Vaginal Sacrospinous Fixation Research Articles

Complications during Vaginal Sacrospinous Fixation along with McCall Culdoplasty in Stage III and IV POP

In Bangladesh, about half a million women are suffering from stage III or IV pelvic organ prolapse (POP). With traditional surgical methods, there is a chance of recurrence, especially of apical prolapse. Sacrospinous fixation (SSF) along with MacCall Culdoplasty during vaginal hysterectomy can reduce this recurrence rate enormously. This study was designed to identify, manage as well as to prevent per-/post-operative complications during SSF. The study period was from August 2017 to December 2021 at Kumudini Women’s Medical College and Hospital, Bangladesh. Total 335 stage III and IV utero-vaginal prolapse cases were included in this study. The surgeries performed were vaginal hysterectomy followed by modified McCall Culdoplasty and right-sided vaginal sacrospinous ligament fixation (SSF) along with anterior and posterior fascial closure and perineorrhaphy. A standard data collection sheet was used to record the information. Per-operatively, main complications were hemorrhage (3.57%) due to vessel injury and rectal injury (0.90%). The immediate early postoperative complication was buttock pain (24%). Of these, in 97.53% cases, pain subsided within 6 weeks with analgesic and counselling. Only one patient had recurrence of apical prolapse within 1st week of operation. It should be concluded that with proper knowledge of anatomy and careful surgical technique, most of the complications can be avoided. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 90-97

Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse: a randomised controlled trial and prospective cohort (SALTO-2 trial).

To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP-Q stage ≥2 vaginal vault prolapse (VVP). Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. Seven non-university teaching hospitals and two university hospitals in the Netherlands. Patients with symptomatic post-hysterectomy vaginal vault prolapse, requiring surgical treatment. Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP-Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. Primary outcome was disease-specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri-operative data, complications and sexual function. A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease-specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow-up period of 12 months.

MP07-01 MESH-FREE MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE: A COMPARATIVE STUDY OF VAGINAL SACROSPINOUS FIXATION V ROBOTIC UTEROSACRAL LIGAMENT SUSPENSION

You have accessJournal of UrologyCME1 Apr 2023MP07-01 MESH-FREE MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE: A COMPARATIVE STUDY OF VAGINAL SACROSPINOUS FIXATION V ROBOTIC UTEROSACRAL LIGAMENT SUSPENSION Sandra Elmer, Omar Salehi, Niranjan Sathianathen, Jodie McDonald, Nathan Lawrentschuk, and Caroline Dowling Sandra ElmerSandra Elmer More articles by this author , Omar SalehiOmar Salehi More articles by this author , Niranjan SathianathenNiranjan Sathianathen More articles by this author , Jodie McDonaldJodie McDonald More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , and Caroline DowlingCaroline Dowling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) significantly impacts quality of life for many women. Mesh sacral colpopexy (SCP) has a recurrence rate up to 23%, and vaginal procedures to correct apical POP up to 41%. After the FDA warnings and restrictions of transvaginal mesh, increasing concerns regarding mesh have resulted in a need for mesh-free alternatives. This study compares 2 mesh-free techniques, robotic/laparoscopic uterosacral ligament suspension (RUSL) and vaginal sacrospinous fixation (SSF) in managing apical POP. METHODS: A prospective clinical audit of 115 women with apical POP who underwent RUSL (n=61) or SSF (n=54) by a single surgeon. Demographic data included age, parity, and previous POP surgery. A pre-operative (preop) pelvic floor (PF) questionnaire was used to identify prevalence of bladder, bowel and vaginal symptoms. POP-Q was recorded at surgery and at post-operative (postop) reviews. The absolute change in POP-Q scores were recorded as objective measures of PF support. Other postop metrics used include symptomatic vaginal bulge, need for repeat POP surgery (reop) and subjective improvement in symptoms based on patient-reported outcome measures (PROMs). Postop adverse events (AE) were recorded (Clavien Dindo grading scale). Wilcoxon rank sum test, Pearson’s Chi-squared test and Fisher’s exact test were used to compare groups, and univariate analysis to predict factors for success/reop. RESULTS: Baseline demographics were similar (Table 1). Mean time from surgery was 736 (RUSL) and 565 days (SSF). Difference in postop C points was not significant (RUSL: median -8 (IQR 2), SSF: median -7cm (IQR 2), p=0.279). Procedure success rates (postop C point <0) were not different (RUSL 90.2%, SSF 92.5%, p=0.92). Reop rates for apical recurrence were SSF 1.9%, RUSL 6.6%, p=0.21; univariate odds ratio 0.26 [95% CI 0.03 to 2.43]. Univariate analysis for reop found that age, parity and surgery type were not predictors of reoperation (p=0.26, p=0.92, p=0.78). The most common postop AE was urinary tract infection (RUSL 10.2%, SSF 10.5%). CONCLUSIONS: RUSL and SSF are safe and effective mesh-free techniques for management of apical POP based on objective improvements in POP-Q score and PROMs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e84 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandra Elmer More articles by this author Omar Salehi More articles by this author Niranjan Sathianathen More articles by this author Jodie McDonald More articles by this author Nathan Lawrentschuk More articles by this author Caroline Dowling More articles by this author Expand All Advertisement PDF downloadLoading ...

