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Apical Prolapse

Cheng-Yu Long, Chiu-Lin Wang, Chin-Ru Ker, Yung-Shun Juan, Eing-Mei Tsai, Kun-Ling Lin
To assess whether our novel uterus-sparing procedure- laparoscopic organopexy with non-mesh genital(LONG) suspension is an effective, safe, and timesaving surgery for the treatment of apical prolapse. Forty consecutive women with main uterine prolapse stage II or greater defined by the POP quantification(POP-Q) staging system were referred for LONG procedures at our hospitals. Clinical evaluations before and 6 months after surgery included pelvic examination, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms with overactive bladder symptom score(OABSS), the short forms of Urogenital Distress Inventory(UDI-6) and Incontinence Impact Questionnaire(IIQ-7), and the Female Sexual Function Index(FSFI)...
March 20, 2018: Scientific Reports
Laura N Nguyen, Morgan Gruner, Kim A Killinger, Kenneth M Peters, Judith A Boura, Michelle Jankowski, Larry T Sirls
OBJECTIVES: To evaluate additional treatments, symptoms, satisfaction and quality of life 1 year after vaginal and abdominal pelvic organ prolapse (POP) repair. METHODS: Adult women enrolled in a prospective POP database were reviewed. Baseline and outcomes data 1 year after surgery were collected including the Pelvic Floor Distress Inventory (PFDI) and mailed surveys. Data were analyzed with descriptive statistics, Fisher's exact tests and t tests. RESULTS: Of 222 women, 147 (66%) had vaginal and 75 (34%) had abdominal repair...
March 16, 2018: International Urology and Nephrology
Sissel Hegdahl Oversand, Anne C Staff, Ellen Borstad, Rune Svenningsen
INTRODUCTION AND HYPOTHESIS: Classical native-tissue techniques for pelvic organ prolapse (POP) repairs, such as the Manchester procedure (MP), have been revitalized because of vaginal mesh complications. However, there are conflicting opinions regarding sufficient apical (mid-compartment) support by the MP and concerns about the risk of dyspareunia. The aims of this study were therefore to investigate anatomical and patient-reported outcomes 1 year after MP. METHODS: Prospective cohort study of 153 females undergoing an MP for anterior compartment POP between October 2014 and June 2016...
March 12, 2018: International Urogynecology Journal
Kai B Dallas, Lisa Rogo-Gupta, Christopher S Elliott
INTRODUCTION: Several factors are hypothesized to impact the risks of mesh-augmented pelvic organ prolapse (POP) repair including, 1) characteristics of the material itself, 2) surgical experience, and 3) patient selection. We present a large population-based approach to explore their impact on outcomes and to describe an ideal mesh usage strategy. METHODS: Data from the Office of Statewide Health Planning and Development was accessed identifying all women undergoing POP repair in California from 2005-2011...
March 3, 2018: Journal of Urology
Pichai Leerasiri, Parit Wachasiddhisilpa, Pattaya Hengrasmee, Chutimon Asumpinwong
INTRODUCTION AND HYPOTHESIS: The Pelvic Organ Prolapse Quantification (POP-Q) assessment is a standardized tool for evaluating pelvic organ prolapse (POP). However, intraoperative evaluation reveals greater apical prolapse than do POP-Q scores. There is a need to implement a method for performing POP-Q at the outpatient clinic that reveals maximal prolapse and causes the least pain. This study was performed to compare the degree of uterine prolapse between POP-Q with cervical traction and POP-Q in the standing position...
March 6, 2018: International Urogynecology Journal
Daniel Altman, Kirk Geale, Christian Falconer, Edward Morcos
INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the use of a generic and globally accessible instrument for assessing health-related quality of life (HR-QoL) in pelvic organ prolapse (POP) surgery. METHODS: In a prospective multicenter setting, 207 women underwent surgery for apical prolapse [stage ≥2, Pelvic Organ Prolapse Quantificcation (POP-Q) system] with or without anterior wall defect. Demographic and surgical characteristics were collected before surgery...
March 6, 2018: International Urogynecology Journal
Giovanni Panico, Giuseppe Campagna, Daniela Caramazza, Nicola Amato, Alfredo Ercoli, Giovanni Scambia, Mauro Cervigni, Riccardo Zaccoletti
INTRODUCTION AND HYPOTHESIS: Uterovaginal prolapse treatment is a challenge for the urogynecologist. Surgical management for apical prolapse can be successful with native tissue and uterosacral ligament (USL) fixation. However, some complications have been described, especially with use of the vaginal approach. The aim of this video is to describe an alternative laparoscopic approach to a traditional vaginal procedure to reduce nerve injury and ureteral complications. METHODS: A 75-year-old woman was referred to our unit for symptomatic stage III apical prolapse and underwent laparoscopic USL fixation, according to the technique described herein...
