A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh

This study reports the 2-year results of an original technique for rectocele repair by the vaginal route, using a combined sacrospinous suspension and a polypropylene mesh. Twenty-six women were successively operated between October 2000 and February 2003. Mean age was 63.7 years [range 35–92]. 19 women had had previous pelvic surgery for prolapse and/or urinary incontinence (73.1%), but none had had a previous rectocele repair. Patients underwent physical examination staging of prolapse in the international pelvic organ prolapse staging system. Eleven women had stage 2 posterior vaginal wall prolapse (42.3%), seven had stage 3 (26.9%) and eight had stage 4 (30.8%). The procedure included a bilateral sacrospinous suspension and a polypropylene mesh (GyneMesh, Gynecare, Ethicon France) attached from the sacrospinous ligaments to the perineal body. We did not perform any associated posterior fascial repair, nor myorraphy. Patients were followed up for 10–44 months, with a median follow-up (±SD) of 22.7±9.2 months. Functional results and sexual function were evaluated using the PFDI, the PFIQ and the PISQ-12 self-questionnaires. Twenty-five women returned for follow-up (96.2%). At follow-up, 24 women were cured (92.3%) and one had asymptomatic stage 2 rectocele. All the patients but one had symptoms and impact on quality of life improved. No postoperative infection of the mesh or rectovaginal fistula was found, but there were three vaginal erosions (12%) and one out of 13 had de novo dyspareunia (7.7%).     

Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study

The aim of this study was to evaluate the anatomical and functional results of a low-weight polypropylene mesh coated with an absorbable film in prolapse surgery by vaginal route. We have conducted a prospective multicentre study in 13 gynaecological and urological units. There were 230 patients requiring repair for anterior or posterior vaginal prolapse included. The present report is based on the analysis of the first 143 patients evaluated after at least 10 months follow-up. All patients were operated by the vaginal route using a specially designed mesh (Ugytex, Sofradim, France). Prolapse severity were evaluated using the Pelvic Organ Prolapse staging system. Symptoms and quality of life were evaluated preoperatively and during follow-up using the validated Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) self-questionnaires. Mean age was 63 years (37–91). Anterior, posterior and anterior–posterior repair with the mesh were performed in 67 (46.9%), 11 (7.7%) and 65 (45.4%) patients, respectively. With a mean follow-up of 13 months (10–19), 132 patients were considered anatomically cured (92.3%) with a recurrence rate of 9 of 132 for cystocele (6.8%) and 2 of 76 for rectocele (2.6%). Nine vaginal erosions occurred (6.3%), six of them necessitated another procedure by simple excision. The rate of de novo dyspareunia was 12.8%. At follow-up, improvement of PFDI and PFIQ scores were highly significant (p<0.0001). The use of low-weight polypropylene mesh coated with a hydrophilic absorbable film for vaginal repair of genital prolapse seems to decrease local morbidity while maintaining low recurrence rates.     

Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair

The aim of this study was to assess symptomatic and quality of life outcome scores following site specific fascial reattachment surgery for pelvic organ prolapse using the validated Prolapse Quality of Life (P-QOL) questionnaires. One hundred and ninety two women underwent surgery for pelvic organ prolapse; ninety four underwent anterior repair (thirty four of them had vaginal hysterectomy), and ninety eight had posterior repair. Patients filled P-QOL questionnaires 24 hours prior to surgery and a postal P-QOL questionnaire six months post operatively. Pre and post operative questionnaires were paired. Quality of life and symptoms scores were calculated using Wilcoxon signed rank test. One hundred and one women returned their questionnaires and were suitable to include in the study. Forty nine underwent anterior repair (fifteen had vaginal hysterectomy) and 52 underwent posterior repair. Quality of life scores showed significant improvement in the anterior and posterior repair groups with the exception of general health in the anterior repair group and general health and prolapse impact in the posterior repair group. Anterior repair significantly improved urinary voiding and storage symptoms. Posterior repair group showed significant improvement in defecatory symptoms. Both groups showed improvement in sexual function and general prolapse symptoms. Prolapse repair with site specific fascial reattachment results in significant improvement in quality of life scores six months after surgery. Anterior repair improves urinary voiding and storage symptoms and posterior repair improves defecatory dysfunction and urinary voiding. Sexual function improves following prolapse repair with site specific fascial reattachment. Presentation information: British Society of Urogynaecology Annual Scientific Meeting, Royal College of Obstetricians and Gynaecologists, London, UK. November 17th 2006.     

