Vaginal Sacrospinous Colpopexy Research Articles

Responsibility toward affordable healthcare: disposable versus reusable methods for pelvic floor repair.

BackgroundThe adverse publicity surrounding the use of mesh for correction of pelvic organ prolapse has driven a renewed interest in native tissue repair. Established techniques used reusable instruments, while recent innovations have generally involved disposable equipment. Here, we compare outcomes between the two techniques used for sacrospinous ligament fixation for the correction of apical prolapse: Miya Hook (reusable) and Capio® (single-use) suturing devices.MethodsA prospective cohort study of women undergoing vaginal sacrospinous colpopexy or hysteropexy was undertaken. The patients were assessed preoperatively and 1 year post-operatively. The primary outcomes were improvement in vaginal scores and patient-reported absence of a vaginal bulge. Secondary outcomes included impact on sexual function, quality of life, perioperative complications and apical recurrence. The cost of instruments, operative times and length of stay were analyzed.ResultsIn total, 133 women with advanced prolapse in the apical compartment underwent colpopexy or hysteropexy (63 using the reusable Miya Hook and 40 with the disposable Capio device). Mean follow-up was 16.9 months (SD 7.8) and 14 months (SD 3.1), respectively. There were no significant differences in baseline characteristics or preoperative Pelvic Organ Prolapse Quantification staging between the two cohorts. Significant improvements in vaginal scores, sexual function and quality of life (International Consultation on Incontinence Questionnaire – Vaginal Symptoms) were observed in both groups postoperatively (P<0.01). Both groups had low apical recurrence in the medium term (<3%). There were no significant differences in operative times or length of stay. The use of disposable equipment was associated with higher cost.ConclusionSacrospinous fixation using either the Miya Hook or the Capio device is equally effective for the management of apical prolapse. In the absence of clinical benefit, the choice of instrument should reflect the cost in a financially constrained health-sector environment.

Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial

To compare the efficacy of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in patients with levator ani avulsion. This was a single-center, randomized interventional trial, of two standard surgical procedures for post-hysterectomy vaginal vault prolapse: Prolift Total vs unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair (sacrospinous fixation, SSF), during the period from 2008 to 2011. Entry criteria included at least two-compartment prolapse, as well as complete unilateral or bilateral levator ani avulsion injury. The primary outcome was anatomical failure based on clinical and ultrasound assessment. Failure was defined clinically, according to the Pelvic Organ Prolapse Quantification system, as Ba, C or Bp at the hymen or below, and on translabial ultrasound as bladder descent to 10 mm or more below the lower margin of the symphysis pubis on maximum Valsalva maneuver. Secondary outcomes were evaluation of continence, sexual function and prolapse symptoms based on validated questionnaires. During the study period, 142 patients who were post-hysterectomy underwent surgery for prolapse in our unit; 72 of these were diagnosed with an avulsion injury and were offered participation in the study. Seventy patients were randomized into two groups: 36 in the Prolift group and 34 in the SSF group. On clinical examination at 1-year follow-up, we observed one (3%) case of anatomical failure in the Prolift group and 22 (65%) in the SSF group (P < 0.001). Using ultrasound criteria, there was one (2.8%) failure in the Prolift group compared with 21 (61.8%) in the SSF group (P < 0.001). The postoperative POPDI (Pelvic Organ Prolapse Distress Inventory) score for subjective outcome was 15.3 in the Prolift group vs 21.7 in the SSF group (P = 0.16). In patients with prolapse after hysterectomy and levator ani avulsion injury, SSF has a higher anatomical failure rate than does the Prolift Total procedure at 1-year follow-up.

The Outcome of Transvaginal Sacrospinous Colpopexy : King Hussein Medical Center Short Term Experience

Results: The diagnosis of patients whom were operated included uterine prolpse in 23(72%) patients and vaginal vault prolapse in 9 (28%) patients. The operation was successful in 97% of the patients. During follow-up period, the operation was complicated with urinary tract infection in 3 (9%) patients and 2(6%) patients with low back pain. We had not encountered any intra-operative complications in relation to the procedure. Conclusion: The success rate for vaginal sacrospinous colpopexy operation was 97% in our series with minimal perioperative complications. It may be concluded that vaginal sacrospinous colpopexy may be safely combined with other vaginal surgeries for patients with uterovaginal prolapse.

