Posterior Compartment Repair Research Articles

Posterior vaginal compartment repair: a primer for residents

Posterior vaginal compartment repair: a primer for residents

Native Tissue Posterior Compartment Repair for Isolated Posterior Vaginal Prolapse: Anatomical and Functional Outcomes.

Background and Objectives: Posterior compartment prolapse is associated with constipation and obstructed defecation syndrome. However, there is still a lack of consensus on the optimal treatment for this condition. We aim to investigate functional, anatomical, and quality-of-life outcomes of native tissue transvaginal repair of isolated symptomatic rectocele. Materials and Methods: We retrospective analyzed patients who underwent transvaginal native tissue repair for stage ≥ II and symptomatic posterior vaginal wall prolapse between January 2018 and June 2021. Anatomical and functional outcomes were evaluated. Wexner constipation score was used to assess bowel symptoms, while the Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. Results: Twenty-eight patients were included in the analysis. The median age was 64.5 years, and half of them underwent a previous hysterectomy for benign reasons. The median follow-up time was 33.5 months. A significant anatomical improvement in the posterior compartment was noticed compared with preoperative assessment (p < 0.001 for Ap and Bp), with only two (7.1%) anatomical recurrences. Additionally, obstructed defecation symptoms decreased significantly compared to baseline (p < 0.001), as well as vaginal bulging, with no new-onset cases of fecal incontinence or de novo dyspareunia. PGI-I resulted in 89.2% of patients being satisfied (PGI-I ≥ 2), with a median score of 1.5. Conclusions: Transvaginal native tissue repair for isolated posterior prolapse is safe and effective in managing bowel symptoms, with excellent anatomical and functional outcomes and satisfactory improvement in patients’ quality of life.

PD44-08 POSTOPERATIVE OUTCOMES AFTER ROBOTIC SACROCOLPOPEXY WITH CONCURRENT RECTOPEXY IN WOMEN WITH MULTICOMPARTMENT PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 May 2022PD44-08 POSTOPERATIVE OUTCOMES AFTER ROBOTIC SACROCOLPOPEXY WITH CONCURRENT RECTOPEXY IN WOMEN WITH MULTICOMPARTMENT PELVIC ORGAN PROLAPSE Shivani Gaitonde, Jessie Chen, Craig Olson, Philippe Zimmern, and Maude Carmel Shivani GaitondeShivani Gaitonde More articles by this author , Jessie ChenJessie Chen More articles by this author , Craig OlsonCraig Olson More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and Maude CarmelMaude Carmel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic assisted sacrocolpopexy (RSC) is an established surgical approach to correct pelvic organ prolapse (POP). However, relatively little data has been published regarding utilization of simultaneous rectopexy for patients with POP and defecatory dysfunction. The objective of this study was to describe outcomes of RSC with rectopexy versus RSC alone for patients with multicompartment POP. METHODS: Following IRB approval, we performed a retrospective analysis of women undergoing RSC with or without concurrent rectopexy at a single academic institution from December 2013 to May 2021. Pre- and postoperative demographics, pelvic organ prolapse quantification (POP-Q) score and assessment of defecatory dysfunction were reported. The primary outcomes were postoperative POP-Q Bp score, recurrence of symptomatic POP (POP-Q Ba or Bp>0) and need for additional POP surgery within 1yr. Secondary outcomes included complication rates and persistence of defecatory dysfunction. RESULTS: Of 162 women included in this study, 35 patients underwent combo RSC with rectopexy (22%) while the remainder underwent RSC only (n = 127, 78%). Mean age was 65yr (range 34-90) and BMI was 28.2 (range 19.4-51.4). Preoperative Bp (-1.5 in combo vs 0 in RSC-only), stage of posterior prolapse (mean stage 2 in both) and presence of external rectal prolapse (6% in both) did not significantly differ between groups. 71% of combo patients reported preop defecatory dysfunction vs 50% RSC-only patients. Mean postop follow-up was 23mo (range 1-82). Significantly more patients in the RSC-only group required repeat POP surgery within 1yr (0% combo vs 6% RSC-only, p < 0.05). The most common repeat surgery was posterior colporrhaphy (6/8 patients). However, by 1yr there were no differences in presence of symptomatic recurrent POP (5% combo vs 4% RSC-only) or reported defecatory dysfunction (34% combo vs 30% RSC-only). Median postop Bp was -3 in both groups. No intraoperative complications were noted in the combo group, while 3 patients in the RSC-only group had enterotomies repaired primarily. 2 combo patients had postoperative ileus managed conservatively (6%), and 2 had UTI (6%). 14 RSC-only patients had UTI (11%). CONCLUSIONS: Compared to RSC alone, combined RSC and rectopexy for women with multicompartment POP is associated with improved durability of posterior compartment repair without significant increase in adverse events. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e711 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shivani Gaitonde More articles by this author Jessie Chen More articles by this author Craig Olson More articles by this author Philippe Zimmern More articles by this author Maude Carmel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Correção de Prolapso Apical Via Vaginal com Tecidos Nativos: Sessenta Meses de Experiência

