Ventral rectopexy for rectal procidentia

The main objective of this section is a detailed review of the new approach to rectal procidentia: minimally invasive nerve-sparing ventral rectopexy, laparoscopic ventral rectopexy (LVR), robotic ventral rectopexy (RVR), and its contextual relevance in the surgical treatment of rectal and pelvic organ prolapse. A brief review of rectal prolapse is offered outlining the main perineal and abdominal surgical approaches to its treatment. Further details regarding LVR and its effectiveness in treatment of pelvic organ prolapse, fecal incontinence, and constipation will be reviewed as it applies to external rectal prolapse (ERP) and internal rectal prolapse (IRP). Details regarding the implications of the type of mesh used and complication profile will be covered.     

Multicompartment pelvic floor prolapse repairs: Surgical principles

The operative management of rectal prolapse has evolved substantially over time. Many patients with rectal prolapse also have concomitant prolapse of their anterior and/or middle compartments. Optimal repair of pelvic organ prolapse will address all of the involved compartments, which often requires close collaboration with a urogynecology or female urology team. This chapter describes our technique for robotic ventral mesh rectopexy with sacrocolpopexy when indicated.     

Robotic-assisted pelvic organ prolapse surgery

Background This study describes technical aspect and short-term results of pelvic organ prolapse surgery using the da Vinci robotic system. Methods During a 1-year period, 18 consecutive patients with pelvic organ prolapse were operated on using the da-Vinci system. Clinical data were prospectively collected and analyzed. Results All but one procedure was successfully completed robotically (95%). Performed procedures were colpohysteropexy (n = 12), mesh rectopexy (n = 2), or sutured rectopexy combined with sigmoid resection (n = 4). Average setup time was 21 min and significantly decreased with experience. Mean operative time was 172 min (range, 45–280). There were no mortality and no specific morbidity due to the robotic approach. Mean hospital stay was 7 days. At 6 months, all patients were free of pelvic organ prolapse and stated that they were satisfied with anatomical and functional results. Conclusion Our experience indicates that using the da-Vinci robotic system is feasible, safe, and effective for the treatment of pelvic organ prolapse.     

Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation

Objective Abdominal rectopexy is ideal for otherwise healthy patients with rectal prolapse because of low recurrence, yet after posterior rectopexy, half of the patients complain of severe constipation. Resection mitigates this dysfunction but risks a pelvic anastomosis. The novel nerve‐sparing ventral rectopexy appears to avoid postero‐lateral rectal dissection denervation and thus postoperative constipation. We aimed to evaluate our functional results with laparoscopic ventral rectopexy. Method Consecutive rectal prolapse patients undergoing laparoscopic ventral rectopexy were prospectively assessed (Wexner Constipation and Faecal Incontinence Severity Index scores) pre‐, 3 months postoperatively, and late (> 12 months). Results Sixty‐five consecutive patients with external rectal prolapse (median age 72 years, 34% > 80 years, median follow up 19 months) underwent laparoscopic ventral rectopexy. There was one recurrence (2%) and one conversion. Morbidity (17%) and mortality (0%) were low. Median operating time was 140 min and median length of stay 2 days. At 3 months, constipation was improved in 72% and  mildly induced in 2% (median pre‐and postoperative Wexner scores 9 vs 4, P < 0.0001). Continence was improved in 83% and mild incontinence was induced or  worsened in 5% (median pre‐ and postoperative incontinence score 40 vs 4, P < 0.0001). Significant improvement in both constipation and incontinence (P < 0.0001) remained at median 24 months late follow‐up. Conclusion Ventral rectopexy has a recurrent prolapse rate of < 5%, similar to that of posterior rectopexy. Its correction of preoperative constipation and avoidance of de novo constipation appear superior to historical functional results of posterior rectopexy. A laparoscopic approach allows low morbidity and short hospital stay, even in those patients over 80 years of age in whom a perineal approach is usually preferred for safety.     

Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study

Introduction and hypothesis

To compare the effect of laparoscopic and robot-assisted ventral rectopexy for posterior compartment procidentia on the pelvic floor anatomy and function.

