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1.
Shimon Ginath Alan D. Garely Jonathan S. Luchs Azin Shahryarinejad Cedric K. Olivera Sue Zhou Charles J. Ascher-Walsh Alexander Condrea Michael L. Brodman Michael D. Vardy 《International urogynecology journal》2012,23(11):1569-1576
Introduction and hypothesis
We compared two surgical approaches in patients with symptomatic prolapse of the vaginal apex with normal controls by analyzing pelvic landmark relationships measured using magnetic resonance imaging (MRI) before and after surgery.Methods
In this prospective multicenter pilot study involving 16 participants, nulliparous controls (n?=?6) were compared with ten parous (3.0?±?1.0) women with uterine apical prolapse equal to or greater than?stage 2. Group A (n?=?5) underwent abdominal sacral colpopexy with monofilament polypropylene mesh and group B (n?=?5) with vaginal mesh kit repair (Total ProLift). Subtotal hysterectomy was performed in all group A and no group B women. All patients underwent preoperative and 3-month postoperative Pelvic Organ Prolapse Quantification (POP-Q) and dynamic MRI. Comparison of MRI pelvic angles and distances was performed and analyzed by Mann–Whitney rank sum test and chi-square test.Results
Vaginal apical support is similar at 3 months for abdominal sacral colpopexy (ASCP) and ProLift by POP-Q examination and MRI analysis. In both treatment groups, the postoperative POP-Q point C and MRI parameters were similar to nulliparous controls at 3?months.Conclusions
Anatomic outcomes for ASCP compared with ProLift were similar at 3 months in terms of vaginal apical support by POP-Q and MRI analysis. Continued comparative analysis of postoperative support with objective imaging seems warranted. 相似文献2.
G. Lamblin A. Van-Nieuwenhuyse P. Chabert K. Lebail-Carval S. Moret G. Mellier 《International urogynecology journal》2014,25(7):961-970
Introduction and hypothesis
Our aim was to compare anatomical and functional outcome between vaginal colposuspension and transvaginal mesh.Methods
This was a prospective randomized controlled trial in a teaching hospital. Sixty-eight women with stage ≥3 anterior vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system were assessed, randomized, and analyzed. Patients were randomized to anterior colporrhaphy with vaginal colposuspension (n?=?35) or transvaginal mesh (n?=?33). Primary outcome was objective cure rate of the anterior vaginal wall, defined as POP-Q ≤1 at 2 years. Secondary outcomes were functional results, quality-of-life (QoL) scores, mesh-related morbidity, and onset of urinary incontinence.Results
The anatomical result for point Ba was significantly better at 2 years in the mesh group (?2.8 cm) than in the colposuspension group (?2.4 cm) (p?=?0.02). Concerning POP-Q stages, the anatomical success rate at 2 years was 84.4 % for colposuspension and 100 % for mesh (p?=?0.05). There were 5 anatomic recurrences (15.6 %) in the colposuspension group. The erosion rate was 6 % (n?=?2). No significant difference was noted regarding minor complications. Analysis of QoL questionnaires showed overall improvement in both groups, with no significant difference between them.Conclusions
The vaginal colposuspension technique of anterior vaginal wall prolapse repair gave good anatomical and functional results at 2 years. Transobturator vaginal mesh gave better 2-year anatomical results than vaginal colposuspension, with overall improvement in QoL in both groups. 相似文献3.
