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International Urogynecology Journal

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01-09-2015 | Original Article

Does anesthetic method influence vaginal bulge symptoms and patient satisfaction after vaginal wall repair surgery?

Authors: Joanna Pong, Katja Stenström Bohlin, Corinne Pedroletti, Annika Strandell

Published in: International Urogynecology Journal | Issue 9/2015

Abstract

Introduction and hypothesis

Surgery for pelvic organ prolapse (POP) under local anesthesia has been advocated for several reasons such as lower costs and application in multimorbid patients. The aim of this study was to investigate how the anesthetic method influences the rate of recurrent prolapse and patient satisfaction with POP surgery.

Methods

In this retrospective study 4,936 women operated for single-compartment prolapse between 2006 and 2011 were included from the Swedish National Register for Gynecological Surgery. The feeling of vaginal bulge 1 year after surgery indicated presence of recurrent prolapse. Multivariate logistic regression analyses were used to identify independent factors affecting the outcomes, presented as adjusted odds ratios (aOR) with 95 % confidence interval (CI).

Results

After surgery for single-compartment prolapse patients with cystocele were at a higher risk of feeling a vaginal bulge than patients with rectocele (1.62, CI 1.28–2.06). Applied anesthesia was no independent predictor of bulge symptoms in the cystocele/rectocele population. In the cystocele group local anesthesia compared with general or regional anesthesia implied an increased risk of vaginal bulge symptoms (1.32, CI 1.03–1.68) as well as POP-Q-stage III–IV (1.30, CI 1.09–1.55), and a higher BMI class (1.22, CI 1.03–1.46), while a higher age class decreased the risk (0.79, CI 0.70–0.89). Choice of anesthesia had no impact on bulge symptoms in the rectocele group and no influence on patient satisfaction in any of the groups.

Conclusion

Patients operated for cystocele under local anesthesia were at a higher risk of experiencing vaginal bulge symptoms 1 year after surgery compared with general or regional anesthesia.

Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years and possible related factors. Am J Obstet Gynecol 180:299–305CrossRefPubMed

Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S (2011) Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open 1(2):e000206PubMedCentralCrossRefPubMed

Pakbaz M, Mogren I, Löfgren M (2010) Outcomes of cystocele repair surgery in relation to different anesthesia methods. Acta Obstet Gynecol Scand 89:876–881CrossRefPubMed

Axelsen SM, Bek KM (2004) Anterior vaginal wall repair using local anesthesia. Eur J Obstet Gynecol Reprod Biol 112:214–216CrossRefPubMed

Segal JL, Owens G, Silva WA, Kleeman SD, Pauls R, Karram MM (2007) A randomized trial of local anesthesia with intravenous sedation vs general anesthesia for the vaginal correction of pelvic organ prolapse. Int Urogynecol J 18:807–812CrossRef

Hatasaka HH, Sharp HT, Dowling DD, Teahon K, Peterson CM (1997) Laparoscopic tubal ligation in a minimally invasive surgical unit under local anesthesia compared to a conventional operating room approach under general anesthesia. J Laparoendodc Adv Surg Tech 7:295–299CrossRef

Gurer O, Yapici F, Enc Y, Cinar B, Ketenci B, Ozler A (2003) Local versus general anesthesia for carotid endarterectomy: report of 329 cases. Vasc Endovasc Surg 37:171–177CrossRef

Miedel A, Ek M, Tegerstedt G, Maehle-Schmidt M, Nyrén O, Hammarstrom M (2011) Short term natural history in women with symptoms indicative of pelvic organ prolapse. Int Urogynecol J 22:461–468CrossRefPubMed

Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, Spino C (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609PubMedCentralCrossRefPubMed

10.

Löfgren M, Poromaa IS, Stjerndahl JH, Renstrom B (2004) Postoperative infections and antibiotic prophylaxis for hysterectomy in Sweden. Acta Obstet et Gynecol Scand 83:1202–1207CrossRef

11.

Tegerstedt G, Miedel A, Maehle-Schmidt M, Nygren O, Hammarstrom M (2005) A short- form questionnaire identified genital organ prolapse. J Clin Epidemiol 58:41–46CrossRefPubMed

12.

Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P (2011) Pelvic Organ Prolapse Quantification System (POP-Q)—a new era in pelvic prolapse staging. J Med Life 4(1):75–81PubMedCentralPubMed

13.

Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, Antsaklis A, Milani R (2009) Identification of risk factors for genital prolapse recurrence. Neurourol Urodyn 28:301–304CrossRefPubMed

14.

World Health Organization (2006) BMI classification [updated 02/02/2011]. Available from: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html

15.

Miedel A, Tegerstedt G, Mörlin B, Hammarström M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J 19:1593–1601CrossRef

16.

Shull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183:1365–1374CrossRefPubMed

17.

Whiteside JL, Weber AM, Meyn LA, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 191:1533–1538CrossRefPubMed

18.

Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014. doi: 10.1002/14651858.CD004014.pub5

19.

Barber M, Neubauer N, Klein-Olarte V (2006) Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol 195(4):942–948CrossRefPubMed

20.

Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ (2008) Prevalence of symptomatic pelvic floor disorders in women. JAMA 300(11):1311–1316PubMedCentralCrossRefPubMed

21.

Acharya R, Chhabra SS, Ratra M, Sehgal AD (2001) Cranial subdural hematoma after spinal anesthesia. Br J Anaesth 86:893–895CrossRefPubMed

22.

Flam F, Soderberg MW (2009) New concepts and trends in vaginal prolapse surgery. Acta Obstet Gynecol Scand 88:251–254CrossRefPubMed

Title: Does anesthetic method influence vaginal bulge symptoms and patient satisfaction after vaginal wall repair surgery?
Authors: Joanna Pong
Katja Stenström Bohlin
Corinne Pedroletti
Annika Strandell
Publication date: 01-09-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 9/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2715-8

At a glance: The STEP trials

Springer Medicine

Does anesthetic method influence vaginal bulge symptoms and patient satisfaction after vaginal wall repair surgery?

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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