The vaginally assisted laparoscopic sacrocolpopexy: a pilot study

Introduction and hypothesis

We assessed the efficacy and safety of an operative technique, the vaginally assisted laparoscopic sacrocolpopexy (VALS), for the treatment of women with severe uterovaginal prolapse (UVP).

Methods

A prospective pilot study of women with severe UVP, who underwent VALS, was carried out. Preoperatively, POP was assessed using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system and symptoms were evaluated using the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (ICIQ-VS). VALS is a combined minimally invasive surgical approach where a vaginal hysterectomy is initially performed, followed by a transvaginal placement of a synthetic mesh which is suspended laparoscopically on the sacral promontory. Postoperative assessment at 12 months was identical to the preoperative assessment with the addition of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Perioperative and postoperative complications were recorded.

Results

Twenty-seven women with a mean age of 57.2 (range, 47–73) were included. Twenty women (74.1%) had stage 3 and 7 (25.9%) had stage 4 POP with a median point C?=?+5 (range, +2 to +8). VALS was successfully performed in all patients. All patients completed their follow-up assessment at 12 months. All POP-Q points showed statistically significant improvement apart from TVL, which remained unchanged. ICIQ-VS scores showed a statistically significant improvement of the vaginal symptoms and the total quality of life. The sexual matters score showed a tendency towards improvement, although it did not reach statistical significance.

Conclusions

Vaginally assisted laparoscopic sacrocolpopexy appears to be a valid and safe minimally invasive option when treating women presenting with severe UVP, with encouraging short-term anatomical and functional outcomes.     

Patient goal attainment in vaginal prolapse repair with and without mesh

Introduction and hypothesis

The objective of this study was to describe patient-centered goals and their attainment in vaginal prolapse repair, with and without mesh.

Methods

A secondary analysis of a multicenter randomized controlled trial of prolapse repair with or without vaginal mesh was performed. Participants (n?=?65) selected three preoperative goals ranked by importance. At 3 and 12?months postoperatively, patients graded their goal attainment on a scale of 1 (not at all) to 5 (100?% attainment). Goal attainment was compared with anatomical outcome, symptoms, quality of life, and satisfaction scores. Nonparametric tests and the log-rank test were used to determine statistical significance (p?<?0.05).

Results

A total of 176 goals were selected. The first goal in 37 women (57?%) was improving prolapse symptoms, in 15 (23?%) urinary symptoms, in 7 (11?%) appearance, activity, and self-image, in 2 (3.1?%) bowel symptoms, and in 2 (3.1?%) sexual function. At 3 and 12?months postoperatively, goal achievement for prolapse symptoms was 96.1 and 93.6?%, for urinary symptoms 75.6 and 70.0?%, and for appearance, activity, and self-image 90.5 and 94.7?%, respectively. The effect of anatomical outcome, mesh use, or the presence of mesh erosion on goal attainment could not be demonstrated. Women who achieved their first goal had significantly better symptoms, quality of life, and satisfaction scores than women who did not.

Conclusions

Patient goal attainment after vaginal prolapse repair was high and not consistently related to objective anatomical outcome or mesh use. It persisted between 3 and 12?months postoperatively and was associated with better satisfaction, quality of life, and symptom scores.     

Long-term follow-up of laparoscopic sacrocolpopexy

Introduction and hypothesis

This study evaluates the long-term results of laparoscopic sacrocolpopexy. In a prior publication, we demonstrated that laparoscopic sacrocolpopexy is a safe method with excellent anatomical results and low recurrence rates after a 12-month follow-up. This study now evaluates the long-term objectives and subjective outcomes of laparoscopic sacrocolpopexy after 5 years (mean).