Introdução: O objectivo do estudo foi avaliar a taxa de sucesso e as complicações associadas a diferentes técnicas de correção transvaginal de prolapso apical, recorrendo a tecidos nativos. Material e Métodos: Estudo retrospetivo de 41 cirurgias vaginais para correção de prolapso apical com tecidos nativos, realizadas no Departamento de Uroginecologia de um hospital terciário, de janeiro/2013 a junho/2018. Resultados: Nesta amostra, a idade mediana foi de 66 anos, todas eram multíparas e 95,1% encontravam-se na pós-menopausa; 47,5% referiam história pessoal de histerectomia, 17,5% de colporrafia anterior, 10,0% de colporrafia posterior e 7,5% de correção de prolapso apical. À observação, para além do prolapso apical, 24,4% apresentavam prolapso anterior, 4,9% prolapso posterior e 53,7% prolapso dos três compartimentos. As técnicas utilizadas para correção vaginal do prolapso apical foram a suspensão dos ligamentos útero-sagrados (22,0%), a fixação ao ligamento sacro-espinhoso (68,3%) e a fixação à fáscia do músculo iliococcígeo (9,8%). No mesmo tempo cirúrgico, 39,0% foram histerectomizadas (com colporrafia anterior em 4/16; posterior em 3/16 e ambas em 7/16), 7,3% submetidas a colporrafia anterior, 2,4% a colporrafia posterior e 36,6% a colporrafia anterior e posterior. Não se registaram complicações no período peri-operatório. A taxa de sucesso terapêutico foi de 82,9%. Verificou-se recidiva clínica do prolapso apical em 17,1% e de outros prolapsos em 4,9%, um caso de incontinência urinária de urgência e dois de fístulas. Estas complicações ocorreram nos primeiros seis meses após a cirurgia em 34,1%. Não se registaram diferenças estatisticamente significativas relativamente à taxa de sucesso ou de complicações entre as três técnicas estudadas. Conclusão: O uso de tecidos nativos para correção do prolapso apical revelou-se um método efetivo e seguro com baixa morbilidade. Neste estudo, todas as técnicas estudadas revelaram-se igualmente eficazes, sugerindo que a sua escolha deve depender da experiência do cirurgião.

Posterior Compartment Prolapse Occurrence After Anterior Vaginal Wall Suspension

ObjectiveTo determine the long-term rate of posterior compartment prolapse (PCP) occurrence after native tissue repair of the anterior compartment with anterior vaginal wall suspension (AVWS) procedure. MethodsAn institutional review board approved surgical prolapse database was reviewed for women who underwent AVWS for any degree of anterior compartment prolapse with minimum of 6-month follow-up and no history of apical or posterior compartment repair. Demographic data, smoking status, parity, and uterine status were collected. The primary outcome was need for secondary PCP repair. ResultsA total of 300 women met inclusion criteria with a mean age of 63.8 ± 10.8 years, mean BMI of 26.1 ± 6.2 kg/m2, and a mean parity of 2.5 ± 1.4. At the time of AVWS 46 women (15%) had uterine-sparing AVWS, 74 (25%) had concomitant hysterectomy, and 180 (60%) had prior hysterectomy. Forty-eight women (16%) had secondary posterior compartment repair for PCP (60% abdominal route, 40% done vaginally) over a mean follow-up of 7.1 ± 4.4 years. ConclusionAt long-term follow-up, less than 20% of women undergoing AVWS underwent PCP repair.

