Surgical Management Of Pelvic Organ Prolapse Research Articles

Sexual function in women with pelvic organ prolapse and surgery influence on their complaints.

Sexual health is an essential component of women's wellbeing. Women with pelvic organ prolapse (POP) often suffer from sexual dysfunction. The current review focuses on the impact of POP as well as surgical POP repair on sexual function. A variety of techniques are discussed in relation to this issue, including native tissue repair (NTR), transvaginal mesh (TVM) and sacrocolpopexy (SCP). The majority of studies utilise validated questionnaires to assess sexual function in women pre- and post-POP repair and FSFI (Female Sexual Function Index) and PISQ-IR (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-IUGA revised) are among the most commonly used. According to the available data, surgical management of POP usually results in improved or unchanged scores in sexual function, regardless of the type of procedure used. SCP appears to be the preferred surgical management for women with apical vaginal prolapse that minimises the risk of dyspareunia as compared to vaginal techniques.

Surgical Management of Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a common condition that affects the quality of life of affected women. A prevalence of 12% has been reported in Ghana with the condition affecting mainly the emotional wellbeing, sexual life and women’s relationship with their partners. This review discusses the adequacy of the available surgical options for managing POP and provide our expert opinion and recommendations based on our experience. Surgical management of POP is undertaken through 2 main approaches i.e., obliterative and reconstructive. Obliterative procedures should only be considered for women who are not sexually active and have no desirefor future sex as it closes the vagina. Because of the significant contribution of the apex to vaginal support, inadequate apical support during prolapse repair may lead to a vault prolapse or failure of anterior and posterior vaginal wall repairs. Vaginal mesh is not recommended for the repair of POP. We advise the performance of concurrent anti-incontinent procedure for women with symptomatic and occult stress incontinence at the time of prolapse repair. We do not however advocate the performance of prophylactic antiincontinent procedure (i.e., anti-incontinent procedure for continent women with POP) at the time of prolapserepair. Surgical repair of POP is expected to achieve good anatomical and functional outcome. It is therefore important that surgeons equip themselves with the skills and knowledge necessary to address all the problems confronting the patient.

Comparison of different surgical techniques for pelvic floor repair in elderly women: a multi-institutional study.

The prevalence of pelvic organ prolapse (POP) is increasing. The number of women aged 70-80years requiring surgical management for POP is also increasing. The purpose of this study was to compare the complications associated with three pelvic organ prolapse repair methods, sacrocolpopexy (SCP), native tissue repair (NTR), and vaginal mesh repair (VMR), in women aged 70-80years. We performed a multi-institutional retrospective analysis of 213 women who underwent POP surgical repairs between December 2012 and December 2017. Treatment-related complications were classified using the ClavienDindo grading system and compared among the three groups. Perioperative data, anatomical success rates, patient satisfaction, and postoperative complication data were collected during the follow-up period, which lasted up to 12months. Of 213 patients, 70 (33%) underwent SCP, 85 (40%) underwent NTR, and 58 (28%) underwent VMR. By postoperative day 30, the all-inclusive complication rate was lower in the SCP group than in the NTR or VMR group; however, there was no between-group difference in complication grade. The VMR group underwent fewer concomitant hysterectomies than the other groups, and operative time was the longest for SCP. Overall, recovery time, anatomical success rate, and patient satisfaction were comparable for all three repairs. All three surgical techniques were equivalent in patient satisfaction, anatomical success rate, and complication rate. SCP should be recommended to elderly women who meet criteria for prolonged general anesthesia, as it was associated with fewer perioperative complications than NTR and VMR.

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.

Management of pelvic organ prolapse in French-speaking Belgium: the EPILAPSUS study