Innovative prolapse surgery without mesh implants

In many countries, such as France, England, USA, Canada, Australia, and New Zealand, alloplastic material in prolapse surgery has been paused due to the US Food and Drug Administration (FDA) warning, and restricted in other countries like the Netherlands and Sweden. For Europe and thus Germany, the SCENIHR report allows alloplastic material to be used for prolapse repair after recurrence and in other special situations. Which established and innovative prolapse surgeries without alloplastic material are currently available? Aliterature search was carried out on established, guideline-compliant pelvic floor surgeries without alloplastic material as well as innovative new approaches. An established procedure for adefect in the anterior compartment is anterior colporrhaphy, which is associated with ahigh recurrence rate. The double-layered anterior colporrhaphy is anew approach and so far is associated with an improved 19-month outcome. Apical pelvic organ prolapse can be corrected by sacrouterine ligament fixation and vaginal sacrospinous fixation. New innovative techniques include laparoscopic unilateral pectineal suspension and the use of the semitendinosus tendon autograft to perform pectopexy or sacropexy. However, long-term data are still pending. In case of aposterior vaginal wall prolapse, posterior colporrhaphy is the therapy of choice and is associated with good success rates. Well-known surgical procedures with native tissue are experiencing arenaissance and new, innovative surgical approaches with good postoperative results are being developed. However, long-term studies are still necessary.

“I Felt Something Coming Down Below”: A Case of POP

Pelvic floor disorders, which includes pelvic organ prolapse (POP), have shown an increasing prevalence among women worldwide. (Wu 2014) It is perceived as embarrassment and affect the women’s quality of life. A 68-year-old housewife, Para 3, complained of a 50-cent coin size lump coming down from her vagina since 2019, which could be reduced back manually inside the vagina. The symptom exacerbated by straining and carrying heavy objects. Ignoring the symptom, causing the lump to increase in size and protruded out from her vagina for the past 2 months. She had 3 SVD with maximum birth weight of 3.75kg and a prolonged second stage of labour in her second pregnancy. She was not aware and never practiced pelvic floor exercise nor taken any HRT. There were no urinary symptoms nor constipation. Her BMI is 25.2kg/m2. Abdominal examination was unremarkable. On speculum examination, vagina was atrophic and third degree uterine prolapse was evident. She was arranged to have Vaginal hysterectomy, anterior colporrhaphy and sacrospinous fixation done. The positive risk factors in this case are multiparity, menopausal status, a history of prolonged labor and frequent heavy lifting. The delay in presentation is due to lack of awareness. It was also found in a study that feeling of embarrassment and social stigma could be the reason. (Abhyankar 2019) Pelvic Floor exercise and avoidance of heavy lifting may be beneficial at onset of symptom. For conclusion, POP awareness is crucial to empower women to prevent POP and seek treatment as soon as they are symptomatic.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S24

Short-term outcomes of anterior approach sacrospinous ligament fixation for apical vaginal prolapse - A retrospective study.