Corina Schmid Peter O’Rourke Christopher Maher 《International urogynecology journal》2013,24(5):763-767
Introduction and hypothesis
A prospective case series to assess the safety and efficacy of laparoscopic sacrocolpopexy for the surgical management of recurrent pelvic organ prolapse (POP) after transvaginal polypropylene mesh prolapse surgery.Methods
Between January and December 2010, women with post-hysterectomy recurrent prolapse (≥ stage 2 POP-Q) after transvaginal polypropylene mesh prolapse surgery were included. Perioperative morbidity and short-term complications were recorded and evaluated. Surgical outcomes were objectively assessed utilising the Pelvic Organ Prolapse Quantification system (POP-Q), the validated, condition-specific Australian Pelvic Floor Questionnaire (APFQ) and the Patient Global Impression of Improvement (PGI-I) at 12 months.Results
All 16 women in this study had undergone surgery with trocar-guided transvaginal polypropylene mesh kits. In 75% the recurrent prolapse affected the compartment of prior mesh surgery with the anterior (81%) and apical (75%) compartment prolapse predominating. At a mean follow-up of 12 months, all women had resolution of awareness of prolapse, had < stage 2 POP-Q on examination and high levels of satisfaction on PGI-I post surgery. There were no serious peri- or postoperative complications.Conclusions
This preliminary study suggests that laparoscopic sacrocolpopexy for recurrent prolapse after failed transvaginal mesh surgery is feasible and safe. Further widespread evaluation is required. 相似文献4.
Introduction
In recent years uterine preservation surgery for pelvic organ prolapse has become more popular. Traditional operations such as vaginal hysterectomy do not address the underlying pathophysiology of poor connective tissue support, which may result in a higher incidence of recurrent prolapse.Methods
This video article demonstrates uterine preservation surgery for women with uterine prolapse using laparoscopic abdominal Prolene mesh.Conclusions
This procedure, apart from possible preservation of fertility in younger women, provides strong apical support, which should be long lasting. The other advantages of laparoscopic surgery are quicker recovery, less pain and better cosmesis. 相似文献5.
A. Rogowski P. Bienkowski A. Tosiak M. Jerzak P. Mierzejewski W. Baranowski 《International urogynecology journal》2013,24(12):2087-2092
Introduction and hypothesis
The aim of the present study was to determine possible correlations between mesh retraction after anterior vaginal mesh repair and de novo stress urinary incontinence (SUI), overactive bladder (OAB), and vaginal pain symptoms.Methods
One hundred and three women with symptomatic prolapse of the anterior vaginal wall, stages 3 and 4 based on the Pelvic Organ Prolapse Quantification (POP-Q) system, underwent Prolift anterior? implantation. At a 6-month follow-up, the patients were interviewed for de novo SUI, OAB, and vaginal pain, and underwent an introital/transvaginal ultrasound examination to measure the mesh length in the midsagittal plane.Results
Mesh retraction was significantly larger in a subgroup of patients (n?=?20; 19.4 %) presenting de novo OAB symptoms on the follow-up assessment compared with those without this complication (5.0 cm vs. 4.3 cm; p?<?0.05). Mesh retraction was also significantly larger in a subgroup of patients (n?=?23; 22.3 %) reporting postoperative vaginal pain compared with the women who did not report any postoperative vaginal pain (5.3 cm vs. 4.2 cm; p?<?0.01). A significant correlation was found between mesh retraction and the severity of vaginal pain (R?=?0.4, p?<?0.01). Mesh retraction did not differ between patients with de novo SUI symptoms and those without this complication.Conclusions
Mesh retraction assessed on ultrasound examination after anterior vaginal mesh repair may correlate with de novo OAB symptoms and vaginal pain. 相似文献6.
Philip Rahmanou B. White N. Price S. Jackson 《International urogynecology journal》2014,25(1):131-138
Introduction and hypothesis
Uterine conserving re-suspension surgery has become more popular in recent years. Such surgery may allow preservation of fertility in younger women, but may also have the added benefit of augmenting weak connective tissue and possibly providing stronger apical support than the conventional hysterectomy. Our goal was to evaluate the 1- to 4-year outcome of laparoscopic hysteropexy for the surgical management of uterine prolapse.Methods
This study was a prospective observational study of 182 consecutive women who underwent laparoscopic hysteropexy, with or without additional vaginal repair, from the beginning of 2007 until the end of 2010. Women were invited to attend a dedicated clinic for interview and their prolapse was assessed using the Patient Global Impression of Improvement (PGI-I), the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (ICIQ-VS) and the pelvic organ prolapse quantification (POP-Q) scale. Wilcoxon signed-rank test was used to compare pre-operative with postoperative data. Complications and women’s satisfaction were also noted.Results
One hundred and forty women agreed to participate; the mean interval from operation was 2.1 years (range 1–4.4). Eighty-nine percent of women felt that their prolapse is “very much” or “much” better using PGI-I subjective outcome measure. There was significant improvement for all parameters of ICIQ-VS and POP-Q scoring post-surgery (p?<?0.001). Six women (4 %) had further apical prolapse; of these, 3 underwent further prolapse surgery. None of the participants had any mesh exposure. Ninety two percent of participants would recommend the operation.Conclusions
Laparoscopic hysteropexy is a safe and effective treatment. The 1- to 4-year outcome suggests high patient satisfaction and low rates of apical prolapse recurrence. Longer term follow-up and randomized controlled studies are required. 相似文献7.