Methods

From 2003 to 2007, a prospective study enrolling 101 patients was conducted to evaluate laparoscopic sacrocolpopexy as a treatment for pelvic organ prolapse. The long-term results were assessed postoperatively after 5 years by gynecological examinations, including the Pelvic Organ Prolapse Quantification (POP-Q) system and quality of life assessments using validated questionnaires.

Results

A total of 68 patients received a full clinical follow-up exam between July and September 2011, and 17 patients were assessed by questionnaires only. Altogether, six anatomical recurrences in the anterior, four in the posterior, and one in the apical compartment were found during the 5 years after surgery; 83.8 % of patients had no prolapse in any compartment or stage 0 prolapse according to the International Continence Society (ICS) classification. The total reoperation rate was 3.5 %. Two mesh erosions into the bladder occurred, though no vaginal erosion occurred. The preoperative quality of life index improved from 5.6 to 9.1 (12 months) and 8.3 (60 months) postoperatively, resulting in a subjective cure rate of 95.3 %.

Conclusions

Laparoscopic sacrocolpopexy has demonstrated excellent anatomical and functional long-term results. With the ongoing debate about the complications of vaginal mesh surgery, laparoscopic sacrocolpopexy should be considered a favorable treatment option for patients with pelvic organ prolapse.     

Four-defect repair in women with symptomatic anterior compartment prolapse: a large cohort study

Introduction and hypothesis

We aimed to collect long-term follow-up data and report on both objective and subjective outcome, including morbidity, reinterventions, and sexual function following four-defect repair (FDR) as surgical correction of symptomatic anterior vaginal wall prolapse with or without stress urinary incontinence (SUI).

Methods

Consecutive patients who underwent FDR between 1999 and 2005 were included in this study. We performed a retrospective analysis to evaluate anatomical and functional outcome by reviewing medical charts and sending validated questionnaires (Urogenital Distress Inventory and Defecatory Distress Inventory) to all patients. We also sent a self-developed, nonvalidated questionnaire to assess sexual function and inform the patient about reinterventions for pelvic floor dysfunction.

Results

Two hundred and twenty-nine (60 %) of the 381 patients who underwent FDR participated. At a median follow-up of 40 months (range 5–88), 21 % of patients reported bothersome prolapse symptoms, and 11 % reported bothersome SUI. Temporary postoperative urinary retention occurred in 23 %. During follow-up, posterior vaginal wall prolapse was observed in 14 % of patients. Overall surgical reintervention rates were 15 % and 4 % for (all types of) pelvic organ prolapse and SUI, respectively; dyspareunia was reported by 30 %.

Conclusions

Functional cure rates of FDR as surgical treatment for anterior vaginal wall prolapse with or without SUI are satisfying. Nevertheless, given the negative side effects of FDR (urinary retention, high reintervention rate for posterior vaginal wall prolapse, high risk of sexual dysfunction), we question the superiority of FDR over standard anterior colporrhaphy in patients with anterior vaginal wall prolapse only.     

RCT of vaginal extraperitoneal uterosacral ligament suspension (VEULS) with anterior mesh versus sacrocolpopexy: 4-year outcome

Introduction and hypothesis

This study assessed the safety and efficacy of vaginal extraperitoneal uterosacral ligament suspension (VEULS) with anterior overlay mesh versus sacrocolpopexy (SCP) for posthysterectomy vault prolapse.

Methods

This was a multicenter randomized trial of women with posthysterectomy vault prolapse stage >2 according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Primary outcome was a composite of no vaginal bulge symptoms, no anatomical recurrence in the anterior or apical compartment at or beyond the hymenal ring, and no surgical retreatment for prolapse 12 months postsurgery. Secondary outcomes were peri- and postoperative complications, changes in prolapse, and urogenital and sexual symptoms at 12, 24, and 48 months based on the Pelvic Floor Distress Inventory (PFDI)-20.