Where to for pelvic organ prolapse treatment after the FDA pronouncements? Comment

Dear Editor, With great interest I read the recently published article in the International Urogynecology Journal from Van Geelen and Dwyer titled “Where to for pelvic organ prolapse treatment after the FDA pronouncements?” [1]. One of the issues the authors try to address is the ongoing debate on the optimal approach for apical prolapse repair. They state that there is level I evidence that abdominal sacrocolpopexy (ASC), either by laparotomy or laparoscopy or with the aid of a robotic device, is more effective and durable in correcting anterior and apical anatomy than the vaginal approach using sacrospinous colpopexy. As a reference, they use an article byMaher et al. published in 2004 [2]. In this article, ASC is compared with vaginal sacrospinous colpopexy in 95 women. The objective success rate was 76 % in the abdominal group and 69 % in the vaginal group (P=0.48). The abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colpopexy (P<0.01). Both surgeries significantly improved the patient’s quality of life (P<0.05). The subjective success rate was 94% in the abdominal and 91 % in the vaginal group (P=0.19). This level I evidence does not support the above-mentioned statement of the authors that ASC is more effective than vaginal sacrospinous colpopexy. On the contrary, it shows that there is no significant difference in terms of objective and subjective cure rate between ASC and vaginal sacrospinous colpopexy. Also, it does not justify the extrapolation of ASC data by laparotomy to other techniques, such as laparoscopy or robotassisted laparoscopy. In this light, the recently published article by Nygaard et al. is also very interesting [3]. These authors temper the general feeling that ASC is superior in terms of durability. By year 7, the estimated probability of composite (symptomatic or anatomic) pelvic organ prolapse failure after abdominal sacrocolpopexy was 0.48 when combined with a Burch urethropexy and 0.34 without a Burch urethropexy.

Where to for pelvic organ prolapse treatment after the FDA pronouncements? Reply to Pelikan

Dear Editor, We thank Dr. Pelikan [1] for his interest and comments regarding our review article on the treatment of pelvic organ prolapse (POP) after the US Food and Drug Administration (FDA) pronouncements [2]. The author rightly observes that the study by Maher et al. [3] does not support the statement that abdominal sacral colpopexy (ASC) is more effective than vaginal sacrospinous colpopexy (VSC). Indeed, in their randomized controlled trial (RCT) study comparing ASC and VSC, they conclude that both procedures are highly effective for treating vaginal vault prolapse. There were no differences in subjective and objective success rates between the two groups after 2 years follow-up. The International Consultation on Incontinence (ICI) committee reviewed surgery for POP [4] and identified three RCTs designed to compare vaginal and abdominal routes for surgical correction, including Maher et al.’s study [3]. The results are summarized in a Cochrane review byMaher et al. [5] in which they state that these trials provide level I evidence that the overall outcome (including quality of life) is similar between abdominal and vaginal approaches but that sacrospinousbased vaginal procedures have higher anterior and apical anatomical and dyspareunia recurrence rates than ASC. This is somewhat offset by the higher short-term morbidity of open abdominal sacrocolpopexy [4]. Therefore we should have referred to reference 10 instead of reference 14 in our manuscript to support the statement of higher apical success of ASC. A recently published study by Nygaard et al. on the longterm (7 years) outcomes following ASC for POP, with or without Burch urethropexy, reported increasing failure rates after 7 years, which emphazises the need for RCTs with longterm follow-up [6].