Methods

A prospective randomised single-centre study was carried out of 29 female patients, who underwent robot-assisted or laparoscopic ventral mesh rectopexy for external or internal rectal prolapse with symptoms of obstructive defecation and/or faecal incontinence. Anatomical changes were measured by Pelvic Organ Prolapse Quantification (POP-Q) and magnetic resonance defecography. Functional changes were evaluated using symptom questionnaires before and 3 months after surgery.

Results

After rectopexy, changes in POP-Q measurements were statistically significant for points Ap, Bp, C, D and Ba. The descent of the anorectum and cervix/vaginal cuff during straining were significantly reduced with regard to the reference line (mean, ?10.4?±?14.9 mm, p?=?0.001) and (?13.3?±?18.1 mm, p?<?0.001) respectively. Pelvic organ mobility (POM) was reduced statistically significantly for the posterior (mean, ?16.6?±?20.8 mm, p?<?0.001) and apical compartments (mean, ?13.1?±?14.8, p?<?0.001). The PFDI-20, PFIQ-7 and PISQ-12 questionnaires showed statistically significant improvement of symptoms and sexual function. No significant differences were observed between the robot-assisted and laparoscopic techniques in terms of anatomical or functional parameters.

Conclusion

Ventral mesh recto-colpo-sacropexy effectively corrects the anatomy of the posterior compartment, elevates the vaginal apex and reduces pelvic organ mobility of the posterior and middle compartments. The robot-assisted and laparoscopic techniques had similar anatomical and functional outcomes.

     

Laparoscopic Ventral Rectopexy for Internal Rectal Prolapse Using Biological Mesh: Postoperative and Short-Term Functional Results

Background  

Laparoscopic ventral mesh rectopexy is a novel procedure to correct internal and external rectal prolapse. Several authors have shown that this approach is safe and improves obstructive defaecation symptoms and faecal incontinence, without inducing new-onset constipation, possible after posterior rectopexy. Over the last decade, as for other procedures, biological meshes are used to correct pelvic floor disorders. Literature data are scant. In this study, we present our experience with this procedure using biological mesh.     

Sexual function in women after surgery for pelvic organ prolapse

Our objective was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function. Sixty seven women with pelvic organ prolapse were recruited in the study. Degree of pelvic organ prolapse was assessed using pelvic organ prolapse quantitation (POPQ) staging system. Female sexual function index (FSFI) questionnaire was used to assess sexual function of the cases preoperatively and 12–16 weeks after the operation. Mean age of the cases was 36.03 ± 5.38 years. The total mean FSFI score increased from 15.9 ± 10.7 to 21.9 ± 11.1 (P < 0.05). Domain scores of desire, arousal, lubrication, orgasm, and satisfaction were increased significantly (P < 0.05). The mean score for the pain-free intercourse decreased significantly. Results demonstrated that sexual function was improved postoperatively. Using various instruments to assess female sexual function and differences in demographic and cultural characteristics of study groups might be the reasons of discrepancy between the reports.     

Minimally invasive ventral mesh rectopexy for complex rectocoele: impact on anorectal and sexual function

Aim Minimally invasive surgery for pelvic floor prolapse has recently been shown to be feasible and safe. This study presents the results of robotic‐assisted and laparoscopic rectopexy for complex rectocoele, focusing on less frequently reported outcomes of bowel and sexual function. Method We prospectively assessed 41 consecutive patients who underwent ventral mesh rectopexy (robotic‐assisted or laparoscopic) for a symptomatic complex rectocoele from January 2009 to January 2010. Complex rectocoele was defined as having one or more of the following features: larger than 3 cm, an enterocoele or internal rectal prolapse. Patients with cystocoele underwent bladder suspension concurrently. Both groups were assessed for anatomical recurrence and function, comparing preoperative and postoperative faecal incontinence, obstructive defaecation syndrome and Gastrointestinal Quality‐of‐life Index scores, as well as vaginal discomfort and sexual function. Results Forty‐one women underwent the procedure (16 robotic‐assisted), with four (10.5%) having minor complications and two developing anatomical recurrence. There was significant relief of the commonest predominant symptoms of vaginal bulge/fullness (P < 0.0001) and sexual dysfunction (P = 0.02). There were three conversions to laparotomy (one robotic‐assisted) and five patients declined postoperative functional assessment. In the remaining 33 patients [follow‐up median 12 (8–21) months], analysis revealed no significant difference in overall functional score (P > 0.740) or between patients with one or two meshes inserted (P > 0.486). Only patients with a preoperative obstructive defaecation syndrome score > 6 had a significant improvement postoperatively (P = 0.030). Conclusion Minimally invasive ventral mesh rectopexy for complex rectocoele offers satisfactory anatomical correction and functional results, with the potential for alleviating symptoms of outlet obstruction and improving vaginal comfort and sexual dysfunction.     

