Early mortality risk in incident Chinese hemodialysis patients: a retrospective cohort study

Background: Early mortality risk of maintenance hemodialysis (MHD) patients varies by country and ethnicity. Here, early mortality in incident Chinese HD patients were studied.

Methods: Data from 1 January 2007 to 31 December 2013 were pulled from Beijing dialysis registry system. All included patients were followed to the end of 2013. This time period of dialysis was divided into six intervals (≤120, 121–365 days; 1–2, 2–3, 3–4, ≥5 years). Patients’ demographics, primary cause of end-stage renal disease (ESRD), date of first HD, date of death, cause for death, date and cause of censoring were extracted from the registry database. All-cause mortality (per 100 patient-years) was calculated for each period stratified by sex, age and cause of ESRD. Monthly mortality rates were also calculated.

Results: A total of 11,955 patients were included, 6738 were males and 5217 were females. The mean age at dialysis initiation was 57.7?±?16.1 years. The median follow-up time was 19.8?months. There were total 2555 deaths. The overall mortality rate was 8.2 per 100 patient-years. Mortality rates were 18.7, 7.5, 6.9, 6.9, 6.5 and 6.2 in each period. The first 2?months mortality rates were 41.9 and 16.6 per 100 patient-years. Higher mortality was observed in patients who were older, female, diabetic and hypertensive.

Conclusions: The most critical period was the first 2?months of dialysis initiation. Patients who were older, female, diabetic and hypertensive had higher risk of early mortality. Our analysis highlighted that the transitional period from sever CKD stages to dialysis initiation, when optimal supportive care should be adopted, was crucial for patients’ survival.     

Development and validation of a nomogram for predicting the overall survival of prostate cancer patients: a large population-based cohort study

BackgroundProstate cancer (PC) is the second most common malignant tumor, and its survival is of great concern. However, the assessment of survival risk in current studies is limited. This study is to develop and validate a nomogram for the prediction of survival in PC patients using data from the Surveillance, Epidemiology, and End Results (SEER) database.MethodsA total of 153,796 PC patients were included in this cohort study. Patients were divided into a training set (n=107,657) and a testing set (n=46,139). The 3-, 5- and 10-year survival of the PC patients were regarded as the outcomes. Predictors based on the demographic and pathological data for survival were identified by multivariate Cox regression analysis to develop the predictive nomogram. Internal and subgroup validations were performed to assess the predictive performance of the nomogram. The C-index, time-dependent receiver operating characteristic (ROC) curves, and corresponding areas under the ROC curves (AUCs) were used to estimate the predictive performance of the nomogram.ResultsAge at diagnosis, race, marital status, tumor node metastasis (TNM) stage, prostate specific antigen (PSA) status, Gleason score, and pathological stage were identified as significantly associated with the survival of PC patients (P<0.05). The C-index of the nomogram indicated a moderate predictive ability [training set: C-index =0.782, 95% confidence interval (CI): 0.779–0.785; testing set: C-index =0.782, 95% CI: 0.777–0.787]. The AUCs of this nomogram for the 3-, 5-, and 10-year survival were 0.757 (95% CI: 0.756–0.758), 0.741 (95% CI: 0.740–0.742), and 0.716 (95% CI: 0.715–0.717), respectively. The results of subgroup validation showed that all the AUCs for the nomogram at 3, 5, and 10 years were more than 0.70, regardless of marital status and race.ConclusionsWe developed a nomogram with the moderate predictive ability for the long-term survival (3-, 5-, and 10-year survival) of patients with PC.     

Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience

Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p?<?0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p?<?0.05). Time to develop peritonitis was 10.25?±?3.1 months in CAPD compared to 16.1?±?4 months in APD (p?<?0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1?±?1 and 14?±?1.4 months respectively (p?=?0.3) whereas in peritonitis free patients it was 15?±?1.4 months in CAPD and 23?±?3.1 months in APD (p?=?0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.     

