Prothèse sous-vésicale transobturatrice et sacrospinofixation postérieure vs prothèse sous-vésicale fixée à l’arc tendineux et sacrospinofixation antérieure bilatérale: résultats fonctionnels et ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2011-05-10

AUTHORS

L. Boileau, V. Letouzey, P. Costa, G. Triopon, P. Mares, R. de Tayrac

ABSTRACT

Hypothesis/aims of studyTo compare anatomical and functional results of two different surgical strategies in the combined treatment of anterior vaginal wall and vault prolapse: a transobturator (TO) mesh (Ugytex® Sofradim-Covidien) associated with a posterior sacrospinous ligament suspension (pSLS) compared with an arcus- anchored (AA) mesh (Polyform® or Pinnacle®, Boston Scientific) associated with a bilateral anterior sacrospinous ligament suspension (aSLS) using the Capio® needle driver. Our hypothesis was that the second strategy (AA mesh + aSLS) could be more efficient for anterior wall reconstruction, restoring a more physiological vaginal axis than the posterior approach.Study design, materials and methodsEighty-five women operated for a complex POP were included between March 2005 and March 2009 in a monocentric retrospective and comparative study (group TO/pSLS N = 41; group AA/aSLS N = 44). All patients had at least a POP-Q stage 2 anterior vaginal wall prolapse with Ba point ≥ +1 and a stage 2 vault prolapse with C point ≥ −1. Associated procedures were: site- specific rectocele repair (18 [40%] in the AA/aSLS group vs 32 [78%] in the TO/pSLS group (P = 0.005)). In the post- operative period, anatomical and functional results were evaluated and compared between groups. Post- operative anatomical success was defined by a stage 0 or 1 cystocele for the anterior compartment and by a post- operative vault prolapse stage inferior to the preoperative one for the medium compartment.ResultsThe baseline patient characteristics were similar in both groups, except for the history of prolapse surgery (17 patients [38%] in the AA/aSLS group vs four patients [10%] in the TO/pSLS group (P = 0.002)). The average follow- up was 11.5 ± 8.1 months in the AA/aSLS group and 22.7 ± 16.1 months in the TO/pSLS group (P = 0.011). Anatomical success rate on the anterior compartment was 40/44 (90.1%) in the AA/aSLS group vs 32/41 (78%) in the TO/pSLS group (P = 0.1). Anatomical success rate on the vaginal vault was 43/44 (98%) in the AA/aSLS group vs 37/41 (90%) in the TO/pSLS group (P = 0.19). Total anatomical success on either anterior compartment and vaginal vault was 39/44 (88.6%) in the AA/aSLS group vs 29/41 (70%) in the TO/pSLS group (P = 0.033). De novo prolapse rate on the untreated posterior compartment was 7/26 (27%) in the AA/aSLS group vs 1/9 (11%) in the TO/pSLS group (P = 0.65). Operative complications are represented by: haematomas (2 [4.6%] vs 1 [2.4%]); vaginal erosions (3 [7%] vs 1 [2.4%]); ureteral kinking (4 [9%] vs 0); severe mesh infection with vesico- vaginal fistula (1 [2.3%] vs 0). De novo dyspareunia rate is similar in both groups (2/10 [20%] vs 2/7 [28%]). In total, 8 patients (18.2%) were reoperated in the AA/aSLS group vs 3 (7.3%) in the TO/pSLS group.Concluding messageIn this comparative series, both techniques have a high rate of complications and reoperations, although they were performed by trained operators in vaginal prosthetic surgery. The bilateral anterior sacrospinous ligament fixation shows promising results, but needs reevaluation because of the high rate of complications More... »

PAGES

145-155

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11608-011-0363-4

DOI

http://dx.doi.org/10.1007/s11608-011-0363-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1034185378


