Sacrospinous Fixation Research Articles

Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up

Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction.
 Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse.
 Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment.
 Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.
 Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.

Treatment of vaginal vault prolapse in The Netherlands: a clinical practice survey.

A great variety of conservative and surgical procedures to correct vaginal vault prolapse have been reported. The aim of this study was to describe practice pattern variation-the difference in care that cannot be explained by the underlying medical condition-among Dutch gynecologists regarding treatment of vaginal vault prolapse. A clinical practice survey was conducted from March to April 2017. The questionnaire was developed to evaluate treatment of vaginal vault prolapse. All members of the Dutch Society for Urogynaecology were invited to participate in a web-based survey. One hundred four Dutch gynecologists with special interest in urogynecology responded to the survey (response rate, 44%). As first-choice therapy for vaginal vault prolapse, 78% of the respondents chose pessary treatment, whereas sacrospinous fixation was the second most common therapy choice according to 64% of the respondents. Preferences on how to approach vaginal vault prolapse surgically are conflicting. Overall, the most performed surgery for vaginal vault prolapse is sacrospinous fixation, followed by laparoscopic and robotic sacrocolpopexy. Gynecologists in The Netherlands manage vaginal vault prolapse very differently. No standardized method could be determined for the treatment of vaginal vault prolapse in The Netherlands, and we observed practice pattern variations.

Sacrospinous Fixation for Treatment and Prevention of Vault Prolapse: Study of 20 Cases

Sacrospinous Fixation for Treatment and Prevention of Vault Prolapse: Study of 20 Cases

Outcome of Sacrospinous Ligament Fixation of the Vault during Repair of Pelvic Organ Prolapse

Pelvic organ prolapse includes descent of anterior/ posterior wall and apical (vault) prolapse with significant morbidity. In this study we evaluated the outcome of sacrospinous ligament fixation of vault through vaginal approach as part of the repair for massive uterovaginal (pelvic organ prolapse stage III and stage IV) and vault prolapse. This study on sacrospinous ligament fixation along with repair for Pelvic organ prolapse at Kathmandu Model Hospital from November 2016 to April 2018 was done to assess the outcome in terms of early (during hospital stay) and delayed (six months) post-operative complications and need of removal of sacrospinous fixation suture and recurrence of vault prolapse. Out of 95 Pelvic organ prolapse patients, 80 (84%) were post-menopausal, 28 (29.4%) were in the age group of 70-79 years. There were 61 (64%) POPQ stage III. The post-operative complications during post-operative hospital stay were pain over right buttock in 42 (44%), urinary retention in 7 (7%) and UTI in7 (7%). Sacrospinous suture was released in two patients for severe pain over right buttock. At one-week follow-up, 35 (36%) had right buttock pain of moderate severity and 8 (8%) had vaginal cuff infection. Sacrospinous suture was removed in one patient for neuropraxia two weeks following surgery. At four weeks follow-up, 25 (26%) patients had mild right buttock pain relieved by oral NSAIDs on need. At six months follow-up, five had occasional buttock pain, six had some recurrences and two had some vault prolapse and one each had short vagina and stress incontinence. Sacrospinous ligament fixation is a good procedure for the management of Pelvic organ prolapse with better long-term outcome if performed with good surgical expertise.

Outcome of Sacrospinous Ligament Fixation of the Vault during Repair of Pelvic Organ Prolapse

