Early safety and efficacy outcomes of a novel technique of sacrocolpopexy for the treatment of apical prolapse (original) (raw)
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Journal of Obstetrics, Gynecology and Cancer Research
Background & Objective: Pelvic organ prolapse (POP) is accompanied by a remarkable decline in the quality of life. Determining the best surgical approach for women with POP is difficult because of outcome variations. We compared the outcomes of pelvic organ prolapse (POP) treatment by abdominal sacrocolpopexy (ASC) and vaginal sacrospinous ligament suspension (SSLS) for advanced apical prolapse beyond the level of the hymen (stage≥ II). Materials & Methods: This retrospective study was conducted on a case series of 58 ASC and 48 SSLS surgeries, which were performed through the posterior approach for advance prolapse during January 2019-April 2020. Pelvic Floor Disability Index (PFDI-20) questionnaire was completed both at the first visit and a year postop. All patients were visited ten days after the procedure and re-visited after 2, 4, 6, and 12 months. Results: Of a total of 106 women, 80 cases completed the study (n=40 in each group). Within-group analysis showed that the overall score of PFDI-20 and its subscales decreased in both evaluated groups after surgery (P<0.001). However, the between-group analysis revealed that this reduction in the ASC group was statistically significant in the total score of PFDI, POPDI-6, and UDI-6 subscales (P<0.05). In addition, vaginal length was demonstrated to improve in both groups, which was statistically significant in the ASC group (P=0.001). The stage of prolapse was improved in both groups (P<0.001), and it was more significant in the ASC group (P=0.049). There was no statistically significant difference between the SSLS and ASC in terms of the rate of satisfaction (93% vs. 100%; P=0.241). Conclusion: According to our findings, ASC and SSLS diminished the symptoms of POP. The surgery approach should be chosen based on the condition of patients, POP stage, and the experience of surgeons.
Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations
European journal of obstetrics, gynecology, and reproductive biology, 2016
Sacrocolpopexy is considered a reference operation for pelvic organ prolapse repair but its indications and technical aspects are not standardized. A faculty of urogynecology surgeons critically evaluated the peer-reviewed literature published until September 2015 aiming to produce evidence-based recommendations. PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English language. The modified Oxford data grading system was used to access quality of evidence and grade recommendations. The Delphi process was implemented when no data was available. Thirteen randomized, controlled trials were identified, that provided levels 1 to 3 of evidence on various aspects of sacrocolpopexy. Sacrocolpopexy is the preferred procedure for vaginal apical prolapse (Grade A), monofilament polypropylene mesh is the graft of choice and the laparoscopic approach is the preferred technique (Grade B). Grade B recommendation supports the performance of conc...
The World Clinics Journal of Medical Sciences, 2017
he surgical repair of apical pelvic organ prolapse (POP) includes vaginal and abdominal approaches. 1 The vaginal approaches are lessmorbid than abdominal approaches.However, abdominal approaches provides lower recurrence rates and less dysparenuia than vaginal approaches. 2 Today, sacrocolpopexy is the gold standard procedure for apical POP repair. 1,2 The procedure that can be performed by abdominally (ASC), or minimally invasively (MISC), provides excellent anatomical and functional outcomes. 2 Since vaginal vault prolapses occured more rarely, the number of studies including MISCs are rare. 3 Herein we report our experience with abdominal and minimally invasive approaches of the sacrocolpopexy. In addition, we present the demographic, peri-and postoperative outcomes of abdominal and minimally invasive approaches. MATERIAL AND METHODS SUBJECTS A total of 41 consecutive women who were diagnosed with POP and underwent a sacrocolpopexy operation (21 ASC, 20 MISC) were included in
Sacrocolpopexy for posthysterectomy vaginal vault prolapse: long-term follow-up
International Urogynecology Journal, 2016
Introduction and hypothesis Abdominal sacrocolpopexy (ASC) is considered the gold standard for vaginal vault prolapse (VVP) repair. Our aim was to evaluate the long-term durability of its anatomic and functional results. Methods This was a prospective series of women undergoing ASC for symptomatic VVP stage III or IV according to the Pelvic Organ Prolapse Quantification (POP-Q) system. All patients were followed up every 3 months for the first postoperative year and then annually for anatomical and functional outcomes and complications. Only patients with at least 48 months of follow-up were included in this report. Anatomic success was defined as postoperative prolapse stage 0 or I. Statistical analysis was performed using the nonparametric Mann-Whitney U test for the analysis of continuous variables and the McNemar and χ 2 test for categorical data. Results Sixty-seven women were followed up for a median of 60 months (range 48-144). Anatomical success was 100 % for apical prolapse and 94 and 91 % for anterior and posterior compartments, respectively. There were only four (6 %) and six (9 %) cases of stage II persistence or recurrence for the anterior and posterior compartments, respectively, which did not require reoperation. There was no vault prolapse recurrence. Voiding and storage urinary and sexual symptoms were significantly improved. Anorectal dysfunction symptoms persisted in 40.6 % of patients with these symptoms preoperatively and developed de novo in 22.8 % of patients without them preoperatively. Three mesh exposures were noted. Sixtythree patients (94 %) were extremely or very much improved with sacrocolpopexy according to the Patient Global Impression-Improvement scale. Conclusions Our data confirm the long-term durability of vaginal vault prolapse repair with ASC.
International Journal of Women's Health, 2023
Background: Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women's quality of life. Unfortunately, the literature lacks long-term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting. Methods: In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009-2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05. Results: Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01-1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33-18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure. Conclusion: The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long-term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.
