Top

Published in:

01-04-2017 | General Gynecology

Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients

Authors: Michele Carlo Schiavi, Giorgia Perniola, Violante Di Donato, Virginia Sibilla Visentin, Flaminia Vena, Anna Di Pinto, Marzio Angelo Zullo, Marco Monti, Pierluigi Benedetti Panici

Published in: Archives of Gynecology and Obstetrics | Issue 4/2017

Abstract

Aims

The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair (VNTR) as a surgical treatment for severe pelvic organ prolapse (POP) and, second, to evaluate the impact on the quality-of-life (QoL) and sexual function.

Methods

Women with symptomatic POP (≥III stage according to POP Quantification System) with or without stress urinary incontinence (SUI) underwent VNTR. The clinical stage, 3-day voiding diary, and urodynamic testing were evaluated in the preoperative and postoperative times, respectively. The International Consultation on Incontinence Questionnaire–Urinary Incontinence Questionnaire Short Form (ICIQ–UI SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12), and the prolapse quality-of-life questionnaire (P-QoL) were administered.

Results

One hundred forty-six patients were recruited. The median follow-up was 48 months (36–63). Fifty-two women (36%) had a previous hysterectomy, and 16 (11%) had a previous prolapse/continence surgery. Preoperatively, 135 (92.5%), 109 (74.7%), and 98 (67.1%) patients had anterior, central, and posterior descent ≥III stage, respectively. Thirty-two patients (22%) had concomitant diagnosis of SUI. Median operative time was 85 min (37–154), and median postoperative hospital stay was 2 days (2–4). No intraoperative severe complications occurred. At the long-term follow-up, the subjective cure rate for prolapse was 97.3% and the objective cure rate was 91.1%. A significant improvement of ICIQ-UI SF, the P-QoL, and the PISQ-12 was recorded at the follow-up (p < 0.001).

Conclusion

VNTR is effective, safe, and durable and improves POP-related symptoms and sexual function.

Nygaard I, Barber MD, Burgio KL et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300:1311–1316CrossRefPubMedPubMedCentral

Wu JM, Hundley AF, Fulton RG et al (2009) Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol 114:1278–1283CrossRefPubMed

Vergeldt TFM, Weemhoff M, Inthout J et al (2015) Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J 26:1559–1573CrossRefPubMedPubMedCentral

FDA Safety Communication (2011) Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. Issued 13 July 2011

Funk JM, Visco AG, Weidner AC et al (2013) Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Int Urogynecol J 24:1279–1285CrossRefPubMedCentral

Wei JT, De Lancey JO (2004) Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol 47:3–17CrossRefPubMed

Farthmann J, Watermann D, Erbes T et al (2015) Functional outcome after pelvic floor reconstructive surgery with or without concomitant hysterectomy. Arch Gynecol Obstet 291:573–577CrossRefPubMed

Maher C, Feiner B, Baessler K et al (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 30(4):CD004014

Farthmann J, Mengel M, Henne B et al (2016) Improvement of pelvic floor-related quality of life and sexual function after vaginal mesh implantation for cystocele: primary endpoint of a prospective multicentre trial. Arch Gynecol Obstet 294:115–121CrossRefPubMed

10.

Espuna-Pons M, Dilla T, Castro D (2007) Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence. Neurourol Urodyn 26:836–841CrossRefPubMed

11.

Visco AG, Wei JT, McClure LA et al (2003) Effects of examination technique modifications on pelvic organ prolapse quantification (POP-Q) results. Int Urogynecol J Pelvic Floor Dysfunct 14:136–140CrossRefPubMed

12.

Rogers GR, Coates KW, Kammerer-Doak D et al (2001) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 12:361–365CrossRefPubMed

13.

Digesu GA, Santamato S, Khullar V et al (2003) Validation of an Italian version of the prolapse quality of life questionnaire. Eur J Obstet Gynecol Reprod Biol 106:184–192CrossRefPubMed

14.

Shull BL, Bachofen C, Coates KW et al (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

15.

Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1306CrossRefPubMed

16.

De Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730CrossRefPubMed

17.

Samour H, Amgad Abougamra A, Sabaa HAM (2011) Minimally invasive cystocele repair technique using a polypropylene mesh introduced with the transobturator route. Arch Gynecol Obstet 291:79–84CrossRef

18.

Maher C, Feiner B, Baessler K et al (2016) Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse (Review). Cochrane Database Syst Rev Issue 2 Art. No.: CD012079

19.

Altman D, Vayrynen T, Engh ME et al (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ. N Engl J Med 364:1826–1836CrossRefPubMed

20.

Siff LN, Barber MD (2016) Native tissue prolapse repairs: comparative effectiveness trials. Obstet Gynecol Clin North Am 43:69–81CrossRefPubMed

21.

Marschke J, Hengst L, Schwertner-Tiepelmann N et al (2015) Transvaginal single-incision mesh reconstruction for recurrent or advanced anterior vaginal wall prolapse. Arch Gynecol Obstet 291:1081–1087CrossRefPubMed

22.

Spelzini F, Frigerio M, Manodoro S et al (2016) Modified McCall culdoplasty versus Shull suspension in pelvicprolapse primary repair: a retrospective study. Int Urogynecol J 016-3016-6

23.

Wein AJ (2015) Re: Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. J Urol 193:943–944CrossRefPubMed

24.

Diwadkar GB, Barber MD, Feiner B et al (2009) Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 113:367–373CrossRefPubMed

25.

Paraiso MF, Barber MD, Muir TW et al (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195:1762–1771CrossRefPubMed

26.

Withagen MI, Milani AL, De Leeuw JW et al (2012) Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG Int J Obstet Gynaecol 10:1471–1528

27.

Mothes AR, Radosa MP, Altendorf-Hofmann A et al (2016) Risk index for pelvic organ prolapse based on established individual risk factors. Arch Gynecol Obstet 293:617–624CrossRefPubMed

28.

Zullo MA, Ruggiero A, Plotti F et al (2008) Anterior colporrhaphy plus inside-out tension-free vaginal tape for associated stress urinary incontinence and cystocele. J Minim Invasive Gynaecol 15:446–451CrossRef

29.

Ling C, Chang Y, Lin Y, Chang S (2013) Significance of bladder trabeculation in postmenopausal women with severe pelvic organ prolapse: clinical and urodynamic assessments. Menopause 20:813–817

30.

Jha S, Gray T (2015) A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function. Int Urogynecol J 26:321–327CrossRefPubMed

31.

Mothes AR, Mothes HK, Radosa MP et al (2015) Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien–Dindo classification. Arch Gynecol Obstet 291:1297–1301CrossRefPubMed

32.

Vitale SG, Caruso S, Rapisarda AMC et al (2016) Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality. Arch Gynecol Obstet 293:125–131CrossRefPubMed

33.

Katsara A, Wight E, Heinzelmann-Schwarz V et al (2016) Long-term quality of life, satisfaction, pelvic floor symptoms and regret after colpocleisis. Arch Gynecol Obstet 294:999–1003CrossRefPubMed

Title: Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients
Authors: Michele Carlo Schiavi
Giorgia Perniola
Violante Di Donato
Virginia Sibilla Visentin
Flaminia Vena
Anna Di Pinto
Marzio Angelo Zullo
Marco Monti
Pierluigi Benedetti Panici
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4307-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients

Abstract

Aims

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2017

Serum serotonin, leptin, and adiponectin changes in women with postpartum depression: controlled study

Cardiotocography and the evolution into computerised cardiotocography in the management of intrauterine growth restriction

Erratum to: Pregnancy outcome among partners of male patients receiving imatinib, dasatinib or nilotinib in chronic myeloid leukemia: reports collected by the French network pharmacovigilance centers

Effects of a hyperandrogenaemic state on the proliferation and decidualization potential in human endometrial stromal cells

The role of the SDF-1/ CXCR7 axis on the growth and invasion ability of endometrial cancer cells

The effect of slow release insemination on pregnancy rates: report of two randomized controlled pilot studies and meta-analysis