Results

Between 2006 and 2011, 82 eligible women were randomized: 39 received VEULS and 43 received SCP. Primary composite outcome at 12 months for success was 41% for VEULS and 65% for SCP [odds ratio (OR 2.68, p?=?0.03)]. Perioperative complications were more common in the SCP group. C-point was higher for SCP (?6.0 VEULS vs ?8.0 SCP, p?=?0.005) and total vaginal length (TVL) was longer for SCP (8.0 VEULS vs 9.0 SCP, p?=?0.05). Cumulative mesh exposure rate at 4 years was similar between the uterosacral [4/39 (10.3%)] and sacrocolpopexy [4/43 (9.3%)] groups, bearing in mind that not all patients were examined at 4 years. Subjective outcomes derived from three domains of the PFDI-20 were similar at 12, 24, 48 months. Postoperative Pelvic Organ Prolapse Distress Inventory (POPDI) score improved similarly for both groups at all timepoints, with the minimally important difference of at least 21 reached for both groups.

Conclusions

Composite outcome of success was better for SCP at 12 months, but subjective outcomes for prolapse at all timepoints over 4 years for VEULS and SCP were not significantly different.

     

Sacrospinous ligament fixation for hysteropexy: does concomitant anterior and posterior fixation improve surgical outcome?

Introduction and hypothesis

Uterine preservation in uterine prolapse is an option for young patients. We hypothesized that sacrospinous hysteropexy (SSH) with anchorage to both the anterior and posterior cervix (SSH-ap) would have a better outcome than SSH with anchorage to the posterior cervix only (SSH-p).

Methods

This was a retrospective study including 75 patients who underwent SSH at Chang Gung Memorial Hospital between March 2008 and August 2013. Five were excluded due to incomplete data. Of the remaining 70 patients, 35 underwent SSH-p between March 2008 and June 2011, and 35 underwent SSH-ap between June 2010 and August 2013. The primary outcome was the objective anatomical result, and a successful outcome was considered anatomical correction (POP-Q stage 1 or less) of anterior and apical prolapse. Subjective outcome was evaluated using the POPDI-6 questionnaire, and a patient response of “No or mild abdominal organ falling out sensation” together with “No or mild heaviness” was considered to indicate a successful outcome. Anterior fornix and cervical diameter measurements were included. The secondary outcome was quality of life according to the UDI-6, IIQ-7, POPDI-6, and PISQ-12 questionnaires. The 3-year outcome was used for comparison.

Results

The subjective overall cure rates were significantly different between the SSH-p and SSH-ap groups (74.3% and 94.3%, respectively; p = 0.023). However, the objective overall cure rates were not significantly different (74.3% and 82.9%, respectively).

Conclusion

Anchorage of the anterior cervix and vaginal wall together with the usual posterior anchorage yield better subjective outcomes and apical suspension at 3 years after surgery than anchorage of the posterior cervix and vaginal wall only. The cervix position affected the subjective outcome. Concurrent trachelectomy did not affect the outcome.

     

Single-incision apical and posterior mesh repair: 1-year prospective outcomes

Introduction and hypothesis

The objective of this study was to assess the safety and efficacy of the Elevate Apical and Posterior single-incision mesh system (SIMS) with IntePro Lite for pelvic organ prolapse repair.

Methods

This prospective multicenter study included 139 women with ≥ stage II posterior vaginal prolapse and/or apical descent who underwent placement of type I polypropylene mesh through a single transvaginal incision with no external needle passes. Primary endpoint was the percent of patients with posterior and/or apical stage ≤ I (“cure”) at follow-up. Secondary endpoints included, but were not limited to, rate of mesh extrusion and disease-specific quality of life outcomes.

Results

At 12?months, objective posterior wall and apical cure rates were 92.5 and 89.2?%, respectively, with an extrusion rate of 6.5?%.

Conclusions

The SIMS appears to be effective and safe in treating patients with posterior vaginal and/or apical prolapse. The risks and benefits of transvaginal synthetic mesh insertion should be considered.     

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study

Introduction and hypothesis

To compare the efficacy and safety of the Elevate? anterior and posterior prolapse repair system and traditional vaginal native tissue repair in the treatment of stage 2 or higher pelvic organ prolapse.

