Factors that affect early recurrence after prolapse repair by a nonanchored vaginal mesh procedure

ObjectiveProsima (Ethicon, Somerville, NJ, USA) is a novel procedure for treating pelvic organ prolapse (POP) that uses nonanchored vaginal mesh. However, nonfixation of the mesh may limit effectiveness. The aim of this study was to evaluate the safety, efficacy, and limitations of this procedure.Materials and methodsFrom January 2011 through to December 2011, 52 patients with symptomatic POP ≥ Stage 2 undergoing the Prosima procedure at a tertiary hospital were enrolled consecutively in this prospective study. A Data and Safety Monitoring Plan (DSMP) was developed to assess the results.ResultsFifty of the 52 patients (96%) attended the 3–6-month postoperative assessment. Symptom and quality-of-life scores were found to have improved significantly after surgery (p < 0.05). Forty-two patients (84%) underwent successful treatment for POP (Stage 0-1). The other eight patients (16%) were found to have recurrent Stage 2 anterior vaginal wall prolapse, although most of them (5/8) were asymptomatic. The highest morbidity, namely vaginal mesh exposure, occurred in four patients (8%) and was managed as a minor issue. Statistical analysis showed that anatomic recurrence was significantly (p < 0.05) associated with a “preoperative Ba ≥ +4 cm” (odds ratio = 20.57), “conservation of the prolapsed uterus” (odds ratio = 10.56) and “use of a concomitant midurethral sling” (odds ratio = 0.076).ConclusionProsima seems to have limitations when used to manage severe anterior vaginal wall prolapse and concomitant surgery may further affect its effectiveness. The information obtained from this study's DSMP will contribute to developing a strategy to improve the use of nonanchored vaginal mesh for POP repair.     

Laparoscopic sacral colpopexy versus total vaginal mesh for vault prolapse; comparison of cohorts

The surgical treatment of vaginal vault prolapse can either be performed by the vaginal or the abdominal (laparoscopic) route. The objective of this study was to compare the laparoscopic sacral colpopexy (LSC) and total vaginal mesh (TVM) for vaginal vault prolapse. This study compared a prospective cohort of LSC with bone-anchor fixation and mesh limited to the apex to a prospective cohort of TVM as treatment modalities in patients with a symptomatic vaginal vault prolapse (pelvic organ prolapse-quantification (POP-Q) point C?≥??3). Primary outcome was failure in the apical compartment after 6 month follow-up, defined as POP-Q stage?≥?II with prolapse complaints or re-treatment in apical compartment. Based on an overall failure in all compartments of 23 % in the LSC group and 57 % in the TVM group, 29 patients would be needed in each group with a power of 80 % and alpha 0.05. Ninety-seven women were included, 45 LSC and 52 TVM. The failure rate of symptomatic vault prolapse was 1 (2 %) in each group (p?=?0.99). The failure rate (POP stage?≥?II) in any compartment was 23 (51 %) in the LSC group and 11 (21 %) in the TVM group (p?=?0.002). Each technique had its own type of complications. Short-term failure rates in the apical compartment after TVM and LSC were similar. In case of anterior or posterior prolapsed, additional mesh insertion or additional vaginal colporrhaphy is indicated in LSC surgery.     

Risk factors of surgical failure following transvaginal mesh repair for the treatment of pelvic organ prolapse

Objective

To identify the factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair.

Study design

One hundred and thirteen women with symptomatic POP stage II to IV were scheduled for TVM procedures. All subjects underwent urinalyses and pelvic examination using the POP quantification (POP-Q) staging system before and after surgery.

Results

Seven (6.2%) of 113 women reported POP recurrence after a mean follow-up time of 30 months. We performed a univariate analysis of patients’ characteristics to identify the predictors of surgical failure after TVM. There was no difference between two groups as to body mass index, POP stage, mesh type, and preoperative urinary symptoms and urodynamic parameters (P > 0.05). However, we found that uterine prolapse (P = 0.016) and surgical experience (P = 0.043) were two significant predictors of surgical failure. Multivariate logistic regression showed similar results.

Conclusion

Advanced uterine prolapse and lack of surgical experience were two significant predictors of failure following TVM. POP recurrence after mesh repair appears to be unlikely beyond the learning curve.     

