Pelvic Organ Prolapse and Uterine Preservation: A survey of female gynaecologists (POP-UP survey)

Abstract Backround: The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods: A questionnaire based survey of practicing female gynaecologists in the Czech Republic, Slovenia and Slovakia. Results : A total of 140 female gynaecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. Conclusions: The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

Download Full-text

Pelvic Organ Prolapse and Uterine Preservation: A survey of female gynaecologists (POP-UP survey)

10.21203/rs.3.rs-31667/v2 ◽

2020 ◽

Author(s):

Peter Urdzík ◽

Vladimir Kalis ◽

Mija Blaganje ◽

Zdenek Rusavy ◽

Martin Smazinka ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Uterine Cancer ◽

Information Provision ◽

Pelvic Organ ◽

Management Options ◽

Uterine Preservation ◽

The Czech Republic ◽

Pop Surgery ◽

Anatomical Success ◽

Anatomical Outcome

Abstract Background: The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods: A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia.Results: A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices.Conclusions: The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.Trial registration: not included

Download Full-text

Pelvic Organ Prolapse and Uterine Preservation: A survey of female gynaecologists (POP-UP survey)

10.21203/rs.3.rs-31667/v3 ◽

2020 ◽

Author(s):

Peter Urdzík ◽

Vladimir Kalis ◽

Mija Blaganje ◽

Zdenek Rusavy ◽

Martin Smazinka ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Uterine Cancer ◽

Information Provision ◽

Pelvic Organ ◽

Management Options ◽

Uterine Preservation ◽

The Czech Republic ◽

Pop Surgery ◽

Anatomical Success ◽

Anatomical Outcome

Abstract Background: The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery.Methods: A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia.Results: A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices.Conclusions: The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

Download Full-text

Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey)

BMC Women s Health ◽

10.1186/s12905-020-01105-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Peter Urdzík ◽

Vladimir Kalis ◽

Mija Blaganje ◽

Zdenek Rusavy ◽

Martin Smazinka ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Uterine Cancer ◽

Information Provision ◽

Pelvic Organ ◽

Management Options ◽

Uterine Preservation ◽

The Czech Republic ◽

Pop Surgery ◽

Anatomical Success ◽

Anatomical Outcome

Abstract Background The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia. Results A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. Conclusions The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

Download Full-text

A New Surgical Method of Suprapubic and Extraperitoneal Approach with Uterine Preservation for Pelvic Organ Prolapse: Kurt Extraperitoneal Ligamentopexy

ISRN Obstetrics and Gynecology ◽

10.1155/2013/748232 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Sefa Kurt ◽

Mehmet Tunc Canda ◽

Abdullah Tasyurt

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Vaginal Wall ◽

Uterine Preservation ◽

Pop Surgery ◽

Burch Procedure ◽

The Mean ◽

Manchester Procedure ◽

Rectus Fascia

Objective. To introduce an alternative surgical approach for the optimal treatment of pelvic organ prolapse (POP). Methods. Twenty symptomatic women with grades 2–4 POP diagnosis who opted to choose this alternative surgery were retrospectively analyzed. Results. A total of 22 cases were included. The mean age of the patients was 50.6±13.2 years (29–72 years) with a mean gravid and parity of 5.5±2.66 and 3.4±2.06, respectively. The mean body-mass index of the patients was 24.25±2.43. Nine (45%) patients were premenopausal and 11 (55%) patients were postmenopausal. Uterine descensus was present in all patients, and additionally cystorectocele in 9 patients (45%), cystocele in 6 patients (30%), rectocele in 4 patients (20%), and elangatio colli in 6 patients (30%) were diagnosed. In addition to the alternative surgery, Manchester procedure and anteroposterior vaginal wall repair or Burch procedure was performed where necessary. Mean follow-up time was 48.95±42.8 months (6–171 months). No recurrence of POP occurred. Conclusions. Suprapubic, extraperitoneal, and minimally invasive ligamentopexy of the round ligament to the anterior rectus fascia offers an alternative to conventional POP surgery with favorable outcomes without any recurrence.

Download Full-text

Protocol for a prospective multisite cohort study investigating hysterectomy versus uterine preservation for pelvic organ prolapse surgery: the HUPPS study

BMJ Open ◽

10.1136/bmjopen-2021-053679 ◽

2021 ◽

Vol 11 (10) ◽

pp. e053679

Author(s):

Natalie V Scime ◽

Kaylee Ramage ◽

Erin A Brennand

Keyword(s):

Cohort Study ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Vaginal Vault ◽

Service Utilisation ◽

Uterine Preservation ◽

Subjective Report ◽

Vaginal Vault Suspension ◽

Pop Surgery ◽

Vault Suspension

IntroductionPelvic organ prolapse (POP) is the descent of pelvic organs into the vagina resulting in bulge symptoms and occurs in approximately 50% of women. Almost 20% of women will elect surgical correction of this condition by age 85. Removal of the uterus (hysterectomy) with concomitant vaginal vault suspension is a long-standing practice in POP surgery to address apical (uterine) prolapse. Yet, contemporary evidence on the merits of this approach relative to preservation of the uterus through suspension is needed to better inform surgical decision making by patients and their healthcare providers. The objective of this study is to evaluate POP-specific health outcomes and service utilisation of women electing uterine suspension compared with those electing hysterectomy and vaginal vault suspension for POP surgery up to 1-year postsurgery.Methods and analysisThis is a prospective cohort study planning to enrol 321 adult women with stage ≥2 POP from multiple sites in Alberta, Canada. Following standardised counselling from study surgeons, participants self-select either a hysterectomy based or uterine preservation surgical group. Data are being collected through participant questionnaires, medical records and administrative data linkage at four time points spanning from the presurgical consultation to 1-year postsurgery. The primary outcome is anatomic failure to correct POP, and secondary outcomes include changes in positioning of pelvic structures, retreatment, subjective report of bulge symptoms, pelvic floor distress and impact, sexual function and health service use. Data will be analysed using inverse probability weighting of propensity scores and generalised linear models.Ethics and disseminationThis study is approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-2134). Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, and educational handouts for patients.Trial registration numberNCT04890951.