Vaginal sacrospinous colpopexy using the Capio suture-capturing device versus traditional technique: feasibility and outcome

This study compares the feasibility and outcome of sacrospinous colpopexy for treating vaginal vault prolapse (VVP) performed by either the traditional technique or a simplified procedure using the Capio™ suture-capturing device. Eighty-six patients with VVP were included in the study. Forty-two patients were treated by traditional sacrospinous colpopexy (TSC group) and 44 patients were treated by the modified technique using the Capio device (CSC group). Additional procedures were performed to restore concomitant pelvic floor defects. The mean (±SD) total operative time was significantly lower in the CSC group (71.7 ± 24.5 min) than in the TSC group (105.5 ± 31.5 min; p < 0.001); the intraoperative blood loss was higher in the TSC group than in the CSC group. In the CSC group, the mean operative time required to perform sacrospinous colpopexy was 21.4 ± 3.2 min. In patients who underwent only sacrospinous colpopexy, the time required to perform surgery was significantly lower in the CSC group (20.9 ± 3.3 min) than in the TSC group (39.1 ± 5.2 min; p < 0.001). There was no significant difference in the incidence of surgical complications between the two study groups. The objective and subjective success rates at 3-year follow-up were 88.1 and 92.9 % in the TSC group while in the CSC group they were 86.4 and 92.9 %. The modified technique of sacrospinous ligament fixation using the Capio device reduces the operative time and blood loss when compared to the traditional technique.

Are Costs for Robotic Assisted Sacrocolpopexy Lower Than Those for Open Sacrocolpopexy?

No AccessJournal of UrologyAdult Urology1 Feb 2012Are Costs for Robotic Assisted Sacrocolpopexy Lower Than Those for Open Sacrocolpopexy? Toby C. Chai Toby C. ChaiToby C. Chai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.11.003AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Are Costs for Robotic Assisted Sacrocolpopexy Lower Than Those for Open Sacrocolpopexy?." The Journal of Urology, 187(2), pp. 644–645 References 1 : Vaginal versus abdominal reconstructive surgery for the treatment of pelvic floor support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol1996; 175: 1418. Google Scholar 2 : Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol2004; 190: 20. Google Scholar 3 : The death of cost-minimization analysis?. Health Economics2001; 10: 179. Google Scholar Departments of Surgery (Urology), and Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 2February 2012Page: 644-645Supplementary Materials Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Toby C. Chai More articles by this author Expand All Advertisement PDF downloadLoading ...

Posthysterectomy vault prolapse of vaginal walls: Choice of operating procedure

Post-hysterectomy vaginal vault prolapse is a common complication following different types of hysterectomy with a negative impact on the woman's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important in order to make the right choice of the corrective procedure and also to minimize the risk of posthysterectomy occurrence of vault prolapse. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures. The vaginal approach for vault prolapse is superior to the abdominal approach in terms of complication rates, blood loss, postoperative discomfort, length of hospital stay and cost-effectiveness. Moreover, it allows the simultaneous repair of all coexistent pelvic floor defects, such as cystocele, enterocele and rectocele. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. Other less commonly performed procedures include uterosacral ligament suspension and illeococcygeal fixation with a high risk of ureteric injury. Surgical mesh of non-absorbent material is gaining in popularity and preliminary data from vaginal mesh procedures is encouraging.

Surgical management of pelvic organ prolapse in women.

Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse. To determine the effects of the many different surgeries used in the management of pelvic organ prolapse. We searched the Cochrane Incontinence Group Specialised Register (9 February 2009) and reference lists of relevant articles. We also contacted researchers in the field. Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. Trials were assessed and data extracted independently by two review authors. Six investigators were contacted for additional information with five responding. Forty randomised controlled trials were identified evaluating 3773 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86). However there was no statistically significant difference in re-operation rates for prolapse (RR 0.46, 95% CI 0.19 to 1.11). The vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The three trials contributing to this analysis were clinically heterogeneous.For anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented with a polyglactin mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.72, 95% CI 1.20 to 6.14); but data on morbidity and other clinical outcomes were lacking. Standard anterior repair was associated with more anterior compartment failures on examination than for polypropylene mesh repair as an overlay (RR 2.14, 95% CI 1.23 to 3.74) or armed transobturator mesh (RR 3.55, 95% CI 2.29 to 5.51). Data relating to polypropylene mesh overlay were extracted from conference abstracts without any peer reviewed manuscripts available and should be interpreted with caution. No differences in subjective outcomes, quality of life data, de novo dyspareunia, stress incontinence, re-operation rates for prolapse or incontinence were identified. Blood loss with transobturator meshes was significantly higher than for native tissue anterior repair. Mesh erosions were reported in 10% (30/293) of anterior repairs with polypropylene mesh.For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele or enterocele, or both, than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64); although there was a higher blood loss and post-operative narcotic use. No data exist on efficacy or otherwise of polypropylene mesh in the posterior vaginal compartment.Meta-analysis on the impact of continence surgery at the time of prolapse surgery was performed with data from seven studies. Continence surgery at the time of prolapse surgery in continent women did not significantly reduce the rate of post-operative stress urinary incontinence (RR 1.39, 95% CI 0.53 to 3.70; random-effects model). Abdominal sacral colpopexy was associated with a lower rate of recurrent vault prolapse and dyspareunia than with vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of mesh or graft inlays at the time of anterior vaginal wall repair reduces the risk of recurrent anterior wall prolapse, on examination. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. The value of the addition of a continence procedure to a prolapse repair operation in women who are dry before operation remains to be assessed. Adequately powered randomised controlled clinical trials are urgently needed on a wide variety of issues and particularly need to include women's perceptions of prolapse symptoms.

Perioperative course and long term outcome after vaginal sacrospinous colpopexy for vaginal vault prolapse post hysterectomy: comparison of three different suture methods

To compare long-term results of the vaginal sacrospinous colpopexy (VSC) procedure for the treatment of vaginal vault prolapse after previous hysterectomy with the use of either of the three most commonly used devices (the Deschamps ligature carrier, the Shutt Suture Punch System, or an ordinary straight needle holder). The study group consisted of 73 women (out of 84; response rate 86%) who had undergone VSC for vaginal vault prolapse in between January 1994 and April 2005. All these patients were contacted with a mailed questionnaire and asked about symptoms related to prolapse, possible complications, any subsequent surgical repair and their satisfaction with results of the surgery. All data concerning the patients' characteristics at the time of surgery and perioperative events were retrospectively collected using the patient records (charts). There were no significant differences in age, parity, body mass index, or in proportion of previous prolapse or incontinence surgery between groups. The operation time was similar in all groups, with a median duration around 60 min. There was a wide distribution of the estimated blood loss in the groups, but without significant differences between groups. The rate of complications was low in all groups. Most of the patients were 'very satisfied' with the results of the surgery and rated their satisfaction as 8 to 10. The proportions of patients being very satisfied with the results of the surgery were 84%, 80% and 87% in the Deschamps, Shutt and needle holder groups, respectively. In the present study we could not see any major differences in perioperative data when comparing usage of the three instruments. Operation time, complications rate, perioperative blood loss and the patient's satisfaction with the surgery were equal between the three groups. This indicates that the type of instrument used in VSC is of no importance.

Operative Therapie des Descensus genitalis - Was ist Standard? - Was ist experimentell?

