Comment on “efficacy and safety of skeletonized mesh implants for advanced pelvic organ prolapse: 12 month follow up”

Abstract Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse. Methods This was a retrospective study of patients with severe prolapse (≥ stage 3) who underwent vNOTES for USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES for USLS. Results A total of 35 patients were included. The mean operative duration was 111.7 ± 39.4 min. The mean blood loss was 67.9 ± 35.8 ml. Statistically significant differences were observed between before and after vNOTES USLS in Aa (+ 0.6 ± 1.7 versus − 2.9 ± 0.2), Ba (+ 1.9 ± 2.2 versus − 2.9 ± 0.3), C (+ 1.5 ± 2.2 versus − 6.9 ± 0.9), Ap (− 1.4 ± 1.0 versus − 3.0 ± 0.1) and Bp (− 1.1 ± 1.4 versus − 2.9 ± 0.1) (P < 0.05 for all). The mean pre- and postoperative PFDI-20 score was 19.9 ± 6.7 and 3.2 ± 5.4, respectively, and the mean pre- and postoperative PISQ-12 score was 24.8 ± 2.3 and 38.3 ± 4.1, respectively (P < 0.05 for both). During 1–13 months of follow-up, there were no cases of severe complications or recurrence. Conclusions vNOTES for USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety. Larger studies with more patients and longer follow-up periods should be performed to evaluate the long-term efficacy and safety profile of vNOTES for USLS.

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The effect of reconstructive vaginal surgery on quality of life and sexual functions in postmenopausal women with advanced pelvic organ prolapse in intermediate-term follow-up

Post Reproductive Health ◽

10.1177/20533691211009713 ◽

2021 ◽

pp. 205336912110097

Author(s):

Suna Y Karaca

Keyword(s):

Quality Of Life ◽

Pelvic Organ Prolapse ◽

Sexual Function ◽

Pelvic Organ ◽

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation ◽

Mccall Culdoplasty ◽

Advanced Pelvic Organ Prolapse

Objective To compare sexual function and quality of life in women who underwent McCall culdoplasty versus sacrospinous ligament fixation for pelvic organ prolapse. Materials and methods This study was conducted in our urogyanecology clinic between July 2015 and June 2019. We included sexually active postmenopausal women who had undergone either McCall culdoplasty ( n:80 patients) or sacrospinous ligament fixation ( n:38 patients) procedure for threatened POP. Patients in both groups were matched according to age and body mass index. Sexual function between both groups was evaluated with the pelvic organ prolapse/urinary incontinence sexual function 12 patient-reported outcome measures (PROMs) and quality of life with the prolapse quality of life (PQOL) PROMs. Results Emotional domain was low in the McCall culdoplasty group (21.4 ± 10.1 vs. 30.8 ± 15.2; p = 0.03). There were no significant differences in other P-QOL domains. Pain during intercourse was more in the sacrospinous ligament fixation group (2.9 ± 1.6 vs. 1.3 ± 1.1; p = 0.04). The mean operation time in the McCall culdoplasty group was shorter than the sacrospinous ligament fixation group ( p = 0.03). There was no difference between the two surgical procedures performed in terms of intraoperative blood loss and hospital stay. The prevalence of recurrence in the McCall culdoplasty group was 6.2%, and that of sacrospinous ligament fixation was 5% ( p = 0.75) in one year follow-up. Conclusion Our study demonstrated that McCall culdoplasty has a more positive effect on QOL and sexuality than sacrospinous ligament fixation in appropriately selected patients. McCall culdoplasty could be considered as a good option in the treatment of advanced pelvic organ prolapse in elderly patients.

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Outcome of Colpoclesis in Advanced Pelvic Organ Prolapse in Elderly Women

Bangladesh Medical Journal ◽

10.3329/bmj.v47i2.43528 ◽

2019 ◽

Vol 47 (2) ◽

pp. 17-22

Author(s):

Rehana Pervin ◽

AKM Sadiqul Azam ◽

Kazi Shafiqul Halim ◽

Syed Monirul Islam ◽

Nazma Khalil ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Elderly Women ◽