8.
Carlos A. Delroy Rodrigo de A. Castro Márcia M. Dias Paulo C. Feldner Jr. Maria Augusta T. Bortolini Manoel J. B. C. Girão Marair G. F. Sartori 《International urogynecology journal》2013,24(11):1899-1907
Introduction and hypothesis
The aim of the study was to compare the efficacy and safety of transvaginal trocar-guided polypropylene mesh insertion with traditional colporrhaphy for treatment of anterior vaginal wall prolapse.Methods
This is a randomized controlled trial in which women with advanced anterior vaginal wall prolapse, at least stage II with Ba?≥?+1 cm according to the Pelvic Organ Prolapse Quantification (POP-Q) classification, were randomly assigned to have either anterior colporrhaphy (n?=?39) or repair using trocar-guided transvaginal mesh (n?=?40). The primary outcome was objective cure rate of the anterior compartment (point Ba) assessed at the 12-month follow-up visit, with stages 0 and I defined as anatomical success. Secondary outcomes included quantification of other vaginal compartments (POP-Q points), comparison of quality of life by the prolapse quality of life (P-QOL) questionnaire, and complication rate between the groups after 1 year. Study power was fixed as 80 % with 5 % cutoff point (p?<?0.05) for statistical significance.Results
The groups were similar regarding demographic and clinical preoperative parameters. Anatomical success rates for colporrhaphy and repair with mesh placement groups were 56.4 vs 82.5 % (95 % confidence interval 0.068–0.54), respectively, and the difference between the groups was statistically significant (p?=?0.018). Similar total complication rates were observed in both groups, with tape exposure observed in 5 % of the patients. There was a significant improvement in all P-QOL domains as a result of both procedures (p?<?0.001), but they were not distinct between groups (p?>?0.05).Conclusions
Trocar-guided transvaginal synthetic mesh for advanced anterior POP repair is associated with a higher anatomical success rate for the anterior compartment compared with traditional colporrhaphy. Quality of life equally improved after both techniques. However, the trial failed to detect differences in P-QOL scores and complication rates between the groups. 相似文献9.
Charbel G. Salamon Christa Lewis Jennifer Priestley Emil Gurshumov Patrick J. Culligan 《International urogynecology journal》2013,24(8):1371-1375
Introduction and hypothesis
To prospectively evaluate the use of a particular polypropylene Y mesh for robotic sacrocolpopexy.Methods
This was a prospective study of 120 patients who underwent robotic sacrocolpopexy. We compared preoperative and 12-month postoperative objective and subjective assessments via the Pelvic Organ Prolapse Quantification (POP-Q), the Pelvic Floor Distress Inventory, Short Form 20 (PFDI-20); the Pelvic Floor Impact Questionnaire, Short Form 7 (PFIQ-7); and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire 12 (PISQ-12). Objective “anatomical success” was defined as POP-Q stage 0 or 1 at all postoperative intervals. We further defined “clinical cure” by simultaneously considering POP-Q points and subjective measures. To be considered a “clinical cure,” a given patient had to have all POP-Q points ≤0, apical POP-Q point C ≤5, no reported pelvic organ prolapse symptoms on the PFDI-20, and no reoperation for prolapse at all postoperative intervals.Results
Of the 120 patients, 118 patients completed the 1-year follow-up. The objective “anatomical success” rate was 89 % and the “clinical cure” rate was 94 %. The PFDI-20 mean score improved from 100.4 at baseline to 21.0 at 12 months (p?<?0.0001); PFIQ-7 scores improved from 61.6 to 8.0 (p?<?0.0001); and PISQ-12 scores improved from 35.7 to 38.6 (p?<?0.0009). No mesh erosions or mesh-related complications occurred.Conclusion
The use of this ultra-lightweight Y mesh for sacrocolpopexy, eliminated the mesh-related complications in the first postoperative year, and provided significant improvement in subjective and objective outcomes. 相似文献10.
