Surgical treatment of pelvic organ prolapse: a historical review with emphasis on the anterior compartment

Lensen, E.J.M.; Withagen, Mariëlla I. J.; Kluivers, Kirsten B.; Milani, Alfredo L.; Vierhout, Mark E.

doi:10.1007/s00192-013-2074-2

Cited by 36 publications

(22 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Historically the treatment of anterior wall prolapse has been problematic, and as our study illustrates it is similar after both RASC and RSHS. Placing the mesh as distal as possible on the anterior vaginal wall could possibly improve anterior compartment results.…”

Section: Discussionmentioning

confidence: 57%

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Zanten

Koops

O’Sullivan

et al. 2019

BJOG

View full text Add to dashboard Cite

Objective Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.Design Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery.Setting Two European tertiary referral hospitals.Population Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).Methods Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7).Main outcome measures Primary outcome: anatomical and subjective cure. Secondary outcomes: surgical safety and intraoperative variables.Results A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 AE 62.3 to 13.5 AE 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 AE 38.2 versus 145.3 AE 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).Conclusions This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results.

show abstract

Section: Discussionmentioning

confidence: 57%

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Zanten

Koops

O’Sullivan

et al. 2019

BJOG

View full text Add to dashboard Cite

show abstract

“…At present, the “ideal” cystocele correction plan remains undefined. 26 Having objective measures to identify failure sites in each women whose measurements fall outside a normal range could, in the future, help identifying the best surgical plan for the individual patient.…”

Section: Discussionmentioning

confidence: 99%

Structural Failure Sites in Anterior Vaginal Wall Prolapse

Chen

Lisse

Larson

et al. 2016

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Objective To test the null hypothesis that six factors representing potential fascial and muscular failure sites contribute equally to the presence and size of a cystocele: two vaginal attachment factors (apical support and paravaginal defects), two vaginal wall factors (vaginal length and width), and two levator ani factors (hiatus size and levator ani defects). Methods Thirty women with anterior-predominant prolapse (cases) and 30 controls underwent 3D stress magnetic resonance imaging. The location of the anterior vaginal wall at maximal Valsalva was identified with the modified Pelvic Inclination Coordinate System and the six factors measured. Analysis included repeated measure ANOVA, logistic regression, and stepwise linear regression. Results We identified a collinear triad consisting of apical location, paravaginal location, and hiatus size that were not only the strongest predictors of cystocele size, but were also highly correlated with one another (r = 0.84 – 0.89, p < 0.001) for the presence and size of the prolapse. Together they explain up to 83% of the variation in cystocele size. Amongst the less significant vaginal factors, vaginal length explained 19% of the variation in cystocele size, but no significant difference in vaginal width existed. Cases were more likely to have abnormalities in collinear triad factors (up to 80%) than vaginal wall factors (up to 23.3%). Combining the strongest collinear triad with the vaginal factors, the model explained 92.5% of the variation in cystocele size. Conclusion Apical location, paravaginal location, and hiatus size are highly correlated, and are strong predictors of cystocele presence and size.

show abstract

“…When pharmacologic treatments and mechanical solutions to POP and urinary incontinence fail, surgical approaches to reinforce pelvic floor muscles and prevent recurrent prolapse or incontinence are available. 81,82 Since the 1950s, surgeons have experimented with a variety of synthetic and natural grafts to reinforce the pelvic floor to prevent POP and incontinence. Adaptation of tantalum mesh used for hernia repair for POP was first described in 1955, although persistent defects in the vaginal wall after surgery were common.…”

Section: Transvaginal Meshmentioning

confidence: 99%

“…84 Long-term follow-up of individuals with POP repaired by using high-density, nonabsorable polypropylene or poly-ethylene showed that despite improved sexual function and resolution of prolapse, there remained poor satisfaction (only 42% of individuals reported satisfaction with mesh at 23 months’ postprocedure). 82,85 …”

Section: Transvaginal Meshmentioning

confidence: 99%

“…Mesh devices come in 4 different categories: nonabsorbable synthetic, absorbable synthetic, biologic, and a composite device incorporating features from other categories. 81,82 These devices are created to match common defects in the pelvic floor that cause POP or incontinence. With increased utilization of mesh products, an increasing number of reports of adverse events have been reported to the FDA, prompting a warning issued in 2008 detailing a rare but present risk of mesh erosion, recurrent prolapse, wound infection, and debilitating dyspareunia.…”

Section: Transvaginal Meshmentioning

confidence: 99%

See 1 more Smart Citation

Drugs and Medical Devices: Adverse Events and the Impact on Women’s Health

Carey

Nader

Chai

et al. 2017

Clinical Therapeutics

View full text Add to dashboard Cite

A large number of medications and medical devices removed from the market by the US Food and Drug Administration over the past 4 decades specifically posed greater health risks to women. This article reviews the historical background of sex and gender in clinical research policy and describes several approved drugs and devices targeted for use in women that have caused major morbidity and mortality. The intended population for the medications and devices, population affected, approval process, and the basic and legal actions taken against the medication/drug company are also discussed. It is recognized that women are still at risk for harm from unsafe medications and devices, and continued improvements in legislation that promotes inclusion of sex and gender into the design and analysis of research will improve safety for both men and women.

show abstract

Surgical treatment of pelvic organ prolapse: a historical review with emphasis on the anterior compartment

Abstract: Many surgeons have tried to find the ideal surgical therapy for anterior compartment prolapse, but to date, this has not been achieved.

Cited by 36 publications

References 41 publications

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

Structural Failure Sites in Anterior Vaginal Wall Prolapse

Drugs and Medical Devices: Adverse Events and the Impact on Women’s Health

Contact Info

Product

Resources

About