THE EFFECTIVENESS OF USING THE INFRACOCCYGEAL SACROPEXY IN THE APICAL PROLAPSE TREATMENT

Aim. We purpose to present the current literature on the efficacy of the infracoccygeal sacropexy (IS) or the posterior intravaginal slingplasty (PIS) procedure in women with apical prolapse (AP) who opt for a surgical uterine-sparing method. Method. The databases Pubmed and Medline have been researched after introducing the key words “uterine prolapse”, “apical compartment” and ”sacropexy”, “sling suspension”. We chose the articles published in the german and english language selecting systhematic reviews, methanalyses, retrospective and follow-up studies in which the benefits of the the infracoccygeal sacropexy in women with advanced prolapse of the apical compartment and/or anterior and/or posterior compartment. As it is known that the defects in the compartments are frequently not isolated and appear to be associated one with another, procedures used for anterior or posterior prolapse have also been applied when necessary. Only symptomatic women have undergone operation. The grade of the prolapse has been established using the Pelvic Organ Prolapse Quantitation (POP-Q) system. Results. After selecting the relevant articles there is insufficient information to support a benefit of the IS technique in the treatment of AP. The recurrence rate in the apical compartment is estimated to be between 14 and 50%. The most important complication of the technique are the vaginal and rectal erosions and, rarely, rectovaginal or urethra-vaginal fistulas. The 3 -year success rate varies between 65% and 86% while more than two thirds of women report an improvement in the life-quality. The perioperative morbidity rate is very low. Conclusion. IS appears to temporary improve the prolapse associated symptomatology but it associated with a very high rate of recurrence as well as high rate of postoperative complications compared to other vaginal techniques with tapes for apical prolapse.

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Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

Urologia Internationalis ◽

10.1159/000371726 ◽

2015 ◽

Vol 95 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Maria Angela Cerruto ◽

Carolina D'Elia ◽

Francesca Maria Cavicchioli ◽

Stefano Cavalleri ◽

Matteo Balzarro ◽

...

Keyword(s):

Uterine Prolapse ◽

Pelvic Organ ◽

Consecutive Series ◽

Complication Rates ◽

Early Complications ◽

Robot Assisted ◽

Female Patients ◽

The Mean ◽

Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

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Laparoscopic sacrohysteropexy versus vaginal hysterectomy and apical suspension: 7-year follow-up of a randomized controlled trial

International Urogynecology Journal ◽

10.1007/s00192-021-04932-6 ◽

2021 ◽

Author(s):

Matthew L. Izett-Kay ◽

Philip Rahmanou ◽

Rufus J. Cartwright ◽

Natalia Price ◽

Simon R. Jackson

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Controlled Trial ◽

Apical Prolapse ◽

Apical Suspension ◽

Vaginal Length ◽

Patient Reported ◽

Laparoscopic Sacrohysteropexy ◽

Total Vaginal Length

Abstract Introduction and hypothesis Laparoscopic mesh sacrohysteropexy offers a uterine-sparing alternative to vaginal hysterectomy with apical suspension, although randomised comparative data are lacking. This study was aimed at comparing the long-term efficacy of laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse. Methods A randomised controlled trial comparing laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse was performed, with a minimum follow-up of 7 years. The primary outcome was reoperation for apical prolapse. Secondary outcomes included patient-reported mesh complications, Pelvic Organ Prolapse Quantification, Patient Global Impression of Improvement in prolapse symptoms and the International Consultation on Incontinence Questionnaire Vaginal Symptoms, Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and PISQ-12 questionnaires. Results A total of 101 women were randomised and 62 women attended for follow-up at a mean of 100 months postoperatively (range 84–119 months). None reported a mesh-associated complication. The risk of reoperation for apical prolapse was 17.2% following vaginal hysterectomy (VH) and 6.1% following laparoscopic mesh sacrohysteropexy (LSH; relative risk 0.34, 95% CI 0.07–1.68, p = 0.17). Laparoscopic sacrohysteropexy was associated with a statistically significantly higher apical suspension (POP-Q point C −5 vs −4.25, p = 0.02) and longer total vaginal length (9 cm vs 6 cm, p < 0.001). There was no difference in the change in ICIQ-VS scores between the two groups (ICIQ-VS change −22 vs −25, p = 0.59). Conclusion Laparoscopic sacrohysteropexy and vaginal hysterectomy with apical suspension have comparable reoperation rates and subjective outcomes. Potential advantages of laparoscopic sacrohysteropexy include a lower risk of apical reoperation, greater apical support and increased total vaginal length.

