Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation.

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Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery

International Urogynecology Journal ◽

10.1007/s00192-011-1523-z ◽

2011 ◽

Vol 23 (1) ◽

pp. 43-48 ◽

Cited By ~ 23

Author(s):

Catharina Forsgren ◽

Cecilia Lundholm ◽

Anna L. V. Johansson ◽

Sven Cnattingius ◽

Jan Zetterström ◽

...

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Incontinence Surgery ◽

Stress Urinary Incontinence Surgery ◽

Urinary Incontinence Surgery

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Proximal Trauma Increases Risk of Venous Thrombosis in Soft Tissue Reconstruction of Open Lower Limb Fractures

Frontiers in Surgery ◽

10.3389/fsurg.2020.574498 ◽

2021 ◽

Vol 7 ◽

Author(s):

Nilay G. Yalcin ◽

Frank Bruscino-Raiola ◽

Scott Ferris

Keyword(s):

Limb Salvage ◽

Free Flap ◽

Lower Limb ◽

Pelvic Injury ◽

Control Group ◽

Study Group ◽

Soft Tissue Reconstruction ◽

Complication Rates ◽

Thrombosis Rate ◽

Trauma Group

Lower limb salvage after major trauma is a complex undertaking. For patients who have suffered multi-level trauma to their lower limb we postulated that pelvic injury or ipsilateral lower limb injury proximal to the site of a free flap may increase the rate of post-operative complications. All patients who underwent lower limb free flap reconstruction as a result of acute trauma between January 2010 and December 2017 were included. The patients were divided into the study group (50 patients), who sustained a lower limb or pelvic injury proximal to the free flap site, and control group (91 patients) who did not sustain proximal lower limb or pelvic trauma. Complication rates were compared between the two groups. Overall, the proximal trauma group anastomotic thrombosis rate of 18.0% was significantly higher than the control group thrombosis rate of 2.2%. There was no statically significant difference in rates of hematoma, swelling or infection. Flap loss rate in the proximal trauma group was 4.0%, compared to the control group at 2.2%. All patients with a failed flap went onto have a successful reconstruction with a subsequent flap in the acute admission and there were no amputations. In the proximal injury study group despite the significantly increased rate of microvascular thrombosis requiring revision, the ultimate primary free flap survival rate was still 96%. Overall, severe coexisting proximal trauma predicted a higher venous microvascular complication rate but was not a contraindication to limb salvage.

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PD05-11 IS PROPHYLACTIC STRESS INCONTINENCE SURGERY NECESSARY AT THE TIME OF PELVIC ORGAN PROLAPSE REPAIR? - RATES OF FUTURE SURGERY IN A LARGE POPULATION BASED COHORT IN CALIFORNIA

The Journal of Urology ◽

10.1016/j.juro.2018.02.419 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Raveen Syan ◽

Kai Dallas ◽

Ericka Sohlberg ◽

Christopher Elliot ◽

Lisa Rogo-Gupta ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Stress Incontinence ◽

Large Population ◽

Pelvic Organ ◽

Population Based ◽

Prolapse Repair ◽

Incontinence Surgery ◽

Stress Incontinence Surgery ◽

Pelvic Organ Prolapse Repair

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Treatment of female stress urinary incontinence with transobturator suburetral band compared with single incision sling: 7-year follow-up

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2021.12.00544 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Carmen E Badillo-Bercebal ◽

Sonia De-Miguel-Manso ◽

Elena García-García ◽

Dakota Viruega-Cuaresma ◽

Julio A Gobernado-Tejedor ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Single Incision ◽

Pelvic Organ ◽

Female Stress Urinary Incontinence ◽

Complication Rates ◽

Post Surgery ◽

Single Incision Sling ◽

Subjective Cure

Objetives: Compare the efficacy and post-surgical complications of single-incision sling (SIS) and transobturator band (TO) for the treatment of stress urinary incontinence (SUI) over 7 years’ follow up. Methods: This is a prospective observational study that included 289 women with SUI who went under surgical treatment, either TO (109) or SIS (180). Patients were evaluated pre- and postoperatively through anamnesis, physical examination and ultrasound. Epidemiological information, complications and surgical time were recorded. The primary outcomes were total continence, objective and subjective cure rates at 7-year follow-up. Statistics: T-Student or U-Mann-Whitney for quantitative variables, Chi-Square for qualitative variables. Results: The groups were similar regarding demographic and medical history parameters, except for age and arterial hypertension, which were higher in TO group, and that SIS patients were more physically active tan TO patients. The TO band compared to SIS associated with increased frequency repair of pelvic organ prolapse. Depending on the type of urinary incontinence, pure SUI was more frequent in SIS and mixed in TO. The duration of the surgery was shorter with SIS. During the 7-year follow up there were no differences in the objective cure, subjective cure and complication rates. Conclusion: After 7-years follow-up, no significant differences were found with regard to subjective and objective outcomes, and post-surgery complication rates between the single incisión sling and the transobturator band.