Background: Pelvic organ prolapse includes descent of anterior/ posterior wall and apical (vault) prolapse with significant morbidity. In this study we evaluated the outcome of sacrospinous ligament fixation of vault through vaginal approach as part of the repair for massive uterovaginal (pelvic organ prolapse stage III and stage IV) and vault prolapse. Methods: This study on sacrospinous ligament fixation along with repair for pelvic organ prolapse at Kathmandu Model Hospital from November 2016 to April 2018 was done to assess the outcome in terms of early (during hospital stay) and delayed (six months) post-operative complications, need of removal of sacrospinous fixation suture and recurrence of prolapse. Results: Out of 95 pelvic organ prolapse patients, 80 (84%) were post-menopausal, 28 (29.4%) were in the age group of 70-79 years. There were 61 (64%) POPQ stage III. The post-operative complications during post-operative hospital stay were pain over right buttock in 42 (44%), urinary retention in 7 (7%) and UTI in 7 (7%). Sacrospinous suture was released in two patients for severe pain over right buttock. At one-week follow-up, 35 (36%) had right buttock pain of moderate severity and 8 (8%) had vaginal cuff infection. Sacrospinous suture was removed in one patient for neuropraxia two weeks following surgery. At four weeks follow-up, 25 (26%) patients had mild right buttock pain relieved by oral NSAIDs on need. At six months follow-up, five had occasional buttock pain, six had some recurrences and two had some vault prolapse and one each had short vagina and stress incontinence. Conclusions: Sacrospinous ligament fixation is a good procedure for the management of pelvic organ prolapse with better long-term outcome if performed with good surgical expertise. Keywords: Prolapse; repair; sacrospinous fixation; vaginal hysterectomy.

V10-01 NOVEL VAGINOPLASTY TECHNIQUE: INVERSION OF PENILE SKIN AND USE OF SCROTAL GRAFT WITHOUT SACROSPINAL FIXATION

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2018V10-01 NOVEL VAGINOPLASTY TECHNIQUE: INVERSION OF PENILE SKIN AND USE OF SCROTAL GRAFT WITHOUT SACROSPINAL FIXATION Ervin Kocjancic, Hari Vigneswaran, Laurel Sofer, Jorge Jaunarena, David Whitehead, Luca Morgantini, and Loren Schechter Ervin KocjancicErvin Kocjancic More articles by this author , Hari VigneswaranHari Vigneswaran More articles by this author , Laurel SoferLaurel Sofer More articles by this author , Jorge JaunarenaJorge Jaunarena More articles by this author , David WhiteheadDavid Whitehead More articles by this author , Luca MorgantiniLuca Morgantini More articles by this author , and Loren SchechterLoren Schechter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2657AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The current gold standard in vaginoplasty for gender confirmation is the penile skin inversion technique. The three main challenges of this surgery are: maximal vaginal length, prevention of neovaginal prolapse and optimal cosmetic appearance. We present this video is to show our technique for vaginoplasty using scrotal graft and a modified dissection that prevents neovaginal prolapse, avoiding sacrospinal fixation. METHODS The patient was prepped in lithotomy position. A full–thickness skin graft was harvested from the scrotum, encapsulated, defatted, and sutured over a vaginal dilator. Scroto-perineal flap and penile flaps were designed and elevated, and the penis was degloved. Bilateral orchiectomy was performed. The vaginal cavity was then created using both blunt and sharp dissection with the aid of the Lowsley retractor allowing to fit a 15 x 4cm vaginal dilator. The neoclitoris was fashioned from the dorsal glans penis and dissected on the dorsal neurovascular pedicle incorporating Buck's fascia. The bulbospongiosus and ischiocavernosus muscles were resected, and the corpus spongiosum was separated from the corpora cavernosa, completely dissecting the latter. The spongiosa from the urethral bulb was then resected. Neurovascular bundle of glans was plicated and then sutured to the rectus fascia. The urethra was shortened and spatulated ventrally to create a neomeatus. The penile skin flap was then sutured to the scrotal perineal flap in a layered fashion. The scrotal skin graft was sutured to the penile flap with multiple W-plasties. The distal portion of the urethra is then used to create the vestibulum. An incision was made in this portion of the urethral plate to expose the neoclitoris. Two penrose drains were placed in the vagina. The labia majora were then closed in a layered fashion. The vagina was packed with two Sulfamylon–soaked vaginal packs and lubricating jelly. RESULTS The case took 360 minutes. EBL was 200 mL. Vaginal packing was removed on day 5, and patient was discharged on day 6. Final vaginal length was 13cm.Out of our 46 cases in the last two years, only one morbidly obese patient experienced a degree of neovaginal prolapse. CONCLUSIONS The combination of perineal flap and scrotal graft allows for a significant lengthening of the neovaginal cavity.The extended dissection of the recto-prostatic space, up to the level of the pouch of Douglas, allows for omission of sacrospinal fixation, thus reducing the risk of damage to the pudendal neurovascular bundle. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1072 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ervin Kocjancic More articles by this author Hari Vigneswaran More articles by this author Laurel Sofer More articles by this author Jorge Jaunarena More articles by this author David Whitehead More articles by this author Luca Morgantini More articles by this author Loren Schechter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

