Laparoscopic surgery in the treatment of urogenital prolapse. Current status (original) (raw)
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Annales de Chirurgie
Two hundred and thirty two patients with genitourinary prolapse were operated via an abdominal incision between 1981 and 1994. The technique consisted of retroperitoneal promontofixation, systematically associated with a retropubic colposuspension, levator myorrhaphy, Douglassectomy and uterosacral ligamentoplasty. The mean age of operated patients was 52.57 years (30-85 years), the mean follow-up was 17.8 months (1-105). 65 patients (27.7%) had a history of foetal macrosomy, 125 women (53.4%) were delivered without forceps or expression, and 2 patients (0.8%) had never procreated. The main presenting complaint was prolapse in 197 patients (84.4%), while 140 patients complained of urinary incontinence (60.3%). A urodynamic assessment was systematically performed before the operation and revealed defective transmission in 160 cases (71%); sphincter incompetence in 62 cases (62/228 cases, i.e. 27%); a combination of sphincter incompetence and defective transmission in 40 cases (17.7%)...
Journal de gynécologie, obstétrique et biologie de la reproduction, 2010
The aim of this study was to propose a classification of surgical techniques for treatment of prolapse by vaginal route using prosthetic reinforcements and to relate the evaluation of surgeons involved in the care of surgical patients. A literature review was conducted searching for all articles relating novel technique of surgical management of patients with use of prosthetic reinforcements vaginally. The classification was made from descriptions found and then assessed by questionnaires filled out by surgeons. The classification takes account of all the techniques available today and can integrate new. Among the surgeons, 56.5% (13/23) found that the POP-ST is adapted to reflect the reality and variety of techniques and 60.8% (14/23) will be ready for daily use. A classification covering all the techniques put them at risk of a final tool too complex for routine use. The simplification would make it more usable but limited the comprehensiveness and evolutionary. Only 23 surgeons r...
Progrès en Urologie, 2007
La promontofixation est une technique chirurgicale ancienne réalisée de façon récente par voie coelioscopique . Elle est réalisée en pratique quotidienne par les gynécologues et les urologues. Quelques modifications lui ont été apportées depuis sa première description en 1993 contribuant progressivement à sa standardisation . De nombreux auteurs se sont accordés sur plusieurs points. D'une part sur la nécessité de mettre en place une double bandelette antérieure et postérieure [3] : la controverse sur le traitement systématique de la rectocèle ne trouve plus d'échos dans la littérature récente . D'autre part sur la nécessité de traiter de façon concomitante l'incontinence urinaire d'effort associée au prolapsus, lorsqu'elle est présente à l'examen clinique, de façon patente ou masquée par l'effet pelote . L'agrafage des prothèses au promontoire semble avoir également disparu, au profit d'une fixation au fil non résorbable .
2013
Objectif.-Déterminer les indications et contre-indications de la chirurgie prothétique du prolapsus par voie vaginale. Patientes et méthode.-Revue de la littérature et cotation de propositions selon une méthode inspirée des recommandations par consensus formalisé. Résultats.-Avant une intervention chirurgicale pour prolapsus génital, la patiente doit être informée des différentes techniques existantes (chirurgie abdominale et vaginale, avec et sans prothèse), des raisons pour lesquelles le chirurgien lui propose la mise en place d'une prothèse synthétique et également des autres traitements non chirurgicaux du prolapsus (rééducation et pessaire). L'intervention doit être précédée d'une évaluation des symptômes pelviens, urinaires, digestifs et sexuels, ainsi que de la gêne occasionnée. Pour le traitement chirurgical de la cystocèle par voie vaginale, l'utilisation d'une prothèse inter-vésico-vaginale n'est pas justifiée de manière systématique. Elle doit être discutée au cas par cas compte tenu du rapport bénéfice/risque incertain sur le long terme. Chez les patientes ayant une cystocèle récidivée, la mise en place d'une prothèse inter-vésico-vaginale est une option raisonnable pour réduire le risque de nouvelle récidive. En dehors de quelques situations particulières (rectocèle récidivée), la mise en place par voie vaginale d'une prothèse inter-recto-vaginale n'est pas justifiée en première intention. En cas de prolapsus isolé de l'étage moyen, la fixation du fond vaginal ou de l'utérus par l'intermédiaire de bras prothétiques synthétiques par voie vaginale n'est pas justifiée en première intention. Conclusion.-Le chirurgien devra mettre en oeuvre les mesures préventives établies qui permettent de diminuer le risque de complication.
[Risk factors and prevention of genitourinary prolapse]
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2009
Numerous epidemiological studies in recent years have involved the search for the principal risk factors of genitourinary prolapse. Although it has been agreed for a long time that vaginal delivery increases the risk of prolapse (proof level 1), on the other hand, the Cesarian section cannot be considered a completely effective preventative method (proof level 2). The pregnancy itself is a risk factor for prolapse (proof level 2). Certain obstetrical conditions contribute to the alterations of the perineal floor muscle: a foetus weighing more than four kilos, the use of instruments at birth (proof level 3). If the risk of prolapse increases with age, intrication with hormonal factors is important (proof level 2). The role of hormonal replacement therapy remains controversial. Antecedent pelvic surgery has also been identified as a risk factor (proof level 2). Other varying acquired factors have been documented. Obesity (BMI and abdominal perimeter), professional activity and intense...
[Transvaginal repair of genital prolapse using the Prolift technique: a prospective study]
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2010
To evaluate the efficacy and to report the follow-up of transvaginal repair of genital prolapse using a tension free vaginal mesh. Twenty-eight women were treated for genital prolapse with the Prolift technique and followed prospectively. Preoperative prolapse treatment, associated treatment, complications were reported. Postoperatively, efficacy and complications were reported. Patients were examined at one, three, six and 12 months then yearly. Treatment failure defined as Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. The mean age was 68 years. The median follow-up was 12 months. Ten (35%) and 14 (50%) patients had a stage II and III/IV cystocele respectively. Nineteen (67%) patients had stage II/III rectocele. We reported one bladder injury (3.5%) sutured during surgery and one haematoma (3.5%) requiring secondary management. Important buttock pain appeared in two patients (7%) treated with a total mesh on day 1 and 6 weeks after surgery respectively. They were b...
Journal de gynécologie, obstétrique et biologie de la reproduction, 2011
To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning the adverse events related to surgical procedures involving the use of prosthetic meshes. French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh ; pelvic organ prolapse ; cystocele ; rectocele ; uterine prolapse ; complications ; adverse event ; sacral colpopexy ; extrusion ; infection...). As with any surgery, it is recommended to provide a perioperative smoking cessation (expert opinion) and comply with the prevention of nosocomial infections (regulatory requirement). There is no evidence to recommend routine local or systemic estrogen therapy before or after prolapse surgery using mesh, regardless of the surgical approach (grade C). Antibiotic prophylaxis is recommended, regardless of the approach (expert opinion). It is recommended to seek a pre-operativ...
Pelvi-périnéologie, 2011
after surgery was conducted through: validated questionnaire, clinical examination, pelvic MRI, defecography, satisfaction assessment. Results: Seven patients were included (mean age = 68 ± 6 years old [57-75]). Two months after surgery: any clinical pelvic organ prolapse (P < 0.05), one rectal prolapse was observed on MRI and defecography (patient without symptoms). Six months after surgery: mean Gastrointestinal Quality of Life Index decreased (P < 0.05). The mean Miller and Kess score decreased too but not significantly. Four patients (57%) were very satisfied with the result, would undergo operation again, and recommend it. Five (71%) were very satisfied with the time they went back to usual activity. Any complication during or after surgery was observed. Conclusion: Our study shows the feasibility of a concomitant vaginal treatment of rectal and pelvic prolapse, using Prolift ® mesh, with a low short-term morbidity. The longterm benefit must be studied on a larger population. To cite this journal: Pelvi-Périnéologie 6 (2011).