Potential factors regulating serum parathyroid hormone in maintenance hemodialysis patients: 4-year retrospective study

Background. This study was carried out to evaluate potential factors affecting long-term parathyroid function in patients on maintenance hemodialysis. Methods. Biochemical parameters, including intact parathyroid hormone (i-PTH) and intact osteocalcin (i-OC) were analyzed retrospectively in 120 outpatients receiving hemodialysis, for the 4 years between 1992 and 1996. Patients were classified into the following three groups according to their serum i-PTH levels in 1996: low PTH (<100 pg/ml), normal PTH (100–450 pg/ml), and high PTH (≧450 pg/ml). Results. Among the three PTH groups, no differences were found in age, sex, duration of dialysis, and laboratory parameters, except for serum levels of alkaline phosphatase (ALP), i-PTH, and i-OC. The percentage of diabetic patients was higher in the low PTH group than in the other two PTH groups. Both serum ALP and i-PTH levels increased in the high PTH group, and serum i-PTH level decreased in the low PTH group during the 4 years. The change in serum calcium (Ca) level was negatively correlated with that in serum i-PTH level (1994–1996, r = −0.623, 1992–1996, r = −0.565; P <0.0001). A higher correlation coefficient was observed in the low PTH group than in the other PTH groups, although the difference was not significant. A weak positive correlation of the changes in serum inorganic phosphorus (IP) level (1994–1996) and i-PTH level (1994–1996) was found in the high PTH group (r = 0.379, P < 0.05). Conclusion. Serum Ca level may play a determinant role in suppressing serum i-PTH level in hemodialysis patients. Serum IP level may stimulate serum i-PTH level in patients with hyperparathyroidism, although the physiological role of serum IP is yet to be established. Received: March 23, 1999 / Accepted: September 1, 1999     

单中心维持性血液透析患者的钙磷代谢调查

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者钙磷代谢异常及继发性甲状旁腺功能亢进的患病情况,并分析其相关危险因素.方法 选择2013年4月至2014年3月滁州市第一人民医院血液净化中心行MHD的203例患者进行调查,收集其一般资料,测定血钙、血磷、血全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH),分析终末期肾脏疾病患者的患病率、达标率以及相关危险因素.结果 203例患者中,高钙血症50例,患病率为24.63％;低钙血症11例,患病率为5.42％;高磷血症88例,患病率为43.35％;低磷血症19例,患病率为9.36％;高iPTH86例,患病率为42.36％;低iPTH52例,患病率为25.62％.符合KDI-GO关于慢性肾脏病-矿物质和骨代谢异常诊断的患者比例高达97.54％.本组MHD患者血钙、血磷、iPTH达标率分别为69.95％、48.77％、32.02％.血钙、血磷、iPTH均达标仅17例(占8.37％).血钙和血磷的达标率低于透析预后与实践模式研究4 (the dialysis outcomes and practice patients sutdy 4,DOPPS4).多因素Logistic回归分析显示,高iPTH的危险因素为高磷血症、低钙血症、碱性磷酸酶;低iPTH的危险因素为透析时间、年龄、碳酸钙服用史、活性维生素D服用史.结论 MHD患者慢性肾脏病-矿物质和骨代谢异常的发病率较高,与DOPPS4比较,慢性肾脏病-矿物质和骨代谢异常各项指标达标率较低,其并发症危害值得注意.重视血钙、血磷、血iPTH 的检测,及时纠正血钙、血磷、血iPTH的紊乱可减少透析相关慢性肾脏病-矿物质和骨代谢异常的发生.     

Timing of the first cannulation and survival of arteriovenous grafts in hemodialysis patients: a multicenter retrospective cohort study

Arteriovenous graft (AVG) is an important vascular access route in hemodialysis patients. The optimal waiting time between AVG creation and the first cannulation is still undetermined, therefore the current study investigated the association between ideal timing for cannulation and AVG survival. This retrospective cohort study used data from the Taiwan National Health Insurance Database, which included 6,493 hemodialysis patients with AVGs between July 1^st 2008 and June 30^th 2012. The waiting cannulation time was defined as the time from the date of shunt creation to the first successful cannulation. Patients were categorized according to the waiting cannulation time of their AVGs as follows: ≤30 days, between 31 and 90 days, between 91 and 180 days, and >180 days. The primary outcome was functional cumulative survival, measured as the time from the first cannulation to shunt abandonment. The AVGs which were cannulated between 31 and 90 days (reference group) after construction had significantly superior functional cumulative survival compared with those cannulated ≤30 days (adjusted HR = 1.651 with 95% CI 1.482–1.839; p < 0.0001) and >180 days (adjusted HR = 1.197 with 95% CI 1.012–1.417; p = 0.0363) after construction. An analysis of the hazard ratios in patients with different demographic characteristics, revealed that the functional cumulative survival of AVGs in most groups was better when they received cannulation >30 days after construction. Consequently, in order to achieve the best long-term survival, AVGs should be cannulated at least 1 month after construction, but you should avoid waiting for >3 months.     

Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate,risk factors and its effect on survival risk

Background Sarcopenia is a degenerative syndrome mainly characterized by the atrophy of skeletal muscle, along with the decrease of muscle strength and function. However, there are currently few studies concerning sarcopenia in patients undergoing maintenance hemodialysis dialysis (MHD). This study was aimed to investigate the incidence of sarcopenia in MHD patients and its influencing factors, as well as its impact on survival risk. Method All 131 MHD patients enrolled in our study were tested with bioelectrical impedance analysis (BIA) and grip strength. Demographic data was collected and anthropometric measurement and laboratory examination were conducted. Results The total incidence of sarcopenia within the 131 MHD patients was 13.7% and the incidence of sarcopenia in patients over 60 years was 33.3%. The dialysis duration, with or without diabetes, serum phosphorus and pre-albumin levels of sarcopenic patients were significantly different from those of non-sarcopenicones; the modified quantitative subjective global assessment (MQSGA) scores of sarcopenic patients were higher than those without sarcopenia. Multivariate analysis showed that dialysis duration, diabetes and serum phosphorus level were independent risk factors for sarcopenia in MHD patients. Kaplan–Meier survival analysis showed a one-year survival of 88.9% in sarcopenic patients, which was significantly lower than non-sarcopenic patients. Conclusion The incidence of sarcopenia in MHD patients was high and increased gradually with age. Dialysis duration, diabetes, serum phosphorus level and malnutrition predisposed the patients to sarcopenia. One-year follow-up found that the mortality risk of sarcopenic patients was higher than that of non-sarcopenic patients.     

Comparative survival of elderly renal transplant recipients with a living donor versus a deceased donor: A retrospective single center observational study

Increasing numbers of elderly (≥65 years) patients are listed for kidney transplantation. This study compares the survival outcome between living (LDK), regularly allocated (ETKAS), and Eurotransplant Senior Program (ESP) donor kidneys in elderly recipients. This is a single-center retrospective cohort study of elderly kidney transplant recipients transplanted between 2005 and 2017. Primary outcome measures were nondeath-censored graft, death-censored graft, and patient survival. In total, 348 patients were transplanted, 109 recipients (31.3%) received an LDK, 100 (28.7%) an ETKAS, and 139 (40%) an ESP kidney. 62.5% were male, and median age was 68 years. LDK recipients had significantly better 5-year nondeath-censored graft survival compared with ETKAS and ESP (resp. 71.0% vs. 66.1% vs. 55.6%, P = 0.047). Death-censored graft survival after 1 year was significantly better in LDK recipients (99.1%) (ETKAS 90.8%; ESP 87.7%, P < 0.001). After 5 years, the difference remained significant (P < 0.001) with little additional graft loss (97.7% vs. 88.1% vs. 85.6). There was no significant difference in patient survival after 5 years (71.7% vs. 67.4% vs 61.9%, P = 0.480). In elderly recipients, the patient survival benefits of an LDK are limited, but there is decreased death-censored graft loss for LDK recipients. Nevertheless, graft survival in ETKAS and ESP remains satisfactory.     

Kidney graft survival in patients with hepatitis C: a single center experience

Abstract:  Hepatitis C virus (HCV) infection is highly prevalent in renal transplant candidates; however, its effect on the transplant outcome is still controversial. The aim of the present study was to determine the effect of HCV infection in the outcome of kidney transplantation in a single transplant center. The study population 144 HCV− randomized selected patients and 64 HCV+ patients transplanted from 1973 to 2000, followed for up to 60 months post-transplantation. This retrospective study included the following variables: type of dialysis, time on renal replacement therapy, number of transfusions before and after transplantation, number of transplants, type of donor, immunosuppression, and rejection episodes. The Kaplan–Meier method was used to estimate graft and patient survival. Log-rank test was used to assess the difference in survival between HCV+ and HCV−. A multivariate Cox proportional hazards model was used to analyze the relation between graft and patient survival. HCV+ and HCV− patients had similar demographic and clinical characteristics; however, a higher number of HCV+ patients received blood transfusions after transplantation. Patient survival was not significantly different in 39 HCV+ and 96 HCV− patients transplanted with living-related donors (71% and 77% at five yr, respectively). Similarly, there was not significant difference in 25 HCV+ and 48 HCV− patients transplanted with kidneys from deceased donors, although there was a tendency to better outcome in HCV− patients (55% and 72% at five yr respectively). Regarding graft survival, there was also no differences in HCV+ and HCV− recipients of living-related grafts (61% and 66% at five yr post-transplant, respectively) and recipients of kidneys from deceases donors (44% and 41%, respectively). The results show that HCV+ patients can be transplanted with the same success than HCV− patients.     