Mesh-related complications in single-incision transvaginal mesh (TVM) and laparoscopic abdominal sacrocolpopexy (LASC)

ObjectiveFew studies have investigated the long-term impact of synthetic mesh reconstructive surgery for pelvic organ prolapse (POP) on patient outcomes. This study aimed to examine the incidence and risk factors of mesh exposure and the subsequent requirement for surgical interventions due to mesh-related complications.Materials and methodsThis retrospective study was conducted from November 2010 to April 2018. We recruited women with Pelvic Organ Prolapse Quantification (POP-Q) stage 3 or 4 who underwent mesh reconstructive surgery for POP, and enrolled 487 women who received transvaginal mesh (TVM) and 110 women who received laparoscopic abdominal sacrocolpopexy (LASC). Assessments included mesh exposure rate and mesh-related complications requiring surgical interventions in both groups.ResultsIn the LASC group, the overall mesh-related complication rate was 8.18% over a mean follow-up period of 18 months. Concomitant laparoscopic-assisted vaginal hysterectomy was associated with mesh exposure (OR = 9.240; 95% CI = 1.752–48.728). No patients in the concurrent supracervical hysterectomy group were exposed to mesh. In the single-incision TVM group, the overall rate of mesh-related complications was 3.29% over a mean follow-up period of 19 months. Concomitant total vaginal hysterectomy was also a risk factor for mesh exposure (OR = 4.799; 95% CI = 1.313–17.359).ConclusionPreserving the cervix or uterus decreased the rate of mesh exposure in those undergoing TVM and LASC surgery. The overall rate of mesh-related complications was low after up to 8 years of follow-up.     

Changes in Female Sexual Function following Anterior with and without Posterior Vaginal Mesh Surgery for the Treatment of Pelvic Organ Prolapse

IntroductionComparison of female sexual function following anterior and total transvaginal mesh (TVM) surgery has never been reported.AimTo compare the sexual function after anterior and total TVM repair for the treatment of pelvic organ prolapse (POP).Main Outcome MeasuresThe short forms of Urogenital Distress Inventory (UDI‐6) and Incontinence Impact Questionnaire (IIQ‐7), and the Female Sexual Function Index (FSFI).MethodsOne hundred and sixty‐five women with symptomatic POP stages II to IV defined by the POP quantification (POP‐Q) staging system underwent TVM procedures at our hospitals. Seventy women were included because they were sexually active and had complete follow‐up. All subjects were divided into the anterior group (anterior TVM; N = 39) and total group (anterior and posterior TVM; N = 31). Preoperative and postoperative assessments included pelvic examination using the POP‐Q system, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms with the short forms of UDI‐6 and IIQ‐7, and the FSFI.ResultsThere was no difference between the two groups as for age, parity, diabetes, hypertension, concomitant procedures, and success rates for TVM and mid‐urethral sling in this study (P > 0.05). Regarding the POP‐Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.05) in both groups except for total vaginal length (P > 0.05). The preoperative scores of UDI‐6 and IIQ‐7 were significantly higher in the total group (P < 0.01), and the UDI‐6 and IIQ‐7 scores showed significant decreases in both groups postoperatively (P < 0.01). After TVM surgery, the score of the dyspareunia domain worsened significantly in both groups (P < 0.05), and the deteriorated lubrication domain was noted only in the total group (P = 0.042).ConclusionsTVM procedure creates an effective anatomical restoration of POP, but individual domains of FSFI may worsen. Compared with the anterior group, women of the total group had worse quality of life in term of urinary symptoms preoperatively, and experienced a greater sexual impairment on lubrication following surgery. Long C‐Y, Juan Y‐S, Wu M‐P, Liu C‐M, Chiang P‐H, and Tsai E‐M. Changes in female sexual function following anterior with and without posterior vaginal mesh surgery for the treatment of pelvic organ prolapse. J Sex Med 2012;9:2167–2174.     

Peritoneal tuberculosis mimicking ovarian cancer

Objective

To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP).

Study design

One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire.

Results

We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) except for total vaginal length (P = 0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P < 0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P < 0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low.