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Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up

Journal of obstetrics and women s diseases ◽

10.17816/jowd67355-63 ◽

2018 ◽

Vol 67 (3) ◽

pp. 55-63

Author(s):

Dmitry D. Shkarupa ◽

Nikita D. Kubin ◽

Eduard N. Popov ◽

Ekaterina A. Shapovalova ◽

Gleb V. Kovalev ◽

...

Keyword(s):

Quality Of Life ◽

De Novo ◽

Urine Volume ◽

Operation Time ◽

Pelvic Organ ◽

Stage Ii ◽

Apical Prolapse ◽

Pelvic Floor Reconstruction

Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction. Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse. Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment. Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.

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Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

International Urogynecology Journal ◽

10.1007/s00192-020-04396-0 ◽

2020 ◽

Vol 31 (12) ◽

pp. 2595-2602

Author(s):

Matthew L. Izett-Kay ◽

Dana Aldabeeb ◽

Anthony S. Kupelian ◽

Rufus Cartwright ◽

Alfred S. Cutner ◽

...

Keyword(s):

Service Use ◽

Pelvic Organ ◽

Postal Questionnaire ◽

High Rate ◽

Apical Prolapse ◽

Mesh Complications ◽

Cross Sectional ◽

Patient Reported ◽

Prolapse Symptoms

Abstract Introduction and hypothesis The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in pelvic floor surgery. This study is aimed at determining the incidence of mesh-associated complications and reoperation following this procedure. Methods This was a cross-sectional postal questionnaire study of women who underwent laparoscopic mesh sacrohysteropexy between 2010 and 2018. Potential participants were identified from surgical databases of five surgeons at two tertiary urogynaecology centres in the UK. The primary outcome was patient-reported mesh complication requiring removal of hysteropexy mesh. Secondary outcomes included other mesh-associated complications, reoperation rates and Patient Global Impression of Improvement (PGI-I) in prolapse symptoms. Descriptive statistics and Kaplan–Meier survival analyses were used. Results Of 1,766 eligible participants, 1,121 women responded (response proportion 63.5%), at a median follow-up of 46 months. The incidence of mesh complications requiring removal of hysteropexy mesh was 0.4% (4 out of 1,121). The rate of chronic pain service use was 1.8%, and newly diagnosed systemic autoimmune disorders was 5.8%. The rate of reoperation for apical prolapse was 3.7%, and for any form of pelvic organ prolapse it was 13.6%. For PGI-I, 81.4% of patients were “much better” or “very much better”. Conclusions Laparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required.

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Robotic-Assisted Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Single Center Experience in China

Journal of Healthcare Engineering ◽

10.1155/2022/6201098 ◽

2022 ◽

Vol 2022 ◽

pp. 1-5

Author(s):

Ke Niu ◽

Qingzhi Zhai ◽

Wensheng Fan ◽

Li’an Li ◽

Wen Yang ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Life Quality ◽

Operation Time ◽

Pelvic Organ ◽

Mesh Exposure ◽

Robotic Assisted ◽

Single Center Experience ◽

Hospitalization Time ◽

Mesh Excision

Objective. The aim is to investigate the efficiency and outcome of robotic-assisted sacrocolpopexy (RASC) in a cohort of patients with pelvic organ prolapse (POP) in our Gynecology Department. Methods. We performed a retrospective study of female patients who underwent RASC in Chinese PLA General Hospital from January 2013 to December 2020. Their clinical features included age, degree of prolapse, menopause time, body mass index, pregnancy, delivery, operation time, and bleeding volume. All patients were followed up for more than 6 months. POP-Q was recorded to evaluate the position of prolapsed organs. PFDI-20, PFIQ-7, and PGI-I were used to evaluate the life quality after surgery. Results. Twenty-four patients with POP received RASC in our center. The intraoperative bleeding was 86.9 ± 98.3 ml (20–300 ml). The operation time was 143.5 ± 47.3 min (60–240 minutes). The hospitalization time was 10.4 ± 2.1 days (8–16 days). And the follow-up time was 40.8 ± 22.0 months (6–72 months). In the POP-Q follow-up, postoperative Aa, Ba, Ap, Bp, and C were significantly improved than those before surgery ( P < 0.05 ). The objective and subjective cure rate was 100%. PGI-I score was very good in 9 (9/24), very good in 10 (10/24), and good in 3 (3/24). Postoperative PFDI-20 and PFIQ-7 were 2.78 ± 3.82 and 1.57 ± 3.86, which decreased dramatically after surgery ( P < 0.05 ). Mesh exposure occurred in 4 cases (16.7%) at 2–12 months. The exposed diameters were less than 1 cm in 3 cases (2 A/T3/S1) and 1-2 cm in 1 case (3 B/T3/S1). These mesh exposures healed after conservative observation or mesh excision. Conclusion. RASC for POP has the advantage of less bleeding and hospitalization time. It is a minimally invasive option for pelvic organ prolapse.

