Technique For Pelvic Organ Prolapse Research Articles

A Modified McCall Culdoplasty in Pelvic Organ Prolapse Surgery: Anatomical and Functional Outcomes.

The aim of this study was to evaluate anatomical and functional outcomes of a modified McCall culdoplasty compared with the traditional technique for pelvic organ prolapse. This prospective clinical observational study was conducted in a secondary referral urogynecological center between October 2021 and October 2022. A modified McCall culdoplasty was performed in 85 patients (group A). It was characterized by dissection of uterosacral ligaments up to the ischial spines, their shortening and attachment to the vaginal apex and both the rectovaginal and the vesicovaginal fascia. Outcomes were compared with those of a group of 86 patients (group B) who underwent the traditional culdoplasty between September 2020 and September 2021. Primary outcome was prolapse recurrence. Secondary endpoints included subjective outcomes, vaginal length, quality of life, and urinary and anal incontinence. Statistical analysis was conducted using Fisher's exact, Mann-Whitney U, and Student's t tests. At 12months, prolapse recurrence occurred in 2.5% (CI 0.7-8.8%) of patients in group A and in 6.7% (CI 2.9-14.7%) in group B. Postoperative vaginal length was 8.3 ± 0.78cm in group A and 6.4 ± 1.1cm in group B (p < 0.001). The Patient Global Impression of Improvement questionnaire revealed that 76 patients (96.2%) in group A versus 64 (85%) in group B were very satisfied (p < 0.03). Both groups showed an improvement in urinary symptoms and quality of life. The modified McCall culdoplasty showed successful anatomical and functional outcomes, with a tendency towards lower recurrence rates than the traditional McCall procedure. Further long-term studies are needed to confirm our data.

Subjective Long-Term Outcomes After Vaginal Native Tissue Hysteropexy: Cohort Study.

There are still doubts about long-term satisfaction rates of native tissue uterine preserving surgical techniques for pelvic organ prolapse. The objective of this study was to compare long-term subjective success rates and satisfaction rates between vaginal sacrospinous hysteropexy (SSHP) and vaginal hysterectomy with uterosacral ligament suspension (VH-USLS). This was a retrospective single-center, observational matched cohort study in women receiving either SSHP or VH-USLS between 2004 and 2021. Primary outcome was overall subjective success (combined outcome of absence of bulge nor retreatment, and satisfaction with operation) at least 12 months after surgery. Satisfaction with the operation was defined as a combined Patient Global Impression of Improvement rating ≤ 2 and a patient satisfaction score ≥7. Of 583 patients, 192 patients could be matched (SSHP, 96; VH-USLS, 96), with 55% (SSHP, 60; VH-USLS, 45) participating at the telephone interview. Mean follow-up time was 77 months for VH-USLS, and 36 months for SSHP, respectively. No difference in overall subjective success rates was found between the groups (45% VH-USLS and 51% SSHP; P = 0.54). Overall satisfaction was similar between both groups (70% vs 71%, P = 0.90). Logistic regression found no influence of duration of follow-up and the overall subjective success rate. Both procedures would be recommended to a relative or friend by a large majority of patients (88% vs 85%, P = 0.761). Operative time and hospitalization time were significantly shorter in the SSHP group. No serious complications were reported. Overall success rates did not differ between both procedures after at least 1 year of follow-up with relatively high satisfaction rates. Sacrospinous hysteropexy had shorter operative time and shorter duration of hospitalization.

Long-term outcomes and quality of life after Manchester procedure for pelvic reconstructive surgery in women with cervical elongation

ObjectiveNative-tissue techniques for Pelvic Organ Prolapse (POP) repairs, such as the Manchester Procedure (MP), have recently been revitalized. However, there are conflicting opinions regarding correcting cervical elongation support by the MP, and the risk of possible poor outcomes and postoperative complications.Therefore, this study aimed to investigate anatomical and patient-reported outcomes during one year after MP. DesignProspective cohort study. SettingThis study was conducted on women who underwent the MP for cervical elongation between 2010 and 2020. PatientsWomen with apical compartment prolapse up to stage 3 due to cervical elongation. InterventionsManchester Procedure. MeasurementsPre and postoperative evaluations by POP Quantification (POP-Q) system were performed, and patients filled out the quality-of-life questionnaires including Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 12 months after the procedure. Anatomical outcomes were measured by POP-Q and the changes in POP-related symptoms were evaluated and reported. Main Results33 participants were recruited in the study. Significant anatomical improvements were obtained in all compartments after the surgery. After 12 months in POP-Q examination, the mean (±SD) of Ba was changed from +1.82 (±1.71) to −1.18 (±1.50), C was changed from −1.25 (±2.81) to −6 (±1.82), and D from −6.30 (±1.42) to −7.1 (±1.25) respectively (P < 0.001). POP-Q stage 0–1 was obtained inof7% in the apical compartment (C < −1), but only in 45.4% in the anterior compartment (Ba < −1). A significant reduction in symptom scores was obtained for PFDI-20 (P < 0.01) and PISQ-12 (P = 0.011). ConclusionsOur findings suggest that the MP provides adequate apical support with improvement in anatomic and subjective findings for patients with cervical elongation.

