Total Pelvic Floor Research Articles

Re-treatments of recurrence after pelvic floor repair surgery

Objective: To analyze re-treatments of recurrence after the pelvic floor repair surgery. Methods: The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above), who had received the pelvic floor repair surgery from January 2011 to January 2016. Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy, respectively. Results: Among 81 recurrent patients who were followed up for a median of 35 months (10- 69 months), 78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100% (78/78); 3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback, and 1 case among the three cases had the vaginal foreign body sensation, the subjective satisfaction was 2/3. The methods of surgical operation for the 78 recurrent patients included: total pelvic floor reconstructive surgery (55 cases; 3 of which involve trachelectomy), anterior pelvic reconstructive surgery (2 cases), posterior pelvic reconstructive surgery (3 cases), Y-mesh sacral colpopexy (2 cases), colpocleisis (11 cases), vaginal hysterectomy combined posterior fornix forming (3 cases), and vaginal hysterectomy combined posterior pelvic reconstructive surgery(2 cases). Conclusion: The extent of recurrence, the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery, and then an appropriately individualized re-treatment protocol could be designed for each of the patients.

Deoti surgical flap and sphincteroplasty for treatment of severe perineal deformity

PurposeAnal incontinence is a very stigmatizing condition, which affects biopsychosocially the patient. It is a neglected, but quite common complication of obstetric and anorectal surgery, however it has treatment options. None of the treatment options have exceptional efficacy rates and still associated with risk of recurrence. The surgery techniques known are: anterior and posterior shortening procedure; post-anal repair; anterior elevator plasty and external sphincter plication; total pelvic floor repair and sphincter repair. None of them use a flap rotation of adipose tissue. The purpose is to propose a new surgery technique of anal sphincteroplasty, which uses flap rotation, for severe perineal deformity associated with anal incontinence. MethodsPatient with severe perineal deformity and anal incontinence treated with a new surgery technique of sphincteroplasty with flap rotation. ResultsThe severe perineal deformity was corrected with both esthetic and functional results. Anal continence measured by Wexner and Jorge assessment in a follow-up period of 2 years after the intervention. Pictures and video show esthetic and functional aspects. ConclusionThis is the first time that a flap rotation is used to treat a severe perineal deformity. And the technique presented promising outcomes, which allows perineum reconstruction that is similar to the original anatomy. Therefore, this technique is justified to better evaluate its efficiency and the impact on patients’ prognosis.

Observation about postoperative complication of pelvic floor reconstruction and nursing progress

Total pelvic floor reconstruction is a minimally invasive and effective method for the treatment of pelvic organ prolapsed. It is a minimally invasive and effective method for the treatment of pelvic organ prolapsed, and it significantly improves the quality of life of patients. However, due to the complex anatomy of the pelvic floor, the requirements of clinical physicians and nursing is high, and related complications are easy to occur. This article introduces the observation and nursing care of the complications such as the bladder/rectum and nerve injury, the erosion of the mesh, the symptoms of the pelvic floor reconstruction, the pain or discomfort of the intercourse. Summary of the recent 10 years research results, to provide reference and guidance for clinical nursing work. Key words: Nursing care; Postoperative complications; Pelvic organ prolapse; Pelvic floor reconstruction

Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review.

Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review.

PWE-378 Total pelvic floor ultrasound in pelvic floor defaecatory dysfunction: Abstract PWE-378 Table 1