Download Full-text

Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction

International braz j urol ◽

10.1590/s1677-5538.ibju.2015.0656 ◽

2016 ◽

Vol 42 (4) ◽

pp. 773-778 ◽

Cited By ~ 4

Author(s):

Keshet Fink ◽

Inbar Ben Shachar ◽

Naama Marcus Braun

Keyword(s):

Patient Satisfaction ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Uterine Preservation ◽

Prolapse Repair ◽

Advanced Pelvic Organ Prolapse ◽

Pelvic Organ Prolapse Repair

Download Full-text

Randomised controlled trial to investigate the effectiveness of local oestrogen treatment in postmenopausal women undergoing pelvic organ prolapse surgery (LOTUS): a pilot study to assess feasibility of a large multicentre trial

BMJ Open ◽

10.1136/bmjopen-2018-025141 ◽

2020 ◽

Vol 10 (9) ◽

pp. e025141

Author(s):

Tina Sara Verghese ◽

Lee Middleton ◽

Versha Cheed ◽

Lisa Leighton ◽

Jane Daniels ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Randomised Controlled Trial ◽

Postmenopausal Women ◽

Controlled Trial ◽

Pilot Trial ◽

Pelvic Organ ◽

Oestrogen Treatment ◽

Pop Surgery ◽

Randomised Controlled ◽

Oestrogen Supplementation

ObjectiveTo evaluate the feasibility of a multicentre randomised controlled trial (RCT) comparing oestrogen treatment with no oestrogen supplementation in women undergoing pelvic organ prolapse (POP) surgery.Design and settingA randomised, parallel, open, external pilot trial involving six UK urogynaecology centres (July 2015–August 2016).ParticipantsPostmenopausal women with POP opting for surgery, unless involving mesh or for recurrent POP in same compartment.InterventionWomen were randomised (1:1) to preoperative and postoperative oestrogen or no treatment. Oestrogen treatment (oestradiol hemihydrate 10 μg vaginal pessaries) commenced 6 weeks prior to surgery (once daily for 2 weeks, twice weekly for 4 weeks) and twice weekly for 26 weeks from 6 weeks postsurgery.Outcome measuresThe main outcomes were assessment of eligibility and recruitment rates along with compliance and data completion. To obtain estimates for important aspects of the protocol to allow development of a definitive trial.Results325 women seeking POP surgery were screened over 13 months and 157 (48%) were eligible. Of these, 100 (64%) were randomised, 50 to oestrogen and 50 to no oestrogen treatment, with 89 (44/45 respectively) ultimately having surgery. Of these, 89% (79/89) returned complete questionnaires at 6 months and 78% (32/41) reported good compliance with oestrogen. No serious adverse events were attributable to oestrogen use.ConclusionsA large multicentre RCT of oestrogen versus no treatment is feasible, as it is possible to randomise and follow up participants with high fidelity. Four predefined feasibility criteria were met. Compliance with treatment regimens is not a barrier. A larger trial is required to definitively address the role of perioperative oestrogen supplementation.Trial registration numberISRCTN46661996.

Download Full-text

Minimal important difference and patient acceptable symptom state for PFDI-20 and POPDI-6 in POP surgery

International Urogynecology Journal ◽

10.1007/s00192-020-04513-z ◽

2020 ◽

Author(s):

Päivi K. Karjalainen ◽

Nina K. Mattsson ◽

Jyrki T. Jalkanen ◽

Kari Nieminen ◽

Anna-Maija Tolppanen

Keyword(s):

Pelvic Organ Prolapse ◽

Roc Curve ◽

Minimal Important Difference ◽

Patient Reported Outcome Measures ◽

Pelvic Organ ◽

Population Based ◽

Patient Reported Outcome ◽

Pop Surgery ◽

Patient Reported ◽

Patient Acceptable Symptom State

Abstract Introduction and hypothesis Patient-reported outcome measures are fundamental tools when assessing effectiveness of treatments. The challenge lies in the interpretation: which magnitude of change in score is meaningful for the patients? The minimal important difference (MID) is defined as the smallest difference in score that patients perceive as important. The Patient Acceptable Symptom State (PASS) represents the value of score beyond which patients consider themselves well. We aimed to determine the MID and PASS for Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) in pelvic organ prolapse (POP) surgery. Methods We used data from 2704 POP surgeries from a prospective, population-based cohort. MID was determined with three anchor-based and one distribution-based method. PASS was defined using two different methods. Medians of the estimates were identified. Results The MID estimates with (1) mean change, (2) receiver-operating characteristic (ROC) curve, (3) 75th percentile, and (4) distribution-based method varied between 22.9–25.0 (median 24.2) points for PFDI-20 and 9.0–12.5 (median 11.3) for POPDI-6. The PASS cutoffs with (1) 75th percentile and (2) ROC curve method varied between 57.7–62.5 (median 60.0) for PFDI-20 and 16.7–17.7 (median 17.2) for POPDI-6. Conclusion A mean difference of 24 points in the PFDI-20 or 11 points in the POPDI-6 can be used as a clinically relevant difference between groups. Postoperative scores ≤ 60 for PFDI-20 and ≤ 17 for POPDI-6 signify acceptable symptom state.

Download Full-text