Simplified Laparoscopic Sacrohysteropexy

Study ObjectiveTo demonstrate a simplified technique of performing laparoscopic sacrohysteropexy for uterine prolapse. DesignA technical video demonstrating a simplified method of laparoscopic sacrohysteropexy (Canadian Task force classification level III). SettingThe benign gynecology department at a university hospital. InterventionsA 38-year old woman with grade 3 uterine descent presented requesting surgical management for symptomatic prolapse. ConclusionLaparoscopic sacrohysteropexy is becoming an increasingly popular alternative to hysterectomy to treat uterine prolapse in women. We present a novel approach of performing laparoscopic sacrohysteropexy that differs from previously described methods [1,2]; it is shorter, simpler, and reduces possible complications. Key differences include the mesh type, site of attachment, and dissection of the peritoneum while creating the possibility of future vaginal delivery after pregnancy. Our simplified technique uses a polyvinylidene fluoride mesh woven with a square weave secured to the posterior aspect of the cervix under a layer of visceral peritoneum. Because there is no longitudinal give of the mesh, unlike polypropylene meshes with a diamond weave, a wrap method [2] is not required. No dissection of the broad ligament and bladder is needed, eliminating the risk of bladder perforation and anterior mesh erosion with fewer adhesions and simplifying hysterectomy if required in the future. We also uniquely “tunnel” the peritoneum, reducing the size of defect for suture closure, and reperitonize the mesh. Previous methods restrict cervical dilatation and require women to have cesarean sections. The method described in the video allows women to deliver vaginally and, in the event of late miscarriage, avoid the need for hysterotomy. We have performed 25 cases with 1 mild cystocoele recurrence requiring no surgery, 1 reoperation for posterior compartment repair, and 1 case of cervical elongation requiring Manchester repair. No cases of recurrent uterine prolapse have occurred.

Long-term occurrence of secondary compartment pelvic organ prolapse after open mesh sacrocolpopexy for symptomatic prolapse.

To report on the long-term occurrence of secondary compartment pelvic organ prolapse (POP) after open mesh sacrocolpopexy (MSC). A prospectively maintained, IRB-approved database of non-neurogenic women with symptomatic triple compartment POP who underwent open MSC between 1999 and 2011 and had a 1-year minimum follow-up was reviewed. Length of follow-up was categorized as: intermediate (1-3 yr), late (3-5 yr), and very late (>5 yr). Demographic data, history of POP repairs, exam with Baden-Walker grading, validated questionnaires (Urogenital Distress Inventory short form [UDI-6], QoL), and outcomes at each follow-up visit were recorded. Failure was defined by either secondary compartment prolapse recurrence (BW > 2) on examination at the last visit or re-operation for POP. Out of sixty-eight, sixty-one women met study criteria. Mean age was 66 ± 11, mean BMI 26.1 ± 4.5, mean parity 2.8 ± 1.4 and cohort was mostly Caucasian. --Eighty seven percent had prior hysterectomy and 72% had prior POP repair. Mean follow-up was 6.8 ± 3.9 years with over 75% in the late or very late categories. There were 4/61 (7%) clinical failures, 3 of which underwent surgical repair (2 anterior and 1 posterior compartment repair) at 2-12 year interval post-MSC. Mean changes between baseline and last visit UDI-6, QoL, and BW prolapse grade trended favorably. Following open MSC, the rate of secondary prolapse compartment failure was found low at very long-term follow-up.

