Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques

Husby, Karen Ruben; Larsen, Michael Due; Lose, Gunnar; Klarskov, Niels

doi:10.1007/s00192-019-03950-9

Cited by 31 publications

(30 citation statements)

References 14 publications

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“…It is uncertain if this finding supports the role of mesh augmentation for repair of apical prolapse; the issue remains controversial. Reoperation rates for prolapse of any compartment in our study are comparable with the overall reoperation rate for POP following VH, which was estimated to be 11% at 5 years in a recent large Danish registry study [ 32 ]. It is significantly lower than reoperation rates following suture hysteropexy, which was reported to be 30% in the same study.…”

Section: Discussionsupporting

confidence: 84%

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

et al. 2020

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Introduction and hypothesis The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in pelvic floor surgery. This study is aimed at determining the incidence of mesh-associated complications and reoperation following this procedure. Methods This was a cross-sectional postal questionnaire study of women who underwent laparoscopic mesh sacrohysteropexy between 2010 and 2018. Potential participants were identified from surgical databases of five surgeons at two tertiary urogynaecology centres in the UK. The primary outcome was patient-reported mesh complication requiring removal of hysteropexy mesh. Secondary outcomes included other mesh-associated complications, reoperation rates and Patient Global Impression of Improvement (PGI-I) in prolapse symptoms. Descriptive statistics and Kaplan–Meier survival analyses were used. Results Of 1,766 eligible participants, 1,121 women responded (response proportion 63.5%), at a median follow-up of 46 months. The incidence of mesh complications requiring removal of hysteropexy mesh was 0.4% (4 out of 1,121). The rate of chronic pain service use was 1.8%, and newly diagnosed systemic autoimmune disorders was 5.8%. The rate of reoperation for apical prolapse was 3.7%, and for any form of pelvic organ prolapse it was 13.6%. For PGI-I, 81.4% of patients were “much better” or “very much better”. Conclusions Laparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required. Electronic supplementary material The online version of this article (10.1007/s00192-020-04396-0) contains supplementary material, which is available to authorized users

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Section: Discussionsupporting

confidence: 84%

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

et al. 2020

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“…The superiority of the MP in comparison to VH was also found in a recently published study based on data from the Danish register for gynecological surgery. 159 The reason why we did not find superior outcomes in the CA group in our study may be that the women did not undergo the "full Manchester repair" which includes also posterior colporrhaphy. Further, the Forthergill technique, which includes suspension of the apex by suturing the cardinal ligaments to the cervical stump, might not be performed by all surgeons performing CA in Sweden.…”

Section: Study IIcontrasting

confidence: 54%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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“…Data were harvested from the Danish Urogynaecological Database [2]. When we evaluated the technique in 2019 we found a 40.2 times higher risk of reoperation in the apical compartment after SH (confidence interval [CI]: 21.6-74.7) than after the Manchester operation and a 8.6 times higher risk (CI: 6.0-12.1) than after vaginal hysterectomy [3].…”

Section: Dear Editormentioning

confidence: 99%

Letter to the editor: “Update in native tissue vaginal vault prolapse repair”

2020

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Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques

Cited by 31 publications

References 14 publications

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Letter to the editor: “Update in native tissue vaginal vault prolapse repair”

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