Nachdem suburethrale Vaginalschlingen eine neue Ära in der Behandlung der weiblichen Belastungsharninkontinenz eingeläutet haben, finden nun auch für die Behandlung des Deszensus neue Operationsmethoden mit alloplastischen Netzen bei der Beckenbodenrekonstruktion zunehmend Verbreitung. Damit treten sie in Konkurrenz zu den etablierten Standardverfahren. Zum direkten Vergleich sind kontrollierte klinische Studien notwendig. Zu den klassischen Verfahren zählen sowohl vaginale als auch abdominale Techniken. Die typischen klassischen Verfahren ohne Fremdmaterial sowie die neuen Netzverfahren werden vorgestellt. Die derzeit vorliegenden Daten werden aufgeführt und diskutiert. Nach sorgfältiger Diagnostik bieten auch die Standardverfahren weiterhin hohe Erfolgsraten bei einer insgesamt niedrigen Komplikationsrate. Während das abdominale Vorgehen bei Scheidenstumpfdeszensus im mittleren Kompartiment bezüglich Rezidivrate und Sexualfunktion Vorteile gegenüber dem vaginalen Vorgehen bietet, so zeichnet sich die Vaginaefixatio sacrospinalis nach Amreich-Richter durch ihre geringe Morbidität bei annähernd gleicher Erfolgsrate aus. Das Problem von Kombinationseingriffen bei simultaner oder larvierter Belastungsharninkontinenz lässt sich bislang nicht endgültig mit der vorhandenen Literatur beantworten. Die Verwendung alloplastischer Materialien konfrontiert uns zudem mit einem neuen Komplikationsspektrum, das ein entsprechend angepasstes Management erfordert. Angesichts überwiegend kleiner Studienzahlen mit kurzer Nachbeobachtungszeit sind die Mesh-Verfahren noch nicht abschließend beurteilbar und noch als experimentell anzusehen. Vorläufig ist den etablierten Standardverfahren in der Primärbehandlung der Vorzug zu geben. In speziellen, insbesondere Rezidiv-Situationen bieten die neuartigen Operationsverfahren mit alloplastischen Materialien vielversprechende Alternativen.

Surgical management of pelvic organ prolapse in women: A short version Cochrane review

Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse. To determine the effects of the many different surgeries in the management of pelvic organ prolapse. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 3 May 2006) and reference lists of relevant articles. We also contacted researchers in the field. Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. Trials were assessed and data extracted independently by two reviewers. Six investigators were contacted for additional information with five responding. Twenty two randomised controlled trials were identified evaluating 2368 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were too few to evaluate other clinical outcomes and adverse events. The three trials contributing to this comparison were clinically heterogeneous. For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by polyglactin mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.72, 95% CI 1.20 to 6.14), but data on morbidity, other clinical outcomes and for other mesh or graft materials were too few for reliable comparisons. For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh inlay or porcine small intestine graft inlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new urinary symptoms after surgery. Although the addition of tension-free vaginal tape to endopelvic fascia plication (RR 5.5, 95% CI 1.36 to 22.32) and Burch colposuspension to abdominal sacrocolpopexy (RR 2.13, 95% CI 1.39 to 3.24) were followed by a lower risk of women developing new postoperative stress incontinence, but other outcomes, particularly economic, remain to be evaluated. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of mesh or graft inlays at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. The addition of a continence procedure to a prolapse repair operation may reduce the incidence of postoperative urinary incontinence but this benefit needs to be balanced against possible differences in costs and adverse effects. Adequately powered randomised controlled clinical trials are urgently needed.

Editorial comment Re: Surgical management of pelvic organ prolapse in women: A short version Cochrane review

