Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines

The aim of this study is to present long-term results including patients’ satisfaction, pelvic floor symptoms, regret and change in body image in a long-term follow-up after colpocleisis. All women who underwent colpocleisis between September 2001 and February 2014 were identified from the hospital operating lists. These women were contacted for a telephone survey up to 13 years after surgery and asked to complete a structured questionnaire to assess patients’ satisfaction, Quality of Life (QoL) and pelvic floor symptoms. A total of 44 women underwent colpocleisis during the period from September 2001 to February 2014. Mean age was 78 years (range 65–91) years. Mean follow-up time was 41 months (range 10–120). Twenty women could be reached for the survey and were included in the analysis. 15 (75 %) reported a positive impact on QoL, 2 (10 %) a negative because of urinary problems, 2 (10 %) could not report any change in the QoL and 1 (5 %) could not answer this question. There was no recurrence of prolapse. The majority of patients (90 %) would undergo the same surgery again and no patient regretted the loss of her vaginal sexual function. Colpocleisis seems to be an effective treatment for pelvic organ prolapse. In the long term, impact on quality of life is positive, whilst urinary tract symptoms seem to be the most bothersome factor.

Long-term quality of life, satisfaction, pelvic floor symptoms and regret after colpocleisis.

Purpose of review Epidemiologic data suggests that our population greater than 65 years of age will nearly double. In addition, the incidence of women undergoing surgery for pelvic organ prolapse will rise. Chronologic age does not preclude a woman from undergoing a reconstructive procedure, yet the preoperative assessment should be approached most judiciously with great care to insure patient is maximally medically prepared for surgery. Recent findings Surgical procedures in this review include: the abdominal sacral colpopexy, anterior repair, posterior repair, sacrospinous ligament fixation, uterosacral suspension, and iliococcygeus fixation. The advent of robotic surgery has decreased the perioperative morbidity of several of these procedures. However, the risk of more severe complications does appear higher following robotic procedures, when compared with vaginal procedures. Summary Intuitively, one would surmise that there is a point where vaginal surgery should be considered as the primary procedure based on age, risk and durability of the surgery - unfortunately that age is not clear. Thus, the proper selection of prevalence of organ prolapse surgery can only be done after careful discussion with the patient and including the patient in the selection process as much as possible.

Surgical repair of pelvic organ prolapse in elderly patients.

Background: Pelvic organ prolapse (POP) is a major health concern that affects women. Surgeons have increasingly used prosthetic meshes to correct POP. However, the most common used is synthetic mesh, and absorbable mesh is less reported. This research aimed to evaluate the clinical effectiveness of porcine small intestinal submucosa (SIS). Methods: Consecutive forty POP patients who met the inclusion criteria underwent pelvic reconstruction surgery with SIS between March 2012 and December 2013. The patients' clinical characteristics were recorded preoperatively. Surgical outcomes, measured by objective and subjective success rates, were investigated. We evaluated the quality of life (QOL) using the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Sexual QOL was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12). Results: At postoperative 12 months, the subjective recurrence rate (7.5%) was much lower than the objective recurrence rate (40.0%). Postoperatively, no erosion was identified. One underwent a graft release procedure because of urinary retention, and one had anus sphincter reconstruction surgery due to defecation urgency. Another experienced posterior vaginal wall infection where the mesh was implanted, accompanied by severe vaginal pain. Estrogen cream relieved the pain. One patient with recurrence underwent a secondary surgery with Bard Mesh because of stage 3 anterior vaginal wall prolapse. Scoring system of PFDI-20 was from 59.150 ± 13.143 preoperatively to 8.400 ± 4.749 postoperatively and PFIQ-7 was from 73.350 ± 32.281 to 7.150 ± 3.110, while PISQ-12 was from 15.825 ± 4.050 to 12.725 ± 3.471. Conclusions: QOL and the degree of subjective satisfaction were significantly improved postoperatively. Anterior repair deserves more attention because of the higher recurrence rate. The long-term follow-up of the patient is warranted to draw firm conclusion.

Porcine Small Intestinal Submucosa Mesh for Treatment of Pelvic Organ Prolapsed

Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh

Resume Objectif Evaluer l’efficacite et les complications du traitement du prolapsus genital par interposition d’une prothese transvaginale. Patientes et methodes Vingt-huit femmes ont eu une cure de prolapsus genital selon la technique Prolift ® et ont ete suivies prospectivement. Les traitements anterieurs, les interventions associees, les complications peroperatoires et postoperatoires etaient notees. Les resultats anatomiques etaient notes durant le suivi. Les patientes etaient revues a un, trois, six mois puis annuellement. L’echec etait defini par une recidive superieure ou egale au stade II de la classification POP-Q. Resultats L’âge moyen etait de 68 ans. Le suivi median etait de 12 mois. Dix (35 %) et 14 (50 %) patientes avaient respectivement des cystoceles de stade II et III/IV. Dix-neuf (67 %) patientes avaient des rectoceles de grade II/III. Une plaie vesicale (3,5 %) et un hematome (3,5 %) intervesico-vaginal peroperatoires etaient rapportes. Une douleur fessiere qui a necessite l’ablation d’un des bras posterieurs de la prothese etait rapportee chez deux patientes respectivement a j1 et a six semaines. Une (3,5 %) erosion vaginale traitee par excision partielle, une incontinence urinaire d’effort de novo (3,5 %), deux cas d’urgenturie (7 %) et un cas (3,5 %) de dyspareunie etaient notees. L’efficacite etait de 96,5 %. Conclusion La cure du prolapsus par voie vaginale par interposition d’une prothese etait faisable et efficace avec une morbidite acceptable.

Traitement du prolapsus génital par renfort transvaginal Prolift® : une étude prospective

The aim of this review was to summarize recent published data about indications, surgical technique and results of colpocleisis. We conducted a literature search on Medline using PubMed from 1990 to 2008. Anatomical and functional results were assessed for each selected study according to the age and the morbidity of the surgical procedure. As the colpocleisis was complete or partial, anatomic success rates were reported near 100 % with a follow-up ranged from one month to six years. Colpocleisis is an effective procedure for treatment of advanced pelvic organ prolapse in selected patient who no longer desire preservation of coital function. Concomitant anti-incontinence procedure is not associated with increased postoperative morbidity. However, preoperative urodynamics remain to be established for an optimal management of urinary incontinence.

Le cloisonnement vaginal : indications, technique et résultats

The aim of this review was to summarize the available literature on transvaginal anterior colporrhaphy (AC) in the management of anterior vaginal wall prolapse A medline search from 1978 to 2008 was performed Anatomical results were assessed for each study according to the severity of cystocele, the previous pelvic organ prolapse (POP) procedure and the numbers of procedures preformed concomitantly to the AC The anatomic success rates of single anterior colporrhaphy varied between 0 and 100 % with a follow-up ranged from 1 month to 20 years The highest rates of anatomical recurrence were reported in series which encompassed a large number of women with high grade cystocele and/or previous POP procedures However, the excellent short-term results and the feasibility of this technique suggest that AC can still be performed in selected cases

La colporraphie traditionnelle a-t-elle encore une place dans le traitement de la colpocèle antérieure ?

La colporraphie traditionnelle a-t-elle encore une place dans le traitement de la colpocèle antérieure ? Does traditional colporraphy still have a role to play in the treatment of anterior colpocele?

Le cloisonnement vaginal : indications, technique et résultats Colpocleisis: Indications, technique and results

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