Introduction and hypothesis
A study was carried out to investigate the relationship of anterior vaginal wall descent or prolapse to overactive bladder and its potential mechanisms, advancing the management of overactive bladder (OAB).Methods
Two hundred twenty-six consecutive women with OAB symptoms were prospectively studied using OAB questionnaire (OAB-q) and pelvic organ prolapse quantification (POP-Q). According to POP-Q staging, they were divided into three groups: stages 0, I, and II. For statistical analysis, a one-way ANOVA was used to test for significant differences with Student–Newman–Keuls post hoc analysis for continuous variables (OAB-q symptom severity, health-related quality of life total scores, and age) and chi-squared test for discrete variable (number of menopausal women).Results
Twenty-two women (9.73%) did not show any prolapse on examination; 204 (90.26%) had anterior vaginal wall descent or prolapse. The outcome statistics denoted that the difference in OAB-q scores among three groups has statistical significance (P?<?0.05). Anterior vaginal wall descent or prolapse may have associations with OAB.Conclusions
Anterior vaginal wall descent or prolapse may have associations with OAB and is directly correlated to OAB severity. 相似文献11.
Laurent de Landsheere Silvia Blacher Carine Munaut Betty Nusgens Chrystèle Rubod Agnès Noel Jean-Michel Foidart Michel Cosson Michelle Nisolle 《International urogynecology journal》2014,25(12):1673-1681
Introduction and hypothesis
The purpose of this study was to analyze the histomorphometric properties of the vaginal wall in women with pelvic organ prolapse (POP).Methods
In 15 women undergoing surgery for POP, full-thickness biopsies were collected at two different sites of location from the anterior and/or posterior vaginal wall. Properties of the precervical area (POP-Q point C/D) were compared with the most distal portion of the vaginal wall (POP-Q point Ba/Bp) using histological staining and immunohistochemistry. The densities of total collagen fibers, elastic fibers, smooth muscle cells, and blood vessels were determined by combining high-resolution virtual imaging and computer-assisted digital image analysis.Results
The mean elastin density was significantly decreased in the lamina propria and muscularis layer of the vaginal wall from the most distal portion of the prolapsed vaginal wall compared with the precervical area. This difference was statistically significant in the lamina propria for both anterior (8.4?±?1.2 and 12.1?±?2.0, p?=?0.048) and posterior (6.8?±?0.5 and 10.1?±?1.4, p?=?0.040) locations, and in the muscularis for the anterior (5.2?±?0.4 and 8.4?±?1.2, p?=?0.009) vaginal wall. There were no statistically significant differences in the mean densities of collagen fibers, smooth muscle cells or blood vessels between the two locations.Conclusions
In this study, we observed changes in elastin density in two different locations of the vaginal wall from women with POP. The histomorphometric properties of the vaginal wall can be variable from one place to another in the same patient. This result supports the existence of most vulnerable locations within the vaginal wall and the potential benefit of site-specific prolapse surgery. 相似文献12.