Conclusion

TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.     

Concomitant trocar-guided transvaginal mesh surgery with a midurethral sling in treating advanced pelvic organ prolapse associated with stress or occult stress urinary incontinence

ObjectiveThe purpose of this study was to evaluate the efficacy and feasibility of concomitant trocar-guided transvaginal mesh (TVM) surgery with a midurethral sling (MUS) for treating women with advanced pelvic organ prolapse (POP) and stress urinary incontinence (SUI) or occult SUI (OSUI).Materials and methodsEighty-nine women with advanced POP and SUI or OSUI were retrospectively enrolled. The Total Prolift and Tension-free Vaginal Tape-Obturator Systems were used for trocar-guided TVM surgery and MUS. Patients received regular follow-up at 1 week, and 1 month, 3 months, 6 months, and 12 months postoperatively, and then annually thereafter. The endpoints were the success rate for POP, and perioperative and postoperative complications. Functional outcomes were the presence of voiding difficulty, persistent or de novo overactive bladder symptoms, postoperative SUI, and paresthesia.ResultsThe median follow-up period was 35 months (range, 12–50 months). Within the follow-up period, 84 patients (94.4%) were objectively cured, five patients (5.6%) had vaginal apical mesh exposure, 29 individuals (32.6%) had persistent or de novo overactive bladder symptoms, six individuals (22.5%) had de novo SUI (two were found by urodynamics), and nine individuals (10.1%) had voiding difficulties (two were found by urodynamics). In addition, the vaginal hysterectomy group had greater blood loss, longer operation times, and a higher mesh erosion rate compared to the uterine suspension group.ConclusionConcomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.     

Role of MR imaging in surgical planning and prediction of successful surgical repair of pelvic organ prolapse

ObjectiveTo determine the role of magnetic resonance imaging (MRI) in surgical planning for females with pelvic organ prolapsed (POP) and to determine the clinical utility of MR imaging in predicting successful surgical repair.MethodsFifteen patients with different varieties of pelvic floor dysfunction and 15 nulliparous females as control subjects were studied by magnetic resonance imaging (static and dynamic). Intraoperative findings related to POP were correlated to MRI findings. In the symptomatic patients, magnetic resonance imaging was repeated within 6–12 months after surgery.ResultsPreoperative MRI and operative findings showed a significant correlation in all types of prolapse, except rectocele. On the other hand preoperative pelvic examination and operative findings were significantly correlated for cystocele, rectocele and vaginal cuff prolapse (r = 0.75, P < 0.008). Preoperative magnetic resonance imaging added information that changed the management in 40% of symptomatic women. Postoperative magnetic resonance imaging showed normal pelvic floor in asymptomatic patients (n = 13). Abnormal imaging findings were found in patients with persistent postoperative or de novo complaints (n = 2).ConclusionMagnetic resonance imaging can accurately localize pelvic floor defects, evaluate success or failure of surgical procedures, predict the need for more extensive reconstruction, and identify complications.     

Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery

ObjectiveThis study was conducted to investigate the risk factors of third- and fourth-degree lacerations following vaginal deliveries in Taiwanese women, and to offer clinical guidance for the reduction of severe perineal lacerations.Materials and methodsA total of 1879 women who underwent vaginal deliveries assisted by midline episiotomy at a tertiary hospital were included. Obstetric risk factors were analyzed for women with and without third- and fourth-degree lacerations.ResultsTwo hundred and five deliveries (10.9%) resulted in third- or fourth-degree lacerations. Parity, duration of first and second stages of labor, rate of instrument-assisted vaginal deliveries, the newborn's birth weight and head circumference, and the ratio of the newborn's birth weight to maternal body mass index were significantly different between women with and without severe perineal lacerations. Logistic regression demonstrated that nulliparity (odds ratio = 3.626, p < 0.001), duration of second stage of labor (odds ratio = 1.102, p = 0.044), instrument-assisted vaginal delivery (odds ratio = 4.102, p < 0.001), and newborn's head circumference (odds ratio = 1.323, p < 0.001) were independent risk factors of severe perineal lacerations. Instrument-assisted vaginal delivery was a common independent risk factor for severe lacerations shared between primiparous and multiparous women.ConclusionsWith regard to severe perineal lacerations during vaginal delivery, there are multiple obstetric contributory factors despite routine episiotomy, among them, nulliparity, longer labor duration, greater newborn head circumference, and instrument-assisted vaginal delivery. The latter should only be performed after careful evaluation.     