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The Outcome of a Single-Incision Sling versus Trans-Obturator Sling in Overweight and Obese Women with Stress Urinary Incontinence at 3-Year Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm8081099 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1099

Author(s):

Hui-Hsuan Lau ◽

Sugarmaa Enkhtaivan ◽

Tsung-Hsien Su ◽

Wen-Chu Huang

Keyword(s):

Single Incision ◽

Obese Women ◽

Cure Rate ◽

Pad Test ◽

Single Incision Sling ◽

Wound Pain ◽

Urine Leakage ◽

Assess Quality ◽

Subjective Cure

Background: Being overweight or obese is a risk factor for incontinence and has negative impacts on the surgical outcomes. Compared with trans-obturator sling (TOS), single incision sling (SIS) is a new generation of anti-incontinence surgery. However, the data on SIS in overweight and obese women remains limited. Methods: This retrospective study analyzed the objective and subjective cure rate of overweight and obese women who underwent sling surgeries. Other evaluations included valid questionnaires to assess quality of life and 1-hour pad test to quantify urine leakage. Surgical characteristics and adverse events were also analyzed. Results: A total of 217 patients were analyzed with a median follow-up period of 37.3 months (range, 9–84 months). For overweight and obese patients, the objective and subjective cure rate were comparable (all p > 0.05). However, the SIS group had worse post-operative incontinence-related symptom distress (p < 0.001) and 1-hour pad test (p = 0.047). On the other hand, SIS had a shorter surgery time (p = 0.017) and lower pain score (p < 0.001). Conclusions: Compared with TOS, SIS had non-significant cure rates in the overweight and obese women. SIS had worse urine leakage and incontinence symptoms, but less surgical and wound pain in obese women. Thorough pre-operative counseling is necessary.

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Faculty Opinions recommendation of Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718225862.793498383 ◽

2014 ◽

Author(s):

Dudley Robinson

Keyword(s):

Systematic Review ◽

Pelvic Organ Prolapse ◽

Stress Incontinence ◽

Meta Analysis ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Randomised Trials ◽

Incontinence Surgery ◽

Stress Incontinence Surgery

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Sacrospinous hysteropexy – an alternative in primary surgical treatment of apical compartment prolapse

Česká gynekologie ◽

10.48095/cccg2021200 ◽

2021 ◽

Vol 86 (3) ◽

pp. 200-204

Author(s):

Prokop Homola ◽

◽

Germund Hensel ◽

Milan Košťál

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Operation Time ◽

Pelvic Organ ◽

Complication Rates ◽

Female Population ◽

Sacrospinous Hysteropexy ◽

Pubmed Database ◽

Common Diagnosis ◽

Apical Compartment

Summary Objective: To present a surgical treatment of pelvic organ prolapse and its outcomes according to the literature. Methods: PubMed database search. Conclusion: Pelvic organ prolapse is a common diagnosis with prevalence around 40% of female population. Vaginal delivery, especially with levator ani trauma, increasing age and obesity are the basic risk factors. Native tissue repair is a possible surgical treatment. Unfortunately, concomitant hysterectomy is still a very common procedure. It is established that uterus plays a passive role in pelvic organ prolapse. Sparing of the uterus keeps the original fixation structures and compartments intact and provides a solid tissue to anchor the stitches. Patients with benign and malign uterine diseases cannot have their uterus spared. In sacrospinous hysteropexy, nonabsorbable sutures are passed through the namesaked ligament on one or both sides to elevate the uterus. Several studies and their metaanalyses show comparable anatomical and functional outcomes with shorter operation time, decreased blood loss, faster recovery and lower complication rates in comparison with hysterectomy and uterosacral ligament fixation. In a prospective randomized control trial, sacrospinous hysteropexy provides significantly lower reoperation rate for apical compartment prolapse in a long-term follow-up. It is a safe and effective procedure for patients who wish to keep their uterus in place. Sacrospinous hysteropexy is an alternative in primary surgical treatment of pelvic organ prolapse.

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Concomitant pelvic organ prolapse surgery with TVT procedure

International Urogynecology Journal ◽

10.1007/s00192-005-1337-y ◽

2005 ◽

Vol 17 (1) ◽

pp. 60-65 ◽

Cited By ~ 34

Author(s):

Kuan-Hui Huang ◽

Fu-Tsai Kung ◽

Hsi-Mi Liang ◽

Chih-Wei Chen ◽

Shiuh-Young Chang ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Tvt Procedure ◽

Pelvic Organ Prolapse Surgery

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Efficacy and patient satisfaction of pelvic organ prolapse reduction using transvaginal mesh: A Canadian perspective

Canadian Urological Association Journal ◽

10.5489/cuaj.5095 ◽

2018 ◽

Vol 12 (10) ◽

Cited By ~ 1

Author(s):

Mélanie Aubé ◽

Marilyne Guérin ◽

Caroline Rhéaume ◽

Le Mai Tu

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Class Action ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Complication Rates ◽

Medical Chart Review ◽

Repeat Operation ◽

Canadian Perspective ◽

Report Data

Introduction: Due to U.S Food and Drud Administration warnings and class-action lawsuits, the use of transvaginal mesh for pelvic organ prolapse surgery is controversial. We report data from two Canadian centres, focusing on recurrence and reoperation rates, complication rates, and patient satisfaction.Methods: A retrospective medical chart review was performed. Patients were also invited to a long-term followup clinic for a complete questionnaire and gynecological exam. Patients unable to present to clinic for followup had the option to answer the questionnaire via telephone.Results: A total of 334 patients were operated between 2000 and 2013. Median followup was 38 months for questionnaire and 36 months for physical exam. Thirty-seven patients (11.1%) required repeat operation, including 17 for recurrent prolapse and 10 for mesh exposure; 98.8% of patients reported feeling subjectively improved by their prolapse surgery.Conclusions: Midterm results are satisfactory and patient subjective satisfaction is high following transvaginal mesh repair of pelvic organ prolapse.

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