Combined Burch urethropexy and anterior rectopexy in pelvic organ prolapse: skip the mesh

Purpose

Pelvic organ prolapse (POP) is a common accompaniment of advancing age. Current repair techniques incorporate transvaginal and transabdominal approaches with or without prosthetic mesh insertion. In this paper, we present the short- and medium-term results of a unit policy directed at patients with POP of combined abdominal rectopexy and Burch retropubic urethropexy without the use of prosthetic mesh assessing its safety profile in selected cases.

Methods

Between January 2009 and January 2011, 16 women with tri-compartmental prolapse who had all undergone prior hysterectomy underwent combined surgical pelvic floor repair. Preoperative symptom assessment by validated questionnaires and clinical examination were pre- and postoperatively recorded. Cures were defined as either optimal or satisfactory outcomes based on combined clinical, radiological examinations and reported patient satisfaction.

Results

The mean age of the 16 patients was 57.2?years, and their mean BMI was 28.6 (±5 SD). Pelvic examination revealed a POP-Q stage III prolapse in 12 patients and stage IV in 4 patients. The mean operating time was 57.5?min (range 40–85), with a mean length of hospital stay of 4.5?days. Cystocele and enterocele resolution was noted in every case on dynamic magnetic resonance imaging (MRI).

Conclusions

Our results in a small patient cohort employing a simple ‘all-in-one’ repair approach combining a retropubic colposuspension with an anterior rectopexy appear to be satisfactory. Further larger randomized studies are required, incorporating a laparoscopic arm in order to determine the longer-term effectiveness of this approach.     

Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction

Objective Whilst trans‐abdominal fixation +/? resection offers better functional results and lower recurrence than perineal procedures, mesh rectopexy is complicated by constipation. Laparoscopic autonomic nerve‐sparing, ventral rectopexy allows correction of the underlying abnormalities of the rectum, vagina, bladder and pelvic floor. Method A prospective database was used to audit our 7‐year experience of this technique. The recto‐vaginal septum was mobilized anteriorly to the pelvic floor avoiding nerve damage. A prolene mesh was sutured to the ventral rectum, posterior vagina and vaginal fornix and secured to the sacral promontory. Patients were assessed with questionnaires and Cleveland Clinic scores. Results Eighty patients, six males, median age 59 years (range 31–90) underwent laparoscopic prolapse surgery between Jan 1997 and Dec 2005; 55% had full thickness prolapse and 46% rectal anal intussusception. Five had a solitary rectal ulcer. A total of 58% had undergone previous surgery; hysterectomy 33%, posterior colporrhaphy 15%, posterior rectopexy 6%, Delorme's rectal mucosectomy 5% and Birch colposuspension 3%. Half (54%) were incontinent (mean Wexner score 11, range 2–17) and 31% reported symptoms of obstructed defecation; seven had slow transit constipation and underwent resection. The median operative time was 125 min (range 50–210) with one conversion. Median time to diet was 12 h and median length of stay 3 days (1–12). No patient has developed recurrent full thickness prolapse at a median follow‐up of 54 months (30–96). Incontinence improved in 39 of 43 patients (91%); median post‐operative Wexner score 1 (0–9). Obstructed defecation resolved in 20 of 25 patients (80%). Pelvic pain resolved in all but one. Complications occurred in 21%; faecal impaction 4%, wound infection 2%, bleeding 2%, leak 1%, chest infection 1%, retention 1%. Three developed minor evacuatory difficulties and two, urinary stress incontinence. Conclusion Laparoscopic ventral rectopexy is safe with relatively low morbidity. In the medium‐term, it provides good results for prolapse and associated symptoms of incontinence and obstructed defecation.     