Epidemiology and outcome analysis of 1359 intensive care burn patients: A 14-year retrospective study in a major burn center

AimsGlobally, burn-related morbidity and mortality still remain high. In order to identify regional high-risk populations and to suggest appropriate prevention measure allocation, we aimed at analyzing epidemiological characteristics, etiology and outcomes of our 14-year experience with an intensive care unit (ICU) burn patient population.MethodsA retrospective observational study was conducted including patients treated between March 2007 and December 2020 in our intensive care burn unit. Demographic, clinical and epidemiological data were collected and analyzed.ResultsA total of 1359 patients were included. 68% of the subjects were males and the largest age group affected entailed 45–64-year-old adults (34%). Regarding etiology, flame and contact burns were the most common in all age groups. Mean affected total body surface area (TBSA) was 13 ± 14.5% in all subjects. Most of the burns occurred domestically or during recreational activities. Mean hospital stay was 17.77 ± 19.7 days. The average mortality was 7.7%. The mortality rate showed an overall decreasing trend whilst burn severity remained consistent from 2007 to 2020.ConclusionsDespite consistent burn severity presentations of annual ICU admissions, burn injury mortality showed a decreasing trend, which was in part attributed to substantial progress in burn care and treatment and improved burn prevention awareness. Statistically significant age and gender differences could be detected with regard to burn etiology and seasonality, as well as outcomes, which highlight the importance of individualized primary prevention programs.     

Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center

Despite increasing experience and improved material, endovascular treatment of cerebral aneurysms still has risks linked to the technique itself and to the specificity of the pathology treated. The purpose of this report is to examine procedural technical and clinical negative events, even minimal ones, occurring in this type of treatment. We considered 557 procedures carried out from January 1994 to December 2005 in 533 patients harboring 550 aneurysms. Of the patients, 448 presented with SAH and 85 with unruptured aneurysms. All procedures were performed under general anesthesia. The GDC-10 system was routinely used. Additional devices like the balloon remodeling technique, Trispan and stents were also occasionally used. Every procedural complication occurring during or soon after treatment was registered. Endovascular treatment was completed in 539 out of 557 procedures. There were 18 failures (3.3%). Occlusion of the aneurysm was judged complete in 343 (64%), near complete in 184 (34%) and incomplete in 12 (2%). Procedural complications occurred in 72 (13%) of the cases. The most frequent negative events were thromboembolisms (6.6%) and ruptures (3.9%). Other types (coil migration, transient occlusions of the parent vessel, dissections and early rebleeding) were rarer (2.5%). In the majority of cases there were no clinical consequences. Procedural morbidity and mortality were 1.1 and 1.8%, respectively. Considering the 449 procedures performed in ruptured and the 90 in the unruptured aneurysms separately, morbidity and mortality were 1.1 and 2.2% in the former group and 1.1 and 0% in the latter. Many factors influence the risk of complications. Being progressively aware of this and with increasing experience, the frequency can be limited. Negative events linked to the procedure have more significant serious clinical consequences in patients admitted in a critical clinical condition after SAH, because of the already present changes involving the brain parenchyma and cerebral circulation.     

