Suspension For Pelvic Organ Prolapse Research Articles

Minimally Invasive Sacrohysteropexy Versus Vaginal Hysterectomy With Uterosacral Ligament Suspension for Pelvic Organ Prolapse: A Prospective Randomized Non-Inferiority Trial

Study ObjectiveTo investigate whether minimally invasive Sacrohysteropexy (SH) is non-inferior to Vaginal hysterectomy (VH) with uterosacral ligament suspension (USLS) in women with symptomatic uterovaginal prolapse. DesignProspective, randomized, non-inferiority study SettingTertiary university-based hospital. PatientsA total of 146 patients with uterovaginal prolapse between July 2016 and August 2019. InterventionsPatients were randomly assigned in a 1:1 ratio to either laparoscopic or robotic SH surgery or VH with USLS surgery. Measurements and Main ResultsThe primary outcome was prolapse recurrence at 1 year after surgery, defined as prolapse ≥ stage 2 evaluated using the pelvic organ prolapse quantification system, bothersome vaginal bulge symptoms, or retreatment for prolapse. The secondary outcomes included operation time, estimated blood loss, hospital stay, operation-related complications, pain intensity, quality of life, and activities of daily living. Of 146 women who underwent randomization, 73 in the SH group and 73 in the VH with USLS group were analyzed. SH was non-inferior for recurrence compared with VH with USLS (16.4% vs.15.8%, 95% confidence interval: -13.0%, 14.2%). Operating duration and transvaginal length were significantly longer in the SH group, while there were no significant differences in the estimated blood loss, length of hospital stay, or postoperative complication rates. Although perioperative pain intensity was greater from 1 week to 1 month in the SH group, the quality of life and activities of daily living did not differ between the groups throughout postoperative year 1. ConclusionLaparoscopic or robotic SH was non-inferior to VH with USLS for the recurrence of pelvic organ prolapse at the 1-year follow-up.

EnPlace®: A truly minimally invasive vaginal pelvic organ prolapse suspension with no deep dissection and no mesh, personal 581 operations experience

EnPlace®: A truly minimally invasive vaginal pelvic organ prolapse suspension with no deep dissection and no mesh, personal 581 operations experience

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial.

To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C < -1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p < 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p = 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.

68 - Recurrent pelvic prolapse after Pelvic Organ Prolapse Suspension: Analysis and treatment of an emerging clinical issue

68 - Recurrent pelvic prolapse after Pelvic Organ Prolapse Suspension: Analysis and treatment of an emerging clinical issue

Robotic Lateral Pelvic Organ Prolapse Suspension of Multicompartment Vaginal Prolapse.

Robotic Lateral Pelvic Organ Prolapse Suspension of Multicompartment Vaginal Prolapse.

Association Between Enlarged Genital Hiatus and Composite Surgical Failure After Vaginal Hysterectomy With Uterosacral Ligament Suspension.

The impact of a persistently enlarged genital hiatus (GH) after vaginal hysterectomy with uterosacral ligament suspension on prolapse outcomes is currently unclear. This secondary analysis of the Study of Uterine Prolapse Procedures Randomized trial was conducted among participants who underwent vaginal hysterectomy with uterosacral ligament suspension. We hypothesized that women with a persistently enlarged GH size would have a higher proportion of prolapse recurrence. Women who underwent vaginal hysterectomy with uterosacral ligament suspension as part of the Study of Uterine Prolapse Procedures Randomized trial (NCT01802281) were divided into 3 groups based on change in their preoperative to 4- to 6-week postoperative GH measurements: (1) persistently enlarged GH, 2) improved GH, or (3) stably normal GH. Baseline characteristics and 2-year surgical outcomes were compared across groups. A logistic regression model for composite surgical failure controlling for advanced anterior wall prolapse and GH group was fitted. This secondary analysis included 81 women. The proportion with composite surgical failure was significantly higher among those with a persistently enlarged GH (50%) compared with a stably normal GH (12%) with an unadjusted risk difference of 38% (95% confidence interval, 4%-68%). When adjusted for advanced prolapse in the anterior compartment at baseline, the odds of composite surgical failure was 6 times higher in the persistently enlarged GH group compared with the stably normal group (95% confidence interval, 1.0-37.5; P = 0.06). A persistently enlarged GH after vaginal hysterectomy with uterosacral ligament suspension for pelvic organ prolapse may be a risk factor for recurrent prolapse.