Gilad A. Filmar Hilaire W. Fisher Enrique Aranda Peter M. Lotze 《International urogynecology journal》2014,25(12):1645-1653
Introduction and hypothesis
We describe our techniques, outcomes, and complications with laparoscopic procedures for correcting pelvic organ prolapse (POP). We hypothesized that laparoscopic abdominal sacrocolpopexy (ASC) gives better anatomic results than laparoscopic uterosacral ligament suspension (USLS), without increased complications.Methods
This was a retrospective cohort study of 290 patients who underwent laparoscopic suspensions in a 2-year period. Anatomic measurements using the Pelvic Organ Prolapse Quantification (POP-Q) system were collected. Subjective data were obtained from the Pelvic Floor Distress Inventory Short-Form 20 (PFDI) questionnaire. The anatomic improvement for each stage and complication rates were analyzed. The difference in the risk of mesh erosion between patients undergoing concomitant total hysterectomy and those who had a prior hysterectomy was determined. In 102 patients with stage 2 prolapse, a comparison between ASC and USLS in anatomic and subjective results and complication rates was performed.Results
Anatomic success rates ranged between 86 % and 95 %. Overall mesh erosion rate was 1.2 %, showing no difference between concomitant total laparoscopic hysterectomy (0 %) and prior hysterectomy (2.1 %, p?=?0.155). ASC resulted in statistically significantly better anterior-compartment support than USLS (p?=?0.043). There was no difference in apex or posterior compartment position or in PFDI scores.Conclusion
Laparoscopic ASC may be better than USLS for correcting anterior-compartment prolapse, with only a minor risk of mesh erosion. 相似文献13.
Dara F. Shalom Katy J. Ledford Anwaar Qadir Lawrence R. Lind Harvey A. Winkler 《International urogynecology journal》2013,24(11):1909-1914
Introduction and hypothesis
Owing to the recent upsurge in adverse events reported after mesh-augmented pelvic organ prolapse (POP) repairs, our aim was to determine whether the location and depth of synthetic mesh can be measured postoperatively within the vaginal tissue microstructure using optical coherence tomography (OCT).Methods
Seventeen patients with prior mesh-augmented repairs were recruited for participation. Patients were included if they had undergone an abdominal sacral colpopexy (ASC) or vaginal repair with mesh. Exclusion criteria were a postoperative period of <6 months, or the finding of mesh exposure on examination. OCT was used to image the vaginal wall at various POP-Q sites. If mesh was visualized, its location and depth was calculated and recorded.Results
Ten patients underwent ASC and 7 patients had 8 transvaginal mesh repairs. Mesh was visualized in 16 of the 17 patients using OCT. In all ASC patients, mesh was imaged centrally at the posterior apex. In patients with transvaginal mesh in the anterior and/or posterior compartments, the mesh was visualized directly anterior and/or posterior to the apex respectively. Mean depth of the mesh in the ASC, anterior, and posterior groups was 60.9, 146.7, and 125.7 μm respectively. Mesh was visualized within the vaginal epithelial layer in all 16 patients despite the route of placement.Conclusion
In this pilot study we found that OCT can be used to visualize polypropylene mesh within the vaginal wall following mesh-augmented prolapse repair. Regardless of abdominal versus vaginal placement, the mesh was identified within the vaginal epithelial layer. 相似文献14.
Laura C. Skoczylas Lindsay C. Turner Li Wang Daniel G. Winger Jonathan P. Shepherd 《International urogynecology journal》2014,25(4):471-477
Introduction and hypothesis
In 2008 and 2011, the US Food and Drug Administration (FDA) released notifications regarding vaginal mesh. In describing prolapse surgery trends over time, we predicted vaginal mesh use would decrease and native tissue repairs would increase.Methods
Operative reports were reviewed for all prolapse repairs performed from 2008 to 2011 at our large regional hospital system. The number of each type of prolapse repair was determined per quarter year and expressed as a percentage of all repairs. Surgical trends were examined focusing on changes with respect to the release of two FDA notifications. We used linear regression to analyze surgical trends and chi-square for demographic comparisons.Results
One thousand two hundred and eleven women underwent 1,385 prolapse procedures. Mean age was 64?±?12, and 70 % had stage III prolapse. Vaginal mesh procedures declined over time (p?=?0.001), comprising 27 % of repairs in early 2008, 15 % at the first FDA notification, 5 % by the second FDA notification, and 2 % at the end of 2011. The percentage of native tissue anterior/posterior repairs (p?<?0.001) and apical suspensions (p?=?0.007) increased, whereas colpocleisis remained constant (p?=?0.475). Despite an overall decrease in open sacral colpopexies (p?<?0.001), an initial increase was seen around the first FDA notification. We adopted laparoscopic/robotic techniques around this time, and the percentage of minimally invasive sacral colpopexies steadily increased thereafter (p?<?0.001). All sacral colpopexies combined as a group declined over time (p?=?0.011).Conclusions
Surgical treatment of prolapse continues to evolve. Over a 4-year period encompassing two FDA notifications regarding vaginal mesh and the introduction of laparoscopic/robotic techniques, we performed fewer vaginal mesh procedures and more native tissue repairs and minimally invasive sacral colpopexies. 相似文献15.