Management of pelvic organ prolapse (POP) may be conducted by abdominal (laparotomy or laparoscopy) or vaginal approach, with or without mesh repair, mainly depending on the surgeon’s expertise. The aim of this study was to determine the trends in surgical management of POP in French-speaking Belgium. The GGOLFB Gynecologic surgery working group initiated a registry of the patients surgically treated for POP from eight centers in French-speaking Belgium. In this prospective multicentric study, conducted between June 2010 and January 2013, we analyzed the clinical and surgical data, the postoperative results at 4 months, the intra and postoperative complications, and reoperation rates. A total of 394 patients were registered in the database. Surgical POP repair was performed vaginally in 83.5 % of the patients, with prosthetic material in 70.2 % of the cases. In case of abdominal procedure, surgery was mainly (93.5 %) performed by laparoscopic sacrocolpopexy. The most common intraoperative complications were severe bleeding (2.3 %), bladder (2 %), and bowel (0.2 %) injuries. At 4 months, the total reoperation rate was 11.3 %. The anatomical success rate (POP-Q < 2) was 87.5 % with 2.1 % of reoperation for recurrence. Mesh exposure was observed in 9.8 % of the cases. Surgery for stress urinary incontinence (SUI) was reported in 5.1 % of the patients. The analysis of the current urogynecological practice in French-speaking Belgium shows that vaginal mesh repair is the preferential approach used for management of POP in the participating centers. The creation of a national database will help to evaluate the global trends in prolapse surgery and the potential impact of the FDA notification in the management of POP in Belgium.

Practice pattern variation in surgical management of pelvic organ prolapse and urinary incontinence in The Netherlands.

Practice pattern variation (PPV) is the difference in care that cannot be explained by the underlying medical condition. The aim of this study was to describe PPV among Dutch gynecologists regarding treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). PPV was calculated from data of healthcare declaration codes of 2010. Data were provided by Vektis and Kiwa Carity. PPV for POP and UI in general was calculated per hospital and per region. Furthermore, PPV for transvaginal mesh and surgical treatment of uterine descent was assessed. PPV of surgical treatment for POP and UI in general was assessed for 91 hospitals. PPV for surgical treatment of uterine descent and transvaginal mesh placement was calculated for 88 hospitals. A high PPV per hospital and per region was found. In some hospitals, a hysterectomy was performed in all cases of uterovaginal prolapse, while in other hospitals, uterus-preserving techniques were mostly performed. A high PPV of transvaginal mesh placement was observed. In the small country of The Netherlands, we found a high PPV in surgical management of POP and UI with respect to the choice for surgical treatment and the type of surgery. This finding might be due to the absence of clearly defined guidelines. Studies with respect to conservative versus surgical treatment and the type of surgery are of need to establish evidence-based guidelines.

Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh.

Pelvic organ prolapse (POP) surgery has lately gained importance in gynecological practice. This study aims to characterize the evolution of POP surgical procedures conducted in Portugal in the last decade and the impact of an FDA 2011 safety communication on mesh POP surgeries. Trends in the surgical management of POP were assessed using the Portuguese National Medical Registry. We considered all records of women with diagnosis of genital prolapse from 1 January 2000 to 31 December 2012. Additionally, we also conducted a survey among members of the Portuguese Society of Urogynecology to evaluate current practices in the surgical management of POP. From 2000 to 2012, 46,819 diagnoses of genital prolapse were registered, with a 105 % increase during the study period (2,368 in 2000 to 4,941 in 2012). POP mesh surgery represented only 6 % of total prolapse diagnoses, but mesh use greatly increased up to 2011, when only a slight increase was registered. Among gynecologists who responded to the questionnaire, there was considerable variability on the procedures of choice to treat POP. Fifty-seven per cent of respondents performed vaginal mesh POP surgery, but only 27 % of those actually reported having changed their practice after the FDA 2011 safety communication. Surgical procedures for POP conducted in Portugal greatly increased over the last decade. The use of surgical meshes is still limited, but despite FDA safety communication it has increased over the years, with a slight increase in 2012, which illustrates the need for further analyses in the coming years.

