Mariëlla Withagen - Academia.edu (original) (raw)

Papers by Mariëlla Withagen

Ultrasound in Obstetrics & Gynecology

Objectives To assess change in levator hiatal dimensions between pregnancy and different timepoin... more Objectives To assess change in levator hiatal dimensions between pregnancy and different timepoints after vaginal delivery, and map recovery of the hiatus in order to contribute to secondary prevention of symptoms of pelvic floor disorders. Methods Twenty nulliparous women with a singleton pregnancy underwent ultrasound assessment of the pelvic floor at rest, on maximum pelvic floor muscle contraction (PFMC) and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. Dimensions of the levator hiatus were measured and contractility and distensibility were calculated. The Wilcoxon signed rank test was used to compare each postpartum value with that at 12 weeks' gestation. Results Levator hiatal area at rest, on PFMC and on Valsalva maneuver was significantly increased at 1 day and at 1 and 2 weeks after vaginal delivery compared with measurements at 12 weeks' gestation. Hiatal area at rest and on PFMC from 3 weeks postpartum onward, as well as contractility from 6 weeks onward, were comparable to values at 12 weeks' gestation, whereas, a significant difference remained on Valsalva maneuver until 24 weeks after delivery. Moreover, distensibility was still increased at 24 weeks postpartum compared with measurements at 12 weeks' gestation. Conclusion The puborectalis muscle has the ability to recover anatomically from a first vaginal delivery, and recovery occurs mainly during the first 3 weeks after delivery. Stretching of the puborectalis muscle, as reflected by distensibility, persisted 24 weeks after the first vaginal delivery. The data provide a better understanding of the early 'normal' regeneration process and we hypothesize

International Urogynecology Journal, 2012

International Urogynecology Journal, 2010

Introduction and hypothesis This study focussed on the factors which predict the presence of symp... more Introduction and hypothesis This study focussed on the factors which predict the presence of symptoms of overactive bladder (OAB) after surgery for pelvic organ prolapse (POP). Methods Consecutive women who underwent POP surgery with or without the use of vaginal mesh materials in the years 2004-2007 were included. Assessments were made preoperatively and at follow-up, including physical examination (POP-Q) and standardised questionnaires (IIQ, UDI and DDI). Results Five hundred and five patients were included with a median follow-up of 12.7 (6-35) months. Bothersome OAB symptoms decreased after POP surgery. De novo bothersome OAB symptoms appeared in 5-6% of the women. Frequency and urgency were more likely to improve as compared with urge incontinence and nocturia. The best predictor for the absence of postoperative symptoms was the absence of preoperative bothersome OAB symptoms. Conclusion The absence of bothersome OAB symptoms preoperatively was the best predictor for the absence of postoperative symptoms.

International Urogynecology Journal, 2011

The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal techniqu... more The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift™ procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2008

Objectives: To determine the safety and efficacy of ultra lightweight titanium coated polypropyle... more Objectives: To determine the safety and efficacy of ultra lightweight titanium coated polypropylene mesh to augment conventional vaginal prolapse repair in women with recurrent symptomatic prolapse stage II or more or primary prolapse stage III or more. Study design: A prospective observational cohort study was performed at two urogynecological centres in The Netherlands. Women with recurrent symptomatic prolapse at least stage II or primary vaginal prolapse ICS POP stage III or more participated in the study. POP-Q and validated urogynecological questionnaires were used pre-and post-operatively. Outcome measures were mesh-related morbidity and prolapse recurrence, defined as ICS POP stage II, as well as changes in domain scores on urogenital distress-and defaecatory distress inventory (UDI and DDI), incontinence impact questionnaire (IIQ) as well as sexual functioning. Wilcoxon's signed ranks test for paired variables and 95% confidence intervals, respectively were used to analyse these data. Results: The study group comprised 71 patients with a median follow-up of 9 months (6-14). Mesh erosions were detected in four patients (5.6%), all on the posterior vaginal wall. After Ti-mesh 1 augmentation in 14 patients (36%) the anterior vaginal wall and in 7 patients (18%) the posterior vaginal wall, was categorised as ICS POP stage II and were thus considered failures. UDI and DDI domain scores all improved significantly, except for the domains of incontinence and pain, respectively. Three out of five domains of the IIQ showed significant improvement. Surgery did not have any significant negative impact on sexual functioning. Conclusion: Ultra lightweight titanized polypropylene mesh to augment conventional vaginal prolapse repair surgery showed minimal morbidity, but no additional value compared to conventional surgery at short-term follow-up. #

