Joint report on terminology for surgical procedures to treat pelvic organ prolapse

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doi:10.1007/s00192-020-04236-1

Cited by 33 publications

(18 citation statements)

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“…In terms of terminology, obliterative prolapse repairs can be categorized as follows: colpocleisis with hysterectomy, colpocleisis without hysterectomy (LeFort colpocleisis), and colpocleisis of the vaginal vault [ 4 ]. Synonyms that are not recommended, but used very often, include partial or total colpocleisis, vaginal obliteration, vaginectomy, and colpectomy [ 4 ].…”

Section: Methodsmentioning

confidence: 99%

“…The procedure was first performed by Neugebauer of Warsaw (in 1867) and later performed and published by LeFort of Paris (in 1877). Originally, it did not include a concomitant hysterectomy [ 3 , 4 ]. During surgery, the vaginal epithelium is dissected off the underlying fibromuscular layers anteriorly and posteriorly, with or without leaving epithelial strips on the sides to create tunnels of drainage if the uterus is preserved.…”

Section: Introductionmentioning

confidence: 99%

“…During surgery, the vaginal epithelium is dissected off the underlying fibromuscular layers anteriorly and posteriorly, with or without leaving epithelial strips on the sides to create tunnels of drainage if the uterus is preserved. The anterior and the posterior denuded walls are sewn together, either with purse-string or horizontal rows of interrupted sutures, a few centimeters above the hymen [ 4 ]. After the vagina has been inverted, the superior and the inferior margins of the vagina are sutured horizontally.…”

Section: Introductionmentioning

confidence: 99%

“…After the vagina has been inverted, the superior and the inferior margins of the vagina are sutured horizontally. In order to reduce the genital hiatus, perineal repair and/or levator plication is often performed concomitantly, although it is not an inherent part of the procedure [ 4 ]. Some modifications of the technique include using a synthetic or a biological graft between the anterior and the posterior vaginal walls [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

et al. 2021

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Introduction and hypothesis The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis. Methods A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed. Results A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0–14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%. Conclusions Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

et al. 2021

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“…The PROPEL study (ClinicalTrials.gov-Identifier: NCT00638235) was a prospective, observational, multicenter trial, supported by American Medical Systems (AMS), to evaluate the Elevate anterior/apical and Elevate posterior/apical transvaginal surgical mesh devices for POP reconstruction [14]. These devices used macroporous, monofilament polypropylene mesh with attached fixation anchors for standard apical sacrospinous ligament fixation and were inserted all through a single transvaginal incision [15]. All subjects were females, aged > 21 years, with a clinically significant prolapse (symptomatic POP-Q stage > 2) in one or more compartment, anterior, apical and/or posterior.…”

Section: Methodsmentioning

confidence: 99%

The impact of sacrospinous ligament fixation on pre-existing nocturia and co-existing pelvic floor dysfunction symptoms

et al. 2020

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Introduction and hypothesis To evaluate whether nocturia and coexisting pelvic floor symptoms in women with pelvic organ prolapse (POP) can be improved by ligamentous fixation of apical vaginal prolapse to the sacrospinous ligament. Methods We evaluated the PROPEL study data from 281 women with pelvic organ prolapse stage > 2. Bothersome nocturia and coexisting pelvic floor symptoms were assessed with the Pelvic Floor Disorder Inventory (PFDI) questionnaire preoperatively and at 6, 12 and 24 months after successful vaginal prolapse repair. Women with successful reconstruction (POP-Q stage < 1 at all compartments throughout the 2-year follow-up), defined as anatomical "responders," were compared to the anatomical "nonresponders." Results Among the patients completing all PFDI questions (N = 277), anatomical responders and non-responders were the groups of interest for our analysis. We found the occurrence rates of "moderate" or "quite a bit" of nocturia was significantly reduced after surgery in all subgroups (48.7% at baseline vs. 19.5% after 24 months). The occurrence of nocturia was halved for responders compared to non-responders (45.4% and 48.3% at baseline vs. 14% and 29.5% after 24 months). Anatomical nonresponders still had a relevant improvement of POP-Q stages, especially in the apical compartment. Prevalence rates of coexisting over-and underactive bladder, fecal incontinence, defecation disorders and pain symptoms were also significantly reduced postoperatively. Conclusion Nocturia can be associated with symptomatic POP, with improvements seen following vaginal ligamentous prolapse repair. We caution providers, however, when advising patients of the possible resolution of nocturia following POP reconstruction, that all other traditional etiologies of nocturia must first be ruled out.

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Manchester Procedure vs Sacrospinous Hysteropexy for Treatment of Uterine Descent

Enklaar,

Schulten,

van Eijndhoven

et al. 2023

JAMA

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ImportanceIn many countries, sacrospinous hysteropexy is the most commonly practiced uterus-preserving technique in women undergoing a first operation for pelvic organ prolapse. However, there are no direct comparisons of outcomes after sacrospinous hysteropexy vs an older technique, the Manchester procedure.ObjectiveTo compare success of sacrospinous hysteropexy vs the Manchester procedure for the surgical treatment of uterine descent.Design, Setting, and ParticipantsMulticenter, noninferiority randomized clinical trial conducted in 26 hospitals in the Netherlands among 434 adult patients undergoing a first surgical treatment for uterine descent that did not protrude beyond the hymen.InterventionsParticipants were randomly assigned to undergo sacrospinous hysteropexy (n = 217) or Manchester procedure (n = 217).Main Outcomes and MeasuresThe primary outcome was a composite outcome of success, defined as absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by a standardized vaginal support quantification system, absence of bothersome bulge symptoms, and absence of prolapse retreatment (pessary or surgery) within 2 years after the operation. The predefined noninferiority margin was 9%. Secondary outcomes were anatomical and patient-reported outcomes, perioperative parameters, and surgery-related complications.ResultsAmong 393 participants included in the as-randomized analysis (mean age, 61.7 years [SD, 9.1 years]), 151 of 196 (77.0%) in the sacrospinous hysteropexy group and 172 of 197 (87.3%) in the Manchester procedure group achieved the composite outcome of success. Sacrospinous hysteropexy did not meet the noninferiority criterion of −9% for the lower limit of the CI (risk difference, −10.3%; 95% CI, −17.8% to −2.8%; P = .63 for noninferiority). At 2-year follow-up, perioperative outcomes and patient-reported outcomes did not differ between the 2 groups.ConclusionsBased on the composite outcome of surgical success 2 years after primary uterus-sparing pelvic organ prolapse surgery for uterine descent, these results support a finding that sacrospinous hysteropexy is inferior to the Manchester procedure.Trial RegistrationTrialRegister.nl Identifier: NTR 6978

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Joint report on terminology for surgical procedures to treat pelvic organ prolapse

Cited by 33 publications

References 140 publications

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

The impact of sacrospinous ligament fixation on pre-existing nocturia and co-existing pelvic floor dysfunction symptoms

Manchester Procedure vs Sacrospinous Hysteropexy for Treatment of Uterine Descent

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