Top

International Urogynecology Journal

Published in:

01-03-2011 | Original Article

Five-year outcome of uterus sparing surgery for pelvic organ prolapse repair: a single-center experience

Authors: Elisabetta Costantini, Massimo Lazzeri, Alessandro Zucchi, Vittorio Bini, Luigi Mearini, Massimo Porena

Published in: International Urogynecology Journal | Issue 3/2011

Abstract

Introduction and hypothesis

The study aims to report an extended follow-up of our case series of sacrohysteropexy for pelvic organ prolapse (POP).

Methods

Fifty-five patients with symptomatic POP underwent uterus sparing surgery. All patients were followed up for 1, 3, 6 and 12 months and then annually. Objective success was defined as a well-supported cervix and no vaginal prolapse stage ≥ 2. Subjective success was no prolapse-related symptoms or voiding disorder.

Results

The mean follow-up was 60 ± 34 months. Anterior compartment prolapse (cystocele) stage ≥ 2 was present in four out of 52 patients (7.7%), while posterior compartment prolapse (rectocele) stage ≥ 2 was present in three (5.7%). Voiding symptoms were resolved in 42 out of 45 patients (93.4%) and storage symptoms in 30 out of 36 (83.3%); one patient reported de novo urgency. Sexual activity was maintained in 28 out of 29 patients (95.5%). Four patients showed de novo stress urinary incontinence.

Conclusion

Our findings support the use of uterus preservation, with significative objective and subjective outcomes in treating POP.

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

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

Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98:646–651CrossRefPubMed

Nygaard IE, McCreery R, Brubaker L, Pelvic Floor Disorders Network et al (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104:805–812CrossRefPubMed

Swati JHA, Moran PA (2007) National survey of prolapse in the UK. Neurol Urodyn 26:325–331CrossRef

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 20:1313–1319CrossRefPubMed

Hilton P (2009) Long-term follow-up studies in pelvic floor dysfunction: the Holy Grail or a realistic aim. BJOG 115:135–143

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

Abrams P, Cardozo L, Fall M, Standardisation Sub-committee of the International Continence Society et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178CrossRefPubMed

10.

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

11.

Altman D, Granath F, Cnattingius S, Falconer C (2007) Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet 370:1494–1499CrossRefPubMed

12.

Richardson DA, Scotti RJ, Ostergard DR (1989) Surgical management of uterine prolapse in young women. J Reprod Med 34:388–392PubMed

13.

Kovac SR, Cruikshank SH (1993) Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol 168:1778–1783PubMed

14.

Zucchi A, Lazzeri M Porena M, Del Zingaro M, Costantini E (2010) Uterus preservation in prolapse surgery. Nat Med 7:626–633

15.

Dietz V, Koops SES, van der Vaart CH (2009) Vaginal surgery for uterine descent; which options do we have? A review of the literature. Int Urogynecol J 20:349–356CrossRef

16.

Rozet F, Mandron E, Arroyo C et al (2005) Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urol 47:230–236CrossRefPubMed

17.

Price N, Slack A, Jakson SR (2010) Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG 117:62–68CrossRefPubMed

18.

Neuman M, Lavy Y (2007) Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingplasty operation. Int Urogynecol J 18:889–893CrossRef

19.

Hefni M, El-Toukhy T, Bhaumik J, Katsimanis E (2003) Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol 188:645–650CrossRefPubMed

20.

van Brummen HJ, van de Pol G, Aalders CI, Heintz AP, van der Vaart CH (2003) Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J Pelvic Floor Dysfunct 14:350–355CrossRefPubMed

21.

Ozcan U, Gungor T, Ekin M, Eken S (1999) Sacrospinous fixation for the prolapsed vaginal vault. Gynecol Obstet Invest 47:65–68CrossRefPubMed

22.

Nicita G, Li Marzi V, Filocamo MT et al (2005) Uterus-sparing vaginal surgery of genitourinary prolapse employing biocompatible material. Urol Int 75:314–318CrossRefPubMed

23.

Higgs P, Goh J, Krause H, Sloane K, Carey M (2005) Abdominal sacral colpopexy: an independent prospective long-term follow-up study. Aust N Z J Obstet Gynaecol 45:430–434CrossRefPubMed

24.

Lin LL, Ho MH, Haessler AL, Betson LH, Alisond RM, Liu CY, Bhatia NN (2005) A review of laparoscopic uterine suspension procedures for uterine preservation. Curr Opin Obstet Gynecol 17:541–546CrossRefPubMed

25.

Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354:1557–1566CrossRefPubMed

26.

Costantini E, Zucchi A, Giannantoni A, Mearini L, Bini V, Porena M (2007) Must colposuspension be associated with sacropexy to prevent postoperative urinary incontinence. Eur Urol 51:788–794CrossRefPubMed

27.

Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2008) Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial. J Urol 180:1007–1012CrossRefPubMed

Title: Five-year outcome of uterus sparing surgery for pelvic organ prolapse repair: a single-center experience
Authors: Elisabetta Costantini
Massimo Lazzeri
Alessandro Zucchi
Vittorio Bini
Luigi Mearini
Massimo Porena
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 3/2011
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-010-1342-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Five-year outcome of uterus sparing surgery for pelvic organ prolapse repair: a single-center experience

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2011

Pubococcygeal activity on perineal ultrasound in incontinent women

Is standardised vaginal sacrospinous ligament fixation a safe teaching procedure for residents?

Outcome of tension-free obturator tape procedures in obese and overweight women

Transobturator adjustable tape for severe stress urinary incontinence and stress urinary incontinence with voiding dysfunction

A novel approach to teaching the pelvic organ prolapse quantification (POP-Q) exam

Combined anterior trans-obturator mesh and sacrospinous ligament fixation in women with severe prolapse—a case series of 30 months follow-up