MP10-04 LONG-TERM OUTCOMES OF ABDOMINAL VS. VAGINAL APICAL PROLAPSE REPAIR AMONG FEMALE MEDICAIRE BENEFICIARIES

Pearson’s Chi-square, Fisher’s Exact, Wilcoxon rank sum tests, and repeated measures. RESULTS: 130 women were identified. 50 women had a posterior repair (PR+). 28 were combined with anterior apical repair, and 22 only had a posterior repair. 80 women had anterior apical repair without posterior repair (PR-). There was no significant difference in mean age (PR+ 63, PR64 years, p1⁄40.66) or placement of transvaginal mesh (PR+ 56%, PR73%). Being sexually active at baseline was similar (PR+ 48%, PR50%) and remained similar at 6 months (PR+ 52%, PR57%) and 1 year (PR+ 53%, PR47%). Answers to PISQ question #5 showed that dyspareunia was not different at baseline (PR+ 23%, PR10%, p 1⁄4 0.26), 6 months (PR+ 12% PR13%, p 1⁄4 1.0), or 1 year (PR+ 12%, PR17%, p 1⁄4 1.0). Baseline PISQ scores were similar and remained so at 6 months and 1 year (Table 1). PISQ scores improved significantly in both groups over time (PR+ 0.0013, PR0.0014). CONCLUSIONS: At 6 months and 1 year follow-up, women with posterior compartment repair have similar rates of being sexually active, dyspareunia, and similar improvement in PISQ scores as women with anterior apical compartment repairs.

Manometric comparison of anorectal function after posterior vaginal compartment repair with and without mesh.

Background:Although repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction, the data about posterior compartment are scarce. The aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse (POP).Methods:This was a prospective, double-blind, clinical pilot study of 22 postmenopausal women with symptomatic POP (overall POP-quantification [POP-Q] Stage III-IV) who underwent total pelvic floor reconstruction. Patients were grouped according to the use of mesh for posterior vaginal compartment repair: A mesh group and a nonmesh group. POP-Q stage, the pelvic floor impact questionnaire short form-7 (PFIQ-7) and anorectal manometry were evaluated before and 3 months after surgery. Anatomical success was defined as POP-Q Stage II or less. A t-test was used to compare preoperative with postoperative data in the two groups.Results:Totally, 17 (71%) were available for the follow-up. POP-Q measurements improved significantly compared to baseline (P < 0.05) in both groups. No recurrence was observed. Subjects in both groups reported improvement in pelvic floor symptoms, and there was no significant difference in the PFIQ-7 score between groups at follow-up (P > 0.05). Compared with baseline, the nonmesh group exhibited a statistically significant decrease in anal residual pressure, a significant increase in the anorectal pressure difference during bowel movement, and a reduced rate of dyssynergia defecation pattern (P < 0.05).Conclusions:Provided there is sufficient support for the anterior wall and apex of vagina with mesh, posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.

Pelvic posterior compartment defects: comparative study of two vaginal surgical procedures

This study was undertaken to compare two surgical techniques for rectocele repair. Between January 2005 and December 2010, 180 patients with III grade symptomatic rectocele were enrolled in this alternative prospective randomized study. 90 patients (group A) were treated with perineal body anchorage of posterior septum, and 90 (group B) with the traditional Denonvilliers’ transversal suture. Pre- and post-operative data, including Ap and Bp values, recurrence rates and quality of life was assessed. The mean follow-up was 22 months (range 9-72 months). For statistical purpose, Student’s &lt;em&gt;t&lt;/em&gt; test, chi-square test and logistic regression analysis were evaluated. Post-operatively, in group A Ap and Bp value were respectively –2.0±1.0 and –2.5±0.5 (P&amp;lt;0.001 for both values). In group B, Ap and Bp value were respectively –1.9±2.1 and –2.1±0.9 (P&amp;lt;0.001 for both values). A total of 81 (93.1%) patients in group A and 76 (86.3%) in group B reported improvement in symptoms (P=0.222) after surgery. Recurrence rates were 5 (5.7%) and 6 (6.8%) respectively (P=0.984). Quality of life improved significantly in both groups. In conclusion, both techniques are effective for the posterior compartment repair.

Use of surgisis for treatment of anterior and posterior vaginal prolapse.

Aim. To evaluate the anatomical success and complication rate of Surgisis in the repair of anterior and posterior vaginal wall prolapse. Methods. A retrospective review of 65 consecutive Surgisis prolapse repairs, involving the anterior and/or posterior compartment, performed between 2003 and 2009, including their objective and subjective success rates using the pelvic organ prolapse quantification (POPQ) system. Results. The subjective success rate (no symptoms and no bulge beyond the hymen) was 92%, and the overall objective success rate (no subsequent prolapse in any compartment) was 66% (43 of 65). The overall reoperation rate for de novo and recurrent prolapse was 7.7% with 3 women undergoing repeat surgery at the same site (anterior compartment). No long-term complications occurred. Conclusions. Surgisis has a definite role in the surgical treatment of prolapse. It may decrease recurrences seen with native tissue repair and long-term complications of synthetic mesh. Its use in posterior compartment repair in particular is promising.

