scholarly journals Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up

2019 ◽  
Vol 79 (09) ◽  
pp. 983-992 ◽  
Author(s):  
Murat Yassa ◽  
Niyazi Tug
Keyword(s):  
Patient Satisfaction ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Organ ◽  
Stage Ii ◽  
Pelvic Floor Ultrasound ◽  
Anterior Compartment ◽  
Tertiary Center ◽  
Laparoscopic Lateral Suspension ◽  
Subjective Cure

Abstract Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than − 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.

scholarly journals Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study

2021 ◽  
Author(s):  
Zhi-jing Sun ◽  
Tao Guo ◽  
Xiu-qi Wang ◽  
Jing-he Lang ◽  
Tao Xu ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Reconstructive Surgery ◽  
Tissue Repair ◽  
Pelvic Organ ◽  
Native Tissue Repair ◽  
Post Surgery ◽  
Management Of Complications ◽  
Surgery Delay

Abstract Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.

scholarly journals Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eren Akbaba ◽  
Burak Sezgin
Keyword(s):  
Pelvic Organ Prolapse ◽  
De Novo ◽  
Pelvic Organ ◽  
Laparoscopic Technique ◽  
Life Questionnaire ◽  
Advanced Stage ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Mesh Graft ◽  
Laparoscopic Lateral Suspension

Abstract Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients

2017 ◽  
Vol 28 (11) ◽  
pp. 1685-1693 ◽  
Author(s):  
Nikolaus Veit-Rubin ◽  
Jean-Bernard Dubuisson ◽  
Angèle Gayet-Ageron ◽  
Sören Lange ◽  
Isabelle Eperon ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Continuous Series ◽  
Laparoscopic Lateral Suspension

Repair of cystocele and apical genital prolapse using 6-strap mesh implant

2019 ◽  
Vol 87 (3) ◽  
pp. 130-136
Author(s):  
Mikhail Elikovich Enikeev ◽  
Dmitry Victorovich Enikeev ◽  
Dmitry Olegovich Korolev ◽  
Olesya Vyacheslavovna Snurnitsyna ◽  
Mikhail Vladimirovich Lobanov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Organ ◽  
Stage Ii ◽  
Stage Iii ◽  
Pelvic Organ Prolapse Quantification ◽  
Genitourinary Prolapse ◽  
Mesh Implant

Objective: To assess the outcomes of surgical repair of anterior apical prolapse using the 6-strap mesh implant. Study Design: The prospective study included 100 patients with genitourinary prolapse. We used advanced 6-strap mesh implant. The results were assessed at 1 (n = 100) and 12 (n = 93) months after surgery. Maximum follow-up was over 4 years. The anatomical outcomes according to the Pelvic Organ Prolapse Quantification system and intraoperative and postoperative complications were assessed. Stage II and higher prolapse was considered to be a recurrence. The quality of life and sexual function were assessed using Pelvic Organ Prolapse Distress Inventory 20, Pelvic Floor Impact Questionnaire 7, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire 12. Results: Median age was 57 years (34–78 years (95% confidence interval)). All patients had stage III cystocele. The anterior vaginal wall descent in all the patients was associated with uterine descent: 37 (37%), stage II; 60 (60%), stage III; in 3 (3%), stage IV. In eight cases, postoperative de novo stress urinary incontinence developed. The quality of life improved in 93 (93%) women as judged by the Pelvic Floor Distress Inventory 20 data and in 87 (87%) women, according to the Pelvic Floor Impact Questionnaire 7 data. The desirable anatomical result (⩽stage I according to the Pelvic Organ Prolapse Quantification system) was achieved in 97 (97%) patients. With the exception of mesh fragment excision due to erosion (grade 3a), all the complications were classified as grade I according to the Clavien–Dindo classification. Conclusion: Genitourinary prolapse repair using 6-strap mesh is efficacious and relatively safe. The method demonstrates good anatomical results in relation to both anterior and apical prolapses with relatively short-term complications.

scholarly journals Modified Laparoscopic Lateral Suspension with A 5 Arm Mesh in Pelvic Organ Prolapse Surgery.

