96: Pelvic organ prolapse recurrence in young women undergoing vaginal and abdominal colpopexy for the management of apical prolapse

Abstract Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.

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Pelvic Organ Prolapse Recurrence and Patient-Centered Outcomes Following Minimally Invasive Abdominal Uterosacral Ligament and Mesh-Augmented Sacrohysteropexy

Female Pelvic Medicine & Reconstructive Surgery ◽

10.1097/spv.0000000000000710 ◽

2019 ◽

Vol 26 (12) ◽

pp. 763-768 ◽

Cited By ~ 1

Author(s):

Emily R.W. Davidson ◽

Viviana Casas-Puig ◽

Marie Fidela R. Paraiso ◽

Beri Ridgeway ◽

Cecile A. Ferrando

Keyword(s):

Pelvic Organ Prolapse ◽

Minimally Invasive ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Patient Centered ◽

Prolapse Recurrence

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Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2327-x ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Alkan Cubuk ◽

Orkunt Ozkaptan ◽

Jörg Neymeyer

Keyword(s):

Case Report ◽

Pelvic Organ Prolapse ◽

De Novo ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Uterine Disease ◽

Apical Prolapse ◽

Sacral Promontory ◽

Laparoscopic Supracervical Hysterectomy ◽

Supracervical Hysterectomy

Abstract Background Iatrogenic endometriosis is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions. The rate of iatrogenic endometriosis after gynecologic surgeries due to benign uterine disease is 1–2%. Laparoscopic supracervical hysterectomy is also a part of frequently used surgical treatment of apical pelvic organ prolapse, which is followed by sacrocervicopexy. However, there are no data about iatrogenic endometriosis after apical prolapse surgery in the current literature. Herein, we present a case report of a patient diagnosed with de novo endometriosis 1 year after laparoscopic supracervical hysterectomy and sacrocervicopexy. Case presentation A 46-year-old parous Slavic woman who underwent laparoscopic supracervical hysterectomy and sacrocervicopexy secondary to grade 3 symptomatic apical prolapse 1 year earlier was admitted to the same clinic with pelvic pain that had started 6 months following surgery. Deep vaginal palpation was painful. Transvaginal ultrasonography revealed an area with hypervascularization on the sacral promontory. She was scheduled for diagnostic laparoscopy. A 2 × 2-cm solid, wine-colored, hypervascular hemorrhagic lesion was seen on the sacral promontory. The lesion and the peritoneal layer behind it were totally excised. The patient was discharged on the first postoperative day, without any complications. Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within the connective tissue, along with hemosiderin-laden macrophages. The symptoms of the patient resolved after the surgery, and no further adjuvant treatment was needed. Conclusion Although the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.

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Long-term pelvic organ prolapse recurrence and mesh exposure following sacrocolpopexy

International Urogynecology Journal ◽

10.1007/s00192-020-04291-8 ◽

2020 ◽

Vol 31 (9) ◽

pp. 1763-1770 ◽

Cited By ~ 1

Author(s):

Tonya N. Thomas ◽

Emily R. W. Davidson ◽

Erika J. Lampert ◽

Marie F. R. Paraiso ◽

Cecile A. Ferrando

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Mesh Exposure ◽

Prolapse Recurrence

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Oral Poster 10: Uterine Preservation and the Repair of Apical Prolapse: A Comparison of Transvaginal Surgical Outcomes for Apical Pelvic Organ Prolapse Repair with and without Hysterectomy

Journal of Pelvic Medicine and Surgery ◽

10.1097/01.spv.0000134010.17735.5f ◽

2004 ◽

Vol 10 ◽

pp. S17

Author(s):

R Tyagi ◽

L J. Romanzi

Keyword(s):

Pelvic Organ Prolapse ◽

Surgical Outcomes ◽

Pelvic Organ ◽

Apical Prolapse ◽

Uterine Preservation ◽

Prolapse Repair ◽

Pelvic Organ Prolapse Repair

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Surgical Options for Apical Prolapse Repair

Women s Health ◽

10.2217/whe.12.44 ◽

2012 ◽

Vol 8 (5) ◽

pp. 557-566

Author(s):

Ngoc-Bich Le ◽

Lisa Rogo-Gupta ◽

Shlomo Raz

Keyword(s):

Pelvic Organ Prolapse ◽

Primary Care Physicians ◽

Medical Condition ◽

Pelvic Organ ◽

Medical Community ◽

Apical Prolapse ◽

Prolapse Repair ◽

Common Medical Condition ◽

The Usa ◽

Surgical Options

Pelvic organ prolapse is a common medical condition that affects the quality of life of many women. Approximately 50% of parous women have pelvic organ prolapse and the lifetime risk for surgical intervention is 6.7% at the age of 80 years. In the USA, the number of women at risk for symptomatic prolapse is increasing, which is consistent with the recent increase in the overall number of prolapse and incontinence procedures being performed. Although prolapse is usually multicompartmental and isolated defects are rare, the apical compartment deserves special attention because apical support is integral to a durable prolapse repair. Since many women may initially present to their primary care physicians, all members of the medical community should have a basic understanding of the diagnosis and treatment for apical prolapse.

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