PD29-04 THE QUALITY OF CARE PROVIDED TO WOMEN WITH PELVIC ORGAN PROLAPSE: AN INFRASTRUCTURE FOR QUALITY ASSESSMENT

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 2014PD29-04 THE QUALITY OF CARE PROVIDED TO WOMEN WITH PELVIC ORGAN PROLAPSE: AN INFRASTRUCTURE FOR QUALITY ASSESSMENT Jennifer T. Anger, Alexandriah N. Alas, Catherine Bresee, Karyn S. Eilber, Karen Toubi, Rezoana Rashid, Carol P. Roth, Paul G. Shekelle, and Neil S. Wenger Jennifer T. AngerJennifer T. Anger More articles by this author , Alexandriah N. AlasAlexandriah N. Alas More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Karyn S. EilberKaryn S. Eilber More articles by this author , Karen ToubiKaren Toubi More articles by this author , Rezoana RashidRezoana Rashid More articles by this author , Carol P. RothCarol P. Roth More articles by this author , Paul G. ShekellePaul G. Shekelle More articles by this author , and Neil S. WengerNeil S. Wenger More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2139AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our aim was to assess the feasibility of recently developed quality indicators (QIs) for pelvic organ prolapse (POP) and, identify deficits in patient care. METHODS A panel ranked 14 QIs based on RAND Appropriateness Method assessing screening and diagnosis, treatment with pessaries, and surgical management of POP. Retrospective chart abstraction was performed using ICD-9 codes. RESULTS Total of 283 patients. Ninety-eight percent of patients with new complaint of vaginal bulge had a pelvic exam. POP was described but not staged in 6%, and not documented at all in 25.1%. Pessary was discussed in 43% of eligible patients. Among those managed with pessaries, 98% had vaginal exams every 6 months. Among women who underwent surgery, only 49% had complete pre-operative staging of the anterior, posterior, and apical compartments. Only 20% of women undergoing apical surgery had documentation of counseling about different surgical approaches, but 71% had counseling about the risk of post-operative stress incontinence. Only 14.5% of patients had documented counseling regarding risks of mesh. Only 48% of hysterectomies for POP had a concomitant vault suspension. Intra-operative cystoscopy was performed in 86% undergoing anterior and/or apical surgery. Within three months of surgery, 89% of patients had a post-operative pelvic exam. Only 37% who received mesh had documented follow-up at one year. CONCLUSIONS We demonstrated the 14 QIs are feasible in that they are identifiable in medical records and can be used to measure quality through retrospective chart abstraction. Overall, care to patients was adequate, but deficits in care were identified. Table 1. Incidence of appropriate care given for each quality indicator Quality Indicators # cases meeting criteria / # cases eligible (%) Pelvic exam after complaint of new or worsening POP 1 83/85 (98%) Offered a pessary if has symptomatic prolapse 2 85/198 (43%) Vaginal exam every 6 months if using a pessary 3 96/98 (98%) Asymptomatic POP stage 1 or less should not be offered surgery 4 5/6 (83%) Should be staged by preoperative exam and specific prolapse components if having surgery for POP 5a+5b+5c+5d 88/88 (100%) Zero components 5a 10/88 (11%) One of three components 5b 10/88 (11%) Two of three components 5c 25/88 (28%) All three components 5d 43/88 (49%) Women should be counseled about risk and benefits for both vaginal and abdominal approach if having surgery for symptomatic apical POP 6 8/41 (20%) If prolapse surgery contains mesh, women should be counseled about specific risks 7 10/69 (14.5%) Hysterectomies for POP should include a vault suspension 8 10/21 (48%) Women should be counseled about the risk of post-operative SUI after apical/anterior POP repair 9 42/59 (71%) Women who undergo abdominal sacrocolpopexy should be offered a continence procedure 10 13/13 (100%) Women over 65 with stage 3 or greater POP should be offered colpocleisis if no longer wishing to be sexually active 11 1/1 (100%) An intraoperative cystoscopy should be performed on after anterior or apical vaginal prolapse surgery 12 51/59 (86%) Women should have a pelvic exam within 3 months of POP surgery 13 78/88 (89%) Women should have a pelvic exam 1 year after POP surgery if mesh was used 14 23/63 (37%) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e780-e781 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jennifer T. Anger More articles by this author Alexandriah N. Alas More articles by this author Catherine Bresee More articles by this author Karyn S. Eilber More articles by this author Karen Toubi More articles by this author Rezoana Rashid More articles by this author Carol P. Roth More articles by this author Paul G. Shekelle More articles by this author Neil S. Wenger More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Protocol for Translabial 3D-Ultrasonography for diagnosing levator defects (TRUDIL): a multicentre cohort study for estimating the diagnostic accuracy of translabial 3D-ultrasonography of the pelvic floor as compared to MR imaging