Vaginal sacrospinous fixation and sacrospinous hysteropexy (SSF/SSHP) are highly effective procedures for apical compartment prolapse. The established technique is the posterior vaginal approach. The alternative anterior approach through an anterior vaginal incision, although occasionally mentioned in the literature, is less well established. However, this approach is a more appropriate route if posterior vaginal surgery is not indicated. The aim of this paper is to review surgical outcomes of anterior approach in our centre and to compare outcomes of SSF vs SSHP. Retrospective case note review of 60 patients who underwent anterior SSF for prolapse between 2009-2017 was performed. Preoperative and postoperative symptoms and findings were recorded. Anterior SSF involved an anterior vaginal incision and paravaginal access to the ligament for dissection and fixation to either the cervix or vault. SSF was performed in 39 patients, out of which 8 underwent vaginal hysterectomy concomitantly. SSHP for uterine prolapse was performed in 21 patients. There were no cases of recurrent apical prolapse in the cohort at mean follow-up of 1 year. No intra-operative visceral injuries were observed. Recurrence of anterior wall prolapse and postoperative voiding dysfunction was observed in 8.3% and short-term buttock pain in 6.6% of patients. Anterior approach SSF and SSHP is a safe and effective technique for apical prolapse and is the recommended route when posterior vaginal surgery is not required.

Role of Preoperative and Postoperative Pelvic Floor Distress Inventory-20 in Evaluation of Posthysterectomy Vault Prolapse.

Background:Posthysterectomy vault prolapse is a common problem after vaginal or abdominal hysterectomy. The objective was to assess the role of Pelvic Floor Distress Inventory 20 (PFDI-20) in evaluation of vault prolapse.Materials and Methods:Prospective study in 20 women with posthysterectomy vault prolapse of Stage 2 and above. The outcome measure was to calculate PFDI-20 score in all cases before surgical intervention and to recalculate it again in 6 months after different surgical procedures for vault prolapse and to statistically compare the PFDI-20 score in different types of surgery over 4 years period at a tertiary referral hospital for surgical treatment. Prolapse was classified using Pelvic Organ Prolapse Quantification and intraoperative findings. All women were operated for vault prolapse as per hospital protocol and stage of prolapse by either vaginal sacrospinous fixation or abdominal sacrocolpopexy.Results:Mean age, parity, and body mass index were 54.8 years, 3.5, and 22.71 kg/m2 respectively. Preceding surgery was vaginal hysterectomy in 75% women and abdominal hysterectomy in 25% women. Complaints were bulge or mass feeling at perineum (100%), pressure in lower abdomen and perineum (55%), and constipation (60%). The type of prolapse was vault prolapse (100%), cystocele (100%), rectocele (100%), and enterocele (45%). The range of PFDI-20 was 88–152 with mean being 123.50 ± 22.71 before surgery while its range decreased significantly to 80–126 with mean being 106.40 ± 16.45 after surgery (P < 0.01). Mean postoperative PFDI-20 score was 107.40 in vaginal sacrospinous fixation group and was 105.30 in abdominal sacrocolpopexy group and was not statistically different (P = 0.18).Conclusion:PFDI-20 score can be used to see the adverse impact of vault prolapse on pelvic floor and to assess the beneficial effect of different types of surgeries on the score.

Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial.

Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse. In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002). Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.

Perioperative complications and long term consequences of sacrospinous ligament fixation and abdominal sacrocolpopexy

Objective: This retrospective study was done for comparison of early complications and long term consequences sacrospinous fixation (SSF) and abdominal sacrocolpopexy. Method: This sutdy was performed retrospectively from july 2015 to september 2017. Fifty four women were included the study. Forty women underwent vaginal sacrospinous fixation following vaginal hysterectomy for total prolapse and vaginal vault repair. Fourteen women underwent abdominal sacrocolpopexy procedure for preventing vaginal vault prolapsus. Perioperative complications were defined as any complication occurs during surgery or at the first 6 weeks postoperatively. Results: All patients were followed up for 6 weeks, 3, 6. and 12 th months postoperatively. Intraoperative presacral venous bleeding during the abdominal sacrocolpopexy were detected in two subjects. They were treated with applying pressure with gauze pad about 10 minutes. Vesical injury occured in one subject during the vaginal hysterectomy which was repaired easily via vaginally. The mean duration of follow-up was 12 months. Recurrent vaginal vault prolapses and cystocele in two cases, rectosel in one case and stress incontinence in two cases were detected following SFF. Conclusions: SSF can be used as an adjunctive and easy procedure after vaginal hysterectomy in pelvic organ prolapse. The advantage of the operation is avoiding of the laparatomy and preserve the functionality of the vagina. Abdominal sacrocolpopexy was associated with a higher succes of operative result.

Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study.

