Article

Surgical management of pelvic organ prolapse in women (Review)

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Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2007; 4(3):CD004014. DOI: 10.1002/14651858.CD004014.pub3
Source: PubMed

ABSTRACT

There was not enough evidence about the effects of different types of surgery for pelvic organ prolapse. Pelvic organs, such as the uterus, bladder or bowel, may protrude into the vagina due to weakness in the tissues that normally support them. The symptoms that they cause vary, depending on the type of prolapse. The types of surgery also vary, depending on the type of prolapse and associated symptoms. The impact of pelvic organ prolapse surgery on bowel, bladder and sexual function can be unpredictable. The review of trials demonstrated that abdominal sacral colpopexy may be better than the vaginal sacrospinous colpopexy for uterine or vault prolapse. Limited evidence suggests that vaginal surgery may be better than transanal surgery for posterior vaginal wall prolapse. However, there was not enough evidence about most types of common prolapse surgery.

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    • "In particular, repair of cystocele with polypropylene mesh was found to result in less anatomical and symptomatic recurrent anterior prolapse than traditional colporrhaphy [5]. However, transobturator mesh systems have been reported to result in mesh extrusions and surgical reintervention at rates of 11.4% and 6.8%, respectively [5], as well as an increased incidence of de novo SUI [5]. Consequently, the use of mesh devices has come under increasing scrutiny by the US Food and Drug Administration because of concerns about complications [6]. "
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    ABSTRACT: Objective . To evaluate the clinical outcomes and urodynamic effects of tailored anterior transvaginal mesh surgery (ATVM) and tailored posterior transvaginal mesh surgery (PTVM). Methods . We developed ATVM for the simultaneous correction of cystocele and stress urinary incontinence and PTVM for the simultaneous correction of enterocoele, uterine prolapse, vaginal stump prolapse, and rectocele. Results . A total of 104 women enrolled. The median postsurgical follow-up was 25.5 months. The anatomic cure rate was 98.1% (102/104). Fifty-eight patients underwent urodynamic studies before and after surgeries. The pad weight decreased from 29.3 ± 43.1 to 6.4 ± 20.9 g at 3 months. Among the 20 patients with ATVM, 13 patients had objective stress urinary incontinence (SUI) at baseline while 8 patients came to have no demonstrated SUI (NDSUI), and 2 improved after surgery. Among the 38 patients who underwent ATVM and PTVM, 24 had objective SUI at baseline while 18 came to have NDSUI, and 2 improved after surgery. Mesh extrusion ( n = 4), vaginal hematoma ( n = 3), and voiding difficulty ( n = 2) were noted postoperatively. Quality of life was substantially improved. Conclusions . Our findings document the advantages of these two novel pelvic reconstructive surgeries for pelvic organ prolapse, which had a positive impact on quality of life. ATVM surgery additionally provided an anti-incontinence effect. This clinical trial is registered at ClinicalTrials.gov ( NCT02178735 ).
    Full-text · Article · Nov 2015
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    • "Favorable long-term objective and subjective outcomes with improved quality of life with vaginal sacrospinous ligament fixation (SSF) surgery have been shown [9]. Moreover, concomitant use of mesh for anterior vaginal wall repair may reduce risk of recurrent cytocoele [10]. The objective of this study was to estimate the association of age with outcomes of vaginal SSF and anterioretransobturator mesh repair surgery for advanced pelvic organ prolapse. "
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    ABSTRACT: Objective The objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups. Materials and methods Vaginal sacrospinous ligament fixation with anterior mesh repair as primary prolapse surgery was performed on 225 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was determined according to feedback of POPDI-6 (Questions 2 and 3). Patients provided responses to UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and postsurgery. Outcome measures were observed in cohorts of two age groups (<75 years and ≥75 years). Results Postoperative data of 217 patients were available. The cumulative objective cure rates were 93.0% and 92.5% for patients aged ≥75 years and <75 years, respectively, with mean follow-up of 33.93 ± 18.52 months and 36.44 ± 19.34 months respectively. The UDI-6, IIQ-7, POPDI-6, and PISQ-12 scores within each of the two age groups improved significantly after surgery. Comparatively, the POPDI-6 score was better whereas the PISQ-12 score was poorer among patients aged ≥75 years. Older women had significantly more preoperative comorbidities. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. The intraoperative blood loss was significantly less in the older group and neither group had mortality. Conclusion This study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.
    Full-text · Article · Sep 2014 · Taiwanese Journal of Obstetrics and Gynecology
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    • "Certaines de ces complications, parfois sévères et pouvant engager le pronostic vital, pourraient être spécifiques de la coelioscopie comme par exemple les occlusions postopératoires ou l'hémorragie incoercible par plaie des vaisseaux iliaques. Ainsi, le risque de complications graves pourrait être augmenté dans la coelioscopie par rapport à la voie vaginale, mais là-aussi aucune donnée comparative de qualité satisfaisante ne permet d'étayer cette hypothèse [9]. Ces critères (complications liées ou non aux prothèses, dyspareunie, algies pelviennes chroniques, signes fonctionnels ) sont des critères de tolérance. "

    Full-text · Article · Sep 2013 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
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