Influence of palliative surgical resection on overall survival in patients with advanced colorectal cancer: a retrospective single institutional study

Background The role of palliative surgical resection in patients presenting with locally advanced or metastatic colorectal cancer (CRC) is unclear. Resection is often limited to symptomatic management of bleeding, obstruction, perforation or for relief of pain, in patients with an adequate performance status and an expected life span of over several weeks. An exploratory analysis to evaluate the influence of a palliative surgical resection on survival outcome in patients with advanced CRC is reported. Method A retrospective review of medical records of all patients diagnosed with advanced CRC at our institution between the years 1998 and 2003 was undertaken. Tumour registry data were reviewed to identify age, gender, modalities of therapy [i.e. surgery (S), chemotherapy (C), radiation] and overall survival. IRB approval was obtained for this study. Results One hundred and eighty‐five patients were identified. Median age was 67 years (range 30–99). M:F ratio was 1:1. Sixty‐two per cent of patients (115/185) underwent a palliative surgical intervention. Median survival of patients who underwent S and those that did not undergo S was 22 and 3 months respectively (P < 0.0001). Forty‐eight per cent of patients (79/184) underwent systemic C. Median survival of patients who received C + S, and patients who received C alone was 30 and 15 months respectively (P < 0.0004). Fifty‐one per cent of patients who underwent S, received C; 30% of patients who did not undergo S, received C. Chemotherapy data were available on 46 of 79 patients. Patients treated with S + C, and C without S, received a median of 9 and 6 months of therapy respectively. The median number of regimens used were similar in both. Conclusion These exploratory data suggest a positive influence of a palliative resection performed during the disease course of patients with advanced CRC. The increased frequency of utilization and the more prolonged duration of C in the surgically treated patients may in part contribute to this improved survival. This may also be reflective of performance status at the time of diagnosis. Future trials enrolling patients with advanced CRC should prospectively stratify for surgical intervention to further clarify the influence of this modality on the outcome of systemic therapy in this disease.     

Comparison of 5- and 10-year survival rates in operated gastric cancer patients

Summary To evaluate whether it is appropriate to estimate the postoperative curability of gastric cancer based on the 5-year survival rate, we compared 5- and 10-year survival rates in 477 primary gastric cancer patients who had undergone gastrectomy during the 8-year period from 1960–1967. In patients who had died more than 5 years after surgery, the cause of death was investigated. The 10-year survival rate of 315 curatively operated patients was 59.1%, 3.9% lower than the 5-year survival rate. Of 176 patients who survived more than 5 years postoperatively, only 9 (5.1%) died of cancer recurrence, suggesting that the 5-year survival rate adequately reflects the curative success of gastric cancer surgery.

---

Ein Vergleich der 5- und 10-Jahres-Überlebensrate beim operierten Magencarcinom-PatientenEvaluierung der 5-Jahres-Überlebensrate als Indikator für die postoperative Heilungsrate

Zusammenfassung Um herauszufinden, ob die 5-Jahres-Überlebensrate tatsächlich aussagekräftig betreffs der postoperativen Heilungsquote ist, wurden die 5- und 10-Jahres-Überlebensraten bei 477 Patienten mit primärem Magencarcinom verfolgt, die während einer 8-Jahresperiode von 1960 bis 1967 gastrektomiert wurden. Bei den Patienten, die mehr als 5 Jahre nach der Operation verstarben, wurde die Todesursache untersucht. Die 10-Jahre Überlebensrate von 315 kurativ operierten Patienten, lag bei 59,1% d. h. 3,9% niedriger als die 5-Jahres-Überlebensrate. Von 176 Patienten, die mehr als 5 Jahre nach der Krebsoperation überlebten, verstarben nur 9 (5,1%) an einem Krebsrezidiv. Somit wird demonstriert, daß die 5-Jahres-Überlebensquote tatsächlich den Heilerfolg bei der Magenkrebschirurgie adäquat reflektiert.

     

Influencing factors for mortality in prostate cancer patients with T1 and T2 stage: a retrospective cohort study