We compared vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior polyvinylidene fluoride mesh versus abdominal sacrocolpopexy for the treatment of primary apical prolapse in postmenopausal women. A prospective, randomized, single-blind, parallel study [Registro Brasileiro de Ensaios Clinicos (REBEC) trial register code RBR-7t6rg2] was performed from October 2015 to May 2016. A total of 71 postmenopausal women with advanced pelvic organ prolapse (POP) and undergoing surgery were randomized to the abdominal sacrocolpopexy (ASC) (n= 36) or the vaginal sacrospinous fixation with anterior mesh (VSF-AM) (n= 35) groups. Pelvic Organ Prolapse Quantification (POP-Q) system classification was performed for objective assessment, and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) questionnaires were filled out for subjective evaluation by women before and 1year after surgery. All procedures were performed by a single surgeon. Both groups had improvement in almost POP-Q points (except for vaginal length in the VSF-AM group) and all ICIQ scores. The ASC group had a longer operative time (129 versus 117min, p= 0.0038) and duration for return to activities (103 versus 57days, p< .05). Four women (11%) in the VSF-AM group were reoperated versus none from the ASC group (p =.05). Although the study did not achieve the planned recruitment, after 12months of follow-up, ASC did not differ from VSF-AM in objective and subjective scores (ICIQ questionnaires; POP-Q measurements). Recovery time was longer after open abdominal surgery.

Does the Vaginal Flora Modify When a Synthetic Mesh is Used for Genital Prolapse Repair in Postmenopausal Women? A Pilot, Randomized Controlled Study.

The vaginal flora from postmenopausal women with pelvic organ prolapse (POP) is different from younger women. We hypothesized that the decision of a surgical route using a mesh would modify the vaginal flora. The purpose of this study was to analyze the vaginal flora from postmenopausal women that were submitted to abdominal sacrocervicopexy or vaginal sacrospinous fixation. A pilot, randomized controlled study with 50 women aged 55 to 75 years (n = 25; abdominal sacrocervicopexy + subtotal hysterectomy; n = 25 vaginal sacrospinous fixation + vaginal hysterectomy) was performed. A polyvinylidene mesh was used in both arms. The vaginal content analysis was collected before and 60 days after the surgery. The type of flora, the presence of lactobacilli/leukocytes, and the Nugent criteria were analyzed. Most of the women were white (80%), with at least 1 comorbidity (69.9%), did not present sexual activity (60%), and presented advanced stage 4 POP. Two thirds of women presented a type 3 flora, and half of them did not present lactobacilli (48.3%). About the Nugent criteria, 51.7% presented normal flora, 46.6% found altered flora, and 1.7% had bacterial vaginosis. There were no differences about the type of flora (P = 1), number of lactobacilli (P = 0.9187), Nugent criteria (P = 0.4235), inflammation (P = 0.1018), and bacterial vaginosis (P = 0.64) before and after surgery in both groups. In this pilot study, the use of synthetic mesh by vaginal or abdominal route did not affect the vaginal flora in postmenopausal women operated on by POP surgery.

Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse, a randomized controlled trial: SALTO-2 trial, study protocol

BackgroundHysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of prolapse symptoms, will visit a gynaecologist for a surgical correction of a vaginal vault prolapse thereafter. Vaginal vault prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for prolapse of the vaginal vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique.To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of vaginal vault prolapse.MethodsWe will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, vaginal vault prolapse will be included. Participants will be randomized to the vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group.Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, post-operative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included.DiscussionThe SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 vault prolapse.Trial registrationNetherlands Trial Register (NTR): NTR3977; Registered 28 April 2013.

A new reusable suturing device for vaginal sacrospinous fixation: feasibility and safety study

ObjectiveWe sought to evaluate the feasibility and safety of SeraPro® (Serag-Wiessner, Germany), an innovative reusable suturing device for vaginal sacrospinous ligament fixation. Study designWe reviewed the electronic files of all women who underwent vaginal sacrospinous ligament fixation with SeraPro® for apical pelvic floor prolapse, with or without mesh implant, performed between April 2013 and September 2013. Preoperative demographic, clinical, operative and postoperative data were analyzed. The women were interviewed and examined before the procedure, at one month postoperatively and tele-interviewed again after three months. ResultsOverall, 88 women were included in the study. Fifty-three patients (60.2%) had additional anterior mesh placement, 42 (47.7%) had posterior mesh, and 16 (18.2%) had both anterior and posterior mesh insertion. Five patients (5.7%) had no mesh implant. Sixteen patients (18.2%) had an additional mid-urethral sling for the treatment of stress urinary incontinence. No significant technical difficulty was recorded at the procedures. None of the patients had significant long-term morbidity. The mean 3-month follow-up demonstrated significant anatomical and functional improvement. ConclusionsThe SeraPro® reusable suturing device is a feasible and safe tool for sacrospinous ligament fixation during vaginal pelvic floor reconstruction.