Effects of Delayed Newborn Bathing on Breastfeeding,Hypothermia, and Hypoglycemia

ObjectiveTo determine whether delaying the newborn bath by 24 hours increases the prevalence of breastfeeding initiation and exclusive breastfeeding at discharge in healthy full-term and late preterm newborns (34 0/7–36 6/7 weeks gestation) and to examine the effect of delayed newborn bathing on the incidences of hypothermia and hypoglycemia.DesignPre–post implementation, retrospective, cohort study.SettingProvincial children’s hospital with an average of 2,500 births per year.ParticipantsHealthy newborns (N = 1,225) born at 34 0/7 weeks or more gestation who were admitted to the mother–baby unit.MethodsWe compared newborns who were bathed before 24 hours (n = 680, preimplementation group) to newborns who were bathed after 24 hours (n = 545, postimplementation group).ResultsAfter adjustment for confounders, the odds of exclusive breastfeeding at discharge were 33% greater in the postimplementation group than in the preimplementation group (adjusted odds ratio = 1.334; 95% confidence interval [1.049,1.698]; p = .019). Delayed bathing was associated with decreased incidence of hypothermia and hypoglycemia (p = .007 and p = .003, respectively). We observed no difference in breastfeeding initiation between groups.ConclusionDelaying the newborn bath for 24 hours was associated with an increased likelihood of exclusive breastfeeding at discharge and a decreased incidence of hypothermia and hypoglycemia in healthy newborns. The implementation of a delayed bathing policy has the potential to improve breastfeeding rates and reduce the incidence of hypothermia and hypoglycemia.     

Changes in Sexual Function after Treatment for Prolapse Are Related to the Improvement in Body Image Perception

IntroductionIn a previous study, sexual function was related to a woman's self-perceived body image and degree of bother from pelvic organ prolapse (POP).AimsTo evaluate sexual function, prolapse symptoms, and self-perceived body image 6 months following treatment for POP and to explore differences in body image perception and sexual function following conservative and surgical treatment for POP.MethodsAfter institutional review board approval, consecutive women with ≥stage II POP were invited to participate. In addition to routine urogynecologic history and physical examination, including Pelvic Organ Prolapse Quantification (POP-Q), the participants completed three validated questionnaires before, and 6 months after, treatment for POP: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Modified Body Image Perception Scale and Prolapse subscale of Pelvic Floor Distress Inventory to assess condition specific bother from POP.Main Outcome MeasuresChanges in sexual function and body image perception following treatment for POP.ResultsA total of 235 women with a mean age of 62 ± 12 years returned for a 6-month follow-up. The majority of our participants had surgical repair for POP (88%). At 6-month follow-up visits, the patients reported significant improvement in sexual function from baseline (33 ± 0.6 vs. 43 ± 0.8, respectively P < 0.0001). Improvement in sexual function, as measured by PISQ-12, was not significant among sexually active patients treated with a pessary compared with those treated surgically (–2.5 ± 5.5 vs. 11.5 ± 1, respectively P < 0.0001). A multivariate linear regression model demonstrated that body mass index and changes in body image perception were the only independent factors associated with changes in PISQ score following POP treatment (β = ?0.5, P < 0.01 and β = ?0.4, P < 0.03, respectively).ConclusionsResolution of POP symptoms after treatment improves women's self-perceived body image and sexual function. Not surprisingly, pessary is less effective in improving sexual function compared with surgical repair of POP. Lowenstein L, Gamble T, Sanses TVD, van Raalte H, Carberry C, Jakus S, Pham T, Nguyen A, Hoskey K, and Kenton K for the Fellow's Pelvic Research Network. Changes in sexual function after treatment for prolapse are related to the improvement in body image perception.     

Impact of total vaginal mesh surgery for pelvic organ prolapse on female sexual function

Objective

To evaluate the short-term impact of surgical repair with total transvaginal mesh (TVM) on sexual function among women with pelvic organ prolapse (POP).