BackgroundFew reports have focused on the influencing factors of localized prostate cancer (PCa)-specific mortality so far. This study aimed to develop a competitive risk model for identifying the factors influencing the localized PCa mortality rate based on 135,310 subjects in the Surveillance, Epidemiology, and End Results (SEER) database.MethodsWe included 135,310 localized PCa male patients from SEER database 2004–2016 in this cohort study, and collected the baseline information of all patients, including age of diagnosis, race, marital status, socioeconomic status (SES), American Joint Committee on Cancer (AJCC) stage, prostate-specific antigen (PSA) Gleason score, and so on. The outcome was considered as PCa-specific mortality in this study. The end time of follow-up was November 2018. Independent risk factors were examined by multivariate Fine-Gray analysis. The results are shown by hazard ratio (HR) and 95% confidence interval (CI).ResultsAll patients were divided into three groups: died from localized PCa (n=1,400), died from other causes (n=16,996), and survived (n=116,914). The diagnostic age of 119,899 patients was ≥55 years. The multivariate Fine-Gray analysis indicated that age of diagnosis (55–70 years: HR =1.473, 95% CI: 1.124–1.930; >70 years: HR =2.528, 95% CI: 1.901–3.362), race (American India/Alaska Native, Asian/Pacific Islander: HR =0.653, 95% CI: 0.490–0.870), marital status (divorced: HR =1.433, 95% CI: 1.197–1.717; single: HR =1.463, 95% CI: 1.244–1.719; widowed: HR =1.485, 95% CI: 1.222–1.804), therapeutic method (radiotherapy: HR =1.500; 95% CI: 1.119–2.011), SES (4–10: HR =0.799, 95% CI: 0.664–0.961; ≥11: HR =0.670; 95% CI: 0.534–0.839), AJCC stage (HR =0.820, 95% CI: 0.715–0.940), level of PSA (HR: 1.002, 95% CI: 1.002–1.002) and Gleason score (HR: 2.226, 95% CI: 2.108–2.350) were associated with the risk of localized PCa mortality.ConclusionsThe study determined the influencing factors for mortality in patients with localized PCa through a competitive risk model. This finding may provide a reference for localized PCa patients: localized PCa patients who are older, divorced, widowed, single, have a radiotherapy, have a high PSA level, and Gleason score may be at high risk.     

肺移植治疗终末期肺疾病的单中心十年经验总结

目的 探讨肺移植治疗终末期肺疾病的效果,并对单中心肺移植的经验进行总结.方法 回顾2003年1月至2012年12月间52例肺移植病例的临床资料,受者年龄为24～76岁,≥65岁者13例;受者原发病主要为肺气肿33例(63.5％)及特发性肺间质纤维化8例(15.4％).术后对所有受者的并发症发生率、死亡情况及存活率进行分析.结果 供肺缺血时间＞6 h者28例(53.8％),其中缺血超过10 h者20例(38.5％).术后出现吻合口狭窄3例(5.8％),住院期间发生细菌感染14例(26.9％),真菌感染13例(25.0％),巨细胞病毒性肺炎1例(1.9％).发生急性排斥反应20例(38.5％),经甲泼尼龙冲击治疗3d后均逆转;发生慢性排斥反应7例(13.5％),其中2例接受再次肺移植后效果良好,3例调整免疫抑制方案后缓解,2例死亡.术后1年内死亡9例(17.3％),术后1、3和5年的总体累积存活率分别为81.4％,54.5％和30.9％.结论 肺移植是治疗终末期肺疾病的有效方法,恰当的病例选择、良好的肺保护、正确的围手术期处理及系统的术后管理是肺移植成功的关键.     

Laparoscopic promontofixation for pelvic organ prolapse: a 10-year single center experience in a series of 501 patients

Objectives: To assess the long‐term outcomes of laparoscopic promontofixation (LP) for the treatment of pelvic organ prolapse (POP). Methods: A total of 501 consecutive patients with POP were included in this prospective study. The patients' mean age was 63.23 (36–90) years, their mean body mass index was 25.14 (15–36) and their mean number of deliveries was 3.3 (0–14). A POP grade ≥3 was diagnosed in 70.4% of the patients and 38.9% of them had a history of abdominal surgery. The patients underwent a Bonney test and urodynamic study. In cases of stress urinary incontinence (SUI), the patients underwent the simultaneous insertion of a tension‐free vaginal tape. A prolapse quality of life questionnaire was sent to all patients. Results: The mean operative time was 97.4 min (50–210) and there were 1.7% cases of intra‐operative complications. The mean hospitalization time was 3.7 days (1–13 days). During the mean follow‐up of 20.7 months (3–120), 91 (17.8%) complications were recorded, including constipation (5.5%), SUI (3.5%), vaginal erosion (2.4%), and urge incontinence (2%). Recurrences were recorded in 11.5% of the patients within an average time of 37.2 months. Risk factors for recurrence were the use of the polypropylene mesh compared with the polyester mesh (P < 0.0001), an intra‐operative hysterectomy (P = 0.02), and bleeding (P = 0.049). There was a statistical significant (P < 0.001) improvement in most of the symptoms in the prolapse quality of life questionnaire. Conclusions: LP is safe with effective long‐term results, with low recurrence and morbidity rates, and a good quality of life.