A Prospective Randomized Study Comparing Abdominal Sacrocolpopexy and Vaginal Sacrospinous Fixation for the Management of Vault Prolapse

Introduction Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life [1]. Some degree of prolapse is common in most parous women, but treatment is required

Highlights of IUGA 37th annual meeting in Brisbane 2012

It was a long journey for most of the international delegateswho came to Brisbane, Australia for the 37th InternationalUrogynecological Association (IUGA) annual scientificmeeting this year. Despite the distance, there was not suffi-cient time to digest all the abstracts in-flight. Indeed, 17nations were represented, with 1,400 delegates attending the2012 IUGA. There were 21 workshops in the first 2 days, 7state-of-the-art roundtable addresses and debates, 96podium/video presentations, and 228 poster presentations.The meeting began with interactive workshops which wereall popular, especially Abdul Sultan’s anal sphincter repair,the 3 ultrasound workshops, the anatomy cadaver workshopwith John DeLancey, and the Urogynaecological Society ofAustralasia (UGSA) live surgery demonstration chaired byMickey Karram and Malcolm Fraser.The extensive scientific program, which also included theEuropean Urogynecological Association (EUGA) surgicalcourse and Ibero-American urogynecology session, cateredto a variety of experience and educational needs. The com-plementary nature and high caliber of the scientific programwas evident. Basic science communications gave an over-view of current research interests including one describingthe effects of cyclic mechanical loading on fibroblasts fromwomen with different Pelvic Organ Prolapse Quantification(POP-Q) stage [1]. High-quality studies followed with tworandomized controlled trials on the most controversial topicof the day: the mesh repair [2, 3] and a Cochrane review [4]which was awarded best abstract. Further surgical studiesincluded one where the classical Richter suspension (vagi-nal sacrospinous fixation) at hysterectomy had a higherfailure rate in patients with levator injury and was signifi-cantly inferior to the mesh procedure [5] and another wherebetter anatomical and functional success rates were reportedwith mesh compared with traditional anterior colporrhaphy[2]. Surgical procedures were assessed on quality of life [6]and symptoms [7] with greater emphasis on these thananatomical results, highlighting the importanceof subjectiveoutcomes. Nonrandomized controlled studies included, forexample, in the surgical complication category, the impor-tance of diagnosis of intraoperative visceral injury to thebladder with the methylene blue test and digital rectal examin vaginal surgery [8, 9]. An elegant demonstration of ab-dominal prolapse repair with robotic assistance was shownin the video category [10]. The category of urinary dysfunc-tion included topics such as “Does surgery for urinaryincontinence in women affect their use of symptom-relieving medications?” [11], musculoskeletal pain evalua-tion of patients with interstitial cystitis [12], and a system-atic review of bulking agents for urinary incontinence [13].A wide range of conservative therapies were evaluated,includingthe safe andeffective use of pessary over amedianduration of 35 months [14], a prospective multicenter studyof solifenacin for overactive bladder [15], and the role ofpercutaneous stimulation with sensory response as a predic-tor of success [16]. Bladder reeducation and physiotherapywere reemphasized with regard to their role in the manage-ment of urinary incontinence [17]. Obstetric and perinealcare was highlighted in two studies on anal sphincter inju-ries [18] and episiotomy evaluation [19]. There was a fas-cinating presentation on the utility of an open configurationdynamic magnetic resonance imaging (MRI) proctogram[20], showing that erect sitting and supine MRI proctogramsare similar in assessing functional and anatomical disordersof the anorectum.