Methods

Twenty-seven sexually active women who underwent total TVM procedures for symptomatic POP at Buddhist Dalin Tzu Chi General Hospital between 2007 and 2010 were included in the retrospective study. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system, urodynamic studies, and a personal interview to evaluate urinary and sexual symptoms via the urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and female sexual function index (FSFI).

Results

The mean patient age was 51.4 years (range 36–68 years) and the mean parity was 2.7 (range 0–4). Regarding POP-Q parameters, there were significant improvements at points Aa, Ba, C, Ap, and Bp after surgery (P < 0.001). Similarly, the UDI-6 and IIQ-7 scores significantly dropped postoperatively (P < 0.01). After surgery, the scores for the dyspareunia and the lubrication domains of FSFI worsened significantly (P < 0.05). There was no significant change in other domains (desire, arousal, orgasm, satisfaction, and total score; P > 0.05). Two-thirds (66.7%) of women had a lower total FSFI score postoperatively.

Conclusion

TVM surgery was found to contribute successfully to the anatomic correction of POP, but individual domains of sexual function sometimes worsened.     

The significance of pelvic floor support on the pelvic floor muscle functions of women with lower urinary tract symptoms

ObjectiveTo explore the significance of pelvic organ prolapse (POP) on pelvic floor muscle (PFM) function among women with lower urinary tract symptoms (LUTS).Materials and methodsFour-dimensional ultrasound data of 577 women with LUTS were retrospectively analyzed. The bladder neck and genital hiatus were assessed during resting, coughing, and squeezing. The bladder neck location, genitohiatal size, and genitohiatal location were evaluated with bladder neck distance (BNd) and bladder neck angle (BNa), genitohiatal dimension (GHd) and genitohiatal area (GHAR), and genitohiatal angle (GHa), respectively.ResultsCompared with women without POP (n = 306), women with POP (n = 271) exhibited higher rates of levator complete avulsion (6.5% vs. 40.2%, P < 0.001), shorter BNd (2.84 ± 1.56 cm vs. 2.45 ± 0.45 cm, P = 0.018), larger BNa (92 ± 15° vs. 101 ± 21°, P < 0.001), longer GHd (5.25 ± 0.72 cm vs. 5.60 ± 0.87 cm, P < 0.001), larger GHa (141 ± 10° vs. 145 ± 9°, P = 0.004), and larger GHAR (20.0 ± 4.7 cm² vs. 24.2 ± 5.6 cm², P < 0.001) during resting. Fewer women with POP were able to maintain stable bladder neck location (79.5% vs. 65.5%, P < 0.001), genitohiatal size (60.7% vs. 51.9%, P = 0.042), and genitohiatal location (61.6% vs. 52.8%, P = 0.044) following coughing. Fewer women with POP were capable of squeezing (77.8% vs. 58.3%, P < 0.001).ConclusionAmong women with LUTS, the presence of POP is associated with weaker resting, involuntary, and voluntary PFM functions.     

Skin-to-Skin Contact and the Incidence of Transient Tachypnea of the Newborn

ObjectivesTo compare the incidence of transient tachypnea of the newborn (TTN) before and after the implementation of a Baby-Friendly protocol and to determine changes in the rates of TTN symptoms, interventions, completion of skin-to-skin contact.DesignRetrospective cohort study using data in the electronic medical record.SettingCommunity-based tertiary obstetric facility.ParticipantsWe reviewed 934 charts of neonates born at or greater than 34 weeks gestation to women ages 18 years or older and included 790 neonates: 491 in the preimplementation group and 299 in the postimplementation group. Group assignment was based on time of Baby-Friendly protocol implementation. The preimplementation group included neonates born in April, August, and December of 2014, and the postimplementation group included neonates born during these months in 2018.MethodsThe primary outcome was incidence of TTN. Secondary outcomes were rates of the following: tachypnea symptoms, hypoglycemia, antibiotic administration, and completion of skin-to-skin contact.ResultsThe incidence of TTN was 2% (n = 8/491) in the preimplementation group and 1% (n = 4/299) in the postimplementation group (p = 1.000). The rate of tachypnea symptoms decreased from 5% (n = 25/491) to 1% (n = 3/299, p = .003), the rate of hypoglycemia decreased from 11% (n = 54/491) to 3% (n = 10/299, p < .001), and the rate of antibiotic administration decreased from 13% (n = 66/491) to 4% (n = 11/299, p < .001). The skin-to-skin completion rate increased from 16% (n = 79/491) to 61% (n = 183/299, p < .001).ConclusionAlthough skin-to-skin contact facilitates physiologic transition to extrauterine life, incidence of TTN was not significantly reduced after the implementation of the Baby-Friendly protocol. However, increased practice of skin-to-skin contact was an improvement in care with implications for the transition to extrauterine life.     

