scholarly journals Recent advances in pelvic floor repair

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 778 ◽  
Author(s):  
Emma Mironska ◽  
Christopher Chapple ◽  
Sheila MacNeil
Keyword(s):  
Pelvic Floor ◽  
Primary Repair ◽  
Treatment Options ◽  
Pelvic Organ ◽  
Synthetic Mesh ◽  
Social Consequences ◽  
Pelvic Floor Repair ◽  
Recent Advances ◽  
Current Guidance ◽  
Pop Repair

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are conditions which result in significant physical, mental and social consequences for women worldwide. The high rates of recurrence reported with primary repair for POP led to the use of synthetic mesh to augment repairs in both primary and secondary cases following failed previous POP repair. The widely reported, unacceptably high rates of complications associated with the use of synthetic, transvaginal mesh in pelvic floor repair have severely limited the treatment options that surgeons can offer. This article summarises the recent advances in pelvic floor repair, such as improved quantification and modelling of the biomechanics of the pelvic floor and the developing technology within the field of tissue engineering for treatment of SUI/POP, including biomaterials and cell-based therapies. Finally, we will discuss the issues surrounding the commercial introduction of synthetic mesh for use within the pelvic floor and what lessons can be learned for the future as well as the current guidance surrounding treatment for SUI/POP.

scholarly journals Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

2018 ◽  
Vol 7 (6) ◽  
pp. 2230
Author(s):  
Nanthini Saravanan ◽  
Emily Divya Ebenezer ◽  
Vaibhav Londhe ◽  
Lilly Varghese ◽  
Aruna N. Kekre ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Vaginal Hysterectomy ◽  
Voiding Dysfunction ◽  
Short Form ◽  
Pelvic Organ ◽  
Primary Objective ◽  
P Value ◽  
Pelvic Floor Repair ◽  
Defecatory Dysfunction

Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p<0.000 which was highly significant.Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair.

Are conservative treatment options effective for pelvic floor dysfunction due to pelvic organ prolapse?

2016 ◽  
Vol 19 (2) ◽  
pp. 8
Author(s):  
Susan C. Weller ◽  
Hanan Hussein ◽  
Madiha A. Khan ◽  
Preet G. Mangat ◽  
Karen Welch
Keyword(s):  
Pelvic Organ Prolapse ◽  
Conservative Treatment ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Treatment Options ◽  
Pelvic Organ

scholarly journals Surgery for pelvic organ prolapse and stress urinary incontinence and female sexual functions: A quasi-experimental study

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Saida Abrar ◽  
Raheela Mohsin ◽  
Huda Saleem
Keyword(s):  
Experimental Study ◽  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Sexual Function ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Organ ◽  
Pelvic Floor Repair ◽  
Quasi Experimental

Objectives: To assess the effect of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) on various domains of female sexual functions in patients before and after reconstructive surgery for these pelvic floor disorders. Methods: We conducted a quasi-experimental study of 126 women aged 25-65 years, presenting with POP / SUI, from January 1st 2019 to December 31st 2019 at Aga Khan University Hospital. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 18 months after surgery. Results: Mean age of the participants was 51.6, with a mean parity of four. Out of 126 patients, 31 patients underwent vaginal hysterectomy, pelvic floor repair and mid-urethral sling (MUS), 55 had vaginal hysterectomy with pelvic floor repair, 12 women had only pelvic floor repair and 10 patients had uterine suspension surgery for prolapse, while 18 patients underwent MUS operation alone for SUI. There was a statistically significant difference in female sexual functions after surgery for POP and/or SUI (p<0.01). This improvement was observed in both total and individual scores of each domain of FSFI with an overall improvement in sexual function from a mean of 18.5 pre-surgery to 20.8 post-surgery. Conclusions: This study reveals that women sexual functions are affected by POP and SUI and improve remarkably after reconstructive surgeries for these pelvic floor disorders. doi: https://doi.org/10.12669/pjms.37.4.3892 How to cite this:Abrar S, Mohsin R, Saleem H. Surgery for pelvic organ prolapse and stress urinary incontinence and female sexual functions: A quasi-experimental study. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3892 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Long-term outcomes of pelvic organ prolapse repair using a mesh-capturing device when comparing single- versus multicenter use

2020 ◽  
Author(s):  
Christian Falconer ◽  
Daniel Altman ◽  
Georgios Poutakidis ◽  
Päivi Rahkola-Soisalo ◽  
Tomi Mikkola ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Multicenter Study ◽  
Short Form ◽  
High Volume ◽  
Pelvic Organ ◽  
Single Center ◽  
Specific Symptom ◽  
Pop Repair

