Top

International Urogynecology Journal

Published in:

01-04-2021 | Stress Incontinence | Original Article

Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair of the vaginal compartments in patients with advanced pelvic organ prolapse and incontinence

Authors: Ivan Ignjatovic, Milan Potic, Dragoslav Basic, Ljubomir Dinic, Aleksandar Skakic

Published in: International Urogynecology Journal | Issue 4/2021

Abstract

Introduction and hypothesis

The aim of the study was to evaluate hysterectomized and non-hysterectomized patients with prolapse and incontinence. Laparoscopic sacrohysteropexy (LSHP) and minimally invasive sacrocolpopexy (LMSCP) were done in combination with transobturator tape (TOT) and native tissue repair of the anterior and posterior vaginal compartments in patients with pelvic organ prolapse (POP) and occult, stress, or urinary incontinence (SUI). The hypothesis is that both methods are successful.

Methods

A total of 81 patients with POP were evaluated: 44 had vaginal vault prolapse (POPQ points Ba, C, and Bp were 1.2, 2.6, and 0.4, respectively) and 37 had uterine prolapse (POPQ points Ba, C, and Bp were 1.8, 1.7, and 1.3, respectively). LMSCP (which means less dissection of the vagina in its upper third and avoiding possible collision with the ureters anteriorly or the rectum posteriorly) was performed in patients with vault prolapse, whereas patients with uterine prolapse underwent LSHP. Transobturator tape (TOT) was placed in all patients to treat symptomatic and occult urinary incontinence. Systematic anterior and posterior colporrhaphy was performed in both groups.

Results

Both groups showed anatomic (p < 0.0001) and symptomatic improvement (p < 0.001–p < 0.05). Voiding was significantly improved after surgery without postoperative incontinence (p < 0.001). There was no significant difference between groups regarding duration of surgery (p = 0.06), hospital stay (p = 0.13), blood loss (0.83), Clavien-Dindo grade 3 (p = 0.87), and Clavien-Dindo grade 1–2 (p = 0.92) complications.

Conclusion

Minimally invasive LSCP or LSHP combined with TOT and native tissue repair of the anterior and posterior vaginal compartment is a successful treatment for POP.

Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:1201–6. https://doi.org/10.23736/S0026-4784.16.04011-9.CrossRefPubMedPubMedCentral

Geynisman-Tan J, Kenton K. Surgical updates in the treatment of pelvic organ prolapse. Rambam Maimonides Med. 2017;8:e007-17. https://doi.org/10.5041/RMMJ.10294.CrossRef

Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse July 2011; https://www.fda.gov/media/81123/download

Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. Int J Gynaecol Obstet. 2007;97:31–4. https://doi.org/10.1016/j.ijgo.2006.12.011.CrossRefPubMed

Leone Roberti Maggiore U, Finazzi Agrò E, Soligo M, et al. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2017;28:1119–30. https://doi.org/10.1007/s00192-017-3275-x.CrossRefPubMed

Jefferis H, Price N, Jackson S. Laparoscopic hysteropexy: 10 years' experience. Int Urogynecol J. 2017;28:1241–8. https://doi.org/10.1007/s00192-016-3257-4.CrossRefPubMed

Meister MR, Sutcliffe S, Lowder JL. Definitions of apical vaginal support loss: a systematic review. Am J Obstet Gynecol. 2017;216(232):e1-232.e14. https://doi.org/10.1016/j.ajog.2016.09.078.CrossRef

Olsen A, Smith V, Bergstrom J, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. https://doi.org/10.1016/S0029-7844(97)00058-6.CrossRefPubMed

DeLancey JO. What's new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol. 2016;28:420–9. https://doi.org/10.1097/GCO.0000000000000312.CrossRefPubMedPubMedCentral

10.

Lucot JP, Cosson M, Bader G, et al. Safety of vaginal mesh surgery versus laparoscopic mesh Sacropexy for cystocele repair: results of the prosthetic pelvic floor repair randomized controlled trial. Eur Urol. 2018;74:167–76. https://doi.org/10.1016/j.eururo.2018.01.044.CrossRefPubMed

11.

Berger MB, Kolenic GE, Fenner DE, et al. Structural, functional, and symptomatic differences between women with rectocele versus cystocele and normal support. Am J Obstet Gynecol. 2018;218:510.e1–8. https://doi.org/10.1016/j.ajog.2018.01.033.CrossRef

12.

Kaser DJ, Kinsler EL, Mackenzie TA, et al. Anatomic and functional outcomes of sacrocolpopexy with or without posterior colporrhaphy. Int Urogynecol J. 2012;23:1215–20. https://doi.org/10.1007/s00192-012-1695-1.CrossRefPubMed

13.

