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19-01-2022 | Stress Incontinence | Original Article

Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial

Authors: Renaud de Tayrac, Michel Cosson, Laure Panel, Clara Compan, Mohammed Zakarya Zemmache, Sophie Bouvet, Laurent Wagner, Brigitte Fatton, Géry Lamblin

Published in: International Urogynecology Journal | Issue 7/2022

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Abstract

Introduction and hypothesis

The main objective of the study was to evaluate the rates of de novo stress urinary (SUI) and postoperative dyspareunia after both sacrocolpopexy/hysteropexy (SCP) and vaginal mesh surgery.

Methods

A prospective, multicenter, randomized, open-label study with two parallel groups treated by either SCP or Uphold Lite vaginal mesh was carried out. Study participants were ≥ 50 and < 80 years old patients with Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 who were considered eligible for reconstructive surgery and who were sexually active with no dyspareunia and free from bothersome SUI at presentation. Women were assessed before surgery and at 4–8 weeks and 11–13 months after using validated measures including POP-Q, Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Patient Global Impression of Improvement (PGI-I). Data were also collected for health economics evaluation.

Results

Of the required sample of 156 women, 42 women (19 SCP and 23 vaginal mesh) were only recruited owing to the discontinuation of vaginal mesh worldwide. The median follow-up was 376 days. The rates of bothersome de novo SUI were similar in the SCP and Uphold vaginal mesh groups (15.79 vs 15.00%, OR 0.95 [95% CI 0.22–4.14]). Among 30 sexually active patients at follow-up, the rates of women reporting de novo dyspareunia “usually or always” were 6.7% after SCP vs 13.3% after vaginal mesh (p = 1). Health economics evaluation showed a cost saving of 280€ in favor of the Uphold vaginal mesh technique, but no significant difference in the total cost (2,934.97€ for SCP vs 3,053.26€ for Uphold vaginal mesh).

Conclusions

Bothersome de novo SUI and de novo dyspareunia occurred in approximately 15% and 23% of our study cohorts, with no significant difference between sacrocolpopexy/hysteropexy and anterior/apical vaginal mesh surgery. However, these results should be interpreted with caution owing to the small sample size.
Literature
4.
go back to reference Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2(2):CD012079.PubMed Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2(2):CD012079.PubMed
9.
go back to reference Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8(8):CD013108.PubMed Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8(8):CD013108.PubMed
10.
go back to reference Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol. 2020;17:373–90.CrossRef Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol. 2020;17:373–90.CrossRef
12.
go back to reference Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24:485–91. https://doi.org/10.1007/s00192-012-1888-7.CrossRef Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24:485–91. https://​doi.​org/​10.​1007/​s00192-012-1888-7.CrossRef
13.
go back to reference Wagner L, Boileau L, Delmas V, et al. Surgical treatment of prolapse using coelioscopic promontofixation: techniques and results. Prog Urol. 2009;19:994–1005.CrossRef Wagner L, Boileau L, Delmas V, et al. Surgical treatment of prolapse using coelioscopic promontofixation: techniques and results. Prog Urol. 2009;19:994–1005.CrossRef
21.
go back to reference Bataller E, Ros C, Anglès S, et al. Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh. Int Urogynecol J. 2019;30:545–55. https://doi.org/10.1007/s00192-018-3702-7.CrossRefPubMed Bataller E, Ros C, Anglès S, et al. Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh. Int Urogynecol J. 2019;30:545–55. https://​doi.​org/​10.​1007/​s00192-018-3702-7.CrossRefPubMed
22.
go back to reference Gutman RE, Rardin CR, Sokol ER, et al. Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study. Am J Obstet Gynecol. 2017;216:38.e1–11.CrossRef Gutman RE, Rardin CR, Sokol ER, et al. Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study. Am J Obstet Gynecol. 2017;216:38.e1–11.CrossRef
Metadata
Title
Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial
Authors
Renaud de Tayrac
Michel Cosson
Laure Panel
Clara Compan
Mohammed Zakarya Zemmache
Sophie Bouvet
Laurent Wagner
Brigitte Fatton
Géry Lamblin
Publication date
19-01-2022
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 7/2022
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-021-05071-8

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