La chirurgie vaginale prothétique peut-elle être proposée aux patientes âgées de plus de 75 ans ?

Prevalence of pelvic organ prolapse will increase with the aging of the population. Concerning the treatment of pelvic organ prolapse, transvaginal route is often preferred for elderly women. However few data are available concerning transvaginal mesh surgery in this population. The aim of this study was to compare efficiency and complications of transvaginal mesh surgery between women aged over 75 and younger women. A monocentric, retrospective study included all women who underwent anterior sacrospinous suspension with mesh for treatment of pelvic organ prolapse. The primary endpoint was anatomical success at the last follow-up, defined by a pelvic organ prolapse stage 0 or 1 of POP-Q classification. The secondary endpoints were rate of complications and urinary, colorectal and sexual functional results. We included 329 patients, 69 were under 75 years old and 260 were aged over 75. The median of follow-up was 12 months (IQR: 6). The rate of anatomical success was significantly higher in patients aged over 75: 92% versus 85% in younger patients (P=0.02). However this difference was no more significant in multivariate analysis after inclusion of confusions factors (P=0.82). The rate of perioperative complications was low and similar in the 2 groups even in multivariate analysis. Utero-vaginal suspension using bilateral vaginal anterior sacrospinous fixation with mesh seems to achieve at least similar results between women aged more than 75 years and younger women. There is no excess risk of complications in elderly women. 4.

Does the Vaginal Flora Modify When a Synthetic Mesh is Used for Genital Prolapse Repair in Postmenopausal Women? A Pilot, Randomized Controlled Study.

The vaginal flora from postmenopausal women with pelvic organ prolapse (POP) is different from younger women. We hypothesized that the decision of a surgical route using a mesh would modify the vaginal flora. The purpose of this study was to analyze the vaginal flora from postmenopausal women that were submitted to abdominal sacrocervicopexy or vaginal sacrospinous fixation. A pilot, randomized controlled study with 50 women aged 55 to 75 years (n = 25; abdominal sacrocervicopexy + subtotal hysterectomy; n = 25 vaginal sacrospinous fixation + vaginal hysterectomy) was performed. A polyvinylidene mesh was used in both arms. The vaginal content analysis was collected before and 60 days after the surgery. The type of flora, the presence of lactobacilli/leukocytes, and the Nugent criteria were analyzed. Most of the women were white (80%), with at least 1 comorbidity (69.9%), did not present sexual activity (60%), and presented advanced stage 4 POP. Two thirds of women presented a type 3 flora, and half of them did not present lactobacilli (48.3%). About the Nugent criteria, 51.7% presented normal flora, 46.6% found altered flora, and 1.7% had bacterial vaginosis. There were no differences about the type of flora (P = 1), number of lactobacilli (P = 0.9187), Nugent criteria (P = 0.4235), inflammation (P = 0.1018), and bacterial vaginosis (P = 0.64) before and after surgery in both groups. In this pilot study, the use of synthetic mesh by vaginal or abdominal route did not affect the vaginal flora in postmenopausal women operated on by POP surgery.

Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality.

