Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality

Çaltekin

2020

LUTS

Objective To investigate the quality of life (QoL) and sexuality in women affected by pelvic organ prolapse (POP) and treated by bilateral sacrospinous ligament fixation (SSLF) with vaginal hysterectomy. Methods This is a prospective observational study carried out at Isparta City Hospital from July 2017 to December 2018. A total of 26 sexually active women with symptomatic uterine prolapse POP‐Q (Pelvic Organ Prolapse Quantification) stage II or higher requiring surgery were included in the study. Short Form Health Survey (SF‐36) was used preoperatively and at 6 months to examine the impacts of vaginal reconstruction on QoL. To assess sexual functioning, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) was used preoperatively and at 6 months. Results A significant improvement of POP‐Q landmarks was found between pre‐ and posttreatment at 6 months of follow‐up. The patients reported QoL improvement at the follow‐up for all the categories of physical functioning, bodily pain, physical health, general health, vitality, social activity, emotional state, and mental health with respect to the baseline values (P < .001). The results of PISQ‐12 demonstrated a significant improvement for all the three fields: behavioral emotive factor, physical factor, and partner‐related factor, and the total score at 6 months after surgery (P < .001). Conclusion This study clearly demonstrates that bilateral SSLF is able to significantly improve both QoL and sexual function in patients with POP. Improvement in sexuality and QoL after surgery may be explained by correction of avoidance of sexual intercourse due to prolapse and physical recovery.

Section: Discussionmentioning

confidence: 99%

Quality of life and sexuality after bilateral sacrospinous fixation with vaginal hysterectomy for treatment of primary pelvic organ prolapse

Çaltekin

2020

LUTS

Videosurgery and Other Miniinvasive Techniques

“…However, there are still an insufficient number of trials on the impact of urogynaecological surgery on sexual function. Recent studies have reported a considerable improvement of QoL and sexual function after cystocele and vaginal fault prolapse correction [60,61]. It is noteworthy that SUI and POP surgery not only affect the pelvic floor but also the whole physiological well-being of a woman, including her sexual function.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Szymański

Zaręba

Jakiel

et al. 2019

Introduction: The midurethral sling has become the current standard for the treatment of female stress urinary incontinence. Aim: To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures. Material and methods: The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6-and 12-month follow-up. Results: A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13-0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16-0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97-6.3; OR = 2.3, 95% CI: 0.95-5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality. Conclusions: TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.

“…Among all the cases of recurrent POP, vaginal vault prolapse was the most difficult to manage. Studies have provided strategies for prevention 24 and novel methods of treatment 25 . All techniques have been suggested to be effective, but a comparison of the techniques is difficult because of heterogenicity 26 .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Long

Wang

Lin

et al. 2020

Sci Rep

We aim to assess the surgical outcomes of our novel hysteropexy procedure, laparoscopic long mesh surgery (LLMS) with augmented round ligaments. Twenty-five consecutive women with stage II or greater main uterine prolapse defined by the POP quantification staging system were referred for LLMS. Long mesh is a synthetic T-shaped mesh, with the body fixed at the uterine cervix and the two arms fixed along the bilateral round ligaments. The clinical evaluations performed before and 6 months after surgery included pelvic examinations, urodynamic studies, and questionnaires for urinary and sexual symptoms. After a follow-up time of 12 to 24 months, the anatomical reduction rate was 92% (23/25) for the apical compartment. The average operative time was 65.4 ± 28.8 minutes. No major complications were recognized during LLMS. the lower urinary tract symptoms and scores on the questionnaires improved significantly after the surgery, except urgency urinary incontinence and nocturia. Neither voiding nor storage dysfunction was observed after the operations. All of the domains and total Female Sexual Function Index (FSFI) scores of the 15 sexually active women did not differ significantly after LLMS. The results of our study suggest that LLMS is an effective, safe, and timesaving hysteropexy surgery for the treatment of apical prolapse.Pelvic organ prolapse (POP) refers to the downward displacement of pelvic organs 1 . The lifetime risk of surgery for POP in the general female population is 19% 1 . Uterine prolapse, defined by insufficient apical support, is an important issue in the POP field. An increasing number of women with POP choose not to have a hysterectomy for reasons of personal identity, perceived body image, or childbearing potential 2,3 .We started to perform laparoscopic organopexy with non-mesh genital (LONG) suspension in 2014, as an innovative method for treating uterine prolapse in women who wish to preserve their uteri 4 . The LONG procedure has demonstrated promising preliminary results with a cohort of 40 women and a follow-up period of 12-30 months. The anatomical success rate was 85% with no concerning complications reported 4 .Despite the favorable outcome, some skepticism has been raised regarding the durability of suspension power based solely on the adhesion between the transverse fascia beneath the rectus abdominis muscle and the uterus. Other concerns include the long-term effects of the untreated anterior or posterior compartment and the impacts on subsequent hysterectomy, if needed. Studies with longer follow-up durations are ongoing in order to answer these questions. In addition, we have advanced the search for new solutions with our laparoscopic long mesh surgery (LLMS) with augmented round ligaments.Although sacrocolpopexy has been considered the gold-standard procedure for the treatment of apical prolapse, the long operation time and steep learning curve have restricted its popularity 4,5 . Additionally, most of the data have been related to post-hysterectomy prolapse 5 . Transvaginal mesh...