Calidad de vida,complicaciones asociadas y satisfacción con el uso de pesarios para tratamiento conservador del prolapso de órganos pélvicos

BackgroundConservative treatment for pelvic organ prolapse (POP) is indicated when the patient refuses surgery, or when there is surgical contraindication due to adverse medical conditions.ObjectiveTo evaluate the quality of life, complications, and perception of health improvement in women with POP on treatment with pessaries in the Urogynaecology Unit of the Military Hospital, Santiago Chile between 2009 and 2018.MethodRetrospective study that evaluated 60 women with POP on treatment with pessaries. Sociodemographic variables and clinical data were collected at the beginning of the treatment and during follow-up from April 2018 to March 2019. Two validated questionnaires were also completed: Subjective Perception of Improvement and Prolapse Quality of Life (PQoL).ResultsThe ring was the most commonly used pessary (75%). The mean age of the patients was 78.7 years (± 8.2). The most reported complications were: vulvovaginitis, erosion, urinary tract infection, and flange. Around 80% of the patients reported an excellent improvement in their health condition, and 20% reported feeling better. Women with erosion and vulvovaginitis had a longer time of pessary use compared to women who did not have these complications (p < 0.05). In general, Quality of Life associated with prolapse and pessary use was good. Women with urinary incontinence showed a worse quality of life in domains «impact of prolapse» and «social limitations» (p < 0.05).ConclusionConservative treatment with pessaries showed good results in subjective perception of improvement, good quality of life, and low percentage of complications.     

Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery

IntroductionThe effect of transvaginal mesh (TVM) surgery on sexual function between premenopausal and postmenopausal women remains controversial.AimTo compare the changes in sexual function of premenopausal and postmenopausal women following TVM repair.MethodsOne hundred and fifty‐two consecutive women with symptomatic pelvic organ prolapse (POP) stages II to IV were referred for TVM procedures at our hospitals. Sixty‐eight women were included because they were sexually active and had complete follow‐up. All subjects were divided into the premenopausal (N = 36) and postmenopausal (N = 32) groups. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP‐Q) system and a personal interview with the Female Sexual Function Index (FSFI), Urogenital Distress Inventory (UDI‐6), and Incontinence Impact Questionnaire (IIQ‐7).Main Outcome MeasuresThe FSFI, UDI‐6, and IIQ‐7 questionnaires.ResultsThe mean age, rates of hypertension, and previous hysterectomy were significantly higher in the postmenopausal group (P < 0.05) compared with the premenopausal group. As for the POP‐Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) in both groups except for total vaginal length (P > 0.05). Similarly, the UDI‐6 and IIQ‐7 scores significantly decreased postoperatively (P < 0.01). After POP surgery, the score of the dyspareunia domain decreased significantly in the premenopausal group (P < 0.01) but was not the case for the postmenopausal group (P > 0.05). There were no significant changes in other domains and total scores in both groups (P > 0.05). However, higher rates of worsening dyspareunia and total scores were noted in the premenopausal group (P = 0.03 vs. 0.033).ConclusionTVM procedure is effective for the anatomical restoration of POP. However, individual domain of FSFI such as dyspareunia may worsen in the premenopausal women. Additionally, our results revealed that over one third of premenopausal women could have a worsening sexuality domain postoperatively, with significantly higher rate of deteriorated dyspareunia and total FSFI scores than postmenopausal women. Long C‐Y, Hsu C‐S, Wu M‐P, Lo T‐S, Liu C‐M, and Tsai E‐M. Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery. J Sex Med 2011;8:2009–2016.     

