Treatment Of Prolapse Research Articles

3D Printable Hydrogel with Tunable Degradability and Mechanical Properties as a Tissue Scaffold for Pelvic Organ Prolapse Treatment

AbstractPelvic organ prolapse (POP) is a dysfunction that affects a large proportion of women. Current support scaffolds’ lack of biocompatibility, biodegradability, and mechanical compliance are associated with surgical complications including erosion and pain, indicating the urgent need for new tissue scaffolds with customizable functions. A new material that uses polyvinyl alcohol (PVA) as the main ingredient and is chemically tuned to possess suitable mechanical properties and degradation rates for the surgical treatment of POP is developed. Specifically, the thiol‐norbornene “click” chemistry enables the sol‐gel transition of the biomaterial under UV‐light without side‐products. Meanwhile, NaOH treatment further toughens the hydrogel with a higher crosslink density. The PVA‐based biocompatible ink can be printed with UV‐facilitated direct ink writing due to the rapidly UV‐initiated chemical crosslink; in situ image analysis and machine learning methods are applied during this procedure to quantify and improve the printing quality. The cell viability results demonstrate the biocompatibility of the POP scaffolds, suggesting the potential for future animal studies and the possibility of clinical research. This study bridges polymer chemistry and manufacturing engineering with a specific tissue engineering application to solve the common disorder of POP, shedding light on individualized medicine and intelligent systems for biomedical engineering.

Treatment of pelvic organ prolapse by laparoscopic promontory fixation. Our results

Treatment of pelvic organ prolapse by laparoscopic promontory fixation. Our results

Technical modifications for cost optimization in robot-assisted ventral mesh rectopexy: an initial experience

BackgroundRobot-assisted ventral mesh rectopexy is considered a valid option in the treatment of rectal prolapse. However, it involves higher costs than the laparoscopic approach. The aim of this study is to determine if less expensive robotic surgery for rectal prolapse can be safely performed.MethodsThis study was conducted on consecutive patients who underwent robot-assisted ventral mesh rectopexy at Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, from 7 November 2020 to 22 November 2021. The cost of hospitalization, surgical procedure, robotic materials, and operating room resources in patients undergoing robot-assisted ventral mesh rectopexy with the da Vinci Xi Surgical Systems was analyzed before and after technical modifications, including the reduction of robotic arms and instruments, and the execution of a double minimal peritoneal incision at the pouch of Douglas and sacral promontory (instead of the traditional inverted J incision).ResultsTwenty-two robot-assisted ventral mesh rectopexies were performed [21 females, 95.5%, median age 62.0 (54.8–70.0) years]. After an initial experience performing traditional robot-assisted ventral mesh rectopexy in four patients, we adopted technical modifications in other cases. No major complication or conversion to open surgery occurred. In total, mean cost of hospitalization, surgical procedure, robotic materials, and operating room resources was €6995.5 ± 1058.0, €5912.7 ± 877.0, €2797.6 ± 545.6, and €2608.3 ± 351.5, respectively. Technical modifications allowed a significant reduction in the overall cost of hospitalization (€6604.5 ± 589.5 versus €8755.0 ± 906.4, p = 0.001), number of robotic instruments (3.1 ± 0.2 versus 4.0 ± 0.8 units, p = 0.026), and operating room time (201 ± 26 versus 253 ± 16 min, p = 0.003).ConclusionsConsidering our preliminary results, robot-assisted ventral mesh rectopexy with appropriate technical modifications can be cost-effective and safe.