March 2, 2018: International Urogynecology Journal
Ali Emre Tahaoglu, Mehmet Sait Bakir, Nurullah Peker, İhsan Bagli, Ahter Tanay Tayyar
INTRODUCTION AND HYPOTHESIS: This study examined the early outcomes of laparoscopic (LS) pectopexy and evaluated its effects on female sexual function and quality of life (QoL). METHODS: Twenty-two patients with apical prolapse who underwent LS pectopexy were included. Outcomes of the procedure were noted; the Female Sexual Function (FSFI) and Prolapse Quality of Life (P-QOL) questionnaires were completed preoperatively and 6 months postoperatively. RESULTS: There was no evidence of recurrent prolapse or constipation; the percentages of exacerbation of cystocele, rectocele, de novo stress urinary incontinence (SUI), and de novo urgency (UUI) were 4...
March 2, 2018: International Urogynecology Journal
Corina Christmann-Schmid, Isabell Koerting, Esther Ruess, Ivo Faehnle, Jörg Krebs
To date sacrocolpopexy is regarded as the gold standard treatment for primarily apical compartment prolapse and multi-compartment prolapse. Most bladder and bowel dysfunction improves post-operatively after sacrocolpopexy, however de-novo bowel or de-novo bladder dysfunction can occur. The inferior hypogastric nerve is commonly known amongst pelvic surgeons. However the inferior hypogastric nerve and its fine fibers are difficult to identify, iatrogenic lesion is commonly tolerated although this can lead to bladder, bowel and sexual dysfunction...
March 1, 2018: Acta Obstetricia et Gynecologica Scandinavica
Masao Ichikawa, Hanako Kaseki, Shigeo Akira
Laparoscopic sacrocolpopexy (LSC) is attracting increasing attention as a minimally invasive surgery that provides excellent therapeutic effects on apical vaginal prolapse. However, its therapeutic effects on multi-compartmental pelvic organ prolapse (POP) remain unclear. Therefore, the aim of this review was to evaluate the efficacy of LSC on multi-compartmental POP compared with abdominal sacrocolpopexy (ASC). We extracted three articles on randomized controlled trials that compared LSC and ASC. A total of 247 patients (123 for LSC, 124 for ASC) were evaluated...
February 2018: Asian Journal of Endoscopic Surgery
Karen Ruben Husby, Cæcilie Krogsgaard Tolstrup, Gunnar Lose, Niels Klarskov
INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a common diagnosis that imposes high and ever-growing costs to the healthcare economy. Numerous surgical techniques for the treatment of POP exist, but there is no consensus about which is the ideal technique for treating apical prolapse. The aim of this study was to estimate hospital costs for the most frequently performed operation, vaginal hysterectomy with uterosacral ligament suspension (VH) and the uterus-preserving Manchester-Fothergill procedure (MP), when including costs of postoperative activities...
February 26, 2018: International Urogynecology Journal
Sarah Bradley, Robert E Gutman, Lee A Richter
PURPOSE OF REVIEW: Women have an estimated 12.6% lifetime risk of undergoing surgery for pelvic organ prolapse in the USA (Wu et al. in Obstet Gynecol 123(6): 1201-6, 2014). Surgical repair of uterovaginal prolapse most commonly includes hysterectomy and vaginal vault suspension; however, the value of concomitant hysterectomy is uncertain, and there appears to be growing interest in uterine conservation. Multiple procedures have evolved using a variety of approaches. The aim of this paper is to review uterine sparing (hysteropexy) prolapse repair techniques and outcomes...
February 23, 2018: Current Urology Reports
Hung-Yen Chin, Huang-Hui Chen, Ching-Hui Chen, Chi-Hsin Chiang, Chin-Jung Wang
BACKGROUND: To explore the relationship between overactive bladder (OAB) symptoms and paravaginal defects (PVDs), and to identify the necessity of PVD repair by transvaginal mesh (TVM) for the treatment of OAB symptoms. METHODS: A retrospective clinical study of 30 women with advanced cystocele with limited apical and posterior vaginal wall prolapse was conducted to identify any changes in OAB symptoms following a single Perigee procedure. Prolapse was assessed using the pelvic organ prolapse quantification (POP-Q) system, and paravaginal defects were identified by sonography...
February 16, 2018: Journal of the Chinese Medical Association: JCMA
Qinyi Zhu, Huimin Shu, Guiqiang Du, Zhiyuan Dai
BACKGROUND: Pelvic organ prolapse (POP) is a common disease in women. The aim of this research was to evaluate the safety, efficacy and complication of transvaginal modified sacrospinous ligament fixation with mesh using for the treatment of vaginal vault prolapse. MATERIALS AND METHODS: This was a prospective study including information from 60 symptomatic women with anterior-apical pelvic floor prolapse. The patients underwent transvaginal modified sacrospinous ligament fixation combined with anterior vaginal wall mesh between May 2014 and Sep 2015...