International Urogynecology Journal, 2011

Introduction and hypothesis To evaluate the variation in techniques of anterior colporrhaphy amon... more Introduction and hypothesis To evaluate the variation in techniques of anterior colporrhaphy among members of the Dutch Urogynecologic Society. Methods A questionnaire evaluating the technique of anterior colporrhaphy, preoperative and postoperative care, and use of the POP-Q score was sent out by e-mail. Results One hundred thirty-three completed questionnaires were received. The response rate was 65%. There are large variations in incisions, use of hydrodissection, method of plication, and excision of redundant vaginal epithelium. The urinary catheter was generally removed on day 2 after surgery and the vaginal pack on day 1. Less than half of the respondents used the POP-Q score routinely. Conclusions Dutch gynecologists use a variety of surgical techniques to operate on a cystocele. This suggests that there is no widely accepted opinion on the best surgical approach. The lack of differentiation between central and lateral defects is striking and in contrast with the, mostly, American literature.

International Urogynecology Journal, 2009

Introduction and hypothesis The objective of this study was to report 1 year anatomical and funct... more Introduction and hypothesis The objective of this study was to report 1 year anatomical and functional outcomes of trocar-guided total tension-free vaginal mesh (Prolift™) repair for post-hysterectomy vaginal vault prolapse with one continuous piece of polypropylene mesh. Methods We conducted a prospective observational cohort study of 46 patients. A minimum sample size of 35 patients was needed to detect a recurrence rate of less than 20% at 12 months. Instruments of measurement used were pelvic organ prolapse quantification and validated questionnaires. Results Overall anatomical success was 91% (95% confidence interval 83-99), with significant improvement in experienced bother and quality of life. Mesh exposure occurred in seven patients (15%). No adverse effects on sexual function could be detected. Conclusions Trocar-guided total tension-free vaginal mesh (Prolift™) repair with one continuous piece of mesh for post-hysterectomy vaginal vault prolapse is well tolerated and anatomically and functionally highly effective. Results of controlled trials will determine its position in the operative armamentarium.

We present a case in which a polypropylene mesh was placed over the posterior vaginal wall and wa... more We present a case in which a polypropylene mesh was placed over the posterior vaginal wall and was fixed to the sacrospinous ligaments on both sides. Postoperative a rectal obstruction developed which was only resolved after splitting the entire mesh in the midline. It is hypothesised that the obstruction was due to the fixation of the mesh with irresolvable suture material to the sacrospinous ligaments acting as a hinge on which the bowel folded.

International urogynecology journal, Jan 10, 2015

We compared cure rates and complication rates in patients who had undergone primary or recurrent ... more We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary referral center was carried out. All patients had, predominantly, SUI. Exclusion criteria were patients with a neurogenic bladder or a neobladder and patients without postoperative follow-up (FU). The primary objective was to assess the success rate, defined as cured SUI or improved SUI at six weeks and at the latest available moment of FU. The secondary objective was to assess complications. A total of 541 women with SUI underwent surgery for SUI between 2002 and 2010. After exclusion of 102 patients a total of 242 patients with primary SUI and 197 patients with recurrent SUI were identified. The success rate at first FU was 89 %. At last FU (median 205 days) the success rate was 83 % (P < 0.01). There were no significant diff...

Obstetrics & Gynecology, 2011

To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventio... more To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse.