2021 ◽  
Author(s):  
Eren Akbaba
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Synthetic Mesh ◽  
Advanced Stage ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Mesh Graft ◽  
Laparoscopic Lateral Suspension ◽  
The Mean ◽  
Pop Repair

Abstract Background: The LLS procedure is a laparoscopic technique used to treat pelvic organ prolapse (POP), performed with a T-shaped synthetic mesh graft. The posterior compartment is repaired by using a second mesh or a second procedure like posterior colporrhaphy in the LLS procedure. In laparoscopic lateral suspension (LLS) surgery, we want to repair the defect of the posterior compartment in addition to the apical and anterior compartment by using a 5-arm mesh instead of a T-shaped synthetic mesh graft. In this study, we aim to report clinical results of surgeries performed POP repair with a 5-arm mesh.Method: Data from 37 patients who underwent LLS surgery by using a 5-arm mesh with a diagnosis of advanced stage (≥ stage 3) POP and the defect of the posterior compartment were retrospectively analyzed. The postoperative examination included grading and measurement of the POP-Q stage. Surgical outcomes were reported in pursuance of the International Urogynecological Association recommendations. The results of measurements and examinations, the reoperation rates, the erosion rates, lower urinary tract symptoms (LUTS), and complications were recorded. A p-value of < 0.05 was considered to be statistically significant.Results: There was a significant improvement in POP-Q ≤ −1 score in all treated compartments with an overall objective cure rate of 95.3% for the apical compartment, 86.1% for the anterior compartment, and 91.1% for the posterior compartment. The mean operative time was 96.27±15.81 minutes. The mean length of hospitalization was 2±0.82 days. A significant improvement was observed in symptoms of the vaginal bulge, urinary urgency, incomplete voiding, urinary frequency after surgery. Also, an improvement occurred in defecation symptoms of patients after POP repair. While 13 of the patients (35.1%) were sexually active preoperatively, this rate was determined to be 59.4% (n=22) postoperatively. De novo stress urinary incontinence developed in 7 patients (18.9%) postoperatively. The POP-related quality-of-life score (PQOL) improved significantly after surgery.Conclusion: İn advanced stage POP patients undergoing laparoscopic lateral suspension procedure using a 5-arm mesh, damaged compartments including the posterior compartment can be repaired without the need for an additional procedure and the recurrence rate can be reduced.

scholarly journals Responsiveness Of Pelvic Floor Distress Inventory (PFDI) And Pelvic Floor Impact Questionnaire (PFIQ) In Women With Pelvic Organ Prolapse, Undergoing Vaginal Reconstructive Surgery Versus Women With No Surgery

2017 ◽  
Vol 08 (01) ◽  
pp. 11-16
Author(s):  
Naila Mehboob ◽  
Asma Rauf ◽  
Ghana Shahid ◽  
Tehreem Sultana ◽  
Ghazala Mahmud
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Reconstructive Surgery ◽  
Stage Iv ◽  
Pelvic Organ ◽  
Stage Ii ◽  
Cross Sectional ◽  
Vaginal Reconstructive Surgery ◽  
Surgical Group

Objective: To determine the responsiveness of Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women with pelvic organ prolapse, undergoing vaginal reconstructive surgery versus women with no surgery. Methodology: This study was a cross sectional comparative study carried out in the department of Obstetrics and Gynecology, Pakistan Air Force Hospital, Mianwali in a period from January 2011 to December 2015. Prolapsed women with stage II or more and with willingness for surgery were included in the surgery group. Those willing for conservative management (pelvic floor exercises) were included in the non-surgical group. All patients in both groups completed the PFDI and PFIQ at baseline and 6 month follow-up. Results: Mean (±SD) age, weight, and parity of the patients were 51.42 (±9.07) years, 58.60 (±6.8) kg and 4.00 (±2.14) respectively. More than half of the patients (61%) belonged to low socio economic status, followed by middle class 34% and upper class 5%. Majority of the patients (61%) were post-menopausal. Most of the patients (72%) had stage II prolapse, followed by stage III (27%) and stage IV (1%). Among the associated symptoms, voiding dysfunction (81%) was most commonly observed symptom. At baseline all the scores were found to be significantly high in surgical group as compared to non-surgical group however at follow-up significantly low scores were observed in surgical group than non-surgical group. Also, significant decrease in mean scores was observed in both the groups from baseline to follow-up. Conclusion: The PFDI and PFIQ both are responsive to change in women undergoing surgical and non-surgical treatment for pelvic organ prolapse. But PFDI and PFIQ are more responsive to change in the surgical group. It was also concluded that PFDI is more responsive than the PFIQ in women with pelvic organ relapse

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