Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Horosz, Edyta; Pomian, Andrzej; Zwierzchowska, Aneta; Majkusiak, Wojciech; Tomasik, Paweł; Barcz, Ewa

doi:10.3390/jcm9030653

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Two-step or sequential treatment has been proposed as an alternative to avoid overtreatment and surgical complications. 9 We found that undergoing concomitant rMUS and RSC treatment was associated with a nearly 4-fold increased failure rate for SUI compared with rMUS alone for women without prolapse. We are not able to comment on the effects of POP stage in this study because its reporting was an inherent difference between groups and selection criteria for procedures performed.…”

Section: Discussionmentioning

confidence: 74%

Failure Rate of Retropubic Midurethral Sling With and Without Concomitant Robotic Sacrocolpopexy

Rustia¹,

Baracy²,

Drouillard³

et al. 2022

Female Pelvic Med Reconstr Surg

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Importance:The retropubic midurethral sling (rMUS) and sacrocolpopexy are treatments for stress urinary incontinence (SUI) and pelvic organ prolapse, respectively, which are often performed concomitantly. Objective:The purpose of this study was to identify whether a difference exists in the failure rates of rMUS when placed alone or at the time of robotic sacrocolpopexy (RSC). Study Design:We conducted a single-center retrospective cohort study of patients who underwent rMUS placement between December 2015 and March 2020. The primary outcome was rMUS failure defined as additional treatment for SUI at any point.Results: There were 160 patients who underwent isolated rMUS and 175 patients who underwent rMUS and RSC. Patients who underwent isolated rMUS were more likely to be obese ( P < 0.01). Patients who underwent RSC were older (63.3 ± 9.9 vs 57.7 ± 13.7 years, P < 0.0001) and more likely to be White ( P = 0.02). Follow-up ranged from 0 to 46 months (median, 3 months; interquartile range, 3 months). Failure was observed in 2.3% of rMUS placed alone and 8.6% of rMUS with RSC. Patients who underwent rMUS and RSC had an odds ratio of 3.63 for rMUS failure ( P = 0.03; 95% confidence interval, 1. 16-11.38). Hypertension was associated with 4 times higher rMUS failure (odds ratio, 4.18; P = 0.02; 95% confidence interval, 1.29-13.58). Conclusions:We observed a significantly increased rate of rMUS failure from those placed alone to those placed at the time of RSC. Retropubic midurethral sling at the time of RSC was 4 times more likely to result in additional SUI treatment.

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Section: Discussionmentioning

confidence: 74%

Failure Rate of Retropubic Midurethral Sling With and Without Concomitant Robotic Sacrocolpopexy

Rustia¹,

Baracy²,

Drouillard³

et al. 2022

Female Pelvic Med Reconstr Surg

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“…During follow‐up, 5.5% of the patients required a subsequent anti‐incontinence procedure. It has been demonstrated that a two‐step approach to POP and urinary incontinence is as safe and effective as primary sling placement 28 . In fact, according to the theory of integral system by Petros et al., bladder reposition and reinforcement of cardinal and uterosacral ligaments may also correct further urinary symptoms, such as urinary incontinence.…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that a two-step approach to POP and urinary incontinence is as safe and effective as primary sling placement. 28 In fact, according to the theory of integral system by Petros et al, bladder reposition and reinforcement of cardinal and uterosacral ligaments may also correct further urinary symptoms, such as urinary incontinence. In this cohort, only 30.8% of the patients who complained of preoperative SUI continued to report symptoms in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study

Calleja Hermosa,

Sánchez Guerrero,

Viegas

et al. 2024

Int J of Urology

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ObjectiveThe study evaluated the anatomical and functional outcomes, as well as the safety data of laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) using a lightweight macroporous mesh.MethodsA multicentric observational study was developed including five expert centers between March 2011 and December 2019. Inclusion criteria were female patients with symptomatic ≥stage II POP (POP‐Q classification), who underwent a LSC. A lightweight and macroporous mesh device (Surelift Uplift) was used. Baseline anatomical positions were evaluated using POP‐Q stage. The anatomical outcomes and procedural complications were assessed during the postoperative period. Primary outcomes were anatomical success, defined as POP‐Q stage ≤I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse.ResultsA total of 325 LSCs were analyzed with a median patient age of 66 (interquartile range [IQR] 61–73). After a median follow‐up of 68 months (IQR 46.5–89), anatomical success was found in 88.9%, whereas subjective success was seen in 98.5% of the patients. Recurrent prolapse presented as cystocele (1.5%). Reported complications were bladder (4.6%) or rectum lesions (0.6%), de novo urinary incontinence (12.9%), and mesh extrusion (1.2%).ConclusionsLSC provides significant clinical improvement and excellent anatomical results, with a low risk of serious complications for women with ≥2 grade POP in a real clinical practice setting.

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“…The delayed approach however may lead to under-treatment. If bothersome SUI happens postoperatively, a subsequent anti-incontinence procedure will be performed, although it is demonstrated as safe and effective as primary TVT implantation, it will increase the costs and the risks arising from a new surgery 26 . The universal approach may reduce the incidence of postoperative SUI in both symptomatic and asymptomatic POP patients 27,28 .…”

Section: Sui Often Coexists With Popmentioning

confidence: 99%

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

Xia

et al. 2020

Preprint

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This retrospective cohort study aims to explore the clinical value of urodynamics in evaluating lower urinary tract function in pelvic organ prolapse (POP) patients, and to investigate the urodynamic characteristics of POP patients with occult stress urinary incontinence (OSUI) in whom moderate or above postoperative SUI eventually occurred after prolapse surgery. The medical records of 626 advanced POP patients who underwent vaginal pelvic reconstructive surgery were analyzed. The patients with anterior compartment prolapse were more susceptible to urodynamic changes than those with apical or posterior compartment prolapse (95.1% vs. 40.15%). The proportion of patients with urodynamic abnormality was increased with prolapse severity (68.8% vs. 78.6%). After 3 months, the incidence of moderate or severe postoperative urinary incontinence in the OSUI patients was 20%, while it is 2.8% in non-OSUI patients. In subgroup analysis of OSUI patients, the urodynamics of patients with moderate or above postoperative urinary leakage showed significantly lower Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), maximal bladder volume (MBV) and maximum urine flow rate (MUFR). For POP patients with OSUI, anti-incontinence surgery is only recommended for whom with lower VLPP, MUCP, MBV and MUFR to avoid the risk and costs of secondary surgery or overtreatment.

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Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Cited by 3 publications

References 27 publications

Failure Rate of Retropubic Midurethral Sling With and Without Concomitant Robotic Sacrocolpopexy

Failure Rate of Retropubic Midurethral Sling With and Without Concomitant Robotic Sacrocolpopexy

Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

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