Methods

A cohort study was conducted between January 2010 and July 2012. Patients who underwent transvaginal pelvic reconstruction surgery for prolapse were recruited. The primary outcome was anatomical success 1 year after surgery. The secondary outcome included changes in the quality of life and surgical complications. Recurrence of prolapse was defined as stage 2 or higher prolapse based upon the pelvic organ prolapse qQuantification system.

Results

Two hundred and one patients (100 in the Elevate? repair group and 101 in the traditional repair group) were recruited and analyzed. The anatomical success rate of the anterior compartment was significantly higher in the Elevate? repair group than in the traditional repair group (98 % vs 87 %, p?=?0.006), but not for the apical (99 % vs. 6 %, p?=?0.317) or posterior (100 % vs 97 %, p?=?0.367) compartments after a median 12 months of follow-up. Both groups showed significant improvements in the quality of life after surgery with no statistical difference. Mesh-related complications included extrusion (3 %) and the need for revision of the vaginal wound (1 %). Those in the mesh repair group had a longer hospital stay (p?=?0.04), operative time (p?<?0.001), and greater estimated blood loss (p?=?0.05). Other complications were comparable with no statistical difference.

Conclusions

The Elevate? prolapse repair system had a better 1-year anatomical cure rate of the anterior compartment than traditional repair, with slightly increased morbidity.     

SIS graft for anterior vaginal wall prolapse repair—a case-controlled study

The purpose of this study was to assess the effect on quality of life and prolapse severity of traditional anterior repair compared to anterior repair with a small intestine submucosa (SIS) graft. This report was designed as a case-control study. The sample of this study consisted of 14 women who underwent traditional anterior repair and 14 women who underwent anterior repair with SIS graft (SG) at a London teaching hospital. All women were assessed preoperatively and at 6 and 24 months postoperatively using a validated prolapse quality of life questionnaire and pelvic organ quantification system (POP-Q). Quality-of-life outcomes included the following: (1) General health perception, (2) Prolapse impact, (3) Role limitations, (4) Physical limitations, (5) Social limitations, (6) Personal relationships, (7) Emotions, (8) Sleep/Energy, and (9) Severity measures. The pelvic organ quantification measurement measured nine specific points relating to the anterior and posterior wall of the vagina, vaginal apex, genital hiatus (GH) and perineal body (PB). At 6-month follow-up, the SG repair group showed significant improvement in all quality-of-life parameters measured. In comparison to traditional repair, it was significantly better in improving role limitations, physical limitations and emotions. Both operations significantly improved prolapse quality-of-life severity measures. SG repair improved all POP-Q measurements significantly, except total vaginal length (TVL), whereas traditional repair improved some measurements (AA, midline point of anterior vaginal wall 3 cm proximal to the external urethral meatus; BA, most distal dependant position of the anterior vaginal wall from the vaginal vault or anterior fornix to AA; C, most distal/dependant edge of cervix or vault; AP, point on midline posterior vaginal wall 3 cm proximal to hymenal ring; BP, most distal/dependant point on the posterior vaginal wall from vault or posterior fornix to AP) but not others (location of posterior fornix (D), TVL, GH and PB). At 2-year follow-up, there was no significant difference between the two groups in terms of quality-of-life outcomes or prolapse severity measurements. Surgery for vaginal prolapse results in marked improvement in quality of life and prolapse severity. The greater improvement seen initially in the SG anterior group was not seen at 2-year follow-up.     

The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: a randomized controlled trial

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.     

Pregnancy and delivery after anterior vaginal mesh replacement: a case presentation

A 36-year-old para 2 woman with Pelvic Organ Prolapse Quantification (POP-Q) stage III anterior prolapse and stress urinary incontinence (SUI) was treated using Polypropylene monofilament anterior vaginal mesh kit. She conceived 3 months after mesh replacement. During pregnancy and after delivery, patient satisfaction was achieved in terms of symptom relief, and surgeon satisfaction was obtained in terms of anatomical results. Three years after cesarean section, she had no incontinence, and on exam, POP-Q score was Ba ?2 cm. No mesh complication was noted, and no sexual dysfunction was declared. In summary, vaginal mesh kits can be used satisfactorily for patients with anterior prolapse and SUI who want to be pregnant.     