The Journal of Sexual Medicine, 2011

Introduction. Surgical treatment of pelvic organ prolapse (POP) affects sexual function. Generall... more Introduction. Surgical treatment of pelvic organ prolapse (POP) affects sexual function. Generally, this results in improved sexual function, but deterioration is reported also. Aim. The purpose of this study was to evaluate and compare sexual function in patients with recurrent POP undergoing either a vaginal surgical repair with native tissue or a trocar-guided mesh insertion. Methods. Sexually active patients randomly assigned to either native tissue repair or trocar-guided mesh insertion, which had completed the pelvic organ prolapse (POP)/urinary incontinence sexual questionnaire (PISQ-12) both at baseline and at 12 months, were included. Total, subscale, and individual question analysis were performed. Logistic regression was used to identify factors that were independently associated with improvement/deterioration in total PISQ-12 scores. Main Outcome Measures. Primary outcome was sexual function at 12 months following surgery, measured by the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Secondary outcomes were the identification of factors independently associated with change in PISQ-12 scores and changes in individual PISQ-12 question scores. Results. Sixty patients were included; 32 in the mesh arm and 28 in the native tissue arm. At 12 months, PISQ-12 scores were not different in both treatment arms (34.3, standard deviation [SD] 6.7 vs. 34.7, SD 5.7), but improvement was detected in the native tissue arm, whereas PISQ-12 total score remained unchanged in the mesh arm. Deteriorations were observed in the behavioral/emotive subscale and partner-related items in the mesh arm. In the native tissue arm, significant improvements in the physical and partner-related subscales were observed. The presence of mesh exposure was independently associated with deterioration in total PISQ-12 score. Conclusion. At 12 months, PISQ-12 scores were not different in either treatment arm, but were affected differently by trocar-guided mesh insertion or by native tissue repair. Mesh exposure was independently associated with deterioration in sexual function. Milani AL, Withagen MIJ, The HS, Nedelcu-van der Wijk I, and Vierhout ME. Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: A randomized controlled trial. J Sex Med 2011;8:2944-2953.

International Urogynecology Journal, 2009

Introduction and hypothesis The objective of this study is to evaluate cervical amputation with u... more Introduction and hypothesis The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment. Methods Consecutive women with pelvic organ prolapse who underwent either vaginal hysterectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardised questionnaires (incontinence impact questionnaire, urogenital distress inventory, and defaecatory distress inventory). Results Between 2002 and 2007, 156 patients were included. Ninety-eight patients returned for a 1-year follow-up. In the modified Manchester group, we found no middle compartment recurrence versus two (4%) in the vaginal hysterectomy group. Anterior and posterior compartment prolapse recurrences (stage ≥2) were similar (approximately 50%). Considering operating time and blood loss, modified Manchester was more favourable. There was no difference in the pre-and postoperative subjective scores. The overall functional outcome was acceptable.

International Urogynecology Journal, 2010

Introduction and hypothesis The objective of this study was to assess the effect of the tension-f... more Introduction and hypothesis The objective of this study was to assess the effect of the tension-free vaginal mesh (Prolift™) procedure on the non-treated and initially unaffected vaginal compartments. Methods This prospective observational cohort study involved 150 patients who underwent a Prolift™ procedure. Pelvic organ prolapse (POP) quantification and evaluation of prolapse symptoms with validated questionnaires was performed pre-operatively and 6 and 12 months postoperatively. Primary outcome was the rate of POP stage ≥II in the non-treated vaginal compartments. Results Twenty-three percent of all patients developed a de novo POP stage ≥II in the untreated compartment. This occurred in 46% and 25% of patients after an isolated anterior and isolated posterior Prolift™, respectively. Conclusion Tension-free vaginal mesh treatment of one vaginal compartment seems to provoke the development of vaginal prolapse in initially unaffected vaginal compartments, particularly after an isolated anterior Prolift™ procedure.