February 16, 2018: International Journal of Surgery
Megan S Bradley, Amy L Askew, Monique H Vaughan, Amie Kawasaki, Anthony G Visco
BACKGROUND: Currently, the decision to perform a concurrent posterior repair/perineoplasty at the time of robotic-assisted sacrocolpopexy is not standardized. OBJECTIVE: To compare anatomic failure after robotic-assisted sacrocolpopexy among three groups of patients categorized by their pre- and post-operative genital hiatus size. STUDY DESIGN: We performed a retrospective cohort study of women who underwent robotic-assisted sacrocolpopexy, from 1/2013 to 9/2016...
February 6, 2018: American Journal of Obstetrics and Gynecology
Rebecca G Rogers, Tracy L Nolen, Alison C Weidner, Holly E Richter, J Eric Jelovsek, Jonathan P Shepherd, Heidi S Harvie, Linda Brubaker, Shawn A Menefee, Deborah Myers, Yvonne Hsu, Joseph I Schaffer, Dennis Wallace, Susan F Meikle
OBJECTIVE: To retrospectively compare surgical success and complications between vaginal vault prolapse compared with uterovaginal prolapse in women who underwent apical prolapse repair for stage II-IV prolapse. METHODS: Women in one of three Pelvic Floor Disorders Network prolapse surgical trials were included. Absence of bothersome bulge symptoms, no prolapse beyond the hymen, and no subsequent prolapse treatment defined success and was our primary outcome. Secondary outcomes included comparison of quality-of-life measures, anatomic changes, and adverse events...
March 2018: Obstetrics and Gynecology
Mitchell B Berger, Giselle E Kolenic, Dee E Fenner, Daniel M Morgan, John O L DeLancey
BACKGROUND: Prolapse of the anterior and posterior vaginal walls has been generally associated with apical descent and levator ani muscle defects. However, the relative contributions of these factors to the pathophysiology of descent in the different vaginal compartments is not well understood. Furthermore, symptoms uniquely associated with prolapse in these compartments have not been well-characterized. OBJECTIVES: Compare associations between: 1) apical support, 2) levator ani muscles, and 3) pelvic floor symptoms in women with posterior-predominant prolapse, anterior-predominant prolapse, and normal support...
January 31, 2018: American Journal of Obstetrics and Gynecology
Rodolfo Milani, Matteo Frigerio, Francesca L Vellucci, Stefania Palmieri, Federico Spelzini, Stefano Manodoro
BACKGROUND: Post-hysterectomy vaginal vault prolapse repair is a challenge for pelvic floor surgeons. Native-tissue repair procedures imply lower costs and reduced morbidity. Our study aims to evaluate operative data, complications, objective, subjective and functional outcomes of transvaginal native-tissue repair for post-hysterectomy vaginal vault prolapse. We also investigated differences among available techniques. METHODS: Retrospective study including patients with symptomatic vaginal vault prolapse (≥ stage 2), previously treated with transvaginal vault suspension through native-tissue repair...
January 26, 2018: Minerva Ginecologica
Philippe E Zimmern, Connie N Wang
INTRODUCTION: Most case series describing surgical repair for pelvic organ prolapse (POP) after radical cystectomy (RC) focus on transvaginal repairs. We present our experience of POP after RC repaired by abdominal mesh sacrocolpopexy (ASC) with long-term follow-up. METHODS: Two women with previous RC with ileal conduit diversion underwent open ASC for repair of apical prolapse with concomitant enterocele. Prolapse severity was assessed using the POP quantification staging system, whereas pelvic imaging was performed with magnetic resonance imaging defecography...
January 24, 2018: Female Pelvic Medicine & Reconstructive Surgery
Seth A Cohen, Cassandra L Carberry, Scott W Smilen
Injury to the urinary tract is a known risk of surgical repair of anterior and apical pelvic organ prolapse. Cystoscopy at the time of surgical prolapse repair is a low-risk procedure that can identify genitourinary tract injury by inspecting the bladder and urethra as well as by visualizing the ureters and ureteral efflux. There are several techniques to assist with visualization of ureteral efflux. Identifying injury intraoperatively may allow for mitigation of the morbidity of the injury. Universal cystoscopy should be performed at the time of all pelvic reconstructive surgeries, with the exception of operations solely for posterior compartment defects...
January 24, 2018: Female Pelvic Medicine & Reconstructive Surgery
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