Operation Time ◽

Pelvic Organ ◽

P Value ◽

Urinary Flow ◽

Subjective Outcome ◽

Residual Urine ◽

Advanced Pelvic Organ Prolapse

To find out the safety, effectiveness and outcome of colpocleisis in advanced pelvic organ prolapse in elderly women. A prospective study was conducted in Sheikh Hasina Medical College,Tangail (250 beded general hospital,tangail) among 75 female patients aged 60 years and above with diagnosed cases of Pelvic Organ Prolapse (POP) during the period from February 2014 to February 2018 who had no desire in coital function. Patient information were recorded pre-operative, per-operative and post-operative period. Urodynamic investigation (uroflometry and post void residual urine) were done during pre-operative and early postoperative period. Follow up was done at 6 week, 3 month and then annually. Main outcome measures were relieving symptoms, recurrence of prolapse and development of urinary incontinence. Patient satisfaction (Subjective outcome) measured by interview during follow up. Colpocleisis was performed in 75 patients. Mean (age of the patients was 66.69 SD ±5.9 years, mean BMI 18.12 SD ±1.69 kg/m2 and mean parity 5.56 SD ±1.9. Majority of operation done under saddle block, only 21.31% was done under local anaesthesia. Mean operation time was 36.16 SD±6.23 minutes, mean blood loss was 41.61 SD±8.34 ml and mean hospital stay was 2.24 SD ±0.49 days. Objective and subjective outcome were same 98.7% only 1.3% patient developed recurrent prolapse (Failed operation) and 1.3% patient developed urinary urge incontinence. The mean differences were significant for the pre and postoperative maximum urinary flow rate, voided volume, post void residual urine (P value is 0.001). Colpocleisis is safe, effective with high success rate in the management of advance pelvic organ prolapse, who do not wish to preserve coital function. So it can be considered as one of surgical option for treating advance pelvic organ prolapse. Bangladesh Med J. 2018 May; 47 (2): 17-22

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The Learning Curve in Vaginal Pelvic Reconstruction Surgery for Severe Pelvic Organ Prolapse: Analysis of the Cumulative Summation Test (CUSUM)

10.21203/rs.3.rs-939510/v1 ◽

2021 ◽

Author(s):

Chin-Jui Wu ◽

Kuan-Ju Huang ◽

Wen-Chun Chang ◽

Ying-Xuan Li ◽

Lin-Hung Wei ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Learning Curve ◽

Reconstructive Surgery ◽

Operation Time ◽

Pelvic Organ ◽

Pelvic Reconstructive Surgery ◽

Surgical Success ◽

Advanced Pelvic Organ Prolapse ◽

Cumulative Summation

Abstract Women who underwent vaginal pelvic reconstructive surgery with or without mesh consecutively between 2004 and 2018 were retrospectively analyzed to determine the learning curve in vaginal pelvic reconstructive surgery. With cumulative summation (CUSUM) analysis of surgical failure and operation time, we assessed the learning curve of vaginal pelvic reconstructive surgery, including sacrospinous ligament fixation, anterior colporrhaphy, posterior colporrhaphy, and optional vaginal hysterectomy with or without mesh placement. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeon A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32-54 vaginal pelvic reconstructive surgery procedures without mesh and 37-61 procedures in the same surgery with mesh. The surgical success rates for surgeons A and B were 82.2% and 94.1%, with median follow-up times of 60 and 33 months, respectively. The learning phase of vaginal pelvic reconstructive surgery in advanced pelvic organ prolapse in this institutional cohort required 54 and 61 procedures, respectively. A higher number of procedures were required for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the boundary of proficiency, the surgical success rate and operation time were improved.

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V478: POP-Q Based Staging and Outcomes of Robotic Abdominal Sacrocolpopexy for Advanced Pelvic Organ Prolapse

The Journal of Urology ◽

10.1016/s0022-5347(18)32145-1 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 160-160

Author(s):

Sarah E. McAchran ◽

John C. Kefer ◽

Courtenay Moore ◽

Jihad H. Kaouk ◽

Firouz Daneshgari

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Advanced Pelvic Organ Prolapse ◽

Abdominal Sacrocolpopexy

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Are urodynamics useful prior to surgical treatment for advanced pelvic organ prolapse?

10.26226/morressier.59b63e41d462b80292389804 ◽

2017 ◽

Author(s):

Lucas Abrahão

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Advanced Pelvic Organ Prolapse

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Pelvic organ prolapse surgery and health-related quality of life: a follow-up study

BMC Women s Health ◽

10.1186/s12905-020-01146-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tadesse Belayneh ◽

Abebaw Gebeyehu ◽

Mulat Adefris ◽

Guri Rortveit ◽

Janne Lillelid Gjerde ◽

...

Keyword(s):

Quality Of Life ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Stage Iii ◽

Health Related Quality ◽

Related Quality ◽

Health Related

Abstract Background Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL. Methods A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores. Results In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant’s mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores. Conclusions Surgical repair for prolapse effectively improves patient’s HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.

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