Laparoscopic Sacrocervicopexy Using Ethibond Suture Graft: A Very Economic Yet Effective Fertility Preserving Surgery for Pelvic Organ Prolapse.

The modern era has witnessed a transition to a phase of uterus-preserving surgeries and so holds true for pelvic organ prolapse (POP) surgeries as well. Laparoscopic sacrocervicopexy has become a preferred surgical modality for moderate to severe degrees of POP in most women of the childbearing age group. With the alarming incidences of mesh erosion, synthetic mesh has almost gone offthe market. We advocate a very simple and cost-effective technique of laparoscopic sacrocervicopexy using an Ethibond suture graft. It was a pilot prospective observational study over one year. Consecutive consenting women with symptomatic prolapsed uterus Stage-II of the central component of the quantitative POP classification (POP-Q) were recruited. Laparoscopic sacrocervicopexy was performed under general anesthesia using the standard protocols, and patients were prospectively followed for six months after surgery. The duration of surgery and hospital stay were noted. Patient satisfaction was rated using a five-point Likert scale. The vaginal length was measured immediately after and six months post-surgery. Sexual function was assessed using the validated female sexual function index (FSFI) scale six months after sacrocervicopexy. Out of 28 recruited women, the majority were multiparous, highly qualified, and belonged to the middle socio-economic class. Seven patients had co-morbidity in the form of hypertension (17.8%), diabetes (7.1%), and cardiovascular diseases (7.1%). The mean duration of surgery was 105.8±7.2 minutes in the study population. The mean duration of hospital stay was 2.2±0.6 days. No surgical site infection was noted in any of the cases. Most patients rated "very satisfied" experiences following surgery (67.9%). The mean vaginal length after surgery was 7.6±1.2 centimeters. After a follow-up period of six months, the mean vaginal length was 7.4±0.8 centimeters. The mean FSFI score was 30.8±2.4. Laparoscopic sacrocervicopexy with Ethibond suture graft is a cost-effective and safe surgical technique for POP in resource-limited settings. It also obviates the additional cost of synthetic mesh and the long-term risks of mesh erosion.

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

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

Laparoscopic latero-abdominal colposuspension: Description of the technique, advantages and preliminary results

IntroductionThere are currently various fixation or suspension techniques for pelvic organ prolapse (POP) surgery. Laparoscopic colposacropexy is considered the gold standard. We present the surgical steps of the laparoscopic latero-abdominal colposuspension (LACS) technique and the preliminary results obtained. Material and methodsPatients with anterior and/or apical compartment symptomatic POP undergoing LACS are included. The Baden-Walker scale, the Overactive Bladder Questionnaire-Short Form (OAB-q SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Patient Global Impression of Improvement (PGI-I) scale were used to assess the degree of prolapse, urinary filling and sexual symptoms and the level of satisfaction before and after surgery, respectively. Conventional laparoscopic material and a polyvinylidene fluoride (PVDF) mesh were used. ResultsEighteen patients were included with a minimum follow-up time of 6 months. The mean surgical time was 70.3 ± 23.8 min. Anatomic correction of prolapse was seen in all cases. Only one recurrence was detected. High levels of patient satisfaction were achieved. ConclusionLACS allowed the anatomical reconstruction of the pelvic floor and proved to be a minimally invasive, fast, effective, safe and reproducible technique. More series are needed to evaluate its role against laparoscopic colposacropexy.

Colposuspensión latero-abdominal laparoscópica: descripción, ventajas y resultados preliminares

IntroductionThere are currently various fixation or suspension techniques for pelvic organ prolapse (POP) surgery. Laparoscopic colposacropexy is considered the gold standard. We present the surgical steps of the laparoscopic latero-abdominal colposuspension (LACS) technique and the preliminary results obtained. Material and methodsPatients with anterior and/or apical compartment symptomatic POP undergoing LACS are included. The Baden-Walker scale, the Overactive Bladder Questionnaire-Short Form (OAB-q SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Patient Global Impression of Improvement (PGI-I) scale were used to assess the degree of prolapse, urinary filling and sexual symptoms and the level of satisfaction before and after surgery, respectively. Conventional laparoscopic material and a polyvinylidene fluoride (PVDF) mesh were used. ResultsEighteen patients were included with a minimum follow-up time of 6months. The mean surgical time was 70.3±23.8min. Anatomic correction of prolapse was seen in all cases. Only one recurrence was detected. High levels of patient satisfaction were achieved. ConclusionLACS allowed the anatomical reconstruction of the pelvic floor and proved to be a minimally invasive, fast, effective, safe and reproducible technique. More series are needed to evaluate its role against laparoscopic colposacropexy.