Sexual Dysfunction in Women Suffering from Gynecological Diseases

The analysis of long-term efficiency of operative treatment of pelvic prolapse for 213 women in periods ranging from 12 through questionnaire PISQ-12 (Pelvic Organ Prolapse and Incontinence Sexual Function Questionnaire), recommended for use in clinical practice of the international urogynaecologic Association and adapted by the authors for work . Method of evaluating the effectiveness of surgical treatment of pelvic and prostate has been streamlined through the introduction of a system of qualitative analysis of the results of the study of sexual function. Found that operational treatments pelvic prolapse have a positive effect on sexual function of women. Significant differences of sexual function in remote postoperative period depending on the type of operational benefits.The best effect with regard to the favourable dynamics of sexual function is achieved after laparoscopic operative treatment of pelvic prolapse compared with vaginal hysterectomy

What are the surgical options for recurrent rectal prolapse – retrospective single-center experience

Most authors highlight the absence of international guidelines in the treatment of recurrent rectal prolapse (RRP), even among coloproctologists. However, it is clearly indicated that Delormes or Thierschs surgeries are reserved for older and fragile patients, so on the other hand, transabdominal surgeries are dedicated to generally fitter patients. The aim of the study is evaluation of surgical treatment effects for recurrent rectal prolapse (RRP)Methods: The study group comprised of 20 female and 2 male patients aged from 37 to 92 years (subjected to treatment last 20 years). Initial treatment consisted of abdominal mesh rectopexy (n=4), perineal sigmorectal resection (n=9), Delormes technique (n=3), Thierschs anal banding (n=3), colpoperineoplasty (n=2), anterior sigmorectal resection (n=1). The relapses occured between 2 to 30 months. Reoperations consisted of abdominal without (n=8) or with resection rectopexy (n=3), perineal sigmorectal resection (n=5), Delormes technique (n=1), total pelvic floor repair (n=4), perineoplasty (n=1). 11 patients (50%) were completely cured. 6 patients developed subsequent RRP. They were successfully reoperated (2 rectopexies, 2 perineocolporectopexies, 2 perineal sigmorectal resections). Abdominal mesh rectopexy is the most effective method for RP and RRP treatment. Total pelvic floor repair may prevent RRP. Perineal rectosigmoid resection results of less permament effects of RRP repair.

Robotic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse using the new Hugo RAS system.

Robotic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse using the new Hugo RAS system.

Involving people with a lived experience when developing a proposal for Health Technology Assessment research of nonsurgical treatments for pelvic organ prolapse: Process and reflections.

Patient and public involvement (PPI) is an expectation when conducting research, including Health Technology Assessment (HTA), but practical guidance for those wishing to embed PPI into the grant application process is not always easily accessible. We wanted to ensure that PPI was central when preparing a proposal for an investigator-led evidence synthesis HTA investigating nonsurgical interventions for pelvic organ prolapse (POP) in women. Here, we describe our methods. We recruited two patient co-applicants separately through an open process to help ensure that patient voice was present within our proposal's management and direction. We invited co-applicants to attend research team meetings and comment on the full proposal. We designed, recruited to and facilitated a scoping workshop, as well as undertook its subsequent evaluation. The insight shared within the workshop for patients with a lived experience of POP, including our patient co-applicants, helped us develop the scope and rationale behind our HTA proposal. We particularly considered the interventions to include within the evidence synthesis. We also considered the outcome measures for both the evidence synthesis and economic evaluation. We elicited ideas about where and how results could be disseminated. Feedback suggested the workshop was as valuable for the attendees as it was for the researchers, making them feel valued and listened to. The time spent by researchers working on the activity was substantial and not directly funded but a necessary and valuable activity in developing our potential HTA. Our work was informed using the UK Standards for Public Involvement and the Authors and Consumers Together Impacting on eVidencE (ACTIVE) framework. PPI can be enormously valuable in both developing and strengthening research proposals. However, further guidance is needed to help researchers recognise the level and type of involvement to use at this early stage, particularly given the large time investment needed to embed meaningful PPI. Women with a lived experience of POP were involved at every stage of the grant application process; their involvement is documented in full throughout this work.