Around 1 in 10 women will need a surgical vaginal prolapse repair in their lifetime, and 50% of parous women will have prolapse with symptoms. With our ageing population, this is set to increase. On pages 3 to 12 we publish a precised version of a recently updated Cochrane review on surgery for vaginal prolapse. This shows that despite the prevalence of the problem, and an estimated failure rate for primary surgery of 30%, there is a disappointing lack of evidence about the best surgical techniques. The authors of the Cochrane systematic review, using exhaustive search techniques, found only 22 randomised or quasi-randomised trials on 2368 women undergoing prolapse repair. Most of the trials were small or of poor quality, and addressed disparate operations or types of prolapse, resulting in limited and diffuse evidence. Important take home messages include: abdominal sacrocolpopexy results in a better anatomical outcome than the vaginal sacrospinous colpopexy in women with upper vaginal prolapse, but at higher cost; mesh inlays might improve the objective success rate for anterior repair, but there was no long term evidence of effect on quality of life or failure; and traditional posterior repair is superior to transanal repair for posterior vaginal wall prolapse. In particular, the trials were short on subjective, patient-determined outcomes, which are what matter to women having the surgery. The authors illustrated how limited the current evidence base is for prolapse surgery. This is a particular concern at a time when new procedures, particularly involving mesh or grafts, with or without intro- ducer kits, and laparoscopic approaches, are being promoted without any rigorous evidence about their effectiveness or safety. This raises questions about how well the interests of women are being safeguarded. In particular, the plethora of mesh or graft material, ranging from absorbable (synthetic and biological) to non-absorbable materials, indicates how uncertain we are about the best management. If these were new drugs they would require much more stringent evalua- tion before widespread use. What should we do? One attitude is to just say that there is nothing that can be done, as any research started now will be outdated by the time it is completed. The alternative is to get together as a community, identify the fundamental differ- ences in approaches and to mount collaborative randomised trials to find out which are the most effective, cost-effective and safe. We could also lobby the regulatory authorities to consider introducing safeguards over the introduction of new devices at least until basic safety and efficacy is established. Current impediments at the moment are: lack of stand- ardised, validated outcomes; lack of collaborative clinical networks; a perception that it is not possible to evaluate new surgical procedures (for cost reasons, the long time scale until evidence is available, learning and skill issues, and the introduction of newer procedures before the older ones have been evaluated); and as a result of all these factors, no international track record in mounting such trials.

Vaginal sacrospinous colpopexy and laparoscopic sacral colpopexy for vaginal vault prolapse

Vaginal sacrospinous colpopexy (VSC) and laparoscopic sacral colpopexy (LSC) both correct vault prolapse. The present study compares the perioperative course and long-term results of VSC and LSC. This retrospective study of post-hysterectomy vault prolapse involved 111 patients operated with either VSC (n=51) or LSC (n=60). The median time for the postoperative follow-up visit was 33.6 (range: 13-60) months for the LSC group and 38.4 (range: 7-108) months for the VSC group. Prolapse grade as well as the patient's satisfaction was recorded at the follow-up visit. Operation time was significantly shorter in the VSC group (median: 62 min) compared to the LSC group (median: 129 min). The rate of perioperative complications was low in both groups. There were 3 laparotomies in the LSC group, due to perioperative complications. The inpatients days were similar, with 3.7 days (1-18) and 4.0 days (2-21) in the VSC and the LSC group, respectively. Surgery for the recurrence of vault prolapse at any time before the follow-up visit did not occur in the VSC group, but occurred in 7 patients in the LSC group. At the follow-up visit, there was no recurrence of vault prolapse in either group. The subjective success rate was 82% in the VSC and 78% in the LSC group. This study indicates that VSC and LSC are two equally effective surgical procedures to correct vaginal vault prolapse, but the LSC technique requires a longer operating time.

PD-03.09: Long term outcome of laparoscopic promontofixation for vaginal prolapse

Genito-urinary prolapse is a common benign problem in women. In a prospective randomized study, abdominal sacral colpopexy was superior to the vaginal sacrospinous colpopexy in the treatment of pelvic organ prolapse. Laparoscopic surgery allows a better visualisation than the abdominal approach. We hereby describe our long term outcome of our initial series treated with laparoscopic colpo-sacropexy.

Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse

Background This study was carried out to evaluate the safety and long-term outcome of sacrospinous colpopexy in marked genital prolapse. Setting Gynaecology Department, Benenden Hospital, Kent, UK. Methods A prospective observational study was conducted between September 1993 and May 2000 on 305 women who underwent transvaginal sacrospinous colpopexy. The indications for surgery were marked vault prolapse in 43% and uterovaginal prolapse or enterocele in 57%. Patient follow up was at 6 weeks, 6 months, 1 year and then annually. Data was collected prospectively at the time of initial recruitment, during hospital stay and at the end of each follow up visit. Results Hysterectomy was performed in 117 patients and anterior colporrhaphy in 182. The mean operative time for the entire surgery was 65.6 min (S.D. 27.4, range 20–160 min) and estimated blood loss was 81.8 ml (S.D. 92, range 20–800 ml). After a mean follow up period of 57 months (range 24–84), vault support was maintained in 96%; recurrent vault prolapse occurred in 12 patients (4%) and the mean vaginal length at 1 and 5 years of follow up was 8 ± 0.9 and 7.8 ± 1.2 cm. Symptomatic cystocele occurred in 15 patients (5%). There were six recurrences of rectocele (2%) and there was no enterocele recurrence. Sexual function was maintained in all sexually active women and 43% reported improvement in sexual function. Out of 14 women who complained of fecal incontinence, 10 (71%) reported cure and 3 (21%) improved after surgery. Conclusions Vaginal sacrospinous colpopexy is associated with a high long-term success rate in correcting upper genital prolapse.

Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: A prospective randomized study

Objective The purpose of this study was to compare the abdominal sacral colpopexy and vaginal sacrospinous colpopexy in the treatment of vaginal vault prolapse. Study design Ninety-five women with vaginal vault prolapse were allocated randomly to sacral colpopexy (47 women) or sacrospinous colpopexy (48 women). Primary outcome measurements include subjective, objective, and patient-determined success rates. Secondary outcomes include the impact on bowel, bladder, and sexual function, cost, and quality of life. Results Two years after the operation (range, 6-60 months), the subjective success rate was 94% in the abdominal and 91% in the vaginal group ( P = .19). The objective success rate was 76% in the abdominal group and 69% in the vaginal group ( P = .48). The abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colpopexy ( P<.01). Both surgeries significantly improved the patient's quality of life ( P<.05). Conclusion Abdominal sacral colpopexy and vaginal sacrospinous colpopexy are both highly effective in the treatment of vaginal vault prolapse.

Vaginal sacrospinous colpopexy and perineorrhaphy for faecal incontinence: preliminary report

Objective: To review our experience with vaginal sacrospinous colpopexy combined with perineorraphy performed for patients with genital prolapse who concomitantly suffered from faecal incontinence (FI). Setting: Gynaecology Department, Benenden Hospital, Benenden, Kent, UK. Subjects and methods: Between January 1997 and December 2001, 16 patients presented with symptoms of genital prolapse and faecal incontinence. Eleven out of the 16 patients (69%) had anorectal physiological tests and endoanal ultrasound performed before surgery. All patients had sacrospinous colpopexy and perineorraphy. Simultaneous vaginal hysterectomy was performed in two patients and anterior colporrhaphy in six patients. Results: The mean age was 60 years and median parity was 2. The mean operative time was 62 min (range 35–100) and the mean blood loss was 60 ml (range 30–160). The mean follow-up period was 37 months (6–65). Thirteen patients (81%) reported no faecal incontinence after surgery, and two patients (12.5%) reported improvement. One patient (6.5%) had no improvement in her symptom of faecal incontinence after surgery. None of the patients had recurrence of genital prolapse during follow up. Conclusion: Sacrospinous colpopexy combined with perineorraphy can help to cure symptoms of faecal incontinence associated with genital prolapse. The possible mechanisms for such a favourable result are discussed.

Endoscopically assisted vaginal sacrospinous colpopexy

To describe an endoscopic technique which simplifies the transvaginal sacrospinous colpopexy operation for vault prolapse.Insertion of polydioxanone sutures was carried out under direct endoscopic visualization.The introduction of this new technique has changed the difficult blind step of the operation into a directly visualized endoscopic procedure and has decreased the likelihood of complications, especially injury to pudendal nerve and vessels and postoperative buttock pain. This could allow the majority of the gynaecologists to safely perform the operation.

Indications, operative technique, and outcome of vaginal sacrospinous colpopexy: A prospective observational study of 230 cases of vault and uterovaginal prolapse

Indications, operative technique, and outcome of vaginal sacrospinous colpopexy: A prospective observational study of 230 cases of vault and uterovaginal prolapse