Sacrohysteropexy without mesh for apical prolapse versus a vaginal approach

Objective To evaluate the use of abdominal sacrohysteropexy for the treatment of uterine prolapse without using a mesh versus vaginal sacrospinous fixation in the treatment of uterovaginal prolapse. Design Randomized-controlled trial. Setting Tertiary referral center. Participants and methods Women were randomized into two groups: group I included 20 women who had undergone abdominal sacrohysteropexy with no mesh for the treatment of uterine prolapse. Group II included 20 women who had undergone vaginal sacrospinous fixation. All women were diagnosed as having third-degree or fourth-degree uterovaginal prolapse. Results There was no significant difference between both the groups in the intraoperative or postoperative complications. At the 1-year follow-up postoperatively, there was no statistically significant difference between both the groups in the anatomical results. There were two apical prolapse recurrences of grade two in both the groups with abdominal and vaginal operations. Conclusion Sacrohysteropexy without a mesh is safe, easy, low cost, and effective, with the benefits of uterine preservation in comparison with vaginal operations.

Oral Poster 7

OBJECTIVES: To estimate the reoperation rate for prolapse within 10 years of primary surgery for pelvic organ prolapse. MATERIALS AND METHODS: We identified all patients who underwent primary surgery for prolapse at 3 large regional centers in 1997 and 1978. Hospital databases were searched to determine whether patients had been reoperated for prolapse through 2008. RESULTS: A total of 456 patients (mean age, 62 years; range, 31–93) underwent a primary operation for prolapse in 1997 and 1998. The most common primary operation was vaginal hysterectomy with colporrhaphy (89% of primary procedures). We identified 13 reoperations for prolapse, for a reoperation rate of (at least) 2.9%. The median interval between primary and secondary surgery was 5.5 years (1.5–10) years. Reoperations comprised vaginal sacrospinous fixation (6), anterior + posterior colporrhaphy (3), anterior colporrhaphy only (3), and posterior mesh (1). Seven of the 13 patients reoperated for prolapse were ≤50 years old at the time of primary surgery. CONCLUSION: The 10-year reoperation rate for prolapse after primary vaginal hysterectomy and colporrhaphy appears to be modest.

Die Vaginopexie nach Williams-Richardson: Resümee

Fragestellung: Die Vaginopexie nach Williams-Richardson ist eine abdominale Suspensionsoperation unter Verwendung zweier Faszienstreifen aus der Externusaponeurose. Es soll geprüft werden, ob diese Methode in Anbetracht modernerer konkurrierender Verfahren heute noch gerechtfertigt ist. Patientinnen und Methodik: An der Frauenklinik des AKH Celle wurden von 1995–2005 209 WR-Operationen durchgeführt. Die postoperativen Befunde von 165 Patientinnen wurden ausgewertet. Das Intervall zwischen Operation und Nachuntersuchung betrug durchschnittlich 5 Jahre, wenigstens jedoch 1 Jahr. Ergebnisse: Die Nachuntersuchung ergab in 68,5 % einen Normalbefund, in 30,9 % war ein erneuter Deszensus eingetreten, einmal (0,6 %) bestand ein Totalprolaps. Die Patientinnen mit erneutem Deszensus waren zu zwei Dritteln beschwerdefrei. Bei 13,9 % war es zu einer Bauchwandhernie gekommen. Schlussfolgerungen: Die ohne Verwendung von Fremdmaterial durchgeführte Williams-Richardson-Operation zeigt ähnliche Langzeitergebnisse wie die Sakropexie und die sakrospinale Fixation. Ein ungelöstes Problem sind allerdings die postoperativen Bauchwandhernien.

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.

Long-term follow-up after vaginal sacrospinous fixation: patient satisfaction, anatomical results and quality of life

The objective of this study is to evaluate long-term anatomical results, symptoms of descent, and quality of life after vaginal sacrospinous fixation (SSF) through postoperative follow up study from one institution. Ninety nine women (mean 66 years) underwent vaginal SSF for vault prolapse at our institution. We contacted all patients 2-15 years after surgery for examination (POP-Q, survey). Sixteen out of 55 (29%) patients, who completed follow-up, presented with cystocele, three patients with rectocele, and four patients had a recurrent vault prolapse. As for quality of life, 42/55 (76%) patients reported lower urinary tract symptoms, but only 9/55 (16%) felt a sensation of prolapse. Ten out of 24 patients, who were still sexually active, reported symptoms of sexual dysfunction. There was no correlation between length of follow-up and anatomical or functional results. Vaginal sacrospinous fixation resulted in excellent vault suspension but 29% of the patients developed cystocele formation. Only 16% of patients reported symptoms of descent.