International Urogynecology Journal, 2011

Introduction and hypothesis The objective of this study is to evaluate the complications and anat... more Introduction and hypothesis The objective of this study is to evaluate the complications and anatomical and functional outcomes of the surgical treatment of mesh-related complications. Methods A retrospective cohort study of patients who underwent complete or partial mesh excision to treat complications after prior mesh-augmented pelvic floor reconstructive surgery was conducted. Results Seventy-three patients underwent 30 complete and 51 partial mesh excisions. Intraoperative complications occurred in 4 cases, postoperative complications in 13. Symptom relief was achieved in 92% of patients. Recurrence of pelvic organ prolapse (POP) occurred in 29% of complete and 5% of partial excisions of mesh used in POP surgery. De novo stress urinary incontinence (SUI) occurred in 36% of patients who underwent excision of a suburethral sling. Conclusions Mesh excision relieves mesh-related complications effectively, although with a substantial risk of serious complications and recurrence of POP or SUI. More complex excisions should be performed in skilled centers. Keywords Complications . Excision . Exposure . Mesh . Pelvic organ prolapse . Stress urinary incontinence Abbreviations IVS Intravaginal sling OAB Overactive bladder POP Pelvic organ prolapse SUI Stress urinary incontinence TOT Transobturator tape TVT Tension-free vaginal tape TVT-O Tension-free vaginal tape obturator

International Urogynecology Journal, 2011

Introduction and hypothesis The factors influencing a patient's subjective improvement 1 year aft... more Introduction and hypothesis The factors influencing a patient's subjective improvement 1 year after pelvic organ prolapse (POP) surgery were studied. Methods Women after POP surgery were divided into improved and non-improved group based on their score on the questionnaire Patient Global Impression of Improvement (PGI-I) 1 year after surgery. Anatomical and functional outcomes were assessed as influencing factors for improvement using multivariate logistic regression. Results Three hundred eighty-six (386) women were included in the study, of whom 40 (10%) had not subjectively improved. First POP operation, symptoms and bother of genital prolapse and overactive bladder, and anterior compartment anatomy were independent factors related to subjective improvement. A threshold needed to be reached in these parameters. Conclusions The first operation was more often associated with subjective improvement, and both anatomical and functional outcomes were of importance. The mere finding of a statistical significant improvement was no guarantee for subjective improvement after POP surgery.

American Journal of Obstetrics and Gynecology, 2012

The objective of the study was to compare the 1 year conventional and composite outcomes of troca... more The objective of the study was to compare the 1 year conventional and composite outcomes of trocar-guided vaginal mesh surgery and the identification of the predictors of failure.

Obstetrics & Gynecology, 2011

To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventio... more To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse.

Ultrasound in Obstetrics & Gynecology

Objectives To assess change in levator hiatal dimensions between pregnancy and different timepoin... more Objectives To assess change in levator hiatal dimensions between pregnancy and different timepoints after vaginal delivery, and map recovery of the hiatus in order to contribute to secondary prevention of symptoms of pelvic floor disorders. Methods Twenty nulliparous women with a singleton pregnancy underwent ultrasound assessment of the pelvic floor at rest, on maximum pelvic floor muscle contraction (PFMC) and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. Dimensions of the levator hiatus were measured and contractility and distensibility were calculated. The Wilcoxon signed rank test was used to compare each postpartum value with that at 12 weeks' gestation. Results Levator hiatal area at rest, on PFMC and on Valsalva maneuver was significantly increased at 1 day and at 1 and 2 weeks after vaginal delivery compared with measurements at 12 weeks' gestation. Hiatal area at rest and on PFMC from 3 weeks postpartum onward, as well as contractility from 6 weeks onward, were comparable to values at 12 weeks' gestation, whereas, a significant difference remained on Valsalva maneuver until 24 weeks after delivery. Moreover, distensibility was still increased at 24 weeks postpartum compared with measurements at 12 weeks' gestation. Conclusion The puborectalis muscle has the ability to recover anatomically from a first vaginal delivery, and recovery occurs mainly during the first 3 weeks after delivery. Stretching of the puborectalis muscle, as reflected by distensibility, persisted 24 weeks after the first vaginal delivery. The data provide a better understanding of the early 'normal' regeneration process and we hypothesize

International Urogynecology Journal, 2012

International Urogynecology Journal, 2010

Introduction and hypothesis This study focussed on the factors which predict the presence of symp... more Introduction and hypothesis This study focussed on the factors which predict the presence of symptoms of overactive bladder (OAB) after surgery for pelvic organ prolapse (POP). Methods Consecutive women who underwent POP surgery with or without the use of vaginal mesh materials in the years 2004-2007 were included. Assessments were made preoperatively and at follow-up, including physical examination (POP-Q) and standardised questionnaires (IIQ, UDI and DDI). Results Five hundred and five patients were included with a median follow-up of 12.7 (6-35) months. Bothersome OAB symptoms decreased after POP surgery. De novo bothersome OAB symptoms appeared in 5-6% of the women. Frequency and urgency were more likely to improve as compared with urge incontinence and nocturia. The best predictor for the absence of postoperative symptoms was the absence of preoperative bothersome OAB symptoms. Conclusion The absence of bothersome OAB symptoms preoperatively was the best predictor for the absence of postoperative symptoms.

