Concomitant apical suspensory procedures in women with anterior vaginal wall prolapse in the United States in 2011

Northington, Gina M.; Hudson, Catherine; Karp, Deborah R.; Huber, Sarah A.

doi:10.1007/s00192-015-2894-3

Cited by 11 publications

(9 citation statements)

References 28 publications

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“…These codes are generated by coding personnel, not the surgeon, which can lead to misclassification and transcription errors. 32 As ICD-9 codes are primarily used for hospital billing, this data may not adequately capture the true extent of procedures performed. However, since the codes are used for hospital billing, if a diagnosis or procedure is described in the medical record it is likely to be listed as part of that patient’s hospitalization and/or surgery.…”

Section: Commentmentioning

confidence: 99%

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate

Ross

Meister

Shepherd

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Apical vaginal support is considered the keystone of pelvic organ support. Level I evidence supports re-establishment of apical support at time of hysterectomy, regardless of whether the hysterectomy is performed for prolapse. National rates of apical support procedure performance at time of inpatient hysterectomy have not been well described. Objective To estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. Study Design The National Inpatient Sample was used to identify hysterectomies performed from 2004–2013 for benign indications. ICD-9 codes were used to select both procedures and diagnoses. The primary outcome was performance of an apical support procedure at time of hysterectomy. Descriptive and multivariable analyses were performed. Results There were 3,509,230 inpatient hysterectomies performed for benign disease between 2004 and 2013. In both non-prolapse and prolapse groups, there was a significant decrease in total number of annual hysterectomies performed over the study period (p <0.0001). There were 2,790,652 (79.5%) hysterectomies performed without a diagnosis of prolapse, and an apical support procedure was performed in only 85,879 (3.1%). There was a significant decrease in the proportion of hysterectomies with concurrent apical support procedure (high of 4.0% in 2004 to 2.5% in 2013, p <0.0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (large and medium), and hysterectomy type (vaginal and laparoscopically-assisted vaginal) were associated with performance of an apical support procedure. During the study period, 718,578 (20.5%) inpatient hysterectomies were performed for prolapse diagnoses and 266,743 (37.1%) included an apical support procedure. There was a significant increase in the proportion of hysterectomies with concurrent apical support procedure (low of 31.3% in 2005 to 49.3% in 2013, p<0.0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (medium and large), and hysterectomy type (total laparoscopic and laparoscopic supracervical) were associated with performance of an apical support procedure. Conclusions This national database study demonstrates that apical support procedures are not routinely performed at time of inpatient hysterectomy regardless of presence of prolapse diagnosis. Educational efforts are needed to increase awareness of the importance of re-establishing apical vaginal support at time of hysterectomy regardless of indication.

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Section: Commentmentioning

confidence: 99%

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate

Ross

Meister

Shepherd

et al. 2017

American Journal of Obstetrics and Gynecology

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“…Likewise, in a review of the National Hospital Discharge survey from 1979 to 2009, Stewart and colleagues found that, although there was a significant decrease in the frequency of isolated cystocele/rectocele repair procedures performed for pelvic organ prolapse, 87% of all anterior, apical, and posterior compartment prolapses were still being managed with cystocele/rectocele repair alone 16. Northington et al identified women undergoing prolapse surgery with a primary diagnosis of cystocele in 2011 from the Nationwide Inpatient Sample 17. Only 32% of these women underwent a concomitant apical prolapse procedure, suggesting an ongoing discrepancy between evidence-based medicine and adoption into clinical practice 17.…”

Section: All About the Apexmentioning

confidence: 99%

“…Northington et al identified women undergoing prolapse surgery with a primary diagnosis of cystocele in 2011 from the Nationwide Inpatient Sample 17. Only 32% of these women underwent a concomitant apical prolapse procedure, suggesting an ongoing discrepancy between evidence-based medicine and adoption into clinical practice 17. These data are concerning given that an unacceptably high number (17%) of women who underwent a procedure for POP will undergo a second surgery for recurrent POP within 10 years 18…”

Section: All About the Apexmentioning

confidence: 99%

Surgical Updates in the Treatment of Pelvic Organ Prolapse

Geynisman‐Tan¹,

Kenton²

2017

Rambam Maimonides Med J

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Pelvic organ prolapse affects approximately 8% of women, and the demand for pelvic organ prolapse surgery is expected to increase by nearly 50% over the next 40 years. The surgical techniques used to correct pelvic organ prolapse have evolved over the last 10 years, with multiple well-designed studies addressing the risks, outcomes, reoperation rates, and optimal surgical approaches. Here we review the most recent evidence on the route of access, concomitant procedures, and synthetic materials for augmenting the repair. Ultimately, this review highlights that there is no optimal method for correcting pelvic organ prolapse and that the risks, benefits, and approaches should be discussed in a patient-centered, goal-oriented approach to decision-making.