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Endometrial cancer after the Manchester procedure: a nationwide cohort study

10.22541/au.164003622.29403076/v1 ◽

2021 ◽

Author(s):

Karen Husby ◽

Kim Gradel ◽

Niels Klarskov

Keyword(s):

Endometrial Cancer ◽

Cox Regression ◽

Reference Group ◽

Uterine Prolapse ◽

Pelvic Organ ◽

Anterior Colporrhaphy ◽

Historical Cohort ◽

Manchester Procedure ◽

Overall Mortality

Objectives To investigate whether the Manchester procedure affects the risk and prognosis of endometrial cancer. Design Nationwide historical cohort. Setting The nationwide Danish registers including all residents with lifelong follow-up. Population All Danish women born 1947–2000, living in Denmark at one point during 1977–2018 undergoing the Manchester procedure (N = 23,935) or anterior colporrhaphy (reference group N = 51,008) during 1977–2018. Methods We conducted a nationwide cohort with full follow-up. Chi-Square test for trend to compare the diagnostic stage for the two groups of women. Cox Regression to analyse the risk of endometrial cancer and mortality. The models were adjusted for age, calendar year, income level, and parity. Main outcome measures Number of women diagnosed with endometrial cancer, the stage of endometrial cancer at the time of diagnosis and the cancer specific and overall mortality. Results During the follow up (median 13 years), 271 (1.13%) women were diagnosed with endometrial cancer after the Manchester procedure and 520 (1.05%) after anterior colporrhaphy. The adjusted hazard ratio (HR) for endometrial cancer was 1.00 (95% confidence interval (CI) 0.86 to 1.16). No difference in stage of cancer was found (p=0.18), nor when stratifying for calendar year. The HR for cancer specific mortality and overall mortality after the Manchester procedure was 0.86 (95% CI 0.65 to 1.15) and 0.93 (95% CI 0.77 to 1.12) respectively. Conclusions The Manchester procedure does not affect the risk or prognosis of endometrial cancer. Keywords Epidemiology, endometrial cancer, Manchester procedure, uterine prolapse, pelvic organ prolapse, vaginal hysterectomy

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Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial

BMJ ◽

10.1136/bmj.l5149 ◽

2019 ◽

pp. l5149 ◽

Cited By ~ 11

Author(s):

Sascha F M Schulten ◽

Renée J Detollenaere ◽

Jelle Stekelenburg ◽

Joanna IntHout ◽

Kirsten B Kluivers ◽

...

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Uterosacral Ligament ◽

Uterosacral Ligament Suspension ◽

Recurrent Prolapse ◽

Composite Outcome ◽

Repeat Surgery ◽

Sacrospinous Hysteropexy ◽

Apical Compartment

Abstract Objective To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery. Design Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial. Setting Four non-university teaching hospitals, the Netherlands. Participants 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years. Main outcome measures Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning. Results At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference−6.7%, 95% confidence interval −12.8% to−0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions. Conclusions At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures. Trial registration trialregister.nl NTR1866.