Clinical observation of 2 patients and a literature review of pregnancy outcome after uterine-sparing apical suspension for pelvic organ prolapse

ObjectiveTo observe pregnancy postoperatively and long-term follow-up after uterine-sparing apical suspension for pelvic organ prolapsed (POP). Study designWe report 2 patients who delivered newborns after uterine-sparing apical suspension for pelvic organ prolapse at our center and a literature review on this topic. ResultsThe patients’ ages were 26 and 32 years at their respective times of surgery. The follow-up times were 7 and 8 years. These patients became pregnant at 52 and 46 months after surgery, and delivered by cesarean section at term. There was no re-prolapse at follow-ups of 15 and 10 months postpartum. The results were consistent with those reported in the literature. ConclusionPatients with POP who have reproductive requirements can benefit from surgical treatment, and this benefit is maintained after cesarean section. SynopsisObservation of 2 patients who delivered newborns after uterine-sparing apical suspension for pelvic organ prolapsed at our center and a literature review.

Management of Pelvic Organ Prolapse with or without Hysterectomy Via Transvaginal Robotic Notes High Uterosacral Ligament

<h3>Study Objective</h3> To demonstrate stepwise techniques for the successful use of the robotic-assisted transvaginal natural orifice transluminal endoscopy surgery high uterosacral ligament suspension (RvNOTES-HUS) technique for pelvic organ prolapse with and without uterine preservation. <h3>Design</h3> Stepwise demonstration with narrated video footage (Canadian Task Force classification III). <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> Case 1: 62-year-old G0P0 with a symptomatic stage Ⅱ anterior vaginal prolapse and Stage Ⅱ uterine prolapse. Preoperative vaginal length was measured at 9cm. Case 2: 42-year-old G3P2 with a symptomatic fibroid uterus with stage Ⅱ anterior vaginal prolapse and Stage Ⅱ uterine prolapse. Preoperative vaginal length was measured at 8cm. <h3>Interventions</h3> Since the approval of the robotic platforms in gynecologic surgery by the Food and Drug Administration in 2005¹, robotic assisted surgery has been proliferating in the treatment of benign gynecological diseases including sacrocolpopexy, hysterectomy, myomectomy and endometriosis resection^2-5. In recent years, publications have demonstrated the feasibility and safety of traditional laparoscopic assisted high uterosacral ligament suspension for pelvic organ prolapse with long term follow up^6-8. However, robotic assisted RvNOTES-HUS has yet to be investigated in a publication. Utilizing the RvNOTES-HUS technique with or without uterine preservation operations greatly reduces the difficulty of intraperitoneal suture for the surgeon and postoperative pain for the patient. <h3>Measurements and Main Results</h3> Case 1: Procedure was successfully performed with a postoperative vaginal length of 8cm. Pain level was 4/10 in the first week, 2/10 in the second, 0/10 in the third. POP was stage 0. Case 2: Procedure was successfully performed with a postoperative vaginal length of 7cm. She had one day of post-operative pain. POP was stage 0. <h3>Conclusion</h3> RvNOTES-HUS is a practical technique in women with uterine prolapse while choosing whether to preserve the uterus. This technique allows for the better exposure of the ureter, while the articulating robotic joints allow for increased precision of dissection and suturing.

Pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse: an unrecognized problem?

The laparoscopic lateral suspension (LLS) represents an alternative mesh procedure to avoid the dissection at the promontory. However, mesh-related complications such as chronic pelvic pain, dyspareunia, and bladder pain are emerging. The present study is aimed to present a video case report and describe a small case series of patients referred to our center for chronic pelvic pain after LLS. A surgical video of the management of a 50-year-old woman with chronic abdominal and pelvic pain, dyspareunia, and recurrent urinary tract infection (UTIs) after uterus sparing LLS is provided. Moreover, we performed a retrospective chart review of similar cases in our institution. The featured procedure was completed without complications and was successful in obtaining symptom relief. Between 2018 and 2022 five patients underwent total or subtotal mesh removal for pain-related symptoms after LLS. At the median follow-up of 24 months, all patients were free from pain, but two (40%) required reoperation for prolapse recurrence CONCLUSIONS: Our experience suggests that LLS involves a certain risk of chronic pelvic pain, which may be challenging to manage and require surgical treatment.

