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Apical Prolapse

Stavros Kontogiannis, Evangelia Goulimi, Konstantinos Giannitsas
Awareness and reporting of mesh-related complications of pelvic organ prolapse repairs have increased in recent years. As a result, deciding whether to use a mesh or not has become a difficult task for urogynecologists. Our aim was to summarize reasons for and against the use of mesh in prolapse repair based on a review of relevant literature. Scopus and PubMed databases were searched for papers reporting on the efficacy and safety of native tissue versus non-absorbable, synthetic mesh prolapse repairs. Randomized controlled trials, systematic reviews, and meta-analyses were included...
October 18, 2016: Advances in Therapy
G Cucinella, G Calagna, G Romano, G Di Buono, G Gugliotta, S Saitta, G Adile, M Manzone, G Accardi, A Perino, A Agrusa
The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. Today, the laparoscopic sacrocolpopexy can be considered the standard treatment for apical prolapse. In the last years, several author performed robotic sacrocolpopexy, obtaining positive results. So, we developed a casecontrol study in order to compare the surgical outcome of robotic group with a control group of laparoscopic approach in patients with symptomatic apical pro-lapsed between January 2015 and December 2015 at University Hospital Policlinico "P...
May 2016: Il Giornale di Chirurgia
Shota Fukuda, Jae-Kwan Song, Keitaro Mahara, Hiroshi Kuwaki, Jeong Yoon Jang, Masaaki Takeuchi, Byung Joo Sun, Yun Jeong Kim, Tetsu Miyamoto, Yasushi Oginosawa, Shinjo Sonoda, Masataka Eto, Yosuke Nishimura, Shuichiro Takanashi, Robert A Levine, Yutaka Otsuji
BACKGROUND: Prominent mitral valve (MV) annular dilatation with only modest left ventricular (LV) dilatation in patients with MV prolapse (MVP) suggests predominant dilatation in adjacent basal LV, which may augment regional wall tension and attenuate contraction by Laplace's law. We hypothesized that MV annular dilatation in patients with MVP is associated with the basal predominance of LV dilatation and attenuated contraction, which can be altered by surgical MV plasty with annulus reduction...
October 2016: Circulation. Cardiovascular Imaging
Christopher Maher, Benjamin Feiner, Kaven Baessler, Corina Christmann-Schmid, Nir Haya, Julie Brown
BACKGROUND: Apical vaginal prolapse is a descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available and there are no guidelines to recommend which is the best. OBJECTIVES: To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials...
October 1, 2016: Cochrane Database of Systematic Reviews
Mallika Anand, Amy L Weaver, Kristin M Fruth, Bijan J Borah, Christopher J Klingele, John B Gebhart
OBJECTIVES: To determine the rate of perioperative complications and cost associated with Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse. METHODS: We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery (MMC, ASC, or RSC) between January 1, 2000, and June 30, 2012, at our institution. For all patients identified, perioperative complications, length of hospital stay, and inpatient costs to patients were abstracted from the medical records and compared by procedure...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Alexandriah N Alas, Orawee Chinthakanan, Luis Espaillat, Leon Plowright, G Willy Davila, Vivian C Aguilar
INTRODUCTION AND HYPOTHESIS: There is a paucity of data evaluating the risk of de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP) in women with no preoperative occult SUI. We hypothesized that apical suspension procedures would have higher rates of de novo SUI. METHODS: This was a retrospective database review of women who had surgery for POP from 2003 to 2013 and developed de novo SUI at ≥6 months postoperatively. Preoperatively, all patients had a negative stress test and no evidence of occult SUI on prolapse reduction urodynamics...
September 27, 2016: International Urogynecology Journal
Melanie R L Meister, Siobhan Sutcliffe, Jerry L Lowder
OBJECTIVE: We sought to identify and summarize definitions of apical support loss utilized for inclusion, success, and failure in surgical trials for treatment of apical vaginal prolapse. STUDY DESIGN: A systematic literature search was performed in 8 search engines: PubMed 1946-, Embase 1947-, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Review Effects, Cochrane Central Register of Controlled Trials,, Proquest Dissertations and Theses, and FirstSearch Proceedings, using key words for apical pelvic organ prolapse and apical suspension procedures through April 2016...