Objective Our aim was to study the efficacy of transvaginal bilateral sacrospinous fixation (TBSF) and its impact on quality of life (QoL) and sexual functions in women affected by second recurrences of vaginal vault prolapse (VVP). Materials and Methods We performed a prospective observational study on 20 sexually active patients affected by second recurrence of VVP, previously treated with monolateral sacrospinous fixation. TBSF was performed in all the patients. They had been evaluated before the surgery and at 12-month follow-up through pelvic organ prolapse quantification (POP-Q) system, Short Form-36 (SF-36), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results At 12-month follow-up, 18 out of 20 (90%) patients were cured of their recurrent VVP. No major intra- and postoperative complications occurred. We found a significant improvement in 4/5 POP-Q landmarks (excluding total vaginal length), SF-36, and PISQ-12 scores. Conclusion According to our data analysis, TBSF appears to be safe, effective, and able to improve both QoL and sexual functions in patients affected by second recurrence of VVP after previous monolateral sacrospinous fixation.

Patient-reported outcomes after sacrospinous fixation of vault prolapse with a suturing device: a retrospective national cohort study.

Innovations in suturing devices have facilitated sacrospinous ligament fixation (SSF) for the correction of vaginal vault prolapse. It is uncertain if outcomes using suturing devices differ from those using a traditional suturing technique. We hypothesize that no difference exists in the efficacy and safety 1year after SSF for vault prolapse performed with suturing devices or using a traditional technique. The objective was to compare SSF using a suturing device with traditional SSF for the treatment of vault prolapse, regarding symptoms of prolapse recurrence, patient satisfaction, incidence of re-operation, and complications 1year postoperatively. We carried out a retrospective cohort study using register-based national data from 2006 to 2013. The Swedish Quality Register of Gynecological Surgery includes assessments pre-operatively, at hospital admittance, surgery, discharge, and questionnaires at 8weeks and 1year after surgery. Demographic variables and surgical methods were included in multivariate logistic regression analyses. In the suturing device group (SDG, n=353), 71.5% were asymptomatic of recurrence after 1year compared with 78.7% in the traditional SSF group (TSG, n=195); risk difference-7.3% (95%CI -15.2%; 0.7%). Adjusted odds ratio (aOR) for being asymptomatic 1year postoperatively was 0.56 (95%CI 0.31; 1.02, p=0.057). Patient satisfaction was similar in SDG and TSG (78.1% vs 78.4%). Reoperation occurred in 7.4% in the SDG compared with 3.6% in the TSG, risk difference 3.8% (95%CI 0.0%; 7.5%), aOR 3.55 (95%CI 1.10; 11.44, p=0.03). Patient satisfaction was similar 1year after SSF, despite symptoms of recurrence being more likely and reoperation more common after using a suturing device compared with a traditional technique. The methods did not differ with regard to surgical complications.

Консервативное лечение гематомы малого таза после сакроспинальной фиксации шейки матки

Консервативное лечение гематомы малого таза после сакроспинальной фиксации шейки матки

The UK National Prolapse Survey: 10\xa0years on

Introduction and hypothesisTo assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and changes in practice since a previous similar survey.MethodsAn online questionnaire survey (Typeform Pro) was emailed to British Society of Urogynaecology (BSUG) members. They included urogynaecologists working in tertiary centres, gynaecologists with a designated special interest in urogynaecology and general gynaecologists. The questionnaire included case scenarios encompassing contentious issues in the surgical management of POP and was a revised version of the questionnaire used in the previous surveys. The revised questionnaire included additional questions relating to the use of vaginal mesh and laparoscopic urogynaecology procedures.ResultsOf 516 BSUG members emailed, 212 provided completed responses.. For anterior vaginal wall prolapse the procedure of choice was anterior colporrhaphy (92% of respondents). For uterovaginal prolapse the procedure of choice was still vaginal hysterectomy and repair (75%). For posterior vaginal wall prolapse the procedure of choice was posterior colporrhaphy with midline fascial plication (97%). For vault prolapse the procedure of choice was sacrocolpopexy (54%) followed by vaginal wall repair and sacrospinous fixation (41%). The laparoscopic route was preferred for sacrocolpopexy (62% versus 38% for the open procedure). For primary prolapse, vaginal mesh was used by only 1% of respondents in the anterior compartment and by 3% in the posterior compartment.ConclusionBasic trends in the use of native tissue prolapse surgery remain unchanged. There has been a significant decrease in the use of vaginal mesh for both primary and recurrent prolapse, with increasing use of laparoscopic procedures for prolapse.