Combined surgery in pelvic organ prolapse is safe and effective

Objective In women, rectal prolapse is often accompanied by other signs of generalized pelvic floor weakness including uterine and bladder prolapse. The purpose of this study was to compare whether there are differences in outcomes of rectal prolapse surgery between women having combined pelvic organ prolapse (POP) surgery with a urologist or urogynecologist (CS) vs those having abdominal rectal prolapse surgery alone (RP). Method Charts were reviewed to collect perioperative data on those having surgery from 1995 to 2001. Phone surveys were conducted to obtain Cleveland Clinic Foundation (CCF) Incontinence score, Knowles‐Eccersley‐Scott‐Symptom (KESS) Constipation Score, Short Form 36 (SF‐36) quality of life score and recurrence rate. Appropriate statistical analysis was performed. Results Ninety‐four operations were performed (23 CS and 71 RP). Forty‐six (49%) could be contacted by phone. Mean follow‐up was similar in both groups (CS 4.1 vs RP 3.6 years; P = 0.796). There were no significant differences between both groups regarding age, American Society of Anesthesiology classification Score, complications, length of hospital stay, CCF Incontinence score, KESS Constipation Score, SF‐36 Score and recurrence rate of rectal prolapse. The operative time (CS 226 vs RP 122 min; P < 0.001) and blood loss (CS 377 vs RP 183 ml; P < 0.001) were significantly increased in the CS group. Conclusion Combined surgery for POP is safe and effective when considering outcomes of rectal prolapse surgery. Therefore surgeons should not hesitate to address all pelvic floor issues during the same operation by working in partnership with the anterior pelvic floor colleagues.     

Unusual site of graft erosion after abdominal sacrocervicopexy

Large fasciomuscular damage of the feminine pelvic floor resulting in pelvic organ prolapse constitutes a challenge for surgical reconstruction.Between 2005 and 2010, ten women aged 47–75 years were treated by abdominoperineal implantation of polypropylene mesh for modified sacral perineocolporectopexy and subsequently followed up. They were suffering from enterocele (9), genital prolapse (8), descending perineum (5), rectal prolapse (4), and rectocele (3). Five women were incontinent (mean Wexner 9) and six had incomplete rectal evacuation. Defecography revealed enterocele III? (5) and II? (4). Magnetic resonance (MR) diagnosed descending perineum in five patients (mean 3.8 cm).Permanent reconstruction of the pelvic floor and remission of organ prolapse was achieved at 12-months of follow-up in all except one patient. There were two small vaginal mesh erosions and one hematoma within the pelvic floor. Improvement at rectal emptying and anal incontinence (mean Wexner 4) were found.Modified sacral perineocolporectopexy is effective in the treatment of complex pelvic floor anatomical defects and organ prolapse. Improvements in rectal emptying, pelvic feeling of heaviness, and dyspareunia were achieved. The procedure was safe and characterized by good implant tolerance and a low rate of complications.     

Laparoscopic ventral rectopexy for internal rectal prolapse: short‐term functional results

Objective Over the last 15 years, posterior rectopexy, which causes rectal autonomic denervation, was discredited for internal rectal prolapse because of poor results. The condition became medical, managed largely by biofeedback. We aimed to audit the short‐term functional results of autonomic nerve‐sparing laparoscopic ventral rectopexy (LVR) for internal rectal prolapse. Method Prospectively collected data on LVR for internal rectal prolapse were analysed. End‐points were changes in bowel function (Wexner Constipation Score and Fecal Incontinence Severity Index) at 3 and 12 months. Analysis was performed using Mann–Whitney U‐test for unpaired data and Wilcoxon signed rank test for paired data (two‐sided p‐test). Functional outcomes were compared with those achieved previously for external rectal prolapse (ERP). Results Seventy‐five patients underwent LVR (median age 58, range 25–88 years, median follow up was 12 months). Mortality (0%), major (0%) and minor morbidity (4%) were acceptably low. Median length of stay was 2 days. Preoperative constipation (median Wexner score 12) and faecal incontinence (median FISI score 28) improved significantly at 3 months (Wexner 4, FISI 8, both P < 0.0001) and 12 months (Wexner 5, FISI 8, both P < 0.0001). No patient had worse function. Functional outcomes were similar to those for ERP. Conclusion Laparoscopic ventral rectopexy for internal rectal prolapse improves symptoms of obstructed defaecation and faecal incontinence in the short‐term. This establishes proof of concept for a nerve‐sparing surgical treatment for internal rectal prolapse.     

