Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence.

https://www.europeanurology.com/article/S0302-2838(13)01492-9/pdf/a-review-of-the-current-status-of-laparoscopic-and-robot-assisted-sacrocolpopexy-for-pelvic-organ-prolapse

A Review of the Current Status of Laparoscopic and Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse

STUDY OBJECTIVE: To evaluate feasibility and anatomic and functional results of complete laparoscopic treatment of genital prolapse with meshes. DESIGN: Retrospective monocentric study (Canadian Task Force classification II-2). SETTING: Centre Hospitalier Universitaire de Clermont-Ferrand, Polyclinique Hotel Dieu, France. PATIENTS: One hundred thirty-eight consecutive patients operated from January 1, 1998, through December 31, 2003. INTERVENTIONS: Laparoscopic promontofixation using meshes placed anteriorly in the vesicovaginal space and posteriorly to the levator ani muscles and in the prerectal space. In the space of Retzius, the anterior compartment was treated with paravaginal repair, Burch colposuspension, or both. MEASUREMENTS AND MAIN RESULTS: Mean follow-up was 33.7 months, with 7 patients lost to follow-up. Mean operating time was 190 minutes without any conversion to laparotomy or major perioperative complications. In all, 98% of patients were satisfied with the operation. Anatomic recurrence rate was 11%, and functional recurrence rate was 12%, with maximum delay of 40 months. A total of 57 patients (46%) had postoperative stress urinary incontinence (grade 1 or 2 in most cases), including 9 who did not receive any perioperative treatment for stress urinary incontinence. Seven patients (5%) had vaginal erosion, and for 2 of them (1%), meshes had to be removed because of infectious complications. CONCLUSION: Complete laparoscopic treatment of prolapse including promontofixation appears to be an efficient and viable technique. Treatment of stress urinary incontinence as a consequence of surgery should be improved. Laparoscopic placement of meshes induced few complications. © 2007 AAGL. All rights reserved.

omplete laparoscopic treatment of genital prolapse with eshes including vaginal promontofixation and anterior epair: A series of 138 patients

Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve.

Obesity is a chronic disease which affects a substantial number of patients. It also increases a person’s risk of genital prolapse. Conventional techniques of prolapse repair (sacropexy, transvaginal meshes and sacrospinal fixation) are used in very adipose women, but the effectiveness of this technique is sometimes restricted due to the difficultly of performing the surgery. Here we will describe a new method of endoscopic prolapse surgery, which is especially developed for obese patients. The lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. We have already used this method successfully in 12 patients without any complications. This method provides a stable and durable repair. The laparoscopic access reduces morbidity. The operation time for this procedure is approximately 50 min.

Laparoscopic pectopexy: a new technique of prolapse surgery for obese patients

Study Objective To assess the feasibility and results of laparoscopic sacrocolpopexy (LSC) with two separate meshes along the anterior and posterior vaginal walls in correcting multicompartment pelvic organ prolapse (POP). Design Prospective study (Canadian Task Force classification I). Setting Tertiary care university-affiliated teaching hospital. Patients Forty-six consecutive women with radiologic diagnosis of multicompartment POP with or without genuine stress urinary incontinence and no history of surgery for either disorder. Intervention LSC with or without laparoscopic Burch colposuspension or tension-free vaginal tape procedure. Measurements and Main Results LSC was performed in 89% of patients. Mean operating and hospitalization times were 171 ± 37 minutes and 4.0 ± 2.1 days, respectively. Intraoperative complications were 7% of bladder injuries successfully treated by laparoscopic suture. The success rate for POP was 83%. The main recurrence was rectocele (12%), which occurred only among women undergoing LSC plus laparoscopic Burch colposuspension (P = 0.036). The LSC was effective in treating symptoms in 95% of women. Because of excessive mesh tension, one patient (2%) developed obstructed defecation, and two (5%) had de novo urinary incontinence. In no patient did occlusion or mesh infection and/or erosion in adjacent organs occur. Conclusion LSC appears to be feasible and effective in treatment of multicompartment POP. Performing concomitant Burch colposuspension significantly enhances the risk of rectocele recurrence or development.

Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse.

Le syndrome du perinee descendant decrit en 1970 par PARKS reste d'interpretation physiopathologique et clinique difficile. A partir de la litterature, de 1966 a 2004, et de la lecture retrospective de 1023 colpocystogrammes, une revue generale sur le perinee descendant a ete effectuee. La symptomatologie observee est le plus souvent secondaire a des lesions associees. Les perinees descendants radiologiques n'ont pas toujours de traduction clinique. Le colpocystogramme montre la descente perineale et les troubles associes de la statique pelvienne anterieurs et moyens alors que la defecographie permet de mieux expliquer la dyschesie qui resulte en general d'un trouble posterieur associe (rectocele avec intussusception rectale). La prise en charge des perinees descendants repose sur le traitement medical et la reeducation. Il n'y a pas de consensus concernant le traitement chirurgical. La chirurgie traite en general les lesions associees. En cas d'effondrement complet du perinee, la voie abdominale avec soutien sous vesical, pre et retro-rectal, fixe sans tension au promontoire, pourrait etre interessante alors qu'une refection transanale du rectum a l'agrafeuse pourrait etre proposee lorsque le perinee descendant n'est associe qu'a une intussusception rectale ou a une rectocele.

Descending perineum in women

Resume Objectif. – Proposer une attitude rationnelle dans la prise en charge des lesions infracliniques du sein a partir de l’analyse retrospective de 176 dossiers. Patientes et methode. – Cent soixante-seize patientes ont ete prises en charge durant l’annee 2000 pour une lesion infraclinique du sein. Les donnees epidemiologiques, mammographiques, les procedures diagnostiques effectuees et les resultats histologiques ont ete recueillis. Resultats. – Les patientes ont ete adressees pour une lesion ACR 2 dans 0,8 % des cas, ACR 3 : 34,8 %, ACR 4 : 43,2 % et ACR 5 : 21,2 %. Cent seize patientes ont beneficie d’une macrobiopsie stereotaxique : 55 Advanced Breast Biopsy Instrumentation (ABBI ® ), 61 Minimal Invasive Breast Biopsy (MIBB ® ). A l’histologie, 59,5 % correspondaient a une lesion benigne, 33,6 % a une lesion maligne, 2,6 % a une lesion frontiere et 4,3 % a un resultat suspect ou non contributif. Quarante-deux patientes ont eu une biopsie chirurgicale dont 56,1 % etaient benignes, 41,5 % malignes et 2,4 % frontiere. Dix-huit patientes ont ete surveillees par mammographie. On retrouve 90 % de lesions benignes en cas d’ACR 3 et 46 % de lesions malignes en cas d’ACR 4. En cas de resultat malin, frontiere ou suspect avec les macrobiospies stereotaxiques, la chirurgie a pu etre realisee en un temps dans 97 % des cas vs 55 % avec les biopsies chirurgicales ( p Discussion et conclusion. – Les lesions infracliniques du sein doivent etre classees radiologiquement selon la classification ACR. Les macrobiopsies stereotaxiques sont indiquees pour les lesions ACR 4 et ACR 5. En raison de leur fiabilite, leur pratique permet d’eviter un acte chirurgical a pres de 50 % des patientes car ces lesions sont benignes en cas d’ACR 4. Lorsque le resultat est malin, elles permettent le plus souvent une prise en charge chirurgicale en un temps.

Prise en charge des lésions infracliniques du sein : expérience à propos de 176 cas consécutifs

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Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse.

Descending perineum in women

Prise en charge des lésions infracliniques du sein : expérience à propos de 176 cas consécutifs