International Urogynecology Journal, 2011

The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal techniqu... more The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift™ procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2008

Objectives: To determine the safety and efficacy of ultra lightweight titanium coated polypropyle... more Objectives: To determine the safety and efficacy of ultra lightweight titanium coated polypropylene mesh to augment conventional vaginal prolapse repair in women with recurrent symptomatic prolapse stage II or more or primary prolapse stage III or more. Study design: A prospective observational cohort study was performed at two urogynecological centres in The Netherlands. Women with recurrent symptomatic prolapse at least stage II or primary vaginal prolapse ICS POP stage III or more participated in the study. POP-Q and validated urogynecological questionnaires were used pre-and post-operatively. Outcome measures were mesh-related morbidity and prolapse recurrence, defined as ICS POP stage II, as well as changes in domain scores on urogenital distress-and defaecatory distress inventory (UDI and DDI), incontinence impact questionnaire (IIQ) as well as sexual functioning. Wilcoxon's signed ranks test for paired variables and 95% confidence intervals, respectively were used to analyse these data. Results: The study group comprised 71 patients with a median follow-up of 9 months (6-14). Mesh erosions were detected in four patients (5.6%), all on the posterior vaginal wall. After Ti-mesh 1 augmentation in 14 patients (36%) the anterior vaginal wall and in 7 patients (18%) the posterior vaginal wall, was categorised as ICS POP stage II and were thus considered failures. UDI and DDI domain scores all improved significantly, except for the domains of incontinence and pain, respectively. Three out of five domains of the IIQ showed significant improvement. Surgery did not have any significant negative impact on sexual functioning. Conclusion: Ultra lightweight titanized polypropylene mesh to augment conventional vaginal prolapse repair surgery showed minimal morbidity, but no additional value compared to conventional surgery at short-term follow-up. #

International Urogynecology Journal, 2011

Introduction and hypothesis To evaluate the variation in techniques of anterior colporrhaphy amon... more Introduction and hypothesis To evaluate the variation in techniques of anterior colporrhaphy among members of the Dutch Urogynecologic Society. Methods A questionnaire evaluating the technique of anterior colporrhaphy, preoperative and postoperative care, and use of the POP-Q score was sent out by e-mail. Results One hundred thirty-three completed questionnaires were received. The response rate was 65%. There are large variations in incisions, use of hydrodissection, method of plication, and excision of redundant vaginal epithelium. The urinary catheter was generally removed on day 2 after surgery and the vaginal pack on day 1. Less than half of the respondents used the POP-Q score routinely. Conclusions Dutch gynecologists use a variety of surgical techniques to operate on a cystocele. This suggests that there is no widely accepted opinion on the best surgical approach. The lack of differentiation between central and lateral defects is striking and in contrast with the, mostly, American literature.

International Urogynecology Journal, 2009

Introduction and hypothesis The objective of this study was to report 1 year anatomical and funct... more Introduction and hypothesis The objective of this study was to report 1 year anatomical and functional outcomes of trocar-guided total tension-free vaginal mesh (Prolift™) repair for post-hysterectomy vaginal vault prolapse with one continuous piece of polypropylene mesh. Methods We conducted a prospective observational cohort study of 46 patients. A minimum sample size of 35 patients was needed to detect a recurrence rate of less than 20% at 12 months. Instruments of measurement used were pelvic organ prolapse quantification and validated questionnaires. Results Overall anatomical success was 91% (95% confidence interval 83-99), with significant improvement in experienced bother and quality of life. Mesh exposure occurred in seven patients (15%). No adverse effects on sexual function could be detected. Conclusions Trocar-guided total tension-free vaginal mesh (Prolift™) repair with one continuous piece of mesh for post-hysterectomy vaginal vault prolapse is well tolerated and anatomically and functionally highly effective. Results of controlled trials will determine its position in the operative armamentarium.