Trends in pelvic organ prolapse management in Latin America.

To describe practice patterns and perspectives regarding pelvic organ prolapse (POP) management among urologists, gynecologists, and urogynecologists in Latin America (LATAM). A cross-sectional study was conducted from April to September 2016 using a 37-item internet-based survey applied to members of urologic and gynecologic associations from 18 countries. Participants were asked about their background and practice patterns. Descriptive statistics were employed. A total of 673 responses were obtained. Most came from Colombia (33.6%) and Brazil (24.7%). The number of practitioners who perform at least one POP procedure per month and were eligible to finish the survey was 529 (78.6%), out of which 323 (61.0%) were urologists, 156 (29.5%) gynecologists, and 50 (9.5%) urogynecologists. Mesh-based POP repairs were used by 57.1% of participants. Out of non-mesh users, the most frequent vaginal procedures were sacrospinous fixation (30%), colporrhaphy (25%), and uterosacral fixation (12%). Regarding the impact of FDA warnings, 75.2% participants indicated that the use of mesh has declined, and 41.9% considered this has had a negative effect in the use of incontinence tapes as well. Only two physicians reported legal disputes related to mesh procedures, and 75.8% said they would still indicate mesh repairs in certain cases. This is the first report on POP practice patterns in LATAM. Preferences regarding surgical management of POP are not very different from international trends. Despite intense scrutiny and media exposure, mesh-based procedures are still largely used in LATAM.

Sacrospinous Ligament Fixation in Patients with Second-degree Uterine Prolapse

ABSTRACT Background Sacrospinous ligament fixation is a simple procedure we use today to treat cases with uterine prolapse. Aim The aim is to test the effectiveness of this procedure in the treatment of second-degree uterine prolapse. Materials and methods The study included 50 women with second-degree uterine prolapse. Out of 50 women, 25 (group I) were treated with bilateral sacrospinous ligament fixation, while the other 25 (group II) were treated with unilateral sacrospinous ligament fixation. The efficacy and intraoperative and postoperative complications are recorded (follow-up of patients occurred 3 and 6 months postoperatively). Results Mean operative time in unilateral sacrospinous fixation is 52 ± 10.6 minutes, while in bilateral procedure, it is 73 ± 12.6 minutes. However, postoperative pain is more in bilateral than unilateral procedure. Conclusion Sacrospinous ligament fixation is an effective treatment for patients having second-degree uterine prolapse. Unilateral is better than bilateral sacrospinous operation regarding postoperative pain. How to cite this article Rady HA. Sacrospinous Ligament Fixation in Patients with Second-degree Uterine Prolapse. J South Asian Feder Obst Gynae 2017;9(3):235-238.

Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse, a randomized controlled trial: SALTO-2 trial, study protocol

BackgroundHysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of prolapse symptoms, will visit a gynaecologist for a surgical correction of a vaginal vault prolapse thereafter. Vaginal vault prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for prolapse of the vaginal vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique.To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of vaginal vault prolapse.MethodsWe will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, vaginal vault prolapse will be included. Participants will be randomized to the vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group.Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, post-operative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included.DiscussionThe SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 vault prolapse.Trial registrationNetherlands Trial Register (NTR): NTR3977; Registered 28 April 2013.

Incidence of PostOperative Urinary Retention after Pelvic Organ Prolapse Reconstruction

Abstract
 Objective: To determine the incidence of post-operative urinary retention
 after pelvic organ prolapse reconstruction and associated
 factors.
 
