Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk ... View Full Text


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Article Info

DATE

2019-04

AUTHORS

Eduardo Bataller, Cristina Ros, Sonia Anglès, Miriam Gallego, Montserrat Espuña-Pons, Francisco Carmona

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Few studies have compared the different approaches of mesh surgery in patients with severe pelvic organ prolapse (POP). In addition to laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx), anterior vaginal mesh (AVM) may be an effective approach for correcting anterior vaginal wall associated with apical POP in women with advanced POP. METHODS: A randomised controlled trial (RCT; January 2011 to March 2016) including 120 patients (60/group) with advanced symptomatic POP, with a predominant anterior vaginal wall descent stage III or greater in combination with a stage II or III apical defect (uterus or vaginal vault). Patients underwent four visits: baseline, 3, 6 and12 months after surgery. The main outcome was anatomical success defined as anterior and posterior vaginal wall not descending beyond the hymen and vaginal apex descent no more than one third into the vagina. Secondary variables: PFDI, ICIQ-UI-SF, intraoperative variables, postoperative morbidity and complications. RESULTS: Anatomical success was achieved with LSC-Cx in 79% and with AVM in 76% (NS). No statistically significant differences were found among POP-Q anterior vaginal wall points between groups, whereas better results were obtained with LSC-Cx in posterior vaginal wall points and total vaginal length. Intraoperative outcomes were similar in the two groups, except for operating time (78.05 min LSC-Cx vs 44.28 min AVM). There were no statistically significant differences related to de novo stress urinary incontinence and dyspareunia. Worse results were found in the CRADI-8 in the LSC-Cx group, owing to constipation. Late postoperative complications and reinterventions were similar in the two groups. CONCLUSIONS: No differences were found in the anatomical correction of anterior and apical POP. The LSC-Cx group presented better correction of posterior vaginal wall defects and a longer total vaginal length. More... »

PAGES

1-11

References to SciGraph publications

  • 2007-07. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift™ technique)—a case series multicentric study in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2010-11. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2014-01. Long-term follow-up after native tissue repair for pelvic organ prolapse in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2015-01. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009 in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2016-02. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP) in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2017-12. Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2018-01. Risk factors for prolapse recurrence: systematic review and meta-analysis in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2012-01. Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2018-01. Risk factors for recurrence after hysterectomy plus native-tissue repair as primary treatment for genital prolapse in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2013-11. Uterine-preserving POP surgery in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2015-11. Risk factors for pelvic organ prolapse and its recurrence: a systematic review in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2013-03. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2012-09. Reoperation for pelvic organ prolapse within 10 years of primary surgery for prolapse in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00192-018-3702-7

    DOI

    http://dx.doi.org/10.1007/s00192-018-3702-7

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        "description": "INTRODUCTION AND HYPOTHESIS: Few studies have compared the different approaches of mesh surgery in patients with severe pelvic organ prolapse (POP). In addition to laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx), anterior vaginal mesh (AVM) may be an effective approach for correcting anterior vaginal wall associated with apical POP in women with advanced POP.\nMETHODS: A randomised controlled trial (RCT; January 2011 to March 2016) including 120 patients (60/group) with advanced symptomatic POP, with a predominant anterior vaginal wall descent stage III or greater in combination with a stage II or III apical defect (uterus or vaginal vault). Patients underwent four visits: baseline, 3, 6 and12\u00a0months after surgery. The main outcome was anatomical success defined as anterior and posterior vaginal wall not descending beyond the hymen and vaginal apex descent no more than one third into the vagina. Secondary variables: PFDI, ICIQ-UI-SF, intraoperative variables, postoperative morbidity and complications.\nRESULTS: Anatomical success was achieved with LSC-Cx in 79% and with AVM in 76% (NS). No statistically significant differences were found among POP-Q anterior vaginal wall points between groups, whereas better results were obtained with LSC-Cx in posterior vaginal wall points and total vaginal length. Intraoperative outcomes were similar in the two groups, except for operating time (78.05\u00a0min LSC-Cx vs 44.28\u00a0min AVM). There were no statistically significant differences related to de novo stress urinary incontinence and dyspareunia. Worse results were found in the CRADI-8 in the LSC-Cx group, owing to constipation. Late postoperative complications and reinterventions were similar in the two groups.\nCONCLUSIONS: No differences were found in the anatomical correction of anterior and apical POP. The LSC-Cx group presented better correction of posterior vaginal wall defects and a longer total vaginal length.", 
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    36 schema:description INTRODUCTION AND HYPOTHESIS: Few studies have compared the different approaches of mesh surgery in patients with severe pelvic organ prolapse (POP). In addition to laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx), anterior vaginal mesh (AVM) may be an effective approach for correcting anterior vaginal wall associated with apical POP in women with advanced POP. METHODS: A randomised controlled trial (RCT; January 2011 to March 2016) including 120 patients (60/group) with advanced symptomatic POP, with a predominant anterior vaginal wall descent stage III or greater in combination with a stage II or III apical defect (uterus or vaginal vault). Patients underwent four visits: baseline, 3, 6 and12 months after surgery. The main outcome was anatomical success defined as anterior and posterior vaginal wall not descending beyond the hymen and vaginal apex descent no more than one third into the vagina. Secondary variables: PFDI, ICIQ-UI-SF, intraoperative variables, postoperative morbidity and complications. RESULTS: Anatomical success was achieved with LSC-Cx in 79% and with AVM in 76% (NS). No statistically significant differences were found among POP-Q anterior vaginal wall points between groups, whereas better results were obtained with LSC-Cx in posterior vaginal wall points and total vaginal length. Intraoperative outcomes were similar in the two groups, except for operating time (78.05 min LSC-Cx vs 44.28 min AVM). There were no statistically significant differences related to de novo stress urinary incontinence and dyspareunia. Worse results were found in the CRADI-8 in the LSC-Cx group, owing to constipation. Late postoperative complications and reinterventions were similar in the two groups. CONCLUSIONS: No differences were found in the anatomical correction of anterior and apical POP. The LSC-Cx group presented better correction of posterior vaginal wall defects and a longer total vaginal length.
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