We present a case in which a polypropylene mesh was placed over the posterior vaginal wall and wa... more We present a case in which a polypropylene mesh was placed over the posterior vaginal wall and was fixed to the sacrospinous ligaments on both sides. Postoperative a rectal obstruction developed which was only resolved after splitting the entire mesh in the midline. It is hypothesised that the obstruction was due to the fixation of the mesh with irresolvable suture material to the sacrospinous ligaments acting as a hinge on which the bowel folded.

International urogynecology journal, Jan 10, 2015

We compared cure rates and complication rates in patients who had undergone primary or recurrent ... more We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary referral center was carried out. All patients had, predominantly, SUI. Exclusion criteria were patients with a neurogenic bladder or a neobladder and patients without postoperative follow-up (FU). The primary objective was to assess the success rate, defined as cured SUI or improved SUI at six weeks and at the latest available moment of FU. The secondary objective was to assess complications. A total of 541 women with SUI underwent surgery for SUI between 2002 and 2010. After exclusion of 102 patients a total of 242 patients with primary SUI and 197 patients with recurrent SUI were identified. The success rate at first FU was 89 %. At last FU (median 205 days) the success rate was 83 % (P < 0.01). There were no significant diff...

Obstetrics & Gynecology, 2011

To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventio... more To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse.

The Journal of Sexual Medicine, 2011

Introduction. Surgical treatment of pelvic organ prolapse (POP) affects sexual function. Generall... more Introduction. Surgical treatment of pelvic organ prolapse (POP) affects sexual function. Generally, this results in improved sexual function, but deterioration is reported also. Aim. The purpose of this study was to evaluate and compare sexual function in patients with recurrent POP undergoing either a vaginal surgical repair with native tissue or a trocar-guided mesh insertion. Methods. Sexually active patients randomly assigned to either native tissue repair or trocar-guided mesh insertion, which had completed the pelvic organ prolapse (POP)/urinary incontinence sexual questionnaire (PISQ-12) both at baseline and at 12 months, were included. Total, subscale, and individual question analysis were performed. Logistic regression was used to identify factors that were independently associated with improvement/deterioration in total PISQ-12 scores. Main Outcome Measures. Primary outcome was sexual function at 12 months following surgery, measured by the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Secondary outcomes were the identification of factors independently associated with change in PISQ-12 scores and changes in individual PISQ-12 question scores. Results. Sixty patients were included; 32 in the mesh arm and 28 in the native tissue arm. At 12 months, PISQ-12 scores were not different in both treatment arms (34.3, standard deviation [SD] 6.7 vs. 34.7, SD 5.7), but improvement was detected in the native tissue arm, whereas PISQ-12 total score remained unchanged in the mesh arm. Deteriorations were observed in the behavioral/emotive subscale and partner-related items in the mesh arm. In the native tissue arm, significant improvements in the physical and partner-related subscales were observed. The presence of mesh exposure was independently associated with deterioration in total PISQ-12 score. Conclusion. At 12 months, PISQ-12 scores were not different in either treatment arm, but were affected differently by trocar-guided mesh insertion or by native tissue repair. Mesh exposure was independently associated with deterioration in sexual function. Milani AL, Withagen MIJ, The HS, Nedelcu-van der Wijk I, and Vierhout ME. Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: A randomized controlled trial. J Sex Med 2011;8:2944-2953.

International Urogynecology Journal, 2009

Introduction and hypothesis The objective of this study is to evaluate cervical amputation with u... more Introduction and hypothesis The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment. Methods Consecutive women with pelvic organ prolapse who underwent either vaginal hysterectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardised questionnaires (incontinence impact questionnaire, urogenital distress inventory, and defaecatory distress inventory). Results Between 2002 and 2007, 156 patients were included. Ninety-eight patients returned for a 1-year follow-up. In the modified Manchester group, we found no middle compartment recurrence versus two (4%) in the vaginal hysterectomy group. Anterior and posterior compartment prolapse recurrences (stage ≥2) were similar (approximately 50%). Considering operating time and blood loss, modified Manchester was more favourable. There was no difference in the pre-and postoperative subjective scores. The overall functional outcome was acceptable.