Small intestine prolapse after vaginal hysterectomy with vaginal dome rupture. A clinical case

The relevance of surgical treatment of pelvic organ prolapse is beyond doubt, due to the high prevalence and risk of surgical intervention during life. Surgical treatment of prolapse today remains the only effective method, however, despite more than 400 methods of surgical correction, the number of complications and relapses does not tend to decrease.
 This article presents a clinical case of ineffective choice of surgical treatment of genital prolapse with own tissues and vaginal hysterectomy, which subsequently led to the development of enterocele. In the future, the lack of postoperative follow-up and the preservation of a lifestyle that included the performance of hard physical labor led to a rupture of the dome of the vagina and prolapse of the loops of the small intestine.
 Today, for the prevention of complications and recurrence of genital prolapse, it is mandatory for patients to go through a careful selection for surgical treatment, which should include a clinical study and study of risk factors. When choosing an operative approach, complex treatment is necessary, including the use of the patients own tissues and modern materials that allow creating a reliable physiological framework to strengthen the pelvic organs. When performing this surgery, it is necessary not only to replace the damaged defective pelvic fascia with a new one, but also to create a neofascia that ensures the preservation of the normal function of the pelvic organs.

Pelvic Pain and Pelvic Floor Muscle Dysfunction in Women Seeking Treatment for Prolapse.

Pelvic floor muscle dysfunction (PFMD) can cause pelvic pain, but its associations with pelvic organ prolapse (POP) and POP treatment outcomes are poorly understood. The objectives of this study were to determine (1) if pelvic pain is associated with PFMD in women seeking POP treatment and (2) if baseline PFMD in women seeking management of POP is associated with improvement in pelvic pain at 12 months. This was an ambispective cohort study of women enrolled at one site of the Pelvic Floor Disorders Registry. Pelvic floor muscle dysfunction was identified if tenderness was reported on a standardized pelvic floor muscle examination at baseline. Outcomes included a pelvic pain questionnaire (score 0-70, assessed pain in the past 24 hours in 7 pelvic locations) and the Global Health-10 overall average pain rating (0-10). One hundred forty-four women planning surgery (118) or pessary (26) were included. Twenty (13.9%) had baseline PFMD. Women with PFMD versus no PFMD had greater baseline Pelvic Pain scores (median [IQR], 9.7 [4-23] vs 2.5 [0-7], P < 0.001) and overall average pain (4 [3-6] vs 1 [0-3], P < 0.001). In 107 women with 12-month treatment outcomes, those with PFMD at baseline had greater improvement in pelvic pain compared with those without PFMD (change score -6.5 [-15.2 to 0] vs 0 [-3 to 0] respectively, P = 0.03). Overall pain improved after treatment in the no PFMD group but not in the PFMD group. Patients with baseline PFMD vs none undergoing treatment for prolapse had higher baseline pelvic pain and greater improvement in pelvic pain at 12 months.

Le Fort Partial Colpocleisis: An Early and Feasible Option in Pelvic Organ Prolapse

To evaluate the safety and effectiveness of Le Fort Partial Colpocleisis (LFPC) in the surgical treatment of pelvic organ prolapse (POP) and to determine the incidence of pop recurrence in postoperative follow-up. Cross-sectional study. Ordu University Medical Faculty Training and Research Hospital, Ordu, Turkey, from June 2013 to November 2020. Sixty-four women (82.8% had uterine prolapsed) who had been operated as LFPC operations were included in the study. Patient's characteristics, medical comorbidities, postoperative outcomes, and operation complications were analysed. POP recurrence was evaluated during the postoperative follow-up period reaching 80 months. Eight patients (12.5%) had anti-incontinence surgery. Concomitant vaginal hysterectomy was performed in six patients (9.4%) and concomitant anti-incontinence surgery was performed in eight patients (12.5%). There were no serious intraoperative complications such as hematoma formation, and bladder / bowel injury. Postoperative complications were seen in a quarter of the patients (16/64) and most of them resolved spontaneously. Three of sixty-four patients (4.7%) were complicated with de novo urinary incontinence and all cases were healed without the need for treatment. In the current study, none of the patients reported POP recurrence on average over three years of follow-up. There was a low frequency of intraoperative and postoperative complications in LFPC surgery. In addition, no POP recurrence was observed in any patient during long-term follow-up. Therefore, the LFPC procedure was described as a good surgical option in the selected elderly population with POP. Colpocleisis, Le fort partial colpocleisis, Pelvic organ prolapse.

Long-Term Pain After Minimally Invasive Total Hysterectomy and Sacrocolpopexy.

There are limited long-term data on patient-reported pain after surgical treatment of uterovaginal prolapse. This study aimed to evaluate pain in women undergoing minimally invasive total hysterectomy and sacrocolpopexy with a lightweight polypropylene Y-mesh (Upsylon) >2 years after surgery. This is a planned secondary analysis of a 5-site randomized trial comparing permanent versus absorbable suture for vaginal attachment of a lightweight polypropylene Y-mesh during total laparoscopic hysterectomy and sacrocolpopexy in women with stage ≥2 uterovaginal prolapse. Our primary outcome was patient-reported pain or dyspareunia at >2 years. Of the 185 participants eligible for enrollment in the e-PACT study, 106 enrolled; 98 participants (96%) completed either in-person examinations or study questionnaires regarding pain and are included in this analysis. At >2 years, 28% reported any pain: 14% reported dyspareunia on questionnaires, 5% reported pelvic pain on questionnaires, and 14% of those who had an in-person examination reported pain. Of participants who reported pain or dyspareunia at baseline before surgery, 59% reported resolution of their symptoms >2 years. On multiple logistic regression controlling for age and baseline pain or dyspareunia, baseline pain or dyspareunia was associated with a nearly 3-fold increased risk of reporting any pain >2 years (adjusted odds ratio, 2.7; 95% confidence interval, 1.1-6.9). No women had repeat surgical intervention for pain. Although 60% of women report pain resolution >2 years after surgery, de novo pain was present in 1 of 5 women. Baseline history of pain or dyspareunia is the only factor associated with an increased likelihood of experiencing pain >2 years after surgery.

Estado actual y evolución del manejo de la patología funcional y del suelo pélvico en los hospitales de la Comunidad de Madrid

Introduction and objectivePelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals’ resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. Material and methodsThe survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. ResultsThe number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). ConclusionsMultidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized.

Evaluation and treatment of pelvic organ prolapse.

Pelvic organ prolapse is a common condition that can have a large impact on a patient's quality of life. Patients with prolapse may present with a vaginal bulge or pressure, bladder, bowel, or sexual symptoms. The diagnosis is confirmed on physical examination which may show descent of the anterior vaginal wall, vaginal apex (cervix/uterus or vaginal cuff in those with a prior hysterectomy), posterior vaginal wall, or a combination of these. Patients with asymptomatic prolapse can typically be reassured that it may be managed with observation, though might gradually progress with time. In patients with symptomatic prolapse, management options include conservative measures, pessary use, or surgical intervention. Pessaries can successfully be fitted for most patients that prefer this line of therapy. Surgical interventions include native tissue transvaginal surgeries or a transabdominal (laparoscopic or robotic) approach with use of polypropylene mesh. The choice of surgical procedure includes consideration of an individual's medical and surgical history, physical exam findings, differences in the risks and durability of the operations, and the patient's preference. Ultimately, the surgical plan is based on shared decision making with the patient to best achieve their treatment goals. In this article we will review pertinent clinical considerations in the diagnosis, evaluation, and management of pelvic organ prolapse.

Compare the Role of 5% Phenol in Almond Oil and Injection Sodium Tetradecyl Sulfate in the Treatment of Rectal Prolapse