September 15, 2016: American Journal of Obstetrics and Gynecology
Brian J Linder, Mallika Anand, Christopher J Klingele, Emanuel C Trabuco, John B Gebhart, John A Occhino
OBJECTIVE: The optimal suture selection for mesh attachment during robotic sacrocolpopexy (RSC) is currently unknown. Here, we sought to evaluate the outcomes of RSC using absorbable sutures for vaginal and sacral mesh attachment. METHODS: We retrospectively reviewed 132 RSC surgeries that were performed for vaginal vault prolapse in the Division of Gynecologic Surgery at our institution from February 2007 to December 2013. All cases were performed with absorbable suture (polyglactin) for vaginal and sacral mesh fixation...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Emily E Weber LeBrun, Hazel Asumu, Anne M Richardson, LouAnn A Cooper, John D Davis
OBJECTIVE: This study aims to determine the expectations of Obstetrics and Gynecology (ObGyn) residency and Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship program directors (FPDs) for the independent performance of urogynecologic procedures during residency and to compare these expectations with the Council on Resident Education in Obstetrics and Gynecology (CREOG) educational objectives. MATERIALS AND METHODS: Two parallel, anonymous surveys were distributed simultaneously to all directors of accredited ObGyn residency and FPMRS fellowship programs in the United States...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Hugo H Davila, Taryn Gallo, Lindsey Bruce, Christopher Landrey
The objective of this study was to evaluate our technique and steps of robotic and laparoendoscopic single-site utero-sacral ligament suspension in the treatment of patients with symptomatic apical vaginal prolapse. A retrospective analysis was done using the data in 2 community hospital. Eighteen women presented with vaginal apex prolapse and desired minimally invasive surgery (video): (a) Laparoendoscopic single-site utero-sacral ligament suspension (LESS-UTSLS) (n = 13) or (b) robotic-assisted single-site utero-sacral ligament suspension (RASS-UTSLS) (n = 5) were eligible to participate...
September 8, 2016: Journal of Robotic Surgery
Wan Song, Tae Heon Kim, Jin Woo Chung, Won Jin Cho, Ha Na Lee, Young Suk Lee, Kyu-Sung Lee
OBJECTIVES: To evaluate anatomical and functional outcomes of the Prolift Transvaginal Mesh for treatment of pelvic organ prolapse (POP) with regard to safety and satisfaction. METHODS: We reviewed the medical records of 163 patients who underwent POP repair with Prolift Transvaginal Mesh between December 2005 and March 2012. An "optimal" anatomic outcome was defined as Pelvic Organ Prolapse Quantification System (POP-Q) stage 0, and a "satisfactory" anatomic outcome was defined as POP-Q stage 1...
September 2016: Lower Urinary Tract Symptoms
Carolyn W Swenson, Tovia M Smith, Jiajia Luo, Giselle E Kolenic, James A Ashton-Miller, John O DeLancey
BACKGROUND: It is unknown how initial cervix location and cervical support resistance to traction, which we term "apical support stiffness," compare in women with different patterns of pelvic organ support. Defining a normal range of apical support stiffness is important to better understand the pathophysiology of apical support loss. OBJECTIVE: The aims of our study were to determine whether: (1) women with normal apical support on clinic Pelvic Organ Prolapse Quantification, but with vaginal wall prolapse (cystocele and/or rectocele), have the same intraoperative cervix location and apical support stiffness as women with normal pelvic support; and (2) all women with apical prolapse have abnormal intraoperative cervix location and apical support stiffness...
September 8, 2016: American Journal of Obstetrics and Gynecology
Kazuaki Nishimura, Kazuaki Yoshimura, Kaori Hoshino, Toru Hachisuga
INTRODUCTION AND HYPOTHESIS: Transvaginal ipsilateral uterosacral ligament colpopexy for pelvic organ prolapse (POP), which was reported by Shull et al. (Shull's colpopexy) in 2000, is one of the most frequently performed non-mesh pelvic floor reconstructive surgical procedures. Despite its excellent anatomical outcomes, ureteral injury and difficulty in uterosacral ligament detection (especially in patients with severe POP) are typical issues with this procedure. METHOD: This video demonstrates the procedure in a 58-year-old woman, gravida 2 para 2, with POP-Q stage II uterine prolapse and stage I cystocele...
