Surgical Repair of the Genital Hiatus: A Narrative Review

Kikuchi, Jacqueline Y.; Muñiz, Keila S.; Handa, Victoria L.

doi:10.1007/s00192-021-04680-7

Cited by 8 publications

(13 citation statements)

References 45 publications

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“…Vaughan et al [18] found that the failure rate of complex anatomy in patients with GH ≥ 4 cm was 15.8 times higher than in patients with GH < 4 cm 6 weeks after vaginal apical suspension. Kikuchi et al [19] proposed in the review of laceration and repair that increased laceration was a high-risk factor for primary prolapse and postoperative recurrence.…”

Section: Applied Bionics and Biomechanicsmentioning

confidence: 99%

The Application of a Multidimensional Prediction Model in the Recurrence of Female Pelvic Organ Prolapse after Surgery

Wang¹,

Shao²

2022

Applied Bionics and Biomechanics

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Objective. The relationship between multiple indicators of women and postoperative recurrence of pelvic organ prolapse was analyzed to establish a model for predicting postoperative recurrence of female pelvic organ prolapse. Methods. Three hundred patients with pelvic organ prolapse who underwent pelvic organ prolapse surgery at our hospital were monitored for 1-2 years to determine their prognosis. Whether there was a postoperative recurrence, they were divided into two groups. We collected the relevant data from the two groups of patients before and after surgery. Through single factor and logistic multivariate analysis, we selected the risk factors that may affect the recurrence of patients to construct a prediction model. We verified the identification ability, proofreading ability, and clinical applicability of the model. Results. Eighty-four patients with pelvic organ prolapse who had postoperative recurrence were assigned to the recurrence group, and 216 patients were included in the nonrecurrence group. Based on the logistic multivariate analysis results, we constructed a nomogram model containing 5 dimensions of age, BMI, degree of prolapse, pubic fissure, and serum calcium to predict postoperative recurrence. The tests revealed that the model had an excellent identification ability ( AUC = 0.910 ), and the expected recurrence rate was significantly in agreement with the actual recurrence rate ( U = − 0.007 , Brief = 0.087 ). The Hosmer-Lemeshow goodness-of-fit test demonstrated that the model had good calibration ( c 2 = 29.352 , P = 0.522 ), and the decision curve showed that the threshold probability was in the range of ~12% to 100%, having a high net benefit value. Conclusion. Based on the present study findings, we concluded that the constructed nomogram model has suitable identification, calibration, and clinical applicability.

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Section: Applied Bionics and Biomechanicsmentioning

confidence: 99%

The Application of a Multidimensional Prediction Model in the Recurrence of Female Pelvic Organ Prolapse after Surgery

Wang¹,

Shao²

2022

Applied Bionics and Biomechanics

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“…33 This theory is also supported by previously published work. 14,34 Furthermore, recent studies suggest a strong association between genital hiatus size and prolapse; however, there are limited data on the specific risks of perineal reconstruction concerning other symptoms of pelvic floor dysfunction. 17,35 The findings of the present study are consistent with published data on the benefits of reconstructing the perineal body.…”

Section: Discussionmentioning

confidence: 99%

“…17,35 The findings of the present study are consistent with published data on the benefits of reconstructing the perineal body. 14,34,36 Bergman et al showed an improvement in patient satisfaction after perineal reconstructive surgery when compared with physiotherapy. 12 Correspondingly, in this study, the total postoperative scores were greatly reduced, and the item score "Are you experiencing genital discomfort that affects your quality of life?"…”

Section: Discussionmentioning

confidence: 99%

One‐year follow‐up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery

Rotstein,

Ullemar,

Engberg

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionPerineal tears are common after childbirth and, if not surgically repaired, they may result in a deficient perineum that can cause symptoms of pelvic floor dysfunction. Perineal reconstruction aims to restore the perineal body and increase the support of the pelvic floor. The objective of the present study was to estimate symptom reduction after perineal reconstruction in patients with deficient perineum after vaginal delivery and to compare outcomes between participants with or without concomitant levator ani muscle deficiency.Material and methodsParticipants presenting at the Karolinska Pelvic Floor Center with symptoms of deficient perineum at least 1 year after vaginal birth were invited to the study. Inclusion criteria were a visible perineal scar and confirmed anatomic defect. Levator ani defects were assessed using the Levator Ani Deficiency score. A perineal reconstruction was performed in a standardized way. Subjective symptoms were evaluated using the validated “Karolinska Symptoms After Perineal Tear Inventory” at baseline and 1‐year follow‐up. A score difference in the symptom of an acquired sensation of a wide vagina was the primary outcome. Results were stratified by the presence or absence of a levator ani deficiency.ResultsA perineal reconstruction was performed in 131 patients and 128 patients completed the Karolinska Symptoms After Perineal Tear Inventory at baseline and 119 at follow‐up. Median age was 36.1 (interquartile range [IQR] 7.9), median body mass index 22.3 (IQR 5.1) and a median of two vaginal deliveries. Fifty‐four women (41.2%) had a levator ani deficiency. The mean score reduction for the item “Do you feel that your vagina is too wide/loose?” was −1.56 (SD 0.96; P < 0.001) from a mean score of 2.75 (maximum 3) at baseline. The mean total score reduction was −9.1 points (SD 5.3; P < 0.001) from a mean score of 18.4 (maximum 33) points at baseline. There were no significant differences between groups when stratifying by levator ani deficiency.ConclusionsOur results show that perineal reconstructive surgery significantly decreases symptoms of deficient perineum after vaginal delivery. A concomitant levator ani defect does not affect the symptom reduction of an acquired sensation of a wide vagina or the total score reduction after surgery.

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“…In women complaining of a “widened vagina” sensation, there is some evidence that perineorrhaphy, a level 3 NTR technique, may provide high patient satisfaction rate and few complications 84 . Genital hiatus surgery should be carefully considered at the time of POP surgery, and surgeons should discuss with their patients potential risks and benefits of perineorrhaphy 85 …”

Section: Safety and Efficacy Evidence On Ntr According To Vaginal Seg...mentioning

confidence: 99%

“…84 Genital hiatus surgery should be carefully considered at the time of POP surgery, and surgeons should discuss with their patients potential risks and benefits of perineorrhaphy. 85…”

Section: Level 3-repair Of a Wide Genital Hiatusmentioning

confidence: 99%

European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery

Padoa

Braga

Fligelman

et al. 2023

UROGC

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Surgical Repair of the Genital Hiatus: A Narrative Review

Cited by 8 publications

References 45 publications

The Application of a Multidimensional Prediction Model in the Recurrence of Female Pelvic Organ Prolapse after Surgery

The Application of a Multidimensional Prediction Model in the Recurrence of Female Pelvic Organ Prolapse after Surgery

One‐year follow‐up after standardized perineal reconstruction in women with deficient perineum after vaginal delivery

European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery

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