Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence

Denman, Mary Anna; Gregory, W. Thomas; Boyles, Sarah Hamilton; Smith, Virginia J.; Edwards, S. Renee; Clark, Amanda

doi:10.1016/j.ajog.2008.01.051

Cited by 158 publications

(110 citation statements)

References 12 publications

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“…Surgical correction of prolapse should not just reposition the prolapsed pelvic organs, it should also restore the patientʼs quality of life or at least improve it. As the recurrence rate after conventional anterior colporrhaphy with autologous tissue is high [1,13], the aim is to improve the long-term stability of the pelvic floor through implantation of an alloplastic mesh. A Cochrane analysis of the data on alloplastic meshes in prolapse surgery showed significantly better results in terms of anatomical outcome [14].…”

Section: Methodsmentioning

confidence: 99%

Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months

Fünfgeld¹,

Stehle²,

Henne

et al. 2017

Geburtshilfe Frauenheilkd

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ABSTR AC TIntroduction Pelvic organ prolapse can significantly reduce quality of life of affected women, with many cases requiring corrective surgery. The rate of recurrence is relatively high after conventional prolapse surgery. In recent years, alloplastic meshes have increasingly been implanted to stabilize the pelvic floor, which has led to considerable improvement of anatomical results. But the potential for mesh-induced risks has led to a controversial discussion on the use of surgical meshes in urogynecology. The impact of cystocele correction and implantation of an alloplastic mesh on patientsʼ quality of life/sexuality and the long-term stability of this approach were investigated. MethodIn a large prospective multicenter study, 289 patients with symptomatic cystocele underwent surgery with implantation of a titanized polypropylene mesh (TiLOOP ® Total 6, pfm medical ag) and followed up for 36 months. Both primary procedures and procedures for recurrence were included in the study. Anatomical outcomes were quantified using the POP-Q system. Quality of life including sexuality were assessed using the German version of the validated P-QoL questionnaire. All adverse events were assessed by an independent clinical event committee.Results Mean patient age was 67 ± 8 years. Quality of life improved significantly over the course of the study in all investigated areas, including sexuality and personal relationships (p < 0.001, Wilcoxon test). The number of adverse events which occurred in the period between 12 and 36 months after surgery was low, with just 22 events reported. The recurrence rate for the anterior compartment was 4.5 %. Previous or concomitant hysterectomy increased the risk of recurrence in the posterior compartment 2.8-fold and increased the risk of erosion 2.25-fold.Conclusion Cystocele correction using a 2nd generation alloplastic mesh achieved good anatomical and functional results in cases requiring stabilization of the pelvic floor and in patients with recurrence. The rate of recurrence was low, the patientsʼ quality of life improved significantly, and the risks were acceptable. . The most serious effect of pelvic organ prolapse is impairment of bladder and bowel function accompanied by incontinence and voiding disorders [2,3]. General well-being, personal relationships, particularly sexuality [4], and physical and social activities often suffer from the effects of prolapse [5,6]. The incidence of pelvic organ prolapse in women has increased in parallel with the general increase in life expectancy, and the likelihood that women aged 80 years will require surgical intervention (e.g. hysterectomy, pelvic floor reconstruction) is 12.2 % [7]. One in nine women is affected by prolapse [8]. Up to 30 % of patients require a repeat operation for recurrence within 5 years of the original procedure [9][10][11][12]. Surgical correction of prolapse should not just reposition the prolapsed pelvic organs, it should also restore the patientʼs quality of life or at least improve it. As the recurrence rate...

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Section: Methodsmentioning

confidence: 99%

Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months

Fünfgeld¹,

Stehle²,

Henne

et al. 2017

Geburtshilfe Frauenheilkd

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“…This could be explained by the fact that the study by Tegerstedt and Hammarstrom [8], as mentioned above, had a relatively longer follow-up period of 10 to 12 years; (although many patients were lost during the followup) [14]. History of surgery for POP and/or urinary incontinence at the time of primary surgery was associated with an increased postoperative complications and risk of reoperation in two studies [17,18]. According to Maher et al [19], there were insufficient data to allow evaluation of the impact of prolapsed surgery on continence issues.…”