An ambispective observational study in the safety and efficacy of posterior colporrhaphy with composite Vicryl-Prolene mesh

There is increasing evidence to show that the use of surgical meshes reduces recurrence rates of hernia repair and anterior vaginal wall prolapse. The aim of this study was to determine the safety and efficacy of posterior colporrhaphy with mesh in patients with posterior vaginal prolapse. An ambispective observational study involving 90 patients was conducted with retrospective chart review and prospective subjective and objective assessments at the end of a 1-year study period. Apart from 2 of 90 (2.2%) minor hematoma incidents, there was no other major perioperative morbidity. Prevalence of common prolapse complaints of vaginal lump sensation, constipation, defecation difficulty and dyspareunia all improved significantly postoperatively (p<0.001). Surgical correction was achieved in 27 of 31 (83.9%) at 6 months and beyond. There was no mesh infection but minor vaginal mesh protrusion was found in 7 of 90 (7.8%) patients at 6–12 weeks and 4 of 31 (12.9%) patients at 6 months and beyond. All these were treated easily with trimming without the need of mesh removal. We conclude that posterior colporrhaphy with mesh is effective in treating posterior vaginal prolapse in short term.Editorial Comment: This study reflects the authors experience in using a Vicryl-Prolene mesh, Vypro II, for treatment of rectocele in 90 patients. No serious operative or postoperative complications occurred. The most common minor complication was vaginal mesh protrusion, with a 9 of the 90 being found with this problem; all but 1 of these were resolved with a simple clinic procedure. In a group of 31 patients followed for at least 6 months, the authors note a 16% recurrence rate of rectocele. In a questionnaire given after the surgeries, comparing pre-op and post-op symptoms, 63–79% of the respondents felt improved, depending on the symptom. The authors feel that vaginal colporrhaphy with Vicryl-Prolene mesh will prove to be more efficacious than the existing popular approaches, including site-specific defect repair. Clearly, randomized controlled studies with longer follow-up comparing this method with other colporrhaphy techniques will be needed to validate this assumptionAn erratum to this article can be found at     

A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)

The aim of this study was to develop the short form of a condition-specific, reliable, validated and self-administered instrument to evaluate sexual function in women with pelvic organ prolapse and/or urinary incontinence. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire –12 (PISQ-12) was developed from the data of 99 of 182 women surveyed to create the long form (PISQ-31). An additional 46 patients were recruited for further validation. All subsets regression analysis identified 12 items likely to predict PISQ-31 scores. Short form scores underwent correlation analysis with long form, Incontinence Impact Questionnaire – 7 (IIQ-7), Sexual History Form –12 (SHF-12) and Symptom Questionnaire (SQ) scores. Test–retest reliability was checked with a subset of 20 patients. All subsets regression analysis with R>0.92 identified 12 items that predicted PISQ-31 scores. Short form scores were highly correlated with long form scores (R=0.75–0.95). Correlations of the PISQ-12 with SHF-12 (R=–0.66 and –0.68) and IIQ-7 (R=–0.38 and –0.54) scores were similar to correlation of the PISQ-31 with these other measures. Reliability was moderate to high, with weighted values from 0.56 to 0.93. PISQ-12 scores were lower in patients with low sexual function as measured on the SHF-12 (P <0.001), and lower in women with depression as measured on the SQ (P <0.001). The PISQ-12 is a validated and reliable short form that evaluates sexual function in women with urinary incontinence and/or pelvic organ prolapse and predicts PISQ-31 scores. It is able to distinguish women with poor sexual function as measured on the SHF-12.Editorial Comment: For decades, clinicians and researchers have described treatment success in our field as resolution of either anatomic defects or of urinary of fecal leakage. We have all had patients with perfect anatomic support after a prolapse operation who were unhappy because of problems with pain, leakage, defecation or sexual function. Yet, considering these and other quality of life issues as part of the definition of treatment success is a recent development. The emphasis on