Facts, Views and Vision in ObGyn, 2021
Introduction: Vaginal sacrospinous fixation and sacrospinous hysteropexy (SSF/SSHP) are highly effective procedures for apical compartment prolapse. The established technique is the posterior vaginal approach. The alternative anterior approach through an anterior vaginal incision, although occasionally mentioned in the literature, is less well established. However, this approach is a more appropriate route if posterior vaginal surgery is not indicated. The aim of this paper is to review surgical outcomes of anterior approach in our centre and to compare outcomes of SSF vs SSHP. Methods: Retrospective case note review of 60 patients who underwent anterior SSF for prolapse between 2009-2017 was performed. Preoperative and postoperative symptoms and findings were recorded. Anterior SSF involved an anterior vaginal incision and paravaginal access to the ligament for dissection and fixation to either the cervix or vault. Results: SSF was performed in 39 patients, out of which 8 underwent...
International urogynecology journal, 2018
We compared treatment success and adverse events between women undergoing open abdominal sacrocolpopexy (ASC) vs vaginal repair (VAR) using data from women enrolled in one of three multicenter trials. We hypothesized that ASC would result in better outcomes than VAR. Participants underwent apical repair of stage 2-4 prolapse. Vaginal repair included uterosacral, sacrospinous, and iliococcygeal suspensions; sacrocolpopexies were via laparotomy. Success was defined as no bothersome bulge symptoms, no prolapse beyond the hymen, and no retreatment up to 24 months. Adverse events were collected at multiple time points. Outcomes were analyzed using longitudinal mixed-effects models to obtain valid outcome estimates at specific visit times, accounting for data missing at random. Comparisons were controlled for center, age, body mass index (BMI), initial Pelvic Organ Prolapse Quantification (POP-Q) stage, baseline scores, prior prolapse repair, and concurrent repairs. Of women who met inclu...
Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse
JAMA, 2013
ELVIC ORGAN PROLAPSE (POP) occurs when the uterus or vaginal walls bulge into or beyond the vaginal introitus. It is a common occurrence and 7% to 19% of women receive surgical repair. 1,2 Abdominal sacrocolpopexy is the most durable operation for advanced POP and serves as the criterion standard against which other operations are compared. 3 Abdominal sacrocolpopexy involves attaching the vaginal apex to the sacral anterior longitudinal ligament reinforced with a graft, usually synthetic mesh. 4 Little is known about long-term durability, complications, and pelvic floor symptoms after abdominal sacrocolpopexy. The few studies assessing outcomes beyond2yearsarelimitedbysmallsample sizes, inconsistent outcome assessment, potentially biased examiners, and nonstandardizedfollow-up. 5 Determiningthe long-term outcomes for sacrocolpoplexy in treating POP is important because 225 000 women in the United States undergo POP surgeries annually. The direct costs for these procedures exceed $1 billion per year. As the population ages, it is anticipated that POP and urinary in-For editorial comment see p 2045. Author Audio Interview available at www.jama.com. Importance More than 225 000 surgeries are performed annually in the United States for pelvic organ prolapse (POP). Abdominal sacrocolpopexy is considered the most durable POP surgery, but little is known about safety and long-term effectiveness. Objectives To describe anatomic and symptomatic outcomes up to 7 years after abdominal sacrocolpopexy, and to determine whether these are affected by concomitant anti-incontinence surgery (Burch urethropexy). Design, Setting, and Participants Long-term follow-up of the randomized, masked 2-year Colpopexy and Urinary Reduction Efforts (CARE) trial of women with stress continence who underwent abdominal sacrocolpopexy between 2002 and 2005 for symptomatic POP and also received either concomitant Burch urethropexy or no urethropexy. Ninety-two percent (215/233) of eligible 2-year CARE trial completers were enrolled in the extended CARE study; and 181 (84%) and 126 (59%) completed 5 and 7 years of follow-up, respectively. The median follow-up was 7 years. Main Outcomes and Measures Symptomatic POP failure requiring retreatment or self-reported bulge; or anatomic POP failure requiring retreatment or Pelvic Organ Prolapse Quantification evaluation demonstrating descent of the vaginal apex below the upper third of the vagina, or anterior or posterior vaginal wall prolapse beyond the hymen. Stress urinary incontinence (SUI) with more than 1 symptom or interval treatment; or overall UI score of 3 or greater on the Incontinence Severity Index. Results Of 215 women enrolled in the extended CARE study, 104 had undergone abdominal sacrocolpopexy plus Burch urethropexy and 111 had undergone abdominal sacrocolpopexy alone. Pelvic organ prolapse and urinary incontinence failure rates gradually increased during 7 years of follow-up. Estimated Probability of Failure From Parametric Survival Models 7 Years After Abdominal Sacrocolpopexy (SD) Treatment Difference (95% CI) Urethropexy No urethropexy Pelvic organ prolapse Symptomatic failure 0.29 (0.043) 0.24 (0.038) 0.049 (Ϫ0.060 to 0.162) Anatomic failure 0.27 (0.099) 0.22 (0.049) 0.050 (Ϫ0.161 to 0.271) Composite (symptomatic or anatomic) failure 0.48 (0.092) 0.34 (0.054) 0.134 (Ϫ0.096 to 0.322) Urinary incontinence Stress 0.62 (0.052) 0.77 (0.034) Ϫ0.153 (Ϫ0.268 to Ϫ0.030) Overall 0.75 (0.043) 0.81 (0.032) Ϫ0.064 (Ϫ0.161 to 0.032) Probability of mesh erosion at 7 years (estimated by the Kaplan-Meier method) was 10.5% (95% CI, 6.8% to 16.1%). Conclusions and Relevance During 7 years of follow-up, abdominal sacrocolpopexy failure rates increased in both groups. Urethropexy prevented SUI longer than no urethropexy. Abdominal sacrocolpopexy effectiveness should be balanced with longterm risks of mesh or suture erosion. Trial Registration clinicaltrials.gov Identifier: NCT00099372