Abstract Purpose The aim of this study was to compare long-term effects of high-volume surgery at a single-center to multicenter use when using a mesh-capturing device for pelvic organ prolapse (POP) repair. Methods Five years after surgery 101 (88%) at the single center were compared with 164 (81.2%) in the multicenter trial. Outcome measurements included clinical examination, prolapse-specific symptom questionnaires [Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire—short form (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] and pain estimation by VAS (0–10). Results Optimal apical segment outcome was 95% in the single- compared to 83.3% in the multicenter study (p < 0.001). POP recurrence in the anterior and posterior walls (POP-Q, Ba and Bp ≥ 0) was more common at the multicenter as compared to the single center [(19.8% vs 5.4%) and (26% vs 2.7%), (p < 0.001)]. Reoperations for POP and mesh-related complications were more frequent in the multicenter study [31/202 (15.3%) vs 7/116 (6.1%), p < 0.001]. Total PFDI-20, PFIQ-7 and PISQ-12 scores were comparable between the cohorts. There were no significant differences in overall pain scores in-between the cohorts during follow-up. At the single center, 1/81 patients (1.2%) had VAS 7/10, i.e. severe pain, as compared to 3/131 (2.3%) in the multicenter study (p = 0.277). Conclusions Despite the high objective and subjective long-term effectiveness of the procedure in both regular use, and at a high-volume center, centralizing the use of a standardized capturing-device guided transvaginal mesh for POP repair reduced secondary interventions by more than half.

Synthetic Mesh Used in Gynecologic Reconstructive Surgery for Pelvic Floor Disorders

2017 ◽  
Vol 752 ◽  
pp. 59-63
Author(s):  
Elvira Brătilă ◽  
Petre Brătilă ◽  
Diana Comandașu ◽  
Monica Cîrstoiu ◽  
Roxana Bohîlțea ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Organ ◽  
Synthetic Mesh ◽  
Effective Porosity ◽  
Apical Prolapse ◽  
Mesh Surgery

Pelvic floor disorders including stress urinary incontinence and pelvic organ prolapse represent a challenge for gynecologist or urogynecologist even nowadays. Conservative treatment for these conditions proves its effectiveness only in few cases selected from early forms of incontinence or prolapse the most cases being solved surgically. The introduction of the procedure imagined by Petros and Ulmsten, known as TVT (Trans Vaginal Tape) in which the medium urethra is supported by a synthetic tape produced in 1996 a revolution in the surgical treatment of stress urinary incontinence. Radical changes also appeared in pelvic organ prolapse surgery extrapolating the hernia repair procedure by using synthetic mesh. After nearly 20 years of experience the mesh surgery is today a common practice in urogynecology. Between 2011 and 2015 we operated in private practice a total number of 297 cases of which 187 cases of stress urinary incontinence and 110 cases of pelvic organ prolapse. From these 86 (78,1%) cases were represented by cystoceles, associated with early apical prolapse or rectoceles, 18 (16,3%) cases by apical prolapse (grade III-IV) and 6 (5,4%) cases by posterior compartment prolapse alone. We performed mesh surgery in 32 (29%) cases represented mainly by anterior compartment prolapse. In 6 (18,7%) cases we founded mesh extrusion which required partially resection. In two cases we performed large resection of anterior vaginal wall required grafting with acellular second generation graft. In all cases with mesh extrusion the biomechanical analysis revealed significant decrease in effective porosity of the mesh due to excessive tensioning or folding of the mesh. The use of mesh in stress urinary incontinence and pelvic organ prolapse represent a justified alternative in selected cases. The specific complications due to meshes are more frequent in prolapse surgery compared to stress urinary incontinence. In all cases altered effective porosity due to technical defects in surgery represents the leading cause.

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.

Nonsurgical Management Options for Pelvic Organ Prolapse: Review of the Current Evidence

2018 ◽  
Author(s):  
Nathan Kow
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Uterine Prolapse ◽  
Pelvic Floor Muscle ◽  
Treatment Options ◽  
Pelvic Organ ◽  
Current Evidence ◽  
Management Options ◽  
Nonsurgical Management ◽  
First Line Therapy

Pelvic organ prolapse (POP) is a common disorder that impacts a woman’s quality of life and has been projected to increase in the near future. Although many different treatments are currently available, healthcare practioners should be familiar with the common nonsurgical options that are considered the first-line therapy. Advances in nonsurgical interventions have traditionally included pessaries and pelvic floor muscle therapy.  These optiosn have not changed much over time, however there have been recent trials providing more evidence with regards to their efficacy.  The objective of this article is to review the current evidence for nonsurgical treatment options for POP.  This review contains 2 tables and 19 references Key Words: pelvic floor muscle training, pelvic floor physical therapy, pelvic organ prolapse, pessary, kegel excercises, uterine prolapse, cystocele, rectocele

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