Reliability of laparoscopic lateral suspension videos on YouTube platform

Objective: YouTube is one of the most popular websites globally and its content is not limited to entertainment. The aim of this study is to evaluate the reliability, quality and quantity of information and surgical steps in YouTube videos about laparoscopic lateral suspension with mesh for the surgical treatment of pelvic organ prolapse (LLS). Material and Methods: A search on YouTube was performed with the key words; " laparoscopic lateral suspension’’, ‘’lateral suspension ", ‘’ pelvic organ prolapse surgery’’, ‘’POPS with mesh’’, ‘’Pelvic Organ Prolapse Suspension’’. Each video was further analysed in terms of reliability, quality and quantity of information. Results: A total of 44 videos were evaluated after excluding 36 of the 88 videos associated with LLS. According to the usefulness score, the videos were divided into two groups. 61.4%(n=27) of the videos were in GroupI (not useful and slightly useful) and 38.6% (n=17) were in GroupII ( useful and very useful). There was no difference between the groups in terms of video length, number of views, number of likes, number of dislikes, number of comments and number of subscribers. A Spearman’s rank correlation analysis found no correlation between the usefulness score and like ratio, views ratio, like / view rate, like/subscriber rate, view/subscriber rate, VPI rates. Conclusion: Since the videos uploaded to YouTube do not pass a preliminary examination, their reliability is low even if they are uploaded by health professionals. There is no relationship between quantitative information of the LLS videos and the usefulness scores of the videos.

Laparoscopic sacrocolpopexy versus pelvic organ prolapse suspension for surgical management of pelvic organ prolapse: a retrospective study

This retrospective surgical clinical study compares clinical and functional effects of laparoscopic sacrocolpopexy (LSC) and laparoscopic pelvic organ prolapse suspension (L-POPS) for anterior and central prolapse correction. Thirty patients enrolled were affected by a symptomatic vaginal central compartment stage 2–3 prolapse and vaginal anterior compartment stage 1–3 prolapse without vaginal posterior compartment prolapse. A successful correction of anterior and central compartments prolapse without relapses were observed in both groups (LSC group versus L-POPS group). In patients who underwent L-POPS, a de novo posterior compartment prolapse was recorded. In this group, 7/15 patients complained more bowel symptoms and underwent vaginal colpoperineoplasty. In 20% (group LSC) and in 13.3% (group L-POPS) of cases, a condition of de novo urinary stress incontinence was described. LSC seems to remain the gold standard for pelvic organ prolapse correction, while further preventive strategies should be carried out in L-POPS to avoid a de novo posterior compartment prolapse. Impact Statement What is already known on this subject? Laparoscopic sacrocolpopexy is the gold standard technique for the correction of pelvic organ prolapse; however, laparoscopic pelvic organ prolapse suspension, based on the surgical technique of lateral suspension, is an innovative surgical method for the treatment of POP. What do the results of this study add? L-POPS could be considered a valid alternative to LSC for women with multiple comorbidities because of less operative time and reduced surgical risks. However, in the long follow-up period, some patients underwent L-POPS complained rectal discomfort and dysfunction on quality of life questionnaire and on clinical evaluation from six to twelve months after surgery probably due to the post-operative appearance of posterior compartment prolapse. What are the implications of these findings for clinical practice and/or further research? Considering the retrospective design and the small sample size the major limits of this study, larger, prospective, randomized studies could be encouraged to better compare a modified technique of L-POPS with posterior mesh apposition (preventing the post-operative appearance of posterior compartment prolapse) with the gold standard LSC for the correction of multi-compartment POP.

Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension.

Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement. Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR). At 6months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001). Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.

69 Does size of postoperative genital hiatus influence surgical success of patients undergoing native tissue apical suspension for pelvic organ prolapse?

69 Does size of postoperative genital hiatus influence surgical success of patients undergoing native tissue apical suspension for pelvic organ prolapse?

Dynamic magnetic resonance imaging following native tissue vaginal reconstructive surgery; a prospective study.