Salomon Zebede Aimee L. Smith Roger Lefevre Vivian C. Aguilar G. Willy Davila 《International urogynecology journal》2013,24(1):141-145
Introduction and hypothesis
We aimed to determine if the use of permanent suture for the apical fixation during traditional anterior colporrhaphy results in improved outcomes compared to delayed absorbable suture.Methods
A retrospective case-control study was performed in patients who underwent traditional non-grafted anterior colporrhaphy with reattachment of the anterior endopelvic fascia to the apex/cervix comparing permanent (group 1) or absorbable suture (group 2). Patients were matched based on age, body mass index, and presenting stage of prolapse. The primary outcome assessed was anterior wall vaginal prolapse recurrence defined as Pelvic Organ Prolapse Quantification (POP-Q) points Aa or Ba?≥??1 cm. Secondary outcome measures included overall prolapse stage, subjective reporting of satisfaction, and any healing abnormalities or complications resulting from suture type.Results
A total of 230 patients were reviewed (80 in group 1 and 150 in group 2) and median follow-up was 52 (24–174) weeks. A statistically significant improvement in anterior wall anatomy was seen in group 1 compared to group 2 [(Aa ?2.70?±?0.6 cm vs ?2.5?±?0.75 cm, p?=?0.02) and Ba (?2.68?±?0.65 cm vs ?2.51?±?0.73 cm, p?=?0.03), respectively]. Comparing prolapse stage, there were no observed differences between the groups. Exposure of the permanent suture occurred in 12 patients (15 %) and 5 (6.5 %) required suture trimming to treat the exposure.Conclusions
Reattachment of endopelvic fascia to the apex at the time of anterior colporrhaphy results in low recurrence rates. Use of permanent suture for apical fixation is associated with improved anatomic correction at the expense of increased suture exposures. 相似文献16.
Luisa A. Wetta Kimberly A. Gerten Thomas L. Wheeler II Robert L. Holley R. Edward Varner Holly E. Richter 《International urogynecology journal》2009,20(11):1307-1312
Introduction and hypothesis
This study reports 1-year outcomes in women who underwent transvaginal pelvic organ prolapse (POP) surgery with Prolift® transvaginal mesh.Methods
Pre- and postoperative objective vaginal Pelvic Organ Prolapse Quantification (POP-Q) and subjective symptom and impact assessments (Pelvic Floor Distress Inventory (PFDI)-20 and Pelvic Floor Impact Questionnaire (PFIQ)-7, respectively) were performed. Postoperative vaginal tenderness, stricture, and patient satisfaction were also obtained. Paired t tests were utilized for analysis.Results
Mean age was 61.8?±?9.8 years; mean follow-up interval was 425.0?±?80.0 days (range, 237–717). POP-Q measurements of Ba, Bp, and C were significantly improved (all p values?0.001). PFDI and PFIQ subscale scores significantly improved (all p values?≤?0.004). Thirty-five of 48 (73%) were completely satisfied, and two (4%) were not satisfied. Complications (n (percent)) included graft exposure (1 (2%)), dyspareunia (2 (4%)), and granulation tissue (3 (6%)).Conclusions
Women undergoing transvaginal repair of POP with the Prolift® mesh system showed significant improvement in 1-year anatomic and subjective measures. 相似文献17.
