Vaginal and Abdominal Reconstructive Surgery for Pelvic Organ Prolapse

Aims Although abdominal sacrocolpopexy (ASC) is considered the gold standard for surgical repair of vaginal vault prolapse, the open surgical approach has significant morbidity. We aim to compare anatomic and functional outcomes in women receiving either robotic‐assisted sacral colpopexy (RSC) or ASC for post‐hysterectomy prolapse. Methods We present a retrospective chart review of all women who underwent ASC and RSC at our institution and had 12‐month follow‐up (FU). Pelvic organ prolapse quantification (POP‐Q) staging was assessed both preoperatively and postoperatively. Perioperative and demographic details were collected from the medical records. Results One hundred twenty four women underwent RSC (mean age 63, median FU 16 months). Those in the ASC group (n = 144) were statistically younger (mean age 60) and had longer FU (median 60 months). Both median day of successful voiding trial and discharge day significantly favored RSC. There were no Clavien Grade IV/V complications for either procedure and three RSC procedures were converted to ASC. Both approaches were associated with a significant improvement in POP‐Q stage at FU, with few women requiring additional surgery. Overall, 76% of women in each group were dry from stress urinary incontinence. Improvement in storage and emptying indices, dyspareunia, and quality of life measures was observed after both approaches. Conclusion RSC demonstrates good support of significant vaginal vault prolapse at medium term FU, with shorter hospital stays and low complication rates. Close FU after RSC over a longer period will be needed to fully assess durability of both functional and anatomic outcomes.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Abdominal versus robotic sacral colpopexy: A detailed analysis of outcomes

McFerrin

Pilkington

Pilet

et al. 2021

“…If a prior sling was placed, we allowed it to remain in place, as long it did not interfere with our dissection. Prior to 2011, we created a V‐shaped graft from two separate pieces of soft polypropylene mesh for attachment to the anterior and posterior vagina with anchoring of both at the sacral promontory . Since 2011, we have been performing our SCPs using a pre‐cut Y‐shaped polypropylene mesh in a similar manner.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of three sling procedures at the time of abdominal sacral colpopexy

Tubre

Padmanabhan

Frilot

et al. 2016

All three sling types appear to produce similar cure rates of SUI when done concomitantly with SCP. There did not appear to be any significant differences when stratified by occult or overt SUI. No sling type was associated with more postoperative complications. Larger studies are necessary to confirm the findings of this single-institution, retrospective study. Neurourol. Urodynam. 36:482-485, 2017. © 2016 Wiley Periodicals, Inc.

“…The sling material is of importance for tissue incorporation and there are many mechanical properties to consider with lightweight, macroporous, monofilament polypropylene mesh being superior to heavier, multifilament materials. 18 There are three main surgical approaches used for MUS placement: retropubic (top-down or bottom-up), transobturator (outside-in or inside-out), and single-incision. The Trial of Mid-Urethral Slings (TOMUS) trial showed equivalence in objective measures (negative provocative stress test, negative 24-h pad test, and no retreatment) of success between retropubic (RP) MUS and transobturator (TO) MUS at 1 year, but equivalence was not maintained at two years.…”

Section: Synthetic Midurethral Slingmentioning

confidence: 99%

“…Synthetic midurethral slings (MUS) are placed at the mid‐urethra with the goal of creating a suburethral “hammock” to provide continence during times of increased intra‐abdominal pressure. The sling material is of importance for tissue incorporation and there are many mechanical properties to consider with lightweight, macroporous, monofilament polypropylene mesh being superior to heavier, multifilament materials …”

Section: Introductionmentioning

confidence: 99%

Surgery for female SUI: The ICI algorithm

Kowalik

Dmochowski

2019

Introduction Stress urinary incontinence (SUI) is common in women and can significantly impact quality of life. Methods This is a review of the 6th International Consultation on Incontinence (ICI) chapter analyzing level of evidence on surgical treatment of SUI as well as the consensus algorithm that resulted from the detailed work in the committee report as of April 2017. Included studies in this review were selected to highlight the algorithm for management. Results Non‐operative and surgical treatment options exist; conservative therapies comprise first line management, but if SUI remains bothersome, surgical treatment should be considered. Bulking agents offer a minimally invasive option with moderate short‐term success rates. The most commonly performed surgical treatments for SUI are mid‐urethral and pubovaginal slings, with high cure rates and patient satisfaction. Retropubic suspension is a more traditional but widely accepted procedure. Single incision sling, adjustable sling, or artificial urinary sphincter may be appropriate in carefully selected patients. Conclusions The choice of surgical procedure should be made only after a thorough discussion and shared decision between the patient and surgeon regarding risks, benefits, and alternatives. A trial of conservative therapy should be conducted where relevant. Referral to a specialist should be considered in women with a more complex presentation.