Prolapse Surgery: What Kind of Antibiotic Prophylaxis Is Necessary?

<b><i>Introduction:</i></b> The aim of this study was to assess whether antibiotic prophylaxis or therapy is sufficient for laparoscopic or vaginal prolapse surgery with mesh. <b><i>Methods:</i></b> This is a single-center prospective study. The study was divided into 3 groups. Protocol A: metronidazole (15 mg/kg) and piperacillin-tazobactam (2 g) 1 h before surgery and, for postoperative treatment, gentamycin (160 mg) 1 h before surgery in a single dose. Metronidazole and piperacillin-tazobactam were administered until hospital discharge. Protocol B: gentamycin and piperacillin-tazobactam in the same manner as group A. Protocol C: clindamycin (600 mg) and gentamicin (160 mg) 1 h before surgery in a single dose. <b><i>Results:</i></b> We included 87 consecutive patients who underwent prolapse surgery involving mesh prostheses: 57 by the laparoscopic approach and 30 by the vaginal route. Of these, 30 patients were included in protocol A, 30 in protocol B, and 27 in protocol C. There were no statistically significant differences among the 3 protocols regarding any postoperative complications, except for urinary tract infections that were more in the vaginal approach than in the laparoscopic route, in protocol A (<i>p</i> = 0.002). <b><i>Conclusions:</i></b> One-shot prophylaxis can be successfully used in prolapse surgery regardless of the surgical approach.

Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues?

Here, we describe the current laparoscopic procedures for prolapse surgery and report data based on the application of these procedures. We also evaluate current approaches in vaginal prolapse surgery. Debates concerning the use of meshes have seriously affected vaginal surgery and threaten to influence reconstructive laparoscopic surgery as well. We describe the option of using autologous tissue in combination with the laparoscopic approach. Study data and problematic issues concerning the existing techniques are highlighted, and future options addressed.

A Midurethral Sling to Reduce Incontinence After Vaginal Repair

The OPUS (Outcomes Following Vaginal Prolapse Repair and Midurethral Sling) trial examined the effect of a prophylactic midurethral sling at the time of vaginal prolapse surgery in women without stress urinary incontinence. Women undergoing surgery for pelvic organ prolapse are at risk for developing postoperative stress urinary incontinence even if they do not complain of it preoperatively. This was a randomized controlled trial with intervention patients in the prophylactic midurethral sling group and control patients in the sham group. The authors identified a lower rate of de novo urinary incontinence at 3 and 12 months in women who received a prophylactic midurethral sling at the time of vaginal prolapse surgery. However, they also found higher rates of adverse events. This study provides valuable information for patient counseling and surgical decision-making with respect to concurrent prolapse and incontinence surgeries.

Uterus Preservation in Case of Vaginal Prolapse Surgery Acts as a Protector against Postoperative Urinary Retention

Background: The aim of this study was to identify clinical risk factors for increased post-void residual (PVR) volumes in patients undergoing vaginal prolapse surgery and to find out whether uterus preservation or prolapse hysterectomy influences the incidence of postoperative urinary retention. Methods: This retrospective study included women who presented with pelvic organ prolapse (POP) and planned prolapse surgery between January 2017 and July 2019. PVR was assessed postoperatively and increased amounts were defined as incomplete voiding with residual urine volume greater than 150 mL. Results: Increased PVR at the first postoperative day occurred in 31.8% (56/176). Body mass index (BMI) was significantly lower in patients with increased PVR after pelvic floor surgery compared to patients with normal PVR amounts (p = 0.040). Furthermore, during multiple logistic regression analysis, low BMI (p = 0.009) as well as prolapse hysterectomy (p = 0.032) turned out to be the strongest risk factors associated with increased PVR volume. Conclusion: This is the first study identifying prolapse hysterectomy as an independent risk factor for increased PVR after surgical prolapse repair. Our results might be helpful in counseling patients prior to surgery and underline the option of uterus preservation during prolapse surgery in selected cases.