Objective: To compare the role of 5% Phenol in Almond oil and Injection Sodium Tetradecyl Sulfate in the treatment of rectal prolapse. Methods and material: This study was conducted at Pediatric Surgery Department, Mayo Hospital Lahore. A total of 100 patients were included in the study and randomly divided into 2 groups. In Group-A patients were given 5% Phenol in Almond Oil and in Group-B patients were given Sodium Tetradecyl Sulfate. Patients were followed up at 1st post operative day and at 1st post operative month to see recurrence or any other complications (bleeding, perirectal inflammation, urinary retention, ischiorectal abscess, and necrosis of the rectal mucosa) in cases in both treatment groups. Results: In Group-A mean age was 5.63±3.34 years and in Group-B mean age of children was 7.16±2.80 years. In Group-A 46 and in Group-B 39 children were included.. There was significant association between treatment groups and outcome on 1st postoperative day reduction (P &lt; 0.05). In Group-A 5 and in Group-B 1 child had bleeding PR after postoperative day. No statistically significant association was present between treatment groups and bleeding PR after POD (P &gt; 0.05). In Group-A 49 and in Group-B 44 children had achieved reduction when observed at one month follow up time period. In Group-A reduction was achieved in greater number of patients as compared to that of Group-B patients (P &lt; 0.05). Practical implication: Current study will bring a revolution in the awareness of community amoung rectal prolapse problem and treating it successfully with the knowledge provided with the current literature. The role of 5% Phenol in Almond oil and Injection Sodium Tetradecyl Sulfate is well shown which proven to be a good treatement in Rectal prolapse. Conclusion: We conclude that 5% Phenol almond oil is more effective than Sodium Tetradecyl Sulfate in treating rectal prolepses. i.e., after the one-month follow-up, the post-operative decrease was 98% vs. 88 percent. Keywords: Rectal submucosa, ischiorectal abscess, ulceration, polyps, inflammation, idiopathic rectal prolapse,Etiology.

Evolution and current status of the management of functional and pelvic floor pathology in the hospitals of the Community of Madrid

Introduction and objectivePelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals’ resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. Material and methodsThe survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. ResultsThe number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). ConclusionsMultidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized.

Australian trends in the treatment of pelvic organ prolapse in the non-mesh era.

To assess the contemporary trends in the types and incidence of pelvic organ prolapse (POP) surgery in Australia after the removal of transvaginal mesh from the Australian market. This was a retrospective Australian cohort study utilizing three large Governmental databases covering all private and public POP procedures in Australia. All females ≥25 years old undergoing POP procedures between 2005 and 2021 were included. From 2005-2006 to 2020-2021 there have been a total of 408 881 POP procedures in Australia. The total number of procedures peaked in 2005-2006 at 537.8 procedures per 100 000 age-standardized female population, decreasing by an average of 3.5% per year to 329.0 procedures per 100 000 in 2018-2019, an overall 38.8% decrease (P< 0.001). A sudden growth in private operative procedures was noted between 2019-2020 and 2020-2021, from 218.2 to 268.6 procedures per 100 000 population, a 23.1% increase (P< 0.001). Laparoscopic and abdominal POP repair has seen a 115.8% increase from 13.7 procedures to 29.6 per 100 000 between 2005-2006 and 2020-2021. Over the last 15 years, the most common age group to undergo a procedure has changed from the 55 to 64 years demographic to a later decade of 65 to 74 years. Over the last 15 years, the total number of POP procedures performed has significantly decreased. There has however been a recent rise in interventions seen in the private sector and the utilization of laparoscopic or abdominal POP repair has increased, which has implications for procedural credentialing to ensure patient safety.

Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-KetenciGencer technique.

Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-KetenciGencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). With the Salman-KetenciGencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-KetenciGencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.

Transition to surgery after pessary among female Medicare beneficiaries with pelvic organ prolapse

The American College of Obstetricians and Gynecologists recommends offering a vaginal pessary to women seeking treatment of pelvic organ prolapse. However, single-institution series have suggested that a sizable proportion of women fitted with a pessary will transition to surgery within the first year. This study aimed to estimate the proportion of female US Medicare beneficiaries with pelvic organ prolapse who undergo surgery after pessary fitting, to describe the median time to surgery from pessary fitting, and to identify factors associated with the transition from pessary to surgery. The Medicare 5% Limited Data Set was queried from 2011 to 2016 for women aged ≥65 years with a diagnosis of prolapse who underwent pessary fitting. Cases with at least 3 years of follow-up in the Medicare Data Set were followed longitudinally for the primary outcome of surgery for prolapse. The cumulative incidence of prolapse surgery following index pessary fitting was calculated. Characteristics of women who underwent surgery and those who did not were compared using time-varying Cox regression analysis. Among 2032 women fitted with a pessary, 608 underwent surgery within 7 years. The median time to surgery was 496 days (interquartile range, 187-1089 days). The cumulative incidence of prolapse surgery was 12.2% at 1 year and 30.9% at 7 years. After adjusting for covariates, factors significantly associated with the transition to surgery included previous prolapse surgery (adjusted hazard ratio, 1.50; 1.09-2.07) and a diagnosis of urinary incontinence at the time of pessary fitting (adjusted hazard ratio, 1.20; 0.62-0.99). Factors associated with a lower hazard of surgery included age (adjusted hazard ratio, 0.96 per year; 95% confidence interval, 0.95-0.97), dual Medicare/Medicaid eligibility (adjusted hazard ratio, 0.75; 95% confidence interval, 0.56-1.00), and pessary fitting by a nongynecologist (adjusted hazard ratio, 0.78; 95% confidence interval, 0.62-0.99). In this population of Medicare beneficiaries, within 7 years of pessary fitting, almost one-third of women aged >65 years underwent surgery for prolapse. These results add to our current understanding of the demographics of pessary use in an older population and may aid in counseling older patients presenting for treatment of symptomatic pelvic organ prolapse.