Comparison of clinical outcomes between tailored transvaginal mesh surgery and native tissue repair for pelvic organ prolapse

The most suitable surgical technique for pelvic organ prolapse (POP) remains undetermined. The aim of this study was to compare clinical outcomes of the tailored transvaginal mesh (TVM) surgery and vaginal native tissue repair (NTR) surgery for POP. Between November 2011 and August 2014, medical records of 339 women receiving POP surgeries were reviewed. Compared with the NTR group (n=169), the use of TVM surgery (n=170) was a predictor for longer operation time (coefficient=25.2min, P<0.001) and larger blood loss (coefficient=79.9mL, P<0.001) by multivariable analysis. However, a higher recurrence rate of cystoceles (log-rank test, P=0.001) was found in the NTR group, compared with the TVM group; but not apical prolapse (P=0.32) or rectocele (P=0.45). Multivariable analysis revealed that the TVM surgery (hazard ratio=0.24, 95% confidence interval=0.09-0.64, P=0.004) and old age (hazard ratio=1.07, 95% confidence interval=1.02-1.11, P=0.005) were independent predictors for the recurrence of cystoceles. Based on the receiver operating characteristic curve (ROC) analysis, the cut-off age value was 64 years with an ROC area of 0.65. In women with intact uterus (n=162), the recurrence rate of cystoceles was lower in the TVM group (log-rank test, P=0.0001), compared with the NTR group. However, there was no between-group difference in the recurrence rate of cystoceles in women with prior or concomitant hysterectomy (n=177, P=0.17). In women with intact uterus, the TVM group has a lower recurrence rate of cystoceles than the NTR group. In addition, old age, especially more than 64 years old, is a risk factor for cystocele recurrence.

Sacrospinous Ligament Hysteropexy in the Setting of Procidentia

Objective: Approximately 70,000 hysterectomies performed annually in the United States are due to POP, making it the third most common indication for benign hysterectomy. Uterine-sparing techniques such as colpocleisis or hysteropexy are alternative surgical techniques for the treatment of uterine prolapse. The traditional surgical technique for POP has been a hysterectomy with concomitant vaginal vault suspension. Multiple studies have shown comparable success for apical compartment support with sacrospinous hysteropexy as compared to total vaginal hysterectomy with uterosacral ligament suspension. We performed a unilateral sacrospinous hysteropexy with the plan for postoperative follow-up at two and six weeks. The purpose of this video is to demonstrate the sacrospinous hysteropexy surgical technique in the setting of stage IV pelvic organ prolapse (POP) to serve as an educational tool for pelvic reconstructive surgeons of all levels.

The Manchester procedure: anatomical, subjective and sexual outcomes.

Classical native-tissue techniques for pelvic organ prolapse (POP) repairs, such as the Manchester procedure (MP), have been revitalized because of vaginal mesh complications. However, there are conflicting opinions regarding sufficient apical (mid-compartment) support by the MP and concerns about the risk of dyspareunia. The aims of this study were therefore to investigate anatomical and patient-reported outcomes 1year after MP. Prospective cohort study of 153 females undergoing an MP for anterior compartment POP between October 2014 and June 2016. Pre- and 1-year postoperative evaluations included POP-Q measurements and the questionnaires Pelvic Floor Distress Inventory Short Form 20 (PFDI-20) and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12). At 1year, 97% (148/153) attended the follow-up. Significant anatomical improvements (p < 0.01) were obtained in all compartments. Mean Ba was -1.1 (± 1.4), mean C -5.9 (± 1.7) and mean D -7.0 (± 1.2) at follow-up. Point C ≤ -5 was present in 81.1%. POP-Q stage 0-1 was obtained in 99.3% in the mid-compartment (C < -1), but only in 48.6% in the anterior compartment (Ba < -1). A significant reduction in symptom scores was obtained for PFDI-20 (p < 0.01) and PISQ-12 (p = 0.01). No significant changes were seen in dyspareunia rates (q.5, PISQ-12), but 5.6% reported de novo dyspareunia. Concerning POP symptoms, 96.0% reported being cured or significantly improved. The Manchester procedure provides adequate apical support, albeit inferior anatomical anterior compartment results, and 96.0% reported being subjectively cured or substantially better at 1-year follow-up, with no significant change in dyspareunia.

