The Role of Apical Vaginal Support in the Appearance of Anterior and Posterior Vaginal Prolapse

Lowder, Jerry L.; Park, Amy J.; Ellison, Rennique; Ghetti, Chiara; Moalli, Pamela; Zyczynski, Halina M.; Weber, Anne M.

doi:10.1097/01.aog.0000297309.25091.a0

Cited by 120 publications

(88 citation statements)

References 15 publications

(14 reference statements)

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“…Our results on a large national sample of patients reinforce and strengthen previous single center findings that apical descent is a significant contributor to prolapse of the anterior compartment, and that correcting apical descent significantly reduces anterior compartment reoperation rates (7)(8)(9)(10). The highest cumulative reoperation rate of 20% in our cohort occurred after an isolated anterior colporrhaphy.…”

Section: Discussionsupporting

confidence: 88%

“…Patients whose reoperation was colpocleisis, anterior colporrhaphy with an apical procedure, anterior and posterior colporrhaphy, or an apical procedure alone did not benefit from an apical procedure at the time of posterior colporrhaphy. Although loss of apical support in the pathogenesis of posterior compartment prolapse is less well established than for the anterior compartment, our finding of an overall decreased reoperation rate when posterior colporrhaphy is combined with an apical procedure suggests a significant impact of apical support on posterior vaginal wall prolapse as previously observed by Lowder, et al (8).…”

Section: Discussionsupporting

confidence: 76%

“…Simulated restoration of apical support has been shown to correct both anterior and posterior vaginal prolapse, and the invariable relationship between high stage anterior wall prolapse and loss of apical support has also been demonstrated (8,9,10). Traditionally, the most frequently performed procedures for POP have been anterior or posterior colporrhaphy with fewer patients undergoing vaginal apical suspension (11).…”

Section: Introductionmentioning

confidence: 99%

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2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Eilber¹,

Histed²,

Khan³

et al. 2012

Journal of Urology

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OBJECTIVE-Recurrent pelvic organ prolapse (POP) has been attributed to many factors, one of which is lack of vaginal apical support. To assess the role of vaginal apical support and POP, we analyzed a national dataset to compare long-term reoperation rates after prolapse surgery performed with and without apical support. METHODS-PublicUse File data on a 5% random national sample of female Medicare beneficiaries was obtained from the Centers for Medicare and Medicaid Services. Women with POP who underwent surgery during 1999 were identified by relevant International Classification of Diseases, 9 th revision, Clinical Modification and Current Procedural Terminology, 4 th edition codes. Individual patients were followed through 2009. Prolapse repair was categorized as anterior, posterior, or anterior-posterior with or without a concomitant apical suspension procedure. The primary outcome was the rate of retreatment for POP. 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery that year. There were 2,756 women who underwent an anterior colporrhapy, posterior colporrhaphy, or both with or without apical suspension. After 10 years, cumulative reoperation rates were highest among women who had an isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%, p < 0.01). RESULTS-InCONCLUSION-Ten years after surgery for POP, the reoperation rate was significantly reduced when a concomitant apical suspension procedure was performed.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Eilber¹,

Histed²,

Khan³

et al. 2012

Journal of Urology

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“…The postoperative phenomenon of de novo prolapse in untreated compartments is well known; yet, our numbers were lower than those reported for anterior Prolift® (54 %) [26]. Apical support may be particularly important for the anterior vaginal wall and efficient apical correction reduces the risk for prolapse in the anterior compartment, as seen in an anatomical model [27].…”

Section: Discussioncontrasting

confidence: 60%

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

et al. 2016

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Introduction and hypothesis The objective was to assess safety and clinical outcomes in women operated on using the Uphold™ Lite Vaginal Support System. Methods We carried out a 1-year, multicenter, prospective, single cohort study of 207 women with symptomatic Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 apical pelvic organ prolapse, with or without concomitant anterior vaginal wall prolapse. Safety data were collected using a standardized questionnaire. Anatomical outcome was assessed by the POP-Q and subjective outcomes by the Pelvic Floor Distress Inventory after 2 months and 1 year using a one-way repeated measures analysis of variance. Pain was evaluated using a visual analog scale. Results The overall rate of serious complications was 4.3 % (9 out of 207 patients), including 3 patients with bladder perforations, 1 with bleeding >1,000 ml, 2 who had undergone reoperations with complete mesh removal because of pain, and 3 surgical interventions during follow-up because of mesh exposure. POP-Q stage ≤1 after 1 year was 94 % and subjective symptom relief was reported by 91 % of patients (p < 0.001). Pain after 2 months and 1 year was 60 % lower compared with the preoperative mean (p < 0.001). Minor complications occurred in 20 women (9.7 %) and were dominated by lower urinary tract dysfunction. No predisposing risk factors for complications were found. Conclusions The Uphold™ Lite procedure in women with apical pelvic organ prolapse provided satisfactory restoration of vaginal topography and symptom relief. However, serious complication rates were largely comparable with those of other transvaginal mesh kits.

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“…This modification involved anchoring the anterior mesh to the sacrospinous ligaments bilaterally for additional apical support. We felt this was an important component of our anterior vaginal wall suspension since previous studies have demonstrated that loss of apical support significantly contributed to the presentation of anterior vaginal wall prolapse [7]. The apical anchoring of the anterior mesh was achieved by incising the midline proximal tab for approximately 5 cm and adding prolene suture to the end of each newly created mesh arm to extend its length.…”

Section: Methodsmentioning

confidence: 99%

Perioperative outcomes of the Prolift® pelvic floor repair systems following introduction to a urogynecology teaching service

et al. 2008

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The safety information of the vaginal mesh systems upon introduction to a teaching urogynecology service is limited to date. To determine the frequency of perioperative complications associated with the use of Prolift kits (Gynecare/Ethicon, Somerville, NJ, USA) by a teaching urogynecology service, data from the first 100 consecutive women were analyzed. The primary outcome was any deviation from a normal intraoperative or perioperative course. Complications were graded using the Dindo morbidity scale. Univariate analyses were performed to identify risk factors. Complications included bladder perforation (2%), blood transfusion (2%), mesh exposure (4%), and urinary tract infections (28%). Eleven percent of women reported postoperative pain, and 34% required catheterization at discharge for incomplete bladder emptying. Univariate analysis showed no association between morbidities and patient characteristics, attending experience, or fellow involvement. The integration of Prolift kits for prolapse repair into a urogynecology training program can be achieved with few perioperative complications.

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The Role of Apical Vaginal Support in the Appearance of Anterior and Posterior Vaginal Prolapse

Abstract: II.

Cited by 120 publications

References 15 publications

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

Perioperative outcomes of the Prolift® pelvic floor repair systems following introduction to a urogynecology teaching service

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