Introduction Defaecation proctography is gold standard for pelvic floor defaecatory dysfunction assessment but entails radiation. Total pelvic floor ultrasound (USS) allows a safe, dynamic assessment in clinic. The aim was to determine accuracy of USS, compared to proctography, for anatomical findings in women with pelvic floor defaecatory dysfunction. Secondary aims were identification of USS predictors of a trapping rectocoele, significant enterocoele and surgical treatment. Method All consecutive women undergoing investigation for defaecatory dysfunction between May 2011 and November 2014 were retrospectively reviewed by an interpreter blinded to symptoms and results. The following data were collated; The presence/absence of a rectocoele, intussusception and enterocoele, and grade of intussusception for both modalities. The presence of a trapping rectocoele and/or significant enterocoele for proctography. Subsequent treatment (biofeedback/surgery) was recorded. Results 393 underwent USS and proctography. 69 were excluded (images unavailable (24), incomplete (38) or poor quality (5) or tests performed over 2 months apart (2)). Of the 324 included mean length of follow up was 22 months. On proctography 283 had a rectocoele (111 trapping), 142 intussusception and 80 an enterocoele (40 significant). On ultrasound 284 had a rectocoele, 105 intussusception and 55 an enterocoele. 46 underwent surgery. Using proctography as gold standard USS had the following results. Rectocoeles detected on both transperineal and transvaginal USS were more likely to produce barium trapping on proctography (p An enterocoele detected on USS was more likely a significant enterocoele on proctography (p Agreement between the grading of intussusception by USS and proctography was moderate (intra-class correlation coefficient 0.52). Conclusion Transperineal USS is highly sensitive for detecting rectocoele. A rectocoele visible on both transperineal and transvaginal USS is significantly more likely to produce trapping on proctography and require surgery. Also, an enterocoele detected on USS is significantly more likely to descend onto the lower rectum during proctography. USS may be used as a screening tool to identify those patients who may benefit from defaecation proctography for further treatment planning, including surgery. This may avoid performing defaecation proctography on all patients. Disclosure of interest None Declared.

Transplante de órgãos pélvicos: uma nova proposta de tratamento para incontinência fecal e urinária

Incontinência fecal e urinária é um problema atual de saúde pública, com enorme impacto social e econômico. Tratamentos para esse problema são insuficientes. Após investigação anatômica, percebemos o assoalho pélvico como tecido composto independente que compartilha pedículo vascular (ilíaca interna) e neuronal (pudendo) comum. Neste manuscrito nós descrevemos transplante de órgãos pélvicos em ratos e cadáveres. Doador - Uma incisão combinada perineal e abdominal foi realizada. A dissecção progrediu perto do anel pélvico; o nervo pudendo e seus vasos foram divididos permitindo a mobilização total do assoalho pélvico. Através da incisão abdominal, genitália, bexiga e reto foram mobilizados. A aorta e a veia cava foram isoladas, preservando os vasos ilíacos internos e os vasos espermáticos. Os enxertos contendo pele, complexo muscular, ligamentos, bexiga, uretra, vagina ou pênis, reto, ânus, útero, ovário, testículo e seus condutos foram removidos. Receptor - A mesma estratégia de incisão e dissecção do doador foi realizada. Os vasos ilíacos internos, incluindo vasos retais e nervos pudendo foram divididos e os tecidos do assoalho pélvico foram removidos em bloco. A aorta e a veia cava infra-renal foram isolados, o enxerto foi colocado no abdômen e foi realizada anastomose aorta-aorta e cava-cava. Também realizamos anastomoses do ureter, reto e nervos e vasos pudendo. O assoalho pélvico foi colocado em sua posição original por pontos entre os ligamentos do assoalho pélvico, nervos e vasos pudendo, peritônio e da pele, concluindo a operação. Nesta pesquisa, mostramos que a cirurgia de transplante do assoalho pélvico é viável.

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.

Surgical Technique For Pelvic Floor Transplantation.

Fecal and urinary incontinence (FUI) is a current public health problem with enormous social and economic impact. Treatments for FUI are insufficient. After anatomic investigation we perceived pelvic floor as an en block composite tissue sharing a common vascular pedicle (external iliac) and neuronal trunk (pudenda). In this report we describe pelvicfloor transplantation in male and female cadaver. Donor operation - A combined perineal and abdominal incision are performed. The dissection progress between the leg root tissues and pelvic floor near the pelvic ring and pudendal nerves and vessels are divided allowing the total pelvic floor mobilization - (1A, 1B).Figure: No Caption available.Through the abdominal incision, the genital organs, bladder and rectum are mobilized. The aorta and vena cava are isolated up to the renal vessel and down to the iliac bifurcation preserving the external iliac vessels. The aorta and vena cava are sectioned by the renal vessels to preserve the spermatic vessels. The graft -[Figure 1](1C, 1D) containing skin, muscular complex, ligaments, bladder (B), ureter (UR), vagina (V) or penile (P), rectum (R), anus (A), uterus (UT), ovarian (O), testis (T) and its ducts (D) is removed. Recipient operation - The same donor's perineal and abdominal incision and dissection strategies were performed. The external iliac vessels including rectal vessels and pudendal nerves are divided and the en block pelvic floor tissues are removed. The infrarenal aorta and vena cava were isolated, the graft was positioned in the abdomen and an end to side aorta-aorta and cava-cava anastomosis were performed. We also performed anastomosis between donor and recipient ureter, rectum and pudenda nerves and vessels. The pelvic floor was repositioned in its original position by stitches between pelvic floor ligaments, pudendal nerves and vessels, peritoneum and skin, completing the operation -[Figure 1](1E, 1F). Conclusion. In this survey we show that pelvic floor transplantation surgery is feasible. This innovation is an open door for ethical, physiological, anatomic and surgical debate.

Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: impact on early recovery of urinary continence.

To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes. A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction. There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P < 0.05). The mean interval to achieve continence was significantly shorter in the total pelvic floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003). The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical reinforcement of the pelvic floor. Therefore, this technique is likely to improve urinary continence outcomes after laparoscopic radical prostatectomy.

Total pelvic floor reconstruction versus transvaginal hysterectomy for pelvic organ prolapse: a retrospective cohort

Aims: To evaluate the surgical outcomes following total pelvic floor reconstruction (TPFR) and transvaginal hysterectomy (TVH). Materials and Methods: This was a retrospective cohort study of all patients who underwent TPFR or TVH repair for pelvic organ prolapse (POP) between January 2005 and January 2011. A total of 251 consecutive women were evaluated prior to, and at two, six, and 12 months after surgery. Anatomy, symptoms, and quality of life were measured using the Pelvic Organ Prolapse Quantification system (POP-Q) and pelvic floor distress inventory (PFDI). The surgical outcomes were compared between groups using Student’s t-test and ANCOVA tests (p Results: Of the 251 patients, 129 had a total pelvic floor reconstruction (TPFR group), and concomitant modified transobturator inside-out tension-free urethral suspension (TVT-O) was used in pelvic floor dysfunction patients with stress urinary incontinence. The patients that underwent vaginal hysterectomy surgery (TVH group) were 122. At two, six, and 12 months, respectively, 12.40% (TPFR group) and 18.85% (TVH group) of the patients were lost to follow-up. There were no significant differences between TPFR group and TVH group for all preoperative variables (p > 0.05). The TPFR patients had significantly lower operation time, blood loss, anus exhaust time, remaining catheter time, and the length of stay in hospital (p 0.05). Postoperatively, the recurrence rate in TVH group was higher than that of TPFR group after surgery at six and 12 months (p 0.05). The PFDI score was significantly different between the groups. Conclusions: The short-term clinical results suggest that the two surgeries are safe and effective in treating female POP. The patients’ quality life was improved, but TPFR technique was more conspicuous for treating POP.

Surgery for faecal incontinence in adults.

Faecal incontinence is a debilitating problem with significant medical, social and economic implications. Treatment options include conservative, non-operative interventions (for example pelvic floor muscle training, biofeedback, drugs) and surgical procedures. A surgical procedure may be aimed at correcting an obvious mechanical defect, or augmenting a functionally deficient but structurally intact sphincter complex. To assess the effects of surgical techniques for the treatment of faecal incontinence in adults who do not have rectal prolapse. Our aim was firstly to compare surgical management with non-surgical management and secondly, to compare the various surgical techniques. Electronic searches of the Cochrane Incontinence Group Specialised Register (searched 6 March 2013), the Cochrane Colorectal Cancer Group Specialised Register (searched 6 March 2013), CENTRAL (2013, issue 1) and EMBASE (1 January 1998 to 6 March 2013) were undertaken. The British Journal of Surgery (1 January 1995 to 6 March 2013), Colorectal Diseases (1 January 2000 to 6 March 2013) and the Diseases of the Colon and Rectum (1 January 1995 to 6 March 2013) were specifically handsearched. The proceedings of the Association of Coloproctology of Great Britain and Ireland annual meetings held from 1999 to 2012 were perused. Reference lists of all relevant articles were searched for further trials. All randomised or quasi-randomised trials of surgery in the management of adult faecal incontinence (other than surgery for rectal prolapse). Three review authors independently selected studies from the literature, assessed the methodological quality of eligible trials and extracted data. The three primary outcome measures were change or deterioration in incontinence, failure to achieve full continence, and the presence of faecal urgency. Nine trials were included with a total sample size of 264 participants. Two trials included a group managed non-surgically. One trial compared levatorplasty with anal plug electrostimulation and one compared an artificial bowel sphincter with best supportive care. The artificial bowel sphincter resulted in significant improvements in at least one primary outcome but the numbers were small. The other trial showed no difference in the primary outcome measures.Seven trials compared different surgical interventions. These included anterior levatorplasty versus postanal repair, anterior levatorplasty versus total pelvic floor repair, total pelvic floor versus postanal repair, end to end versus overlap sphincter repair, overlap repair with or without a defunctioning stoma or with or without biofeedback, and total pelvic floor repair versus repair plus internal sphincter plication and neosphincter formation versus total pelvic floor repair. Sacral nerve stimulation and injectables are considered in separate Cochrane reviews. Only one comparison had more than one trial (total pelvic floor versus postanal repair, 44 participants) and no trial showed any difference in primary outcome measures. The review is striking for the lack of high quality randomised controlled trials on faecal incontinence surgery that have been carried out in the last 10 years. Those trials that have been carried out have focused on sacral neuromodulation and injectable bulking agents, both reported in separate reviews. The continued small number of relevant trials identified together with their small sample sizes and other methodological weaknesses limit the usefulness of this review for guiding practice. It was impossible to identify or refute clinically important differences between the alternative surgical procedures. Larger rigorous trials are still needed. However, it should be recognised that the optimal treatment regime may be a complex combination of various surgical and non-surgical therapies.

Conventional repair, Prolift system and Gynemesh system in total pelvic floor reconstruction: a comparison

Objective To compare the conventional repair,Prolift system and Gynemesh system in total pelvic floor reconstruction.Methods Forty patients with pelvic organ prolapse(POP),who were treated in our department from March 2009 to March 2011,were included in the present study.Fifteen cases were in the conventional repair group,10 in the Prolift system surgery,and the other 15 in the Tongshi group(revised total pelvic floor construction with Gynemesh).The pre-,peri-operative data and follow-up results were compared between the 3 groups.Results The body mass index,menopause age,pregnant times and the degrees of prolapses were comparable in the 3 groups(P0.05).The degrees of anterior and posterior vaginal proplase and uterus proplase were not significantly different between the 3 group(P0.05).The intro-operative blood loss,highest body temperature,residual urine,operation time,and hospital stay were not significantly different between the 3 groups(P0.05).The follow-up rate was 100% for the Prolift group,with a mean time of(5.8±2.0) months;one case developed erosion in the anterior vagina1 wall and one had Ⅰ stress urinary incontinence.The follow-up rate was 93.3% in the Gyenmesh group,with a mean time of(9.1±2.0) months;one case had chylous ascites after whole pelvis suspension and one had recurrent anterior vaginal proplase POP-Q Ⅱ.The follow-up rate was 100% in the classical group,with a mean time of(9.1±5.0) months;anterior and posterior vaginal proplase POP-Q Ⅱ were each found in one case.Conclusion Conventional repair,Prolift system and Gynemesh system are all safe and suitable for total pelvic floor reconstruction,and they have no difference concerning the short-term clinical outcomes and complications.

Operation nursing with the materials application of surgimesh system and T-sling system in total reform pelvic floor reconstruction

Objective To summarize up the operation nursing and health education of reforming pelvic floor reconstruction.Methods Totals of 61 women who underwent the surgery for reforming pelvic floor reconstruction were selected and used the materials of surgimesh system and T-sling system during their operation.And the nursing and the health education for the operation were summarized,and the nursing key was proposed.Results All surgeries were successfully completed.Among 61 cases,no case had a relapse,erosion,net exposure,hematom,vaginaled fistel,and hospital infection occurred.Conclusions Health education such as learning knowledge of anatomy before operating,right operative positions,positive and rigorous care cooperation,kegle function exercise and so on,is an efficient path to improve the success of operation and reduce the relapse. Key words: Nursing; Health education; Surgimesh system; T-sling system; Reform pelvic floor reconstruction

Total Pelvic Floor Reconstruction with Uterine Conservation

Total Pelvic Floor Reconstruction with Uterine Conservation

Anal Sphincter Repair zur Therapie der Stuhlinkontinenz - Wann und wie?

Anal incontinence is a disease of high prevalence. For many patients the disease causes severe stress and often results in social isolation. Whenever a sphincter lesion has been diagnosed by digital rectal examination and endosonographic access, anal sphincter reconstruction can be performed with the same results either in overlapping or in end-to-end suture technique. sing these procedures, in more than 60 % of patients the continence can be initially improved. However, benefit decreases after 5 years down to 40-50 %. The prognosis gets worse with increasing age and supplementary descending pelvic floor. Anal repair with reconstruction of internal and external sphincters is performed in neurogenic incontinence. This can be achieved by posterior or anterior anal repair (total pelvic floor repair). Nowadays these procedures are not common, due to unsuccessfulness. Instead, sacral nerve stimulation as a more expensive but less invasive method has displaced the anal repair on this indication. Interpretation of the published results remains delicate because of heterogenous evaluation criteria of postoperative outcome: subjective amelioration, postoperative satisfaction and quality of life, improvement of incontinence score or achievement of complete anal continence. However, it is proven that after immediate reconstruction of traumatic sphincter lesions the postoperative outcome is better than a two-step operation with primary ostomy.

Trans-vaginal total pelvic floor repair using customized prolene mesh: A safe and cost-effective approach for high-grade pelvic organ prolapse

Aims:To assess safety, efficacy, and cost-effectiveness of trans-vaginal total pelvic floor repair with customized prolene mesh in patients with high-grade pelvic organ prolapse.Materials and Methods:A total of 32 patients, who underwent trans-vaginal total pelvic floor repair using a customized prolene mesh from January 2007 to June 2010 for grade III and IV pelvic organ prolapse, were analyzed retrospectively. Prolapse was graded using Pelvic Organ Prolapse Quantification system of International Continence Society. Patients were evaluated for symptoms associated with prolapse pre- and postoperatively.Results:Of the 32 patients, 18 were grade IV uterine prolapse, 10 were grade III uterine prolapse, and 4 were grade IV vault prolapse. Twenty-eight patients underwent vaginal hysterectomy at the time of repair. All the patients had associated anterior and posterior prolapse of varying degree. Follow-up ranged from 6 to 42 months. All patients had symptomatic relief after surgery. There were no intraoperative rectal or bladder injuries. Early complications were perineal pain (30), de novo urgency (4), vaginal discharge (3), vaginal wall hematoma (2), and failure to void (2). Two patients had vaginal erosion of mesh.Conclusions:Trans-vaginal total pelvic floor repair using a customized prolene mesh is safe and effective treatment for comprehensive repair of high-grade pelvic organ prolapse. The use of this custom-made prolene mesh makes the procedure very cost-effective and affordable. The reduction in cost is about 25-30 times with the use of this mesh when compared with commercially available variety.

Resident Duty-Hour Restrictions and Their Effect on Operative Experience in Obstetrics and Gynecology

Background/Aims: To determine the effect of duty-hour restrictions on the operative experience of obstetrics and gynecology residents. Methods: Operative numbers were obtained from graduates of Mayo Clinic (Rochester, Minn., USA) and Good Samaritan Hospital (Cincinnati, Ohio, USA). Mean operative numbers between graduates in 2007 and 2003 were compared. The following procedures were evaluated: spontaneous vaginal delivery, forceps-assisted vaginal delivery, vacuum-assisted vaginal delivery, cesarean delivery, surgery on antenatal patients, amniocentesis, total abdominal hysterectomy, total vaginal hysterectomy, laparotomy, incontinence or pelvic floor surgery, operative laparoscopy, hysteroscopy, cervical conization, and surgical sterilization. The number of procedures performed (total and as the primary surgeon) were evaluated. We analyzed each institution’s residents separately. Results: At Mayo Clinic, the 2007 graduates performed significantly fewer conizations than the 2003 graduates (p = 0.006). At Good Samaritan Hospital, the 2007 graduates performed significantly more vacuum-assisted vaginal deliveries (p = 0.002), cesarean deliveries (p = 0.002), and sterilizations (p < 0.001) than the 2003 graduates. The above findings were unchanged when evaluating procedures for which the resident was the primary surgeon. Conclusion: Duty-hour restrictions have not adversely affected the operative experience of obstetrics and gynecology residents. No significant differences in the number of the spontaneous vaginal deliveries, abdominal hysterectomies, or vaginal hysterectomies performed were observed.

Prospective multi-center study in "Xiehe" pelvic floor reconstruction surgery for severe pelvic organ prolapse

To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery. From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage III to IV from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. With a median follow-up of 14.0 months (6 - 28 months), twenty-three patients showed recurrent prolapse (8.3%, 23/277), and anatomical success (< stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6.9% (19/277). The postoperative de novo stress incontinence rate was 6.5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P < 0.01). And there was no significant difference in the average score of PISQ before and after the surgery (76.6 ± 15.4 versus 75.5 ± 14.5 versus 73.6 ± 12.6, P > 0.05), but the rate of de novo dyspareunia was 11% (9/80). "Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

Total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse.

To evaluate clinical effectiveness of total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse. We retrospectively analyzed the clinical data of 21 patients with severe pelvic organ prolapse. The anatomical outcomes were evaluated by Pelvic Organ Prolapse Quantitation, functional effectiveness by Prolapse Quality of Life method, and sexual function and operation-related complications were also analyzed. All surgical operations were accomplished successfully by the same surgeon. No impairment of bladder, urethra, rectum, or great vessels was noted, and no patient required blood transfusion. The mean operation duration was (63±19) minutes, and the mean intra-operative blood loss was (143±72) ml. One patients experienced post-operative urinary retention for 7 days, and the remaining 20 patients were able to micturate spontaneously 1-2 day after surgery. The post-operative morbidity rate was 14.3%. Three patients (14.3%) experienced mesh erosion. Of 12 patients who were sexually active, two patients suffered from algopareunia from dyspareunia, one from de novo overactive bladder, and one from stress urinary incontinence Questionnaire scores showed that the overall post operative quality of life was improved significantly (P=0.000), while quality of sexual life significantly degraded (P=0.044) The anatomic cure rate was 95.2% (20/21), and the patient subjective satisfaction rate was 85.7% (18/21) The total pelvic floor reconstruction is a safe and effective approach for the repair of severe pelvic organ prolapse, although its functional effectiveness is not as notable as anatomical outcomes However, the complications such as mesh erosion, low urinary tract symptoms, algopareunia, and dyspareunia should be carefully managed.

Total Prolift(TM) system surgery for the repair of recurrent severe pelvic organ prolapse

To evaluate the clinical outcomes of total Prolift(TM) system surgery for the repair of recurrent severe pelvic organ prolapse. The clinical records of 13 cases of recurrent severe pelvic organ prolapse were retrospectively analyzed. The characteristic was vaginal vault prolapse in combination with anterior and posterior wall prolapse. Anatomic effect (according to POP-Q score), functional effect (according to prolapse quality of life) and sexual life (according to sexual life score) of each patient were assessed. All subjects were post-menopausal with a mean age (60 ± 9) years and a mean BMI of (25.6 ± 2.9) kg/m(2). All operations were accomplished successfully without any impairment of bladder, urethra, rectum, great vessels or nerves or blood transfusion. The mean operation time was (61 ± 18) minutes and the mean blood loss (155 ± 84) ml. All patients were followed up for a medium of 19 (15 - 30) months. Except for one post-operative urinary retention for a period of 7 days, 12 patients were able to micturate spontaneously 1 - 2 d post-operatively with a residual urine volume of less than 100 ml. During follow-up, mesh erosion (n = 1), de novo overactive bladder (n = 1), one algopareunia (n = 1) and dyspareunia (n = 1) occurred. Postoperative Quality of Life Scores improved significantly (P < 0.01). However, sexual life scores was impaired (P < 0.05). The anatomic cure rate was 92.3% and the patient subjective satisfactory rate 84.6%. The total Prolift(TM) system surgery represents a safe, simple and useful treatment for recurrent severe pelvic organ prolapse with satisfactory objective clinical outcomes. However, the level of patient subjective satisfaction is lower than objective cure rate. Meanwhile, harmful effects on sexual life remain a main concern.