September 10, 2016: International Urogynecology Journal
Luyun Chen, Sean Lisse, Kindra Larson, Mitchell B Berger, James A Ashton-Miller, John O L DeLancey
OBJECTIVE: To test the null hypothesis that six factors representing potential fascial and muscular failure sites contribute equally to the presence and size of a cystocele: two vaginal attachment factors (apical support and paravaginal defects), two vaginal wall factors (vaginal length and width), and two levator ani factors (hiatus size and levator ani defects). METHODS: Thirty women with anterior-predominant prolapse (women in a case group) and 30 women in a control group underwent three-dimensional stress magnetic resonance imaging...
October 2016: Obstetrics and Gynecology
Robert E Gutman, Charles R Rardin, Eric R Sokol, Catherine Matthews, Amy J Park, Cheryl B Iglesia, Roxana Geoffrion, Andrew I Sokol, Mickey Karram, Geoffrey W Cundiff, Joan L Blomquist, Matthew D Barber
BACKGROUND: There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy. OBJECTIVE: We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy. STUDY DESIGN: This multicenter, prospective parallel cohort study compared laparoscopic sacral hysteropexy to vaginal mesh hysteropexy at 8 institutions...
September 3, 2016: American Journal of Obstetrics and Gynecology
A R Mothes, T Lehmann, A Kwetkat, M P Radosa, I B Runnebaum
BACKGROUND: The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. METHOD: In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G)...
August 2016: Geburtshilfe und Frauenheilkunde
Luiz Gustavo Oliveira Brito, Sarah Lauren Cohen, Olga Tusheva, Neeraj Kohli, Abraham Morse, Emily Rose Goggins, Jon Ivar Einarsson
Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n = 135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected...
August 2016: Revista Brasileira de Ginecologia e Obstetrícia
Elisabetta Costantini, Linda Brubaker, Mauro Cervigni, Catherine A Matthews, Barry A O'Reilly, Diaa Rizk, Konstantinos Giannitsas, Christopher F Maher
Sacrocolpopexy is considered a reference operation for pelvic organ prolapse repair but its indications and technical aspects are not standardized. A faculty of urogynecology surgeons critically evaluated the peer-reviewed literature published until September 2015 aiming to produce evidence-based recommendations. PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English language. The modified Oxford data grading system was used to access quality of evidence and grade recommendations...
October 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Ivan Ignjatovic, Dragoslav Basic, Milan Potic, Ljubomir Dinic, Jablan Stankovic, Svetlana Pavlovic, Vladimir Milic, Aleksandar Skakic
OBJECTIVE: Stress urinary incontinence (SUI) is frequently associated with prolapse of the apical and anterior vaginal compartments. The standard treatment of SUI is transobturator tape (TOT). The usual treatment of prolapse (anterior colporrhaphy) has a high recurrence rate. The aim of this study is to evaluate the results of the treatment of SUI and concomitant anterior and apical prolapse with self-created transobturator tape and simultaneous laparoscopic anterior and apical support...
September 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Daphné Lizee, Giuseppe Campagna, Andrea Morciano, Giovanni Panico, Alfredo Ercoli, Pierre Gadonneix
AIMS: Laparoscopic sacral colpopexy (LSC) for pelvic prolapse is a complex procedure, characterized by an anterior mesh suspension to the sacral promontory and a posterior tension-free mesh fixation. METHODS: Totals of 150 age-BMI and parity matched consecutive POP patients were selected from our Diaconesses Hospital database among women who underwent a laparoscopic supracervical hysterectomy (LSH) plus sacral colpopexy (LSC) from June 2005 to March 2010. We analyzed two group of LSC populations, according to different tension-free apical fixation of the posterior mesh: Promontory (P) group and Utero-Sacral (US) group...
August 26, 2016: Neurourology and Urodynamics
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