Uterine-preserving pelvic organ prolapse surgery using the UPHOLD LITE vaginal support system

Abstract

This article aims to evaluate the safety and outcome of women with pelvic organ prolapse (POP) treated by a minimally invasive bilateral sacrospinous hysteropexy (UPHOLD LITE Vaginal Support System, Boston Scientific) without concomittent anti-incontinence surgery. This retrospective study was conducted between 2014 and 2016. Evaluated items included surgical parameter and postoperative outcome. Three hundred thirteen women with POP were eligible and 22 were excluded because of history of either or more following situations, such as hysterectomy, mesh augmentation, previous anti-incontinence procedures, and radical pelvic surgery before. With a median follow-up of 26 months, surgery-related morbidity rate was 23.7% (69/291), including 1 with bladder injury (0.3%), 2 with hematoma (0.7%), 8 with urinary tract infection (2.8%), 48 with voiding dysfunction (16.5%) and 10 with mesh problems (3.4%). Among these morbidities, 12 patients (4.1%) needed surgical intervention, including 6 for mesh problems, 1 for bladder injury, 2 for hematoma, and 3 for anti-incontinence surgery. The difference of pelvic organ prolapse quantification (POP-Q) stage before and after surgery showed a statistical significance (anterior portion from 1.36 ± 2.60 to −2.69 ± 0.26, posterior portion from −1.29 ± 2.08 to −2.46 ± 0.62, and cervix portion from 2.03 ± 4.80 to −6.98 ± 2.26, all P < .001). At the end of August 2018, re-intervention rate for POP recurrence was 2.1% (n = 6), including abdominal sacrocolpopexy (n = 1), anterior repair (n = 1), vaginal total hysterectomy and uterine-sacral ligament suspension (n = 1), vaginal total hysterectomy and LeFort (n = 1), LeFort (n = 1), and pessary support (n = 1). Because some women developed postoperative lower urinary tract symptom, preoperative evaluation, including careful and detailed history taking, and urodynamic evaluation is suggested. After adequate counseling, uterine-preserving sacrospinal ligament suspension by UPHOLD LITE Vaginal Support System surgery could be considered in the management of women with POP, because of its high successful rate (97.9%) and low morbidity rate.

The clinical and urodynamic outcomes of single-incision mesh surgery using the Uphold system for the treatment of pelvic organ prolapse

“…None of the women with mesh extrusion underwent concurrent hysterectomy. The mesh extrusion rate was comparable to previous studies using the Uphold system for POP surgeries, ranging from 0 to 6.6% 6,10,[15][16][17][18][19][20][21][22] . There was no mesh extrusion after the 52nd surgery, which may indicate that there was a learning curve for the Uphold mesh surgery.…”

“…Intraoperative complications www.nature.com/scientificreports/ apical compartment 6,10,[15][16][17][18][19][20][21] and 77.6% to 97% in the anterior compartment 6,[16][17][18][19]21,22 . This outcome was more similar between different studies compared to the heterogeneous outcome of sacrospinous ligament fixation 4 .…”

Treatment of apical vaginal prolapse with minimal mesh repair (Uphold): patient‐reported long‐term outcomes and mesh‐related complications

“…In the present study, 63% of the women had previously undergone surgery in the anterior compartment, and most patients had undergone an isolated Uphold procedure. Other studies have demonstrated low re‐operation rates of 0%–3% about 2 years after Uphold procedure 18–20 . This might reflect the shorter follow‐up period or a different access to reoperation.…”

“…Other studies have demonstrated low re‐operation rates of 0%–3% about 2 years after Uphold procedure. 18 , 19 , 20 This might reflect the shorter follow‐up period or a different access to reoperation.…”

Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study

“…Therefore, the findings of the current study cannot expand to other populations, such as surgical treatment for patients with gynecological malignancy and/or pelvic floor dysfunction-related benign diseases. However, it is well-known that patients with gynecological cancer may be managed by much complicated surgery, and patients treated with pelvic organ prolapse surgery may have a higher risk of existed or subsequent lower urinary tract symptoms (Bisch et al, 2021; Chang et al, 2019; Chang et al, 2020; Liu et al, 2019), in which all may add the uncertainty to test our hypothesis. The enrolled patients in the current study were limited to benign gynecological tumors which needed surgical excision, regardless of use or no-use of laparoscopy assistance.…”