2086 COMPLEX RECTOVAGINAL FISTULA AFTER POSTERIOR COMPARTMENT REPAIR WITH SYNTHETIC MESH: IDENTIFICATION AND MANAGEMENT OF THIS DEVASTATING COMPLICATION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20112086 COMPLEX RECTOVAGINAL FISTULA AFTER POSTERIOR COMPARTMENT REPAIR WITH SYNTHETIC MESH: IDENTIFICATION AND MANAGEMENT OF THIS DEVASTATING COMPLICATION Vian Nguyen, Sophie Fletcher, and Michael Snyder Vian NguyenVian Nguyen Houston, TX More articles by this author , Sophie FletcherSophie Fletcher Houston, TX More articles by this author , and Michael SnyderMichael Snyder Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2381AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of synthetic mesh for transvaginal pelvic organ prolapse (POP) repair is associated with the rare complication of mesh erosion into hollow viscera. This study presents a single-institution series of complex rectovaginal fistulas (RVF) after synthetic mesh-augmented POP repair. METHODS IRB approval was obtained for this retrospective study. Data was collected on all consecutive patients undergoing RVF repair after POP surgery from 2006–2009. Patient demographics, clinical history, physical exam, diagnostic testing, fistula repair techniques and follow up data were recorded. RESULTS Twenty-two patients underwent RVF repair at our multidisciplinary center for pelvic medicine from 2006 – 2009. Etiologies of RVF were: malignancy (n=12), uterosacral ligament suspension (n=1), robotic sacrocolpopexy (n=1), lap sacrocolpopexy (n=1), and transvaginal POP repair with mesh (n=7). Of the 9 patients with RVF after POP repair using mesh, median age was 52 yrs (range 33–66). Time to presentation was 9 to 960 days after prolapse repair. Presenting symptoms included: drainage of stool in the vagina (4), rectal bleeding (2), dyspareunia (2), vaginal bleeding (1), rectal pain (1), dyschezia (1), mesh protruding from anus (1), and sepsis (1). Mesh was palpated in the rectum in 5 patients. Patients required a median 3 (range 1–5) procedures for definitive RVF repair. Diverting ileostomy was necessary in 5 of 9 patients; one patient refused. Repairs included advancement flap (3), transperineal repair with levator flaps (2), closure with gracilis flap, (1), low anterior resection with primary anastamosis (1), and mesh removal with primary closure (2). Median follow up was 13 mo. (range 6–46). Two patients have persistent fistulas on follow up; one is still diverted. Of those with successful repairs, persistent pain (3) and vaginal mesh extrusion (1) still complicate RVF repair. CONCLUSIONS This series highlights the significant impact of synthetic mesh complications in the posterior compartment. Rectal complications can occur after any posterior POP repair, but those involving mesh are especially disastrous. These complications should be cautionary for synthetic graft use by those with limited experience or with alternate choice of traditional repair. When symptoms of RVF present, a colon and rectal specialist should be involved as soon as possible to minimize repeated attempts at repair and prolonged morbidity. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e834 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vian Nguyen Houston, TX More articles by this author Sophie Fletcher Houston, TX More articles by this author Michael Snyder Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes and Complications of Transvaginal and Abdominal Custom-shaped Light-weight Polypropylene Mesh Used in Repair of Pelvic Organ Prolapse