Mesh implantation for pelvic organ prolapse improves quality of life

Purpose

The use of alloplastic meshes for repair of female pelvic organ prolapse (POP) has recently been discussed for its indications and safety. Mesh exposure and chronic pelvic pain are among the risks that need to be addressed to the patients. The purpose of this prospective observational study is to investigate the effect of vaginal mesh implantation on pelvic floor-related quality of life (QoL).

Methods

55 patients were included in this prospective multicenter study. A validated QoL questionnaire comprising items on prolapse symptoms and bladder, bowel and sexual function was used. QoL data were acquired before and 1 year after POP surgery. Patients underwent POP surgery with implantation of either Prolift^® or Seratom^® mesh.

Results

Quality of life scores improved significantly after surgery. Prolapse complaints were reduced from 4.43 to 0.26 (p < 0.001), and bladder and bowel complaints improved from 3.03 to 1.46 (p < 0.001) and from 1.93 to 1.60 (p < 0.01) at follow-up. Furthermore, the sexual function score improved from 2.31 to 1.12 postoperatively (p < 0.01).

Conclusion

Despite the risks discussed for vaginal mesh repair, we observed a statistically significant improvement of pelvic floor-related quality of life of POP patients.     

阴道植入网片与自体组织修补的临床效果比较

文章对近年来发表的经阴道植入网片（transvaginal mesh,TVM）与经阴道自体组织修补（vaginal native tissue repair,VNTR）治疗盆腔器官脱垂（pelvic organ prolapsed,POP）的文献结果进行了比较。结果显示：（1）两组围手术期及短期并发症以Clavien-Dindo外科并发症严重程度分级系统进行评价,提示网片短期严重并发症并不常见,TVM与VNTR一样安全。（2）两组在近中期主客观效果、复发率、网片重量及对性功能影响方面比较,除一项研究外,多数研究结果表明TVM组患者术后脱垂感知率、前壁脱垂复发率和再次手术率方面都要低于VNTR组,虽然网片独特并发症增加了再次手术率,但两组总体再次手术率无显著差异。轻质网片并发症少于重质网片。两组在性交痛发生率比较也无显著差异。（3）两组术后长期疗效比较,TVM组在阴道前壁和多腔室脱垂治疗方面主客观效果及满意度方面优于VNTR组,且减少了解剖学上的复发率。研究结果显示TVM是治疗POP的一种安全有效术式。适应证选择恰当和训练有素的医生可进一步降低TVM的并发症。     

Pilot study of yoga for breast cancer survivors with poor quality of life

IntroductionStudies show benefits of yoga for breast cancer patients with poor quality of life (QOL); however, none exclusively focus on survivors. This study addresses whether hatha yoga improves breast cancer survivors' QOL.Methods25 breast cancer survivors completed six weeks of yoga. Outcome measures were 5 QOL categories evaluated using the FACT-B survey pre and post-intervention and after 6 months.ResultsEach category was evaluated independently, including: physical (PWB), social (SWB), emotional (EWB), functional (FWB), breast cancer specific well-being (BCS), Trial Outcome Index (TOI), FACT-G, and FACT-B. Significant improvement was found in all categories except social well-being (PWB p = .013, EWB p = .005, FWB p = .003, BCS p < .001, TOI p < .001, FACT-G p = .004, FACT-B p < .001). Patients with below average pre-intervention index scores (n = 13) showed greater improvement in EWB and FWB, while those with above average pre-intervention scores (n = 9) showed greater improvement in PWB.ConclusionsYoga may be feasible and clinically useful for breast cancer survivors with poor QOL.     

Comparing the midterm outcome of single incision vaginal mesh and transobturator vaginal mesh in treating severe pelvic organ prolapse

Objective

The aim of this study is to compare perioperative parameters and midterm clinical outcomes using two different mesh kits: transobturator vaginal mesh (TVM) (both Perigee and Apogee), versus single incision vaginal mesh (SIM) (combined Elevate anterior/apical system and Elevate posterior/apical system) in treating severe pelvic organ prolapse (POP).