BackgroundPelvic organ prolapse (POP) is a condition affecting more than half of the women above age 40. The estimated lifetime risk of needing surgical management for POP is 11%.In patients undergoing POP surgery of the anterior vaginal wall, the re-operation rate is 30%. The recurrence risk is especially high in women with a levator ani defect. Such defect is present if there is a partially or completely detachment of the levator ani from the inferior ramus of the symphysis. Detecting levator ani defects is relevant for counseling, and probably also for treatment. Levator ani defects can be imaged with MRI and also with Translabial 3D ultrasonography of the pelvic floor.The primary aim of this study is to assess the diagnostic accuracy of translabial 3D ultrasonography for diagnosing levator defects in women with POP with Magnetic Resonance Imaging as the reference standard. Secondary goals of this study include quantification of the inter-observer agreement about levator ani defects and determining the association between levator defects and recurrent POP after anterior repair. In addition, the cost-effectiveness of adding translabial ultrasonography to the diagnostic work-up in patients with POP will be estimated in a decision analytic model.Methods/DesignA multicentre cohort study will be performed in nine Dutch hospitals. 140 consecutive women with a POPQ stage 2 or more anterior vaginal wall prolapse, who are indicated for anterior colporapphy will be included. Patients undergoing additional prolapse procedures will also be included.Prior to surgery, patients will undergo MR imaging and translabial 3D ultrasound examination of the pelvic floor. Patients will be asked to complete validated disease specific quality of life questionnaires before surgery and at six and twelve months after surgery. Pelvic examination will be performed at the same time points.Assuming a sensitivity and specificity of 90% of 3D ultrasound for diagnosing levator defects in a population of 120 women with POP, with a prior probability of levator ani defects of 40%, we will be able to estimate predictive values with good accuracy (i.e. confidence limits of at most 10% below or above the point estimates of positive and negative predictive values).Anticipating 3% unclassifiable diagnostic images because of technical reasons, and a further safety margin of 10% we plan to recruit 140 patients.Trial registrationNederlands trial register NTR2220.

The UK national prolapse survey: 5 years on

The objective of this study was to assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and the changes in management since this survey was first conducted 5 years ago. A postal questionnaire survey was sent to practising consultant gynaecologists in UK hospitals. They included urogynaecologists 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 sent 5 years ago. Two hundred and eighteen responses were received of which 190 were completed. For anterior vaginal wall prolapse, anterior colporrhaphy was still the procedure of choice in 71% of respondents. There was a significant rise in graft usage, particularly synthetic graft for recurrent prolapse (56%). A Burch was being performed by only 1% compared to 11% 5 years ago. In women with uterovaginal prolapse, the procedure of choice was still a vaginal hysterectomy and repair (82%). Thirty-five percent of respondents would operate in women whose family was incomplete. In women with posterior vaginal wall prolapse, the procedure of choice was posterior colporrhaphy with midline fascial plication in 66%, marginally less than the previous (75%). For vault prolapse, 73% of respondents would operate, and 43% would perform urodynamics prior to surgery. The procedure of choice was an abdominal sacrocolpopexy (44%), slightly greater than 5 years ago when it was 38%. Basic trends in prolapse surgery remain unchanged. The increase in the use of grafts is in patients with recurrent prolapse.

National survey on the management of prolapse in the UK

To assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners, and compare practice between urogynaecologists (tertiary centres), gynaecologists with a special interest in urogynaecology and general gynaecologists. A postal questionnaire survey was sent to practising consultant gynaecologists in UK Hospitals. They included urogynaecologists 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. Four hundred fifty-eight responses were received and 398 were completed. For anterior vaginal wall prolapse, anterior colporrhaphy was the procedure of choice in 77% of respondents. With concomitant urodynamic stress incontinence, a Burch was the procedure of choice in 11%, but 79% of respondents would perform a midurethral tape combined with repair. In women with utero-vaginal prolapse the procedure of choice was a vaginal hysterectomy and repair (82%). Twenty-four percent of respondents would operate in women whose family was incomplete. In women with posterior vaginal wall prolapse (PWP), the procedure of choice was posterior colporrhaphy with midline fascial plication (75%). For vault prolapse, 66% of respondents would operate. Thirty-six percent would perform urodynamics prior to surgery. The procedure of choice was an abdominal sacrocolpopexy (38%). There are wide variations in the surgical management of prolapse. Management of POP by urogynaecologists varied in some respects from the general gynaecologists, but were similar to the practices of gynaecologists with a designated interest in urogynaecology.