Study Objective To assess the outcomes and complications of transvaginally placed custom-shaped light-weight polypropylene mesh for repair of pelvic organ prolapse. Design Retrospective review of medical records (Canadian Task Force classification II-2). Setting Two urogynecologic centers. Patients Between March 2006 and September 2007, 154 women with anterior, posterior, or apical prolapse underwent vaginal reconstructive surgery using custom-shaped transvaginal or abdominal mesh. Surgical procedures were chosen after informed consent. The primary outcome for the study was recurrence of prolapse, defined as POP-Q (Pelvic Organ Prolapse Quantitative) stage II or greater. Secondary end points included perioperative and postoperative complications. Interventions Anterior compartment repair was performed in 94 patients (61%), and posterior compartment repair in 60 (39%). Combined anterior and posterior repairs were performed in 25 patients. Hysterectomy was performed in 27 patients (18%) (abdominal in 1, vaginal in 19, and laparoscopy-assisted in 7). Apical support techniques included sacrospinous fixation in 69 patients (45%), abdominal sacral colpopexy in 30 (19%), and vaginal culdoplasty in 7 (5%). Transobturator sling procedures were performed in 65 patients (42%). Measurements and Main Results Postoperative follow-up exceeded 24 months in all patients. The overall success of these procedures was 97.4%. There were 4 failures (2.6%), defined as stage II prolapse or greater. Comparison of POP-Q points Aa, Ba, C, Ap, and Bp preoperatively and postoperatively revealed statistically significant improvement at each point (p <.001). Complications were observed in 17 patients (11%), with mesh extrusion in 1 (0.7%). Conclusions Long-term follow-up demonstrated that use of custom-shaped light-weight polypropylene mesh is safe and effective, with a low rate of complications.

Vaginal Repair With Mesh Versus Colporrhaphy for Prolapse: A Randomized Controlled Trial

The use of synthetic mesh to augment vaginal repair procedures for pelvic organ prolapse has increased in large part because of dissatisfaction with the success rates of traditional colporrhaphy. Its use, however, is controversial. Four randomized controlled studies comparing traditional colporrhaphy with vaginal repair using mesh augmentation had conflicting results. This unblinded, prospective, randomized controlled trial investigated whether mesh augmentation during vaginal repair would reduce the rate of recurrent prolapse at 12 months compared with traditional colporrhaphy. A total of 139 women with stage 2 or more prolapse who required both anterior and posterior compartment repair were randomized to mesh augmentation (mesh group, n = 69) or colporrhaphy (no mesh group, n = 70). Study subjects were enrolled between 2003 and 2005 at a tertiary teaching hospital. Prolapse was staged using the pelvic-organ-prolapse quantification (POP-Q) system. The primary study outcome was objective success of surgery defined as the absence of POP-Q stage 2 or more prolapse at 12 months following surgery. Questionnaires were used to assess secondary outcomes including symptoms, quality of life, and patient satisfaction. Of the 139 women, 63 of 69 (93.1%) in the mesh group and 61 of 70 (87.1%) in the no mesh group attended the 12-month follow-up. There was no significant difference at 12 months in objective success (POP-Q stage 0 or 1) between the mesh and no mesh groups (mesh: 81.0% [51/63] vs. no mesh: 65.6% [40/61]; P = 0.07). Although patients in both groups expressed a high level of satisfaction with the surgery and improved symptoms and parameters of quality of life compared to baseline, there was no statistically significant difference in these outcomes between the 2 groups (P = ns). Postoperative complications in the mesh group included four cases (5.6%) of vaginal mesh exposure. At 12 months, de novo dyspareunia was reported in 27.8% (5/18) of the sexually active women without preoperative dyspareunia in the mesh group and in 41.7% (5/12) of those in the no mesh group. These differences were not significant (P = 0.46). These findings show that anterior and posterior vaginal repair with mesh augmentation at 12 months after surgery does not result in significantly less recurrent prolapse than traditional colporrhaphy.

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

ObjectiveTo compare vaginal repair augmented by mesh with traditional colporrhaphy for the treatment of pelvic organ prolapse.DesignProspective randomised controlled trial.SettingTertiary teaching hospital.PopulationOne hundred and thirty-nine women with stage ≥2 prolapse according to the pelvic organ prolapse quantification (POP-Q) system requiring both anterior and posterior compartment repair.MethodsSubjects were randomised to anterior and posterior vaginal repair with mesh augmentation (mesh group, n= 69) or traditional anterior and posterior colporrhaphy (no mesh group, n= 70).Main outcome measuresThe primary outcome was the absence of POP-Q stage ≥2 prolapse at 12 months. Secondary outcomes were symptoms, quality-of-life outcomes and satisfaction with surgery. Complications were also reported.ResultsFor subjects attending the 12-month review, success in the mesh group was 81.0% (51 of 63 subjects) compared with 65.6% (40/61) in the no mesh group and was not significantly different (P-value = 0.07). A high level of satisfaction with surgery and improvements in symptoms and quality-of-life data were observed at 12 months compared to baseline in both groups, but there was no significant difference in these outcomes between the two groups. Vaginal mesh exposure occurred in four women in the mesh group (5.6%). De novo dyspareunia was reported by five of 30 (16.7%) sexually active women in the mesh group and five of 33 (15.2%) in the no mesh group at 12 months.ConclusionIn this study, vaginal surgery augmented by mesh did not result in significantly less recurrent prolapse than traditional colporrhaphy 12 months following surgery.