The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra‐anal rectal intussusception

Aim Optimal treatment of anal incontinence in a patients with a normal anal sphincter is controversial, as is the role of intra‐anal rectal intussusception in anal incontinence. We evaluated the results of abdominal ventral rectopexy on anal continence in such patients. Method Forty consecutive patients with incontinence and intra‐anal rectal intussusception without a sphincter defect were treated by abdominal ventral mesh rectopexy without sigmoidectomy. The Cleveland Clinic Incontinence Score (CCIS), patient satisfaction and constipation before and after surgery and recurrence were recorded. Results The mean CCI scores were 13.2 (=/?4.25) preoperatively and 3 (±3.44) postoperatively (P<0.0001). Patient assessment was reported as ‘cured’ in 26 (65%), ‘improved’ in 13 (32.5%) and ‘unchanged’ in one (2.5%) patient. Constipation was induced in two (5%) patients and was cured in 13 of 20 (65%) patients who were constipated before surgery. One case of recurrent prolapse occurred after a mean follow‐up of 38 months. Conclusion Intra‐anal rectal intussusception may be associated with anal incontinence. For these patients, abdominal ventral mesh rectopexy appears to be an adequate treatment.     

The effect of pelvic organ prolapse repair on vaginal sensation

Introduction and hypothesis

The objective was to evaluate vaginal and clitoral sensation before and after robotic sacrocolpopexy for the repair of pelvic organ prolapse.

Methods

Twenty-two women, mean age 63 years (range 41–77), were admitted for robotic sacrocolpopexy repair of pelvic organ prolapse; 4 were lost to follow-up. Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina (anterior and posterior areas) and clitoris 1 day before and a mean of 12?±?4 months following surgery. Student’s paired t test was used to compare sensory thresholds before and after surgery.

Results

For the 18 women who completed follow-up, sensitivity was significantly higher after surgery (sensory threshold decreased) at the clitoral and vaginal regions, to cold and warm stimuli. In contrast, the vaginal and clitoral vibratory sensory thresholds did not change significantly following surgery.

Conclusion

The repair of pelvic organ prolapse by robotic sacrocolpopexy could potentially play a role in restoring clitoral and vaginal wall sensation. The effects of these sensory changes on sexual function and the quality of sexual life need further investigation.

     

Systematic review on ventral rectopexy for rectal prolapse and intussusception

Objective This systematic review assesses the effectiveness of ventral rectopexy (VR) surgery for treatment of rectal prolapse (RP) and rectal intussusception (RI) in adults. Method MEDLINE, EMBASE, Scopus and other relevant databases were searched to identify studies. Randomized controlled trials or nonrandomized studies with more than 10 patients receiving ventral mesh rectopexy surgery were considered for the review. Results Twelve nonrandomized case series studies with 728 patients in total are included in the review. Seven studies used the Orr‐Loygue procedure (VR with posterior rectal mobilization to the pelvic floor) and five studies used VR without posterior rectal mobilization. Overall weighted mean percentage decrease in faecal incontinence (FI) rate was 45%. The weighted mean percentage decrease in constipation rate was 24%. Weighted mean recurrence rate was 3.4%. Conclusions There are limitations in published literature on VR. The available data indicate that VR has low recurrence and improves FI in patients suffering from these conditions. There is a greater reduction in postoperative constipation if VR is used without posterior rectal mobilization.     

Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse.

BACKGROUND: Full thickness rectal prolapse in young adults with normal pelvic floor is a disease in which the rectum is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, which is expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. METHODS: Thirty-five patients (30 women) of median age 44 years (range 18 to 74) were operated on for full thickness rectal prolapse with normal pelvic floor. The rectum was mobilized posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired with a nonabsorbable mesh. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in 1 patient. Mean hospital stay was 8 days (range 6 to 14). Mean follow-up was 34 months (range 10 to 93). No recurrence was seen. Preoperatively, 33 patients (94%) complained of constipation mainly with emptying problems (21 patients) and 25 patients (71.5%) were incontinent. Postoperatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 17 patients (81%). Eighteen incontinent patients (72%) regained full continence. On the other hand, 2 patients with normal bowel function worsened and 1 patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal pelvic floor undergoing prosthetic rectopexy and sigmoid resection (a) morbidity was low, (b) anatomical control was obtained in all cases, (c) emptying problems were corrected, and (d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.     