To describe the impact of native tissue vaginal reconstruction on pelvic anatomy using dynamic magnetic resonance imaging. This prospective single-cohort observational study involved women undergoing native tissue reconstruction with intraperitoneal vaginal vault suspension for pelvic organ prolapse. Concomitant procedures such as hysterectomy, midurethral sling, and anterior or posterior colporrhaphy were allowed. Enrolled participants underwent dynamic pelvic imaging pre- and postoperatively. Radiographic and anatomic measurements were compared. Secondary outcomes included validated patient questionnaires. Fourteen participants were included in the analysis. The mean age was 62 years; all participants were Caucasian. Most participants had stage III pelvic organ prolapse. Significant improvements were noted in several radiographic measurements. The average H-line (representing levator hiatus width) with straining maneuvers improved following surgery (7.2cm preoperatively vs. 6.6cm postoperatively, p = 0.015). The average M-line (representing levator muscular descent) improved significantly with both straining (4.0cm preoperatively vs. 3.0cm postoperatively, p < 0.001) and defecatory maneuvers (6.2cm preoperatively vs. 5.2cm postoperatively, p = 0.001). The average size of cystocele improved from 5.6cm (moderate) preoperatively to 0.7cm (absent descent) postoperatively (p < 0.001). The average descent of the vaginal apex with defecation preoperatively was 3.0cm (moderate) and 0cm (absent descent) postoperatively (p = 0.003). Posterior compartment descent with defecation did not change following surgical intervention (5.8cm preoperatively vs. 5.2cm postoperatively, p = 0.056). Pelvic Organ Prolapse Quantification measurements improved in all compartments, and Pelvic Floor Distress Inventory-20 scores improved significantly following surgery (102 preoperatively vs. 30 postoperatively, p < 0.001). Native tissue reconstruction with intraperitoneal vaginal vault suspension resulted in significant anatomic improvements, as defined by physical examination and dynamic magnetic resonance imaging.

Laparoscopic Pelvic Organ Prolapse Suspension (Pops) Versus Laparoscopic Ventral Mesh Rectopexy for Treatment of Rectal Prolapse: Prospective Cohort Study.

This study aimed to compare ventral mesh rectopexy (VMR) and pelvic organ prolapse suspension surgery (POPS) in management of patients presenting with rectal prolapse. Our study was a prospective cohort trial in which 120 female patients with complete rectal prolapse were included, 60 patients had had VMR and the other 60 had had POPS as a surgical management for complete rectal prolapse. Results had been compared 6months postoperatively regarding operative time, postoperative pain, hospital stay, complications of surgery including recurrence of the rectal prolapse, the efficacy of each operation in treatment of rectal prolapse and associated symptoms. The patients were assessed 6months postoperatively. There was no significant statistical difference regarding hospital stay and postoperative pain. Operative time was significantly shorter in POPS in comparison with VMR (P value < 0.05). VMR showed slight improvement regarding constipation and continence scores; however, this was statistically significant. VMR showed less complications compared to POPS. Complications with rectopexy happened only with 4 patients compared to 24 patients in POPS groups, 2 cases of recurrence in rectopexy group compared to 6 cases of recurrence in POPS. POPS is comparable to VMR in management of rectal prolapse and in improving the ODS symptoms. Thus, POPS can be used as easier, faster option to treat rectal prolapse in selected patients.

Perioperative performance of a new Pelvic Organ Prolapse Suspension (POPS) for vaginal vault prolapse

Perioperative performance of a new Pelvic Organ Prolapse Suspension (POPS) for vaginal vault prolapse

SC31 - Influence of laparoscopic lateral suspension for pelvic organ prolapse on overactive bladder symptoms

SC31 - Influence of laparoscopic lateral suspension for pelvic organ prolapse on overactive bladder symptoms

Transvaginal high uterosacral ligament suspension: An alternative to McCall culdoplasty in the treatment of pelvic organ prolapse