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Clinical Presentation and Prognosis in Heart Failure Patients with Reduced Ejection Fraction: A Prospective One-Year Follow-Up Study in National Cardiovascular Center Harapan Kita, Indonesia

Cardiology Open Access ◽

10.33140/coa.04.01.2 ◽

2019 ◽

Vol 4 (1) ◽

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Clinical Presentation ◽

Systolic Heart Failure ◽

High Rate ◽

Morbidity Rate ◽

Cardiovascular Center ◽

One Year ◽

National Cardiovascular

Background: Systolic heart failure (HFrEF) is characterized by ejection fraction of <40% and causes significant mortality and morbidity rate. We seek to characterize Indonesian patients’ clinical presentation (low to middle income country), oneyear outcome and prognostic factors of HFrEF patients. Methods and Results: Prospective cohort with consecutive sampling method was done in National Cardiovascular Center Harapan Kita (NCCHK), Jakarta from October 2013 to March 2014. NCCHK is a national heart referral center for 34 provinces in Indonesia. Data was obtained from medical records of HFrEF patients enrolled in ASIAN-HF study. Oneyear follow up was done via medical record or phone interview. Data was analyzed using SPSS version 23. Ninety HFrEF subjects (57.3±1.17 years) were obtained. Angina was more commonly seen in higher EF group (21-40%; p=0.016). At one-year, 22.2% died. Lower EF group had higher rate of death (p>0.05). Age, rales and elevated JVP were predictive of death regardless of EF (p<0.05). Conclusions: Angina was more commonly seen in higher EF group. Signs of congestion are associated with poorer prognosis. Low EF (<20% vs 21-40%) had clinically high rate of death (26.7% vs 13.3%, p>0.05).

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Management of inverted papilloma: review

The Journal of Laryngology & Otology ◽

10.1017/s0022215117000172 ◽

2017 ◽

Vol 131 (4) ◽

pp. 284-289 ◽

Cited By ~ 11

Author(s):

B Attlmayr ◽

S G Derbyshire ◽

A V Kasbekar ◽

A C Swift

Keyword(s):

English Language ◽

Case Series ◽

Inverted Papilloma ◽

High Rate ◽

Frozen Sections ◽

Recurrence Rates ◽

One Year ◽

Randomised Controlled ◽

Common Benign Tumour

AbstractBackground:Inverted papilloma is the most common benign tumour affecting the nose. There is a high rate of recurrence and a potential of malignant transformation. This review article aimed to identify the best available management of this pathology today.Method:A systematic review of the current English-language literature was performed. Only original articles with a minimum follow up of one year and an average follow up of two years were included.Results:A total of 1385 patients from 16 case series were identified. The total recurrence rate for all patients was 11.5 per cent. Significantly lower recurrence rates were found for procedures using an attachment-oriented excision (recurrence of 6.9 per cent;p= 0.0001) and utilising frozen sections (recurrence of 7.0 per cent;p= 0.0001).Conclusion:There is a general trend towards endoscopic surgery. There may be some benefit to the use of attachment-oriented surgery and frozen sections. Multi-centred randomised controlled trials are required.

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Outcomes following abdominal sacrocolpopexy for pelvic organ prolapse

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205231 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4970

Author(s):

Anushree Rawat ◽

Ruchika Garg ◽

Poonam Yadav

Keyword(s):

Cost Effective ◽

Pelvic Organ ◽

Safe Procedure ◽

Recurrence Rates ◽

Needle Holder ◽

Perioperative Morbidity ◽

Medical College ◽

Abdominal Sacrocolpopexy ◽

Prolapse Symptoms

Background: Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10% of women who have had a hysterectomy because of prolapse symptoms. Sacrocolpopexy (sacral colpopexy) is a surgical technique to repair pelvic organ prolapses. Specifically, it is intended to address apical or vaginal vault prolapse in women with lower perioperative morbidity, shorter hospital stay and allows a long-term anatomical restoration. It provides excellent apical support with lower rate of recurrence. Aim of present study was to assess the efficiency of conventional method of sacrocolpopexy and to assess the follow up complaints of patients.Methods: This study is conducted in maternal and child health wing of Sarojini Naidu medical college from June 2019 till December 2019. Sacrospinous fixation was performed with conventional needle holder as compared to Miya hook. Data were collected from participants using a structured questionnaire. Follow up was conducted at 6 weeks and 12 weeks.Results: In this study there were 43.3% pre menopausal patients and 53.6% menopausal patients. Maximum patients were multiparous i.e. para 2 (36.6%). Maximum patient belongs to POP Q stage 3. After 6 weeks of surgery maximum patients had pain in abdomen i.e. 3.33%, dyspareunia 8.33% and 100% success rate of sacropexy.Conclusions: Sacrocolpopexy is a cost effective and safe procedure with high anatomical cure and patient satisfaction rate and low intra-operative and. postoperative complications as well as recurrence rates.

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