessed five years after operation with the transobturator technique. Additionally, twenty-nine women of these women had undergone pelvic floor reconstruction due to different forms of genital prolapse. Quality of life (QoL) was assessed by the Urogenital Distress Inventory-6 (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7) tests.Subjective and objective cure or improvement, complications, and changes in QoL.Fifty women (79%) remained cured, as assessed by the cough test. Eighteen women (28%) reported urine leakage during physical activity. These objective and subjective data were worse than those reported at the one-year follow-up. De novo urge urinary incontinence was reported by 11 women or 17%. Nine of these women had undergone additional pelvic floor surgery. The QoL tests confirmed that cure or improvement was achieved in 78% (49) (UDI-6) and 79% (50) (IIQ-7) of the women.The transobturator tape procedure resulted in acceptable rates of efficacy after five years. Moreover, QoL tests showed cure or improvement in almost four of five women. Nonetheless, women should be informed of the risk of de novo urinary urgency incontinence and the progressive loss of efficacy with time.