Section: Discussionmentioning

confidence: 98%

“…However, limited information suggested that concomitant TVT or Burch colposuspension might reduce postoperative incontinence rates; this benefit needs to be balanced against possible differences in costs and adverse effects. Clark et al [17] demonstrated that having undergone previous POP and urinary incontinence surgery increased the risk of reoperation to 17% compared with 12% for women who underwent a first procedure; moreover Denman et al [18] observed the abdominal approach was protective against reoperation compared with the vaginal approach. Dällenbach et al [7] suggested that POP severity did not increase the risk of complications and reoperation, and that neither did advancing age, BMI and vaginal deliveries, but suggested that the number of prolapsed vaginal wall segments and the absence of complete repair at initial surgery increased the risk of reoperation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Jung

Kim

Moon

et al. 2012

Korean J Obstet Gynecol

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Pelvic organ prolapse (POP) is a bulge or protrusion into or through the vagina of pelvic organs and associated vaginal segments [1]. With the aging population, POP is an increasingly common condition seen in women with a lifetime prevalence of 30% to 50% [1,2]. Symptomatic urogenital prolapse has been shown to have significant negative impacts such as those relating to the lower urinary tract, fecal incontinence, back pain, pelvic pain, defecatory problems, and dyspareunia. Management options for women with symptomatic POP include observation, pelvic floor muscle training, mechanical support (pessaries), and surgery. A patient's perception of discomfort from POP and subsequent treatment will vary in relation to the stage of the POP and her ethnicity. Currently, many surgical approaches have been introduced to correct POP. The life time risk of undergoing surgery was estimated to be between 11% and 19%. However, none of these techniques is without risks for complications [2][3][4]. The prevalence of reopera-ORIGINAL ARTICLE Korean J Obstet Gynecol 2012;55(8) ObjectiveThe aim of this study was to report subjective and objective outcomes and to compare complication and recurrence rate in patients undergoing surgery for International Continence Society (ICS) stage 4 prolapse compared to ICS stage 2 or 3 prolapse. MethodsWe retrospectively reviewed the records of all patients having had surgical treatment for ICS Pelvic Organ Prolapse Quantification (POP-Q) stage 2-4 prolapse between January 2007 and December 2010 at the Yonsei University Severance Hospital. Only patients with ICS POP-Q stage 2-4 prolpase undergoing obliterative procedures or anti-incontinence surgery only were excluded. ResultsThree hundred ninety nine patients met inclusion criteria, including 23 with stage 2, 239 with stage 3 and 137 with stage 4 prolapse. The postoperative recurrence rate of preoperative stage IV was 2.4 times higher than that of stage III. There was a significantly higher incidence rates of perioperative and long-term complications, compared to women with other stage prolapse. The mean operative time was significantly greater in the stage 4 group compared to the stage 2, 3 group. ConclusionThe overall perioperative complication and recurrence rates in women undergoing surgery for pelvic organ prolapse are low. Women undergoing surgery for ICS POP-Q stage 4 prolapse were found to have a significantly greater blood loss and higher incidence rates of perioperative complications and recurrence, compared with women of other stage.

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“…Although the etiology of recurrence of POP is frequently discussed in the literature, very few studies report on the outcome of surgical treatment in women with recurrent disease. In the published case series to date, data on the long-term outcome are often lacking or difficult to compare and therefore the cumulative surgical cure rate and/or independent efficacy of each surgical technique remain uncertain [3,7]. This is usually attributed to the use of various and non-validated tools to measure the outcome of a large number of operative techniques, particularly the novel disposable surgical kits, in a small subset of patient cohorts.…”

mentioning

confidence: 99%

“…This is usually attributed to the use of various and non-validated tools to measure the outcome of a large number of operative techniques, particularly the novel disposable surgical kits, in a small subset of patient cohorts. The lack of a uniformly accepted definition of recurrence including a detailed description of the anatomical location of the defect and whether this is in the same or different vaginal compartment may also be responsible [3,6,7].…”

mentioning

confidence: 99%

Definition of recurrence of pelvic organ prolapse: is it really important?

2011

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Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence

Cited by 158 publications

References 12 publications

Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months

Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months

Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Definition of recurrence of pelvic organ prolapse: is it really important?

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