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11 schema:description Hypothesis/aims of studyTo compare anatomical and functional results of two different surgical strategies in the combined treatment of anterior vaginal wall and vault prolapse: a transobturator (TO) mesh (Ugytex® Sofradim-Covidien) associated with a posterior sacrospinous ligament suspension (pSLS) compared with an arcus- anchored (AA) mesh (Polyform® or Pinnacle®, Boston Scientific) associated with a bilateral anterior sacrospinous ligament suspension (aSLS) using the Capio® needle driver. Our hypothesis was that the second strategy (AA mesh + aSLS) could be more efficient for anterior wall reconstruction, restoring a more physiological vaginal axis than the posterior approach.Study design, materials and methodsEighty-five women operated for a complex POP were included between March 2005 and March 2009 in a monocentric retrospective and comparative study (group TO/pSLS N = 41; group AA/aSLS N = 44). All patients had at least a POP-Q stage 2 anterior vaginal wall prolapse with Ba point ≥ +1 and a stage 2 vault prolapse with C point ≥ −1. Associated procedures were: site- specific rectocele repair (18 [40%] in the AA/aSLS group vs 32 [78%] in the TO/pSLS group (P = 0.005)). In the post- operative period, anatomical and functional results were evaluated and compared between groups. Post- operative anatomical success was defined by a stage 0 or 1 cystocele for the anterior compartment and by a post- operative vault prolapse stage inferior to the preoperative one for the medium compartment.ResultsThe baseline patient characteristics were similar in both groups, except for the history of prolapse surgery (17 patients [38%] in the AA/aSLS group vs four patients [10%] in the TO/pSLS group (P = 0.002)). The average follow- up was 11.5 ± 8.1 months in the AA/aSLS group and 22.7 ± 16.1 months in the TO/pSLS group (P = 0.011). Anatomical success rate on the anterior compartment was 40/44 (90.1%) in the AA/aSLS group vs 32/41 (78%) in the TO/pSLS group (P = 0.1). Anatomical success rate on the vaginal vault was 43/44 (98%) in the AA/aSLS group vs 37/41 (90%) in the TO/pSLS group (P = 0.19). Total anatomical success on either anterior compartment and vaginal vault was 39/44 (88.6%) in the AA/aSLS group vs 29/41 (70%) in the TO/pSLS group (P = 0.033). De novo prolapse rate on the untreated posterior compartment was 7/26 (27%) in the AA/aSLS group vs 1/9 (11%) in the TO/pSLS group (P = 0.65). Operative complications are represented by: haematomas (2 [4.6%] vs 1 [2.4%]); vaginal erosions (3 [7%] vs 1 [2.4%]); ureteral kinking (4 [9%] vs 0); severe mesh infection with vesico- vaginal fistula (1 [2.3%] vs 0). De novo dyspareunia rate is similar in both groups (2/10 [20%] vs 2/7 [28%]). In total, 8 patients (18.2%) were reoperated in the AA/aSLS group vs 3 (7.3%) in the TO/pSLS group.Concluding messageIn this comparative series, both techniques have a high rate of complications and reoperations, although they were performed by trained operators in vaginal prosthetic surgery. The bilateral anterior sacrospinous ligament fixation shows promising results, but needs reevaluation because of the high rate of complications
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18 schema:keywords AA/aSLS group
19 Associated procedures
20 Ba point
21 Capio
22 De novo dyspareunia rate
23 De novo prolapse rate
24 ET
25 Hypothesis/aims
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27 Post- operative anatomical success
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29 TO/pSLS group
30 Total anatomical success
31 aSLS group
32 aim
33 anatomical success
34 anatomical success rate
35 anchored (AA) mesh
36 anterior compartment
37 anterior sacrospinous ligament fixation
38 anterior sacrospinous ligament suspension
39 anterior vaginal wall
40 anterior wall reconstruction
41 antérieure bilatérale
42 approach
43 axis
44 baseline patient characteristics
45 bilateral anterior sacrospinous ligament fixation
46 bilateral anterior sacrospinous ligament suspension
47 bilatérale
48 characteristics
49 chirurgicales
50 comparative series
51 comparative study
52 compartments
53 complex POP
54 complications
55 complications Prothèse sous-vésicale transobturatrice et sacrospinofixation postérieure
56 cystocele
57 design
58 different surgical strategies
59 drivers
60 dyspareunia rates
61 erosion
62 et sacrospinofixation antérieure bilatérale
63 et sacrospinofixation postérieure
64 fistula
65 fixation
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67 fonctionnels et
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72 history
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74 infection
75 kinking
76 ligament fixation
77 ligament suspension
78 l’arc tendineux et sacrospinofixation antérieure bilatérale
79 materials
80 medium compartment
81 mesh
82 mesh infection
83 messageIn
84 months
85 needle driver
86 novo dyspareunia rate
87 novo prolapse rate
88 one
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90 operators
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92 patient characteristics
93 patients
94 period
95 physiological vaginal axis
96 point
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99 post-operative period
100 posterior approach
101 posterior compartment
102 posterior sacrospinous ligament suspension
103 postérieure
104 preoperative ones
105 procedure
106 prolapse
107 prolapse rate
108 prolapse stage
109 prolapse surgery
110 promising results
111 prosthetic surgery
112 prothèse sous-vésicale fixée à l’arc tendineux et sacrospinofixation antérieure bilatérale
113 rate
114 reconstruction
115 rectocele repair
116 reevaluation
117 reoperation
118 repair
119 results
120 résultats fonctionnels et
121 sacrospinofixation antérieure bilatérale
122 sacrospinofixation postérieure
123 sacrospinous ligament fixation
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125 second strategy
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127 severe mesh infection
128 site-specific rectocele repair
129 sous-vésicale fixée à l’arc tendineux et sacrospinofixation antérieure bilatérale
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131 stage
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133 stage 2 anterior vaginal wall
134 stage 2 vault prolapse
135 strategies
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142 surgery
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144 suspension
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146 tendineux et sacrospinofixation antérieure bilatérale
147 transobturator
148 transobturatrice et sacrospinofixation postérieure
149 treatment
150 untreated posterior compartment
151 ureteral kinking
152 vaginal axis
153 vaginal erosion
154 vaginal prosthetic surgery
155 vaginal vault
156 vaginal wall
157 vault
158 vault prolapse
159 vault prolapse stage
160 vesico-vaginal fistula
161 wall
162 wall reconstruction
163 women
164 à l’arc tendineux et sacrospinofixation antérieure bilatérale
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