Endometrial cancer after the Manchester procedure: a nationwide cohort study

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

Native-Tissue Anterior Colporrhaphy Versus Transvaginal Mesh for Anterior Pelvic Organ Prolapse

This article provides a summary of a landmark study in the management of pelvic organ prolapse. This study sought to evaluate if patients with anterior vaginal wall prolapse should be managed with a traditional native tissue colporrhaphy or with transvaginal mesh. This article briefly reviews other relevant studies related to vaginal prolapse and concludes with a relevant clinical case.

COMPARISON OF PREOPERATIVE VERSUS POSTOPERATIVE POST VOID RESIDUAL URINE VOLUME IN PELVIC ORGAN PROLAPSE

Introduction: Post void residual urine is a key marker for the evaluation of the efficacy of bladder emptying particularly in women with pelvic organ prolapse. Objectives of the present study were to compare preoperative versus postoperative post void residual urine volume in patients with pelvic organ prolapse and to assess the role of vaginal hysterectomy with anterior colporrhaphy in relieving urinary disturbances. Methods: This study was done on 50 patients with pelvic organ prolapse admitted for vaginal hysterectomy with anterior colporrhaphy. Staging of the prolapse was done by POP-Q. Ultrasound measurements of post void residual urine volume was done preoperatively and at the time of discharge postoperatively. Post void residual urine volume of more than 50 mL was considered significant. Results: Preoperatively post void residual urine volume < 50 mL seen in 14 women and > 50 mL seen in 36 women respectively. After vaginal hysterectomy with anterior colporrhaphy postoperatively 48 women had post void residual urine volume < 50 mL and only 2 women had > 50 mL respectively,where the P value is < 0.001 which is statistically significant. Conclusion: Vaginal hysterectomy with anterior colporrhaphy will significantly reduce the post void residual urine volume there by correcting the bladder dysfunction.

To the surgical treatment of prolapse

Vogt (Zeit. F. Geb. u. Gyn., Bd. LXXXIX. H. 1) advises, for prolapses in women capable of conceiving, to be limited to plastic surgery on the sleeve, - anterior colporrhaphy with sutures on the bladder and colpoperineorrhaphy, levator sucking sterilization and the use of operations that correct the position of the uterus, whatever the latter may be. During childbirth in women operated on in this way, he recommends applying forceps to the rotated head with simultaneous midline episiotomy and immediate suturing of the perineal incision immediately after delivery.

Non-absorbable versus absorbable sutures for anterior colporrhaphy: study protocol for a randomised controlled trial in South Korea

IntroductionThe anterior vaginal wall is the segment most commonly affected by prolapse. Traditionally, anterior vaginal wall prolapse is repaired via anterior colporrhaphy, which is known to have a high recurrence rate. Several factors might affect the outcome of anterior colporrhaphy, and the use of absorbable sutures might also be associated with the high recurrence rate because the sutures might not be able to retain adequate strength until the plicated pubocervical fascia remodels and regains maximum tensile strength. Nonetheless, no comparative data exist about the relative efficacy and safety of anterior colporrhaphy using non-absorbable versus absorbable sutures. The objective of this study is to compare the surgical outcomes of anterior colporrhaphy using non-absorbable sutures with those of anterior colporrhaphy using absorbable sutures.Methods and analysisThis is a randomised, multicentre, superiority trial. Anterior colporrhaphy will be performed in a traditional manner with midline plication of the fibromuscular layer using either non-absorbable or absorbable sutures. The primary outcome is composite surgical success 1 year after surgery defined as the absence of all of the following: (1) anterior vaginal descent beyond the hymen, (2) the presence of vaginal bulge symptoms and (3) retreatment for recurrent anterior vaginal wall prolapse with either surgery or pessary. The secondary outcomes include the individual components of the composite primary end point, anatomical outcomes, condition-specific quality of life and adverse events related to anterior colporrhaphy. The planned number of participants is 192.Ethics and disseminationThis study was approved by the Institutional Review Board of Seoul National University Hospital (H-1810-037-977). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.Trial registration numberNCT03736811