 Method: This was a prospective cohort study conducted in Dr. Cipto
 Mangunkusumo and another associate hospital. We recruited women
 planned for pelvic organ prolapse reconstruction from April
 2013 to April 2015. Inclusion and exclusion criteria were women
 with pelvic organ prolapse (2nd, 3rd and 4th degree) without prior
 urinary retention, drugs affecting bladder function, and history of
 bladder injury. After surgery, urinary catheter was applied for 24
 hours. Six hours apart from urinary catheter released, residual urine
 was measured. Urinary retention was defined as residual urine more
 than 100 ml.
 
 Result: Of 200 subjects, 59 of them (29.5%) classified as having urinary
 retention. No association found between age, body mass index
 (BMI), degree of prolapse, degree of cystocele and urinary tract infection
 toward urinary retention. Total vagina hysterectomy + anterior
 colporaphy + colpoperineoraphy + sacrospinous fixation and reconstruction
 duration more than 130 minutes were associated with
 urinary retention (relative risk (RR) 3.66; 95% CI 2.91-4.60; p

The novel technique of post-hysterectomy vaginal vault prolapse repair: Apical sling and “neocervix” formation

ObjectiveWe primarily aimed to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling combined with “neocervix” formation in surgical treatment of post − hysterectomy vaginal vault prolapse. The secondary objective was to estimate the impact of the surgery on voiding function and quality of life. Study designThis prospective study involved 61 women suffering from post-hysterectomy prolapse. We used the following criteria to evaluate the results of surgical treatment: results of vaginal examination (POP-Q system), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment. ResultsMean operation time was 35min. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted.At 12-month follow-up anatomical cure rate (≤stage I, POP-Q) was 100%, 94,4% and 100% for vaginal apex, anterior and posterior vaginal walls, respectively. The following long-term complications were noted stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4,9%, respectively. Statistically significant (P<0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. ConclusionThe novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with vaginal vault prolapse. The technique improves voiding function and quality of life.

V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2017V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION Dmitry Shkarupa, Alexey Pisarev, Ekaterina Shapovalova, Anastasia Zaytseva, and Nikita Kubin Dmitry ShkarupaDmitry Shkarupa More articles by this author , Alexey PisarevAlexey Pisarev More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , Anastasia ZaytsevaAnastasia Zaytseva More articles by this author , and Nikita KubinNikita Kubin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6% in patients with prior hysterectomy for uterine prolapse. Sacrocolpopexy is considered the gold standard procedure for VVP correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The objective of this study was to evaluate effectiveness of novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling-1, Lintex) combined with neocervix formation (purse-string suture on the internal surface of the cervical fascia fixed to the tape) in surgical treatment of post - hysterectomy vaginal vault prolapse. Secondary aim was to estimate the impact of the surgery on urinary function and patient′s quality of life. METHODS This prospective study involved 54 women suffering from post-hysterectomy prolapse. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, ultrasound measurement of post-voiding residual volume were used, determined before the surgery and at control examinations after treatment. Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires. RESULTS Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. Median follow-up time was 12 (min-8, max-18) months. There was noted statistically significant improvement in POP-Q points, especially, Ba and C (p<0,001) in all patients. Also statistically significant improvement was found in peak and average flow rate according to uroflowmetry (p<0,05). Recurrent prolapse was noted in anterior compartment in 3.7% (2/54). After 6 months of follow-up stress urinary incontinence de novo was noted in 7.4% (4/54). Most of the patients reported a significant improvement in quality of life after treatment. CONCLUSIONS The novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with post-hysterectomy prolapse. This technique also provides high functional results and improves quality of life. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e134 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dmitry Shkarupa More articles by this author Alexey Pisarev More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Nikita Kubin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V81 - The novel technique of pelvic organ prolapse treatment: Apical sling and subfascial colporrhaphy

Introduction and hypothesis The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy.

The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.

The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy. This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12months after the treatment. At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%. The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.