Long term Follow-up of Transvaginal Anatomical Implant of Mesh in Pelvic organ prolapse

Transvaginal mesh (TVM) is a minimally invasive but effective treatment for pelvic organ prolapse (POP). However, mesh exposure is a common and problematic complication after TVM. This study assessed the safety and long-term outcomes of TVM. A retrospective review was performed on the medical records of 175 consecutive patients who underwent TVM with the anatomical implant technique for pelvic organ prolapse at our center from April 2007 to December 2012. All operations were performed using TVM with the anatomical implant technique. Intraoperative variables, postoperative complications, and TVM outcomes were assessed. In average of 8 years (ranging from 4 to 10 years), the objective cure ratio reached 99.4%; and the subjective success rate of the TVM operation was 91.4%. Only 2 cases (1.1%) were identified as having mesh exposure. The reoperation rate was 4.0% (95% CI, 1.1–6.9%). No patients abstained from sex due to the operation or postoperative discomfort. Our anatomical implant technique for correcting POP is feasible in TVM procedures, which lead to favourable subjective and objective outcomes with the lowest rates of mesh exposure (1.1%) in published data. Therefore, performing TVM operations with the appropriate technique could consider to be permitted.

Why complex pelvic organ prolapse should be repaired vaginally

Vaginal surgery is the true minimally invasive surgery in the treatment of pelvic organ prolapse (POP); however, the robotic industry and decreased resident training in vaginal surgery may result in the loss of skills among our graduates. There are a number of procedures that are well accepted in the management of prolapse, because they are minimally invasive and with few complications compared with the abdominal approach. In this review, we will discuss various vaginal techniques for complex POP. In our opinion, the most minimally invasive approach is vaginal surgery. There are no recent significant findings on the vaginal approach to complex pelvic organ surgery and mostly case series about success of robotic procedures. There are a significant number of studies exploring the benefits of robotic surgery. It has been observed that the operating times are longer and there is a learning curve. Although there are advantages to robotic surgery, one must not overlook the significant cost associated with obtaining the robot, the maintenance and the cost of disposable instruments. There is limited evidence to show that robotic surgery did not benefit women with benign gynecological disease in terms of effectiveness or safety. POP is a vaginal problem, which is best treated vaginally. There are many well designed studies that support the vaginal approach to primary POP.

Transvaginal sacrospinous hysteropexy

Sacrospinous hysteropexy provides a transvaginal technique for pelvic organ prolapse (POP) repair with uterine preservation. The objective of the video is to provide an instructional guide for sacrospinous hysteropexy. The featured patient is a 73-year-old woman with anterior predominant stage 3 POP. The video outlines the steps and surgical principles necessary to achieve a successful sacrospinous hysteropexy. Sacrospinous hysteropexy provides a transvaginal approach to POP repair that minimizes operative times and reduces blood loss and risk of lower genitourinary tract injury. Sacrospinous hysteropexy is a timely technique in an era of increasing interest in uterine preservation and should be considered by surgeons well versed in transvaginal surgery.

Abdominal vs Vaginal approach for pelvic organ prolapse

Pelvic organ prolapse(POP) is a common, affecting women of all ages and costly affliction of older women, especially. It has been known that surgical technique for POP is vaginal approach or abdominal approach with/without synthetic mesh and biological graft the common vaginal and abdominal surgical procedures for POP repair according to the defective compartment, with quoted success rates based on anatomical criteria. The objective of this review is to know pros and cons of two surgical approach. Operator needs to be proficient in many different prolapse surgical techniques so that approach of surgical treatment for POP can be tailored to patient needs.

Chirurgie du prolapsus génital de la femme âgée de plus de 70 ans : revue de la littérature

Objective The purpose of the study was to report surgical techniques for pelvic organ prolapse and complications in women aged more than 70 years. Patients and methods A Medline ® search was made for articles indexed between 2000 and 2006 and dealing with operative techniques for pelvic organ prolapse. Seven articles in English and French were included. Results Three hundred and ninety-four women were treated for pelvic organ prolapse. Transvaginal repairs were reported in 97% (384 women). Vaginal function was preserved in 57% (207 women) and vaginal obliteration techniques represented 40% (145 women) of all prolapse surgery. The death rate was 1% (four deaths). The blood transfusion rate was 12%. The mean complication rate was 3.8% with cardiovascular prevalence (seven pulmonary embolisms, two myocardial infarctions, two congestive heart failures, one prolonged angina, two transient arrhythmias, one cerebrovascular accident, one acute renal failure). The temporospatial disorientation rate was 4.6%. Discussion and conclusion Vaginal hysterectomy with colpo-perineorrhaphy and sacrospinous ligament fixation are alternative procedures instead of colpocleisis to treat pelvic organ prolapse in women aged more than 70 years. For all pelvic prolapse surgery, the overall perioperative morbidity and mortality rate in elderly women are acceptable. This surgery needs a good collaboration between anesthetist and surgeon team and vigilance during postoperative follow-up.