Safety and efficacy of laparoscopic ventral mesh rectopexy for complex rectocele

Aim Laparoscopic ventral mesh rectopexy, previously described for external rectal prolapse, was evaluated for symptomatic complex rectocoele. Method From January 2004 to December 2008, 84 (50.9%) patients (mean age 64 ± 5 years) underwent laparoscopic ventral mesh rectopexy for symptomatic complex rectocoele, confirmed preoperatively on dynamic defaecography, with 26 (31%) patients having a concurrent cystocoele. The operative technique was standardized, and those with cystocoele underwent bladder mesh suspension during the same procedure. Prospectively collected data were analysed for preoperative symptoms, operative and functional results [constipation, faecal incontinence (FI), dyspareunia and satisfaction score]. Results The conversion rate was 3.6% and perioperative morbidity 4.8% with no mortality. At a median follow up of 29 (4–59) months, there was a significant decrease in vaginal discomfort (86–20%) and obstructed defaecation symptoms (83–46%), P < 0.001. There was no significant change in FI (20–16%), no worsening of preoperative symptoms or new complaints of constipation, dyspareunia or FI. Overall, 88% of patients reported an improvement in overall well‐being. Conclusion Laparoscopic ventral mesh rectopexy is a safe and effective method for treating symptomatic complex rectocoele.     

Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging

Objectives. With significant vaginal prolapse, it is often difficult to differentiate among cystocele, enterocele, and high rectocele by physical examination alone. Our group has previously demonstrated the utility of magnetic resonance imaging (MRI) for evaluating pelvic prolapse. We describe a simple objective grading system for quantifying pelvic floor relaxation and prolapse.Methods. One hundred sixty-four consecutive women presenting with pelvic pain (n = 39) or organ prolapse (n = 125) underwent dynamic MRI. The “H-line” (levator hiatus) measures the distance from the pubis to the posterior anal canal. The “M-line” (muscular pelvic floor relaxation) measures the descent of the levator plate from the pubococcygeal line. The “O” classification (organ prolapse) characterizes the degree of visceral prolapse beyond the H-line.Results. The image acquisition time was 2.5 minutes per study. Each study cost $540. In the pain group, the H-line averaged 5.2 ± 1.1 cm versus 7.5 ± 1.5 cm in the prolapse group (P <0.001). The M-line averaged 1.9 ± 1.2 cm in the pain group versus 4.1 ± 1.5 cm in the prolapse group (P <0.001). Incidental pelvic pathologic features were commonly noted, including uterine fibroids, ovarian cysts, hydroureter, urethral diverticula, and foreign body.Conclusions. The HMO classification provides a straightforward and reproducible method for staging and quantifying pelvic floor relaxation and visceral prolapse. Dynamic MRI requires no patient preparation and is ideal for the objective evaluation and follow-up of patients with pelvic prolapse and pelvic floor relaxation. MRI obviates the need for cystourethrography, pelvic ultrasound, or intravenous urography and has become the study of choice at our institution for evaluating the female pelvis.     

Short-term results of robotic sacrocolpopexy using the Quill SRS bi-directional polydioxanone (PDO) suture

The aim of the study was to evaluate the short-term success of robotic sacrocolpopexy using the Quill bi-directional polydioxanone (PDO) suture. This was a retrospective observation study of women undergoing robotic sacrocolpopexy performed by a single surgeon between May 2008 and August 2010. Pelvic organ prolapse was determined using the pelvic organ prolapse quantification scale (POP-Q). Baseline exam were performed preoperatively and scheduled at 6 weeks, 3 months, and yearly thereafter. Treatment success defined as a POP-Q measurement of point C that did not descend for more than one-half the total vaginal length and a measurement for point Ba that was less than −1. A total of 36 patients were eligible for enrolment in the study. The mean age was 70 years (range 49–86 years), and mean body mass index was 27 kg/m² (range 19–41 kg/m²). The mean interval follow-up was 166 days (median 116; range 34–772 days). Anatomic success was 92% (33/36). In the short term, the Quill SRS PDO suture provided sufficient fixation of an Amid type I polypropylene mesh to the vagina to result in excellent anatomic success with only rare complications.