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“…Może dojść do zmiany ułożenia macicy i pochwy, czemu często towarzyszy obniżenie dolnych dróg moczowych -zwykle przebiegające z objawami klinicznymi, a w krańcowych stanach prowadzące do wypadania macicy i pochwy oraz znacznych zaburzeń w oddawaniu moczu. Czynnikiem zaburzającym ekosystem pochwy i wpływającym na atrofię jej ścian jest przebyte leczenie napromienianiem (brachyterapia) z powodu nowotworów macicy (szyjki i endometrium) (9)(10)(11) . Istnieją różne systemy klasyfikacji omawianych zaburzeńoparte na ich liczbie i nasileniu oraz na objawach klinicznych (1,(12)(13)(14) .…”

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“…Sposób leczenia obniżenia przedniej ściany pochwy i nietrzymania moczu zależy od nasilenia objawów, dolegliwości klinicznych, stanu zdrowia kobiety oraz jej oczekiwań i decyzji -zwłaszcza pacjentki, które przebyły leczenie z powodu raka endometrium, nie chciały poddać się operacji, laseroterapii (lasery Er:YAG, CO 2 ) czy zakładaniu pessarów (1,9,19) . Stosuje się wiele metod, w tym klasyczne leczenie operacyjne, wszczepianie różnych siatek lub taśm syntetycznych, techniki stymulacji laserowej i środki farmakolo giczne (6,11,(19)(20)(21) . Do sposobów leczenia cystocele i wysiłko wego nietrzymania moczu należą terapia fizyczna polegająca na ćwiczeniu mięśni miednicy (ćwiczenia Kegla), dopochwowe stosowanie pessarów lub estrogenów i zmiana stylu życia (6,16,22,23) .…”

unclassified

Eff ect of hyaluronate-containing preparations on certain parameters of urogenital organs statics disorders in women

Markowska¹,

Sterlińska-Tulimowska²

2016

Curr. Gynecol. Oncol.

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Zaburzenia statyki narządów moczowo-płciowych dotyczą 30-75% kobiet, a częstość tych zmian wzrasta z wiekiem. Wśród różnych przyczyn problemu powszechnie wymienia się porody, nadmierny wysiłek fizyczny, niedobór estrogenów związany z wiekiem i przebyte leczenie, w tym napromienianie (brachyterapię)-głównie z powodu nowotworów macicy. Dysfunkcje statyki dotyczą zwykle dwóch anatomicznie i rozwojowo powiązanych układów: płciowego i moczowego. W praktyce ginekologicznej najczęściej spotykanymi zmianami są obniżenie przedniej ściany pochwy (cystocele), wysiłkowe nietrzymanie moczu i częste oddawanie moczu. Badaniem objęto 78 kobiet w wieku 50-76 lat, z których 11 chorowało na raka endometrium (dziewięć z nich przeszło brachyterapię). U 63 pacjentek stosowano przez 3 miesiące tampony dopochwowe OB pokryte żelem lub kremem zawierającym kwas hialuronowy, a u części z nich-dodatkowo dwa razy w tygodniu maść z estriolem. Niektórym kobietom (15) zlecono wyłącznie ćwiczenia Kegla. Ocenę wysiłkowego, częstego i nocnego oddawania moczu przeprowadzono po 3 i 6 miesiącach od zaprzestania używania tamponów. Stosowanie tamponów pokrytych preparatami zawierającymi kwas hialuronowy istotnie zmniejsza objawy wysiłkowego i częstego oddawania moczu, a także objawy cystocele. Przedstawiona metoda jest prosta i w znacznej mierze skuteczna. Słowa kluczowe: wysiłkowe nietrzymanie moczu, częste oddawanie moczu, cystocele, ćwiczenia Kegla, kwas hialuronowy Urogenital organs statics disorders affect approximately 30-75% of women; their incidence increases with age. Among various causes, the generally recognized ones are deliveries experiences in the past, excessive physical effort, age-related estrogen deficiency, previous treatment, including irradiation (brachytherapy)-mainly due to uterine tumors. Dysfunctions in statics usually involve two anatomically and developmentally related systems: the reproductive system and the urinary system. In gynecologic practice, the most common pathologies involve a lowering the anterior vaginal wall (cystocele), stress urinary incontinence and polyuria. Study encompassed 78 women, aged 50 to 76, 11 of whom experienced earlier endometrial cancer and nine of whom were also subjected to brachytherapy. In 63 women OB intravaginal tampons were applied for three months, covered with a gel or cream containing hyaluronic acid; in some of them additionally estriolcontaining ointment was applied twice a week. Some women (15) were exclusively recommended to do the Kegel exercises. Evaluation of stress urinary incontinence as well as polyuria and nocturia was conducted 3 and 6 months after tampons stopped to be applied. The application of tampons covered with hyaluronic acid-containing preparations was found to reduce significantly the symptoms of stress urinary incontinence and polyuria and the symptoms of cystocele. The presented method is simple and evidently effective.

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Concomitant apical suspensory procedures in women with anterior vaginal wall prolapse in the United States in 2011

Cited by 11 publications

References 28 publications

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate

Surgical Updates in the Treatment of Pelvic Organ Prolapse

Eff ect of hyaluronate-containing preparations on certain parameters of urogenital organs statics disorders in women

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