ObjectivesDefects in female pelvic organ support are highly prevalent. Uterosacral ligament suspension at the time of primary prolapse repair (McCall culdoplasty) is a well-established surgical option to prevent prolapse recurrences.Recently Shull's high uterosacral ligament suspension technique has gained increasing popularity among Uro-Gynaecologists. A study carried out in 2017 by Spelzini et al. compared these two techniques, showing proper safety and efficacy in the treatment of prolapse, with no statistically significant differences as to operative time, complication rate, anatomical, functional and subjective outcomes [1]. Our study aims at comparing the effectiveness, complication rate, recurrence rate, quality of life and functional result of the two techniques. Study designThis is a retrospective study carried out on 224 patients who underwent vaginal cuff suspension for pelvic organ prolapse. Cases were extracted from hospital medical records of all women managed with surgical prolapse repair at our Gynaecology and Obstetrics department between January 2013 and February 2017. Shull suspension (group A) or McCall culdoplasty (group B) were performed according to surgeon's familiarity with the two suspension techniques. ResultsA total of 224 patients (69 in group A and 155 in group B) underwent surgical cuff suspension. Median operating time was 88 min for both techniques and ureteral injuries were very rare in both group A and B (1 and 0 respectively). In the evaluation of postoperative questionnaires, no statistically significant differences were found, except for "Urinary Impact Questionnaire" (UIQ), which showed significantly less urinary subjective symptoms in group A. Median follow up was 13 months in group A and 15 months in group B. Post-operative Pop-Q items analysis revealed only a higher Aa point in group A at 12 months follow up visit. Objective vaginal cuff recurrence was observed in 1 patient (1,4%) in group A and 4 patients in group B (2,6%) with no statistically significant difference between the two groups. ConclusionsBoth uterosacral ligament suspension procedures are safe and highly effective. There were no statistically significant differences concerning surgical data, complication rates, and the majority of anatomical, functional and subjective outcomes between Shull suspension and McCall culdoplasty.

Assessment of Overactive Bladder after Laparoscopic Lateral Suspension for Pelvic Organ Prolapse.

Background Pelvic organ prolapses (POP) and overactive bladder (OAB) may coexist and both negatively impact quality of life in women. The correlation between POP and OAB remains unclear, but these patients may have the OAB resolution after the surgical treatment of POP. Aim of our study was to assess the anatomical results and the effect on OAB symptoms in women who underwent laparoscopic lateral suspension for POP. Materials and Methods This prospective study included all women with apical POP who underwent surgical repair with laparoscopic uterine lateral suspension from January 2016 to December 2017. The baseline and the 1-year follow-up included post-void residual measurement, urinalysis, vaginal examination, OAB symptoms evaluation, and administration of questionnaires (PFDI-20, UDI 6). Results 64 women underwent laparoscopic lateral suspension for uterine prolapse and 78.1% had concomitant anterior vaginal wall defect. At 1-year follow-up the anatomic success rates were 84.4% for the apical and 76.2% for the anterior compartment. The comparison between OAB symptoms before and after the surgical procedure showed the resolution of OAB in 76% of the women, while de novo OAB was present in 2.6%. With the questionnaires 95.3% (61/64) of our patients were satisfied after the POP repair. We documented a trend in ameliorating of OAB regardless of the POP-Q stage. However, the Pearson test showed this correlation as statistically significant only in women with anterior vaginal wall defect stage III and apical stage II. No patient had vaginal exposure of the polypropylene mesh. Conclusion Our data show how laparoscopic lateral suspension is an effective procedure for apical and anterior vaginal wall defects. This study provides further evidence for the concept that OAB in women with POP >II stage improves after a successful POP surgery. These women may benefit from a resolution of OAB and POP symptoms with the improvement of patient's quality of life.

A Minimally Invasive Technique for the 1-Stage Treatment of Complex Pelvic Floor Diseases: Laparoscopic-Pelvic Organ Prolapse Suspension.

The aim of this prospective study was to assess the safety and effectiveness of a new single laparoscopic operation devised to relieve obstructed defecation, gynecologic and urinary symptoms in a large series of female patients with multiorgan pelvic prolapse. We submitted 384 female patients to laparoscopic pelvic organ prolapse suspension operation, a new technique based on suspension of the middle pelvic compartment, by using a polypropylene mesh and followed up 368 of them, with defecography performed 12 months after surgery and a standardized protocol. The 368 patients were followed-up for 36.3 (±4.4) months, Recurrence rate was 4.9% for obstructed defecation syndrome and 3.3% for stress urinary incontinence. Complication rate was 2.9%. The mean period of daily activity resumption was 16.3 days (±4.8 days). Anorectal and urogynecologic symptoms and scores significantly improved after the operation (P < 0.001), with no worsening of anal continence. Incidence of postoperative fecal urgency was 0%. Postoperative defecography showed a significant (P < 0.001) improvement of all parameters in 315 patients (82%). Short Form 36 Health Survey score significantly improved after the operation (P < 0.01). An excellent/good overall Satisfaction Index was reported by 78.0% of patients. In our experience the Laparoscopic-Pelvic Organ Prolapse Suspension seems to be safe and effective as a 1-stage treatment of associated pelvic floor diseases. Randomized studies with an appropriate control group and longer follow-up are now needed to assess the effectiveness of this promising technique.