The posterior compartment: Evaluation and functional outcomes after surgical repair

Pelvic organ prolapse (POP) will continue to become more prevalent as the female population ages and life expectancy increases. POP repair poses a challenging dilemma that is difficult to manage. Current research on various techniques of posterior compartment repair favors a transvaginal approach. Randomized trials have demonstrated its superiority when compared to transanal repair. Fascial defect reconstruction is superior to levator ani plication, although outcomes are comparable. However, site-specific fascial repairs are inferior to midline fascial plication. No randomized trials compare the transabdominal to transvaginal repair, although the laparoscopic approach has proven superior to transanal repair. The use of graft in posterior compartment repair enhances functional and surgical outcomes; however, mesh erosion, infection, and rejection may influence its use.

412: Lateral Suspension for Utero Vaginal Prolapse in Reproductive Age Group

Technique of prolapse repair while conserving the uterus will be shown in this video. Mesh is fixed to the pubo cervical fasica over the isthumus and is brought out over and fixed to the anterior abdominal wall. Other strip of mesh is fixed to the recto vaginal septum, utero sacral ligament and is fixed to the arcus taurineus. Good antomical and functional correction is obtained. No significant complications noted. Lateral suspension with posterior compartment repair is superior to isolated approaches of sacro hysteropexy or utero sacral suspension for marked prolapse in younger females.

Leiomyoma of the Perineum

In Brief Leiomyomas occur in the pelvis and urogenital tract. Most clinicians' experience with leiomyomas comes from managing uterine leiomyomas. Scattered case reports describe rare vaginal, urethral, paraurethral, and bladder leiomyomas. We report on a 60-year-old female presenting with a 6-month history of perineal discomfort and a mass situated in the perineum. Magnetic resonance imaging helped characterize the lesion preoperatively. The perineum was explored, and the mass was identified and excised. The tumor did not arise from the posterior vaginal wall or the rectum. The pathology demonstrated a 4 × 4 × 3 cm leiomyoma of the perineum. We report on a 60-year-old female with a history of posterior compartment repair and anal sphincter reconstruction with a 6-month history of pelvic pain.

Bowel, bladder and sexual function in women undergoing laparoscopic posterior compartment repair in the presence of apical or anterior compartment dysfunction

The aim of the study was to analyse the functional outcome of women undergoing a laparoscopic posterior compartment repair in the presence of anterior or apical compartment dysfunction. Prospective cohort study. Forty women, median age 65 years (41-78), with symptoms of genital prolapse 31 (78%), urinary dysfunction 32 (80%) and bowel dysfunction 40 (100%), underwent laparoscopic posterior compartment repair in conjunction with an anterior compartment repair. Pre-operative and postoperative bowel and bladder function was prospectively assessed with a Wexner continence score, Vienna constipation score and a urinary dysfunction score. Twenty-eight (70%) and 24 patients (60%) had pre-operative urodynamics and anorectal manometry. Post-operatively all women were also assessed with a Watt's sexual dysfunction score and a linear analogue patient satisfaction score. Twelve women (30%) had postoperative anal manometry. At 20 months median follow-up, 30 (97%), 20 (62%) and 12 (31%) women reported improvement in their prolapse, urinary and bowel symptoms, respectively. Post-operatively, one woman reported denovo faecal incontinence, four worsening obstructive defecation and three denovo urinary dysfunction. Nine women (35%) reported denovo dyspareunia. The mean time to clinical deterioration following surgery was 11 months. Bowel function improvement was the only factor to significantly correlate with postoperative patient satisfaction. The functional outcome of laparoscopic posterior compartment repair in the presence of anterior compartment dysfunction is disappointing. Preoperative counselling is important to ensure that patients have reasonable and realistic expectations from repair surgery, and an understanding that anatomical improvement might not be followed by long-term functional improvement.