International Urogynecology Journal, 2010

Introduction and hypothesis The objective of this study was to assess the effect of the tension-f... more Introduction and hypothesis The objective of this study was to assess the effect of the tension-free vaginal mesh (Prolift™) procedure on the non-treated and initially unaffected vaginal compartments. Methods This prospective observational cohort study involved 150 patients who underwent a Prolift™ procedure. Pelvic organ prolapse (POP) quantification and evaluation of prolapse symptoms with validated questionnaires was performed pre-operatively and 6 and 12 months postoperatively. Primary outcome was the rate of POP stage ≥II in the non-treated vaginal compartments. Results Twenty-three percent of all patients developed a de novo POP stage ≥II in the untreated compartment. This occurred in 46% and 25% of patients after an isolated anterior and isolated posterior Prolift™, respectively. Conclusion Tension-free vaginal mesh treatment of one vaginal compartment seems to provoke the development of vaginal prolapse in initially unaffected vaginal compartments, particularly after an isolated anterior Prolift™ procedure.

International Urogynecology Journal, 2011

Introduction and hypothesis The objective of this study is to evaluate the complications and anat... more Introduction and hypothesis The objective of this study is to evaluate the complications and anatomical and functional outcomes of the surgical treatment of mesh-related complications. Methods A retrospective cohort study of patients who underwent complete or partial mesh excision to treat complications after prior mesh-augmented pelvic floor reconstructive surgery was conducted. Results Seventy-three patients underwent 30 complete and 51 partial mesh excisions. Intraoperative complications occurred in 4 cases, postoperative complications in 13. Symptom relief was achieved in 92% of patients. Recurrence of pelvic organ prolapse (POP) occurred in 29% of complete and 5% of partial excisions of mesh used in POP surgery. De novo stress urinary incontinence (SUI) occurred in 36% of patients who underwent excision of a suburethral sling. Conclusions Mesh excision relieves mesh-related complications effectively, although with a substantial risk of serious complications and recurrence of POP or SUI. More complex excisions should be performed in skilled centers. Keywords Complications . Excision . Exposure . Mesh . Pelvic organ prolapse . Stress urinary incontinence Abbreviations IVS Intravaginal sling OAB Overactive bladder POP Pelvic organ prolapse SUI Stress urinary incontinence TOT Transobturator tape TVT Tension-free vaginal tape TVT-O Tension-free vaginal tape obturator

International Urogynecology Journal, 2011

Introduction and hypothesis The factors influencing a patient's subjective improvement 1 year aft... more Introduction and hypothesis The factors influencing a patient's subjective improvement 1 year after pelvic organ prolapse (POP) surgery were studied. Methods Women after POP surgery were divided into improved and non-improved group based on their score on the questionnaire Patient Global Impression of Improvement (PGI-I) 1 year after surgery. Anatomical and functional outcomes were assessed as influencing factors for improvement using multivariate logistic regression. Results Three hundred eighty-six (386) women were included in the study, of whom 40 (10%) had not subjectively improved. First POP operation, symptoms and bother of genital prolapse and overactive bladder, and anterior compartment anatomy were independent factors related to subjective improvement. A threshold needed to be reached in these parameters. Conclusions The first operation was more often associated with subjective improvement, and both anatomical and functional outcomes were of importance. The mere finding of a statistical significant improvement was no guarantee for subjective improvement after POP surgery.

American Journal of Obstetrics and Gynecology, 2012

The objective of the study was to compare the 1 year conventional and composite outcomes of troca... more The objective of the study was to compare the 1 year conventional and composite outcomes of trocar-guided vaginal mesh surgery and the identification of the predictors of failure.

Obstetrics & Gynecology, 2011

To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventio... more To compare efficacy and safety of trocarguided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse.