Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction

Abstract

Objective:The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus.Materials and Methods:This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient's satisfaction.Results:Sixty-six patients with pelvic organ prolapse stage 3, including uterine pro-lapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at −6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus.Conclusions:Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.

Uterine Fundectomy in Patients With Benign Etiology Undergoing Hysterectomy: New Surgical Technique

“…In the past decade, many uterine preservation techniques have been introduced as alternatives to hysterectomy. These techniques use modern technology and show reliable and comparable results [ 3 ]. In a randomized controlled trial, women in the subtotal hysterectomy group had a significantly better quality of life and improved body image compared to the total hysterectomy group [ 4 ].…”

Histopathology findings of the pelvic organ prolapse

“…Many women are asymptomatic and do not need treatment. The incidence of symptomatic pelvic organ prolapse is approximately 15 %, although it is difficult to estimate due to the lack of methods to evaluate real symptoms and the lack of information regarding patients that in fact make a medical consultation for this matter 1 . It is expected that medical consultations due to symptoms regarding pelvic organ prolapse increase over the next few years due to an increase in life expectancy 2 , especially for women over the age of 65 3 , which means a longer life expectancy post corrective surgery and thus an increase in the possibility of treatment failure and long term complications 2 .…”

“…There are a great variety of options when it comes to treatment, non surgical (pelvic floor muscle excercises, pessa-ries), and surgical 4 . The estimated risk with surgical interventions for prolapse is between 11-19% 1,3,5,6 , with a 29% risk of a second operation 6 . Among those prolapsed compartments, the anterior compartment is the most common, three times more frequent than the posterior compartment and two times more than the apical compartment (uterus or vaginal dome).…”

“…Among those prolapsed compartments, the anterior compartment is the most common, three times more frequent than the posterior compartment and two times more than the apical compartment (uterus or vaginal dome). The pelvic organ prolapse is dynamic and in approximately two thirds of woman more than one compartment is involved 1 . The probability to develop a grade III or IV prolapse in the female population at some time in their lives is around 3 to 6 % 2 .…”

“…The objective of correctional surgery for severe genital prolapse should be the relief of symptoms 2,6 , maintaining and eventually improving the functionality of the pelvic organs as well as the anatomical reestablishment 2 . Vaginal hysterectomy, including some type of vaginal dome suspension has traditionally been the most common surgical treatment for prolapse of the uterus 3,6,7,8 , despite that the descent of the uterus is a consequence and not a cause of the prolapse 7 , but the preservation of the uterus is a technique that is gaining more ground over time 1,6,8 . Over the last few decades, there have been profound changes among women concerning their beliefs and perspectives towards their sexual and reproductive functionality and many women who undergo genital prolapse surgery wish to preserve their uterus 7,8 .…”