Lin L. Ow Caroline E. Walsh Natarajan Rajamaheswari Peter L. Dwyer 《International urogynecology journal》2016,27(4):637-639
Aim of the video/introduction
Vaginal vault prolapse can occur alone or in combination with anterior or posterior compartment prolapse. Apical prolapse has shown a strong correlation with anterior wall prolapse and a moderate correlation with posterior wall prolapse. The McCall culdoplasty uses the extraperitoneal vaginal approach to support the vault at the time of hysterectomy. Sacrospinous fixation and ileococcygeus suspension with or without mesh have also been used for the treatment of vaginal vault prolapse. The uterosacral ligaments can also be used to re-suspend the vaginal vault using the extraperitoneal or transperitoneal approach. With the extraperitoneal approach, the peritoneal sac, which can be difficult to access at times, especially when there are dense pelvic adhesions, does not need to be opened. The extraperitoneal approach also carries a lower risk of ureteric injury, as the ureters and the bladder can be retracted from the field using a Breisky–Navratil retractor.Methods
This video, which documents the surgical treatment of a woman with a complete vaginal eversion and grade 3 pelvic organ prolapse (POP), was recorded in a live workshop during the 2015 Urogynaecology and Reconstructive Pelvic Surgery Conference, held in Chennai, India, in January 2015. It is aimed at educating interested surgeons in the technique of extraperitoneal uterosacral suspension.Conclusions
This video demonstrates the extraperitoneal approach to uterosacral ligament suspension for apical support in women with vaginal vault prolapse.18.
Johanna K. Mäkelä-Kaikkonen Tero T. Rautio Sari Koivurova Eija Pääkkö Pasi Ohtonen Fausto Biancari Jyrki T. Mäkelä 《International urogynecology journal》2016,27(12):1837-1845
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.19.
Patrick J. Culligan Emil Gurshumov Christa Lewis Jennifer L. Priestley Jodie Komar Nihar Shah Charbel G. Salamon 《International urogynecology journal》2014,25(6):731-735
Introduction and hypothesis
The objective of this study was to assess outcomes following robotic sacrocolpopexy using a lightweight polypropylene Y-mesh.Methods
During our study period, all patients who underwent robotic sacrocolpopexy were enrolled in this single-arm prospective trial. Endpoints included Pelvic Organ Prolapse Quantification (POP-Q) values; Pelvic Floor Distress Inventory, short form 20 (PFDI-20); Pelvic Floor Impact Questionnaire, short form 7 (PFIQ-7); Surgical Satisfaction scores; and the Sandvik Incontinence Severity Index. All surgeries were performed with a pre-configured monofilament type 1 polypropylene Y-mesh (Alyte©, C.R. Bard, Covington, GA, USA). Cure rates at 12 months were calculated using two separate definitions: (1) “clinical cure”: no POP-Q points?>?0, point C ≤ ?5, no prolapse symptoms on the PFDI-20, and no reoperations for prolapse and (2) “objective anatomic cure”: POP-Q stage 0 or 1, point C of ≤ ?5, and no reoperations for prolapse.Results
A total of 150 patients underwent robotic sacrocolpopexy and 143 (95 %) were available for 12-month follow-up. Mean age was 58.6 ± 9.8 and mean body mass index was 26.3 ± 4.5. Mean operative time and blood loss were 148?±?27.6 min (range 75–250 min) and 51.2?±?32, respectively. There were no mesh erosions or exposures, and mesh edges were not palpable in any patient. At 12 months the clinical cure rate was 95 %, and the objective anatomic cure rate was 84 %. The PFDI-20 mean score improved from 98 at baseline to 17 at 12 months (p?<?0.0001); PFIQ-7 scores improved from 59 to 6.5 (p?<?0.0001).Conclusions
Robotic sacrocolpopexy using this lightweight polypropylene Y-mesh offers excellent subjective and objective results at 1 year. 相似文献20.
C. M. Durnea A. S. Khashan L. C. Kenny U. A. Durnea M. M. Smyth B. A. O’Reilly 《International urogynecology journal》2014,25(11):1463-1470