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01-10-2019 | Original Article

Severe pelvic organ prolapse. Is there a long-term cure?

Authors: Stavros Athanasiou, Dimitrios Zacharakis, Athanasios Protopapas, Eleni Pitsouni, Dimitrios Loutradis, Themos Grigoriadis

Published in: International Urogynecology Journal | Issue 10/2019

Abstract

Introduction and hypothesis

Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications.

Methods

This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was “composite surgical success” defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence.

Results

The median follow-up was 7 years (range 3–10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit.

Conclusions

The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.

Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26:1559–73. https://doi.org/10.1007/s00192-015-2695-.CrossRefPubMedPubMedCentral

Aslam MF, Osmundsen B, Edwards SR, Matthews C, Gregory WT. Preoperative prolapse stage as predictor of failure of Sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22:156–60. https://doi.org/10.1097/SPV.0000000000000233.CrossRefPubMed

Delancey JO, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199:610 e611–5. https://doi.org/10.1016/j.ajog.2008.04.001.CrossRef

Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;30(4):CD004014. https://doi.org/10.1002/14651858.CrossRef

Wong V, Guzman Rojas R, Shek KL, Chou D, Moore KH, Dietz HP. Laparoscopic sacrocolpopexy: how low does the mesh go? Ultrasound Obstet Gynecol. 2017;49:404–8. https://doi.org/10.1002/uog.15882.CrossRefPubMed

Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016–24. https://doi.org/10.1001/jama.2013.4919.CrossRefPubMedPubMedCentral

Grigoriadis T, Protopapas A, Chatzipapas I, Athanasiou S. Vaginally assisted laparoscopic sacrocolpopexy for the treatment of complete uterovaginal prolapse. Int Urogynecol J. 2015;26:449–50. https://doi.org/10.1007/s00192-014-2541-4.CrossRefPubMed

Athanasiou S, Grigoriadis T, Chatzipapas I, Protopapas A, Antsaklis A. The vaginally assisted laparoscopic sacrocolpopexy: a pilot study. Int Urogynecol J. 2013;24:839–45. https://doi.org/10.1007/s00192-012-1947-0.CrossRefPubMed

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26. https://doi.org/10.1007/s00192-009-0976-9.CrossRefPubMed

10.

Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:178–86.CrossRef

11.

Grigoriadis T, Athanasiou S, Giannoulis G, Mylona SC, Lourantou D, Antsaklis A. Translation and psychometric evaluation of the Greek short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorders: PFDI-20 and PFIQ-7. Int Urogynecol J. 2013;24:2131–44. https://doi.org/10.1007/s00192-013-2144-5.CrossRefPubMed

12.

Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P. 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. 2004;191:73–82.CrossRef

13.

Athanasiou S, Grigoriadis T, Kyriakidou N, Giannoulis G, Antsaklis A. The validation of international consultation on incontinence questionnaires in the Greek language. Neurourol Urodyn. 2012;31:1141–4. https://doi.org/10.1002/nau.22197.CrossRefPubMed

14.

Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8. https://doi.org/10.1007/s00192-009-1069-5.CrossRefPubMed

15.

Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114:600–9. https://doi.org/10.1097/AOG.0b013e3181b2b1ae.CrossRefPubMedPubMedCentral

16.

Sarlos D, Brandner S, Kots L, Gygax N, Schaer G. Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome-a prospective study with 101 cases. Int Urogynecol J Pelvic Floor Dysfunc. 2008;19:1415–22. https://doi.org/10.1007/s00192-008-0657-0.CrossRef

17.

Liang S, Zhu L, Song X, Xu T, Sun Z, Lang J. Long-term outcomes of modified laparoscopic sacrocolpopexy for advanced pelvic organ prolapse: a 3-year prospective study. Menopause. 2016;23:765–70. https://doi.org/10.1097/GME.0000000000000628.CrossRefPubMed

18.

Higgs PJ, Chua HL, Smith AR. Long term review of laparoscopic sacrocolpopexy. BJOG. 2005;112:1134–8.CrossRef

19.

Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol. 2004;191:1533–8.CrossRef

20.

Diez-Itza I, Aizpitarte I, Becerro A. Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1317–24.CrossRef

21.

Weidner AC, Cundiff GW, Harris RL, Addison WA. Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy. Obstet Gynecol. 1997;90:689–91.CrossRef

22.

Visco AG, Weidner AC, Barber MD, Myers ER, Cundiff GW, et al. Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol. 2001;184:297–302.CrossRef

23.

Zacharakis D, Grigoriadis T, Bourgioti C, Pitsouni E, Protopapas A, et al. Pre- and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients? Neurourol Urodyn. 2018;37:316–21. https://doi.org/10.1002/nau.23294.CrossRefPubMed

24.

Nosti PA, Carter CM, Sokol AI, Tefera E, Iglesia CB, et al. Transvaginal versus transabdominal placement of synthetic mesh at time of sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22:151–5. https://doi.org/10.1097/SPV.0000000000000222.CrossRefPubMed

25.

von Pechmann WS, Aungst MJ, Gruber DD, Ghodsi PM, Cruess DF, Griffis KR. A pilot study on vaginally assisted laparoscopic sacrocolpopexy for patients with uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2011;17:115–9. https://doi.org/10.1097/SPV.0b013e318216379d.CrossRef

26.

Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J. 2012;23:527–35. https://doi.org/10.1007/s00192-012-1726-y.CrossRefPubMed

Title: Severe pelvic organ prolapse. Is there a long-term cure?
Authors: Stavros Athanasiou
Dimitrios Zacharakis
Athanasios Protopapas
Eleni Pitsouni
Dimitrios Loutradis
Themos Grigoriadis
Publication date: 01-10-2019
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 10/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3775-3

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Springer Medicine

Severe pelvic organ prolapse. Is there a long-term cure?

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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