Chang OH, Davidson ERW, Thomas TN, et al. Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy? [ published online ahead of print, 2020 mar 7]. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-020-04268-7.

14.

Kanter G, Jeppson PC, McGuire BL, et al. Perineorrhaphy: commonly performed yet poorly understood. A survey of surgeons. Int Urogynecol J. 2015;26:1797–801. https://doi.org/10.1007/s00192-015-2762-1.CrossRefPubMed

15.

Lowder JL. Apical vaginal support: the often forgotten piece of the puzzle. Mo Med. 2017;114:171–5.PubMedPubMedCentral

16.

O'Sullivan OE, Matthews CA, O'Reilly BA. Sacrocolpopexy: is there a consistent surgical technique? Int Urogynecol J. 2016;27:747–50. https://doi.org/10.1007/s00192-015-2880-9.CrossRefPubMed

17.

Cosson M, Rajabally R, Bogaert E, et al. Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures. JSLS. 2002;6:115–9.PubMedPubMedCentral

18.

Wattiez A, Nasir R, Al Maamari B, et al. Laparoscopic prolapse surgery: types and evidence. Curr Opin Obstet Gynecol. 2016;28:430–4. https://doi.org/10.1097/GCO.0000000000000316.CrossRefPubMed

19.

Unger CA, Paraiso MF, Jelovsek JE, et al. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211:547.e1–8. https://doi.org/10.1016/j.ajog.2014.07.054.CrossRef

20.

Matthews CA. Minimally invasive sacrocolpopexy: how to avoid short- and long-term complications. Curr Urol Rep. 2016;17:81. https://doi.org/10.1007/s11934-016-0638-7.CrossRefPubMed

21.

Jeanditgautier E, Mayeur O, Brieu M, et al. Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system. Int Urogynecol J. 2016;27:951–7. https://doi.org/10.1007/s00192-015-2917-0.CrossRefPubMed

22.

Deffieux X, Letouzey V, Savary D, et al. Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol. 2012;165:170–80. https://doi.org/10.1016/j.ejogrb.2012.09.001.CrossRefPubMed

23.

Gutman RE. Does the uterus need to be removed to correct uterovaginal prolapse? Curr Opin Obstet Gynecol. 2016;28:435–40. https://doi.org/10.1097/GCO.0000000000000307.CrossRefPubMed

24.

Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. Pelvic floor disorders network. N Engl J Med. 2012;366:2358–67. https://doi.org/10.1056/NEJMoa1111967.CrossRefPubMedPubMedCentral

25.

Van der Ploeg JM, van der Steen A, et al. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121:537–47. https://doi.org/10.1111/1471-0528.12509.CrossRefPubMed

26.

Burkhard (Chair) FC, Bosch JLHR, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A. EAU Guidelines on urinary Incontinence, 2020.

27.

Fusco F, Abdel-Fattah M, Chapple CR, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2017;72:567–91. https://doi.org/10.1016/j.eururo.2017.04.026.CrossRefPubMed

28.

Chartier-Kastler E, Reus C. Are slings still the gold standard for female stress urinary incontinence? Eur Urol Focus. 2019;5:315–6. https://doi.org/10.1016/j.euf.2019.01.017.CrossRefPubMed

29.

Pan K, Cao L, Ryan NA, Wang Y, Xu H. Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J. 2016;27:93–101. https://doi.org/10.1007/s00192-015-2775-9.CrossRefPubMed

30.

Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6. https://doi.org/10.1001/jama.300.11.1311.CrossRefPubMedPubMedCentral

Title: Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair of the vaginal compartments in patients with advanced pelvic organ prolapse and incontinence
Authors: Ivan Ignjatovic
Milan Potic
Dragoslav Basic
Ljubomir Dinic
Aleksandar Skakic
Publication date: 01-04-2021
Publisher: Springer International Publishing
Keywords: Stress Incontinence
Uterine Prolapse
Kolporraphie Front
Sacrocolpopexy
Published in: International Urogynecology Journal / Issue 4/2021
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04519-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair of the vaginal compartments in patients with advanced pelvic organ prolapse and incontinence

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Long-term safety and efficacy of laparoscopically placed mesh for apical prolapse

Current trends in pessary management of vaginal prolapse: a multidisciplinary survey of UK practice

Change over time in the surgical management of pelvic organ prolapse between 2008 and 2014 in France: patient profiles, surgical approaches, and outcomes

Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes

Prolapse repair after anterior exenteration

The impact of personality traits on pessary treatment outcomes in patients with pelvic organ prolapse