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International Urogynecology Journal

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01-12-2016 | Original Article

Laparoscopic wrap round mesh sacrohysteropexy for the management of apical prolapse

Authors: Anthony Sarkis Kupelian, Arvind Vashisht, Nikola Sambandan, Alfred Cutner

Published in: International Urogynecology Journal | Issue 12/2016

Abstract

Introduction and Hypothesis

Interest in uterine-conserving surgery for apical prolapse is growing. Laparoscopic sacrohysteropexy is one of the conservative surgical options, although different surgical approaches have been described. We report medium-term outcome data using a bifurcated mesh implant, employing ‘wrap round’ uterine attachment.

Methods

All procedures undertaken at our unit were reviewed. Study inclusion was contingent on the collection of baseline and 3-month anatomical and symptomatic outcome data. Medium-term follow-up data were collected by telephone review. Anatomical outcome was reported using the Pelvic Organ Prolapse Quantification scale. Symptom prevalence and treatment response were assessed using validated instruments including the Patient Global Impression of Improvement scale (PGI-I), and the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI) and Vaginal Symptoms (ICIQ-VS) questionnaires. Patient satisfaction was reported using Kaplan-Meier survival analysis.

Results

Data were available for 110 patients. Of 80 patients providing PGI-I data at 3 months, 75 (94 %) described their prolapse symptoms as ‘much better’ or ‘very much better’. Anatomical success in the apical compartment was 98 %. ICIQ-UI and ICIQ-VS responses demonstrated significant improvement. Despite a concurrent vaginal repair in only 11 % of patients, satisfaction at a mean follow-up of 2.6 years was 96 %. Repeat surgery for vaginal wall prolapse was required in only 5 % of patients. No safety concerns or graft complications were recorded.

Conclusions

This surgical variant of laparoscopic sacrohysteropexy is safe and highly effective. These data also cast doubt on the need for correction of modest vaginal wall prolapse at the time of surgery, and imply that apical prolapse may play a dominant role in the generation of symptoms.

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166CrossRefPubMed

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), e000206

Lonnee-Hoffmann RA, Salvesen Ø, Mørkved S, Schei B (2015) Self-reported pelvic organ prolapse surgery, prevalence, and nonobstetric risk factors: findings from the Nord Trondelag Health Study. Int Urogynecol J 26(3):407–414

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506CrossRefPubMed

Marchionni M, Bracco GL, Checcucci V et al (1999) True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med 44(8):679–684PubMed

Prodigalidad LT, Peled Y, Stanton SL, Krissi H (2013) Long-term results of prolapse recurrence and functional outcome after vaginal hysterectomy. Int J Gynaecol Obstet 120(1):57–60CrossRefPubMed

de Boer TA, Milani AL, Kluivers KB, Withagen MI, Vierhout ME (2009) The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication. Int Urogynecol J Pelvic Floor Dysfunct 20(11):1313–1319CrossRefPubMedPubMedCentral

Thys SD, Coolen A, Martens IR et al (2011) A comparison of long-term outcome between Manchester Fothergill and vaginal hysterectomy as treatment for uterine descent. Int Urogynecol J 22(9):1171–8CrossRefPubMed

Roovers JP, Lakeman MM (2009) Effects of genital prolapse surgery and hysterectomy on pelvic floor function. Facts Views Vis Obgyn 1(3):194–207PubMedPubMedCentral

10.

Pakbaz M, Mogren I, Lofgren M (2009) Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care. BMC Womens Health 9:9CrossRefPubMedPubMedCentral

11.

Humalajarvi N, Aukee P, Kairaluoma MV et al (2014) Quality of life and pelvic floor dysfunction symptoms after hysterectomy with or without pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 182C:16–21CrossRef

12.

Cutner A, Kearney R, Vashisht A (2007) Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation. BJOG 114(9):1159–1162CrossRefPubMed

13.

Vashisht A, Kearney R, Cutner A (2011) The new laparoscopic uterine sling suspension procedure: first year follow-up data. Gynecol Surg 8(3):321–323CrossRef

14.

Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP (2004) A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG 111(1):50–56CrossRefPubMed

15.

Costantini E, Mearini L, Bini V, Zucchi A, Mearini E, Porena M (2005) Uterus preservation in surgical correction of urogenital prolapse. Eur Urol 48(4):642–649CrossRefPubMed

16.

Rahmanou P, White B, Price N, Jackson S (2014) Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively. Int Urogynecol J 25(1):131–8CrossRefPubMed

17.

Farkas AG, Shepherd JG, Woodhouse CR (1993) Hysterosacropexy for uterine prolapse with associated urinary tract abnormalities. J Obstet Gynaecol 13:358–360CrossRef

18.

Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P (2004) A scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol 191(1):73–82CrossRefPubMed

19.

Price N, Jackson SR, Avery K, Brookes ST, Abrams P (2006) Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ-VS. BJOG 113(6):700–712CrossRefPubMed

20.

Cotterill N, Norton C, Avery KN, Abrams P, Donovan JL (2011) Psychometric evaluation of a new patient-completed questionnaire for evaluating anal incontinence symptoms and impact on quality of life: the ICIQ-B. Dis Colon Rectum 54(10):1235–1250CrossRefPubMed

21.

Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189(1):98–101CrossRefPubMed

22.

Srikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 21(5):523–528CrossRefPubMed

23.

Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330CrossRefPubMed

24.

Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17CrossRefPubMed

25.

Altman D, Zetterström J, López A, Pollack J, Nordenstam J, Mellgren A (2004) Effect of hysterectomy on bowel function. Dis Colon Rectum 47(4):502–508, discussion 508–9CrossRefPubMed

26.

Forsgren C, Zetterström J, Lopez A, Nordenstam J, Anzen B, Altman D (2007) Effects of hysterectomy on bowel function: a three-year, prospective cohort study. Dis Colon Rectum 50(8):1139–1145CrossRefPubMed

27.

Dua A, Jha S, Farkas A, Radley S (2012) The effect of prolapse repair on sexual function in women. J Sex Med 9(5):1459–1465CrossRefPubMed

28.

Chen LL, Lisse S, Larrson K, Ashton-Miller JA, Delancey JO (2014) The relative contribution of vaginal attachment and vaginal wall failure in determining cystocele size: statistical analysis using 3D stress MRI data. Int Urogynecol J Pelvic Floor Dysfunct 25(S1):113

29.

Dietz HP, Mann KP (2014) What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J 25(4):451–455CrossRefPubMed

30.

Bedford ND, Seman EI, O'Shea RT, Keirse MJ (2013) Effect of uterine preservation on outcome of laparoscopic uterosacral suspension. J Minim Invasive Gynecol 20(2):172–177CrossRefPubMed

Title: Laparoscopic wrap round mesh sacrohysteropexy for the management of apical prolapse
Authors: Anthony Sarkis Kupelian
Arvind Vashisht
Nikola Sambandan
Alfred Cutner
Publication date: 01-12-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 12/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-016-3054-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic wrap round mesh sacrohysteropexy for the management of apical prolapse

Abstract

Introduction and Hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and Hypothesis

Methods

Results

Conclusions

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