Serious Complications and Recurrence following Sacrospinous Ligament Fixation for the Correction of Apical Prolapse.

Objective: To evaluate the rates of serious complications and reoperation for recurrence following sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse. Methods: This was a national registry ancillary cohort comparative study. The VIGI-MESH registry includes data from 24 French health centers prospectively collected between May 2017 and September 2021. Time to occurrence of a serious complication or reoperation for genital prolapse recurrence was explored using the Kaplan-Meier curve and Log-rank test. The inverse probability of treatment weighting, based on propensity scores, was used to adjust for between-group differences. Results: A total of 1359 women were included and four surgical groups were analyzed: Anterior SSLF with mesh (n = 566), Anterior SSLF with native tissue (n = 331), Posterior SSLF with mesh (n = 57), and Posterior SSLF with native tissue (n = 405). Clavien-Dindo Grade III complications or higher were reported in 34 (2.5%) cases, with no statistically significant differences between the groups. Pelvic organ prolapse recurrence requiring re-operation was reported in 44 (3.2%) women, this was higher following posterior compared with anterior SSLF (p = 0.0034). Conclusions: According to this large database ancillary study, sacrospinous ligament fixation is an effective and safe surgical treatment for apical prolapse. The different surgical approaches (anterior/posterior and with/without mesh) have comparable safety profiles. However, the anterior approach and the use of mesh were associated with a lower risk of reoperation for recurrence compared with the posterior approach and the use of native tissue, respectively.

Factors affecting women's decision between uterine-preserving versus hysterectomy-based surgery for pelvic organ prolapse.

Given the prevalence of women seeking surgical treatment for pelvic organ prolapse (POP), there is a need to understand women's decision-making regarding uterine-preserving versus hysterectomy-based surgeries. Historically, hysterectomy-based surgeries have been the preferred treatment for pelvic organ prolapse; however, contemporary evidence supports uterine-preserving surgeries as equivalent. At present, the lack of information available to the general public and limited options presented at surgical consultation for pelvic organ prolapse may hinder women's autonomy as they navigate surgical treatment. To examine the factors affecting women's decision-making processes regarding uterine-preserving or hysterectomy-based surgery for pelvic organ prolapse. This is a qualitative study. We conducted semi-structured, qualitative interviews with women seeking surgery for pelvic organ prolapse to explore the factors affecting women's decision-making between hysterectomy-based and uterine-preserving surgeries. Women (n = 26) used clinical and personal factors to determine which surgery was best. Women noted that the lack of evidence (clinical and/or anecdotal) available to them hindered their decision-making, causing them to rely more on their own interpretations of the evidence, what they perceived to be "normal," and what their surgeon recommended. Even with standardized discussion regarding the existing clinical equipoise between surgeries at the clinical consultation, some women still had misperceptions that hysterectomy-based surgery would convey the lowest risk of prolapse recurrence and be best for severe prolapse. There is a need for more transparency in discussions about prolapse and the factors affecting women's decision-making for surgical repair of pelvic organ prolapse. Clinicians should be prepared to offer the option of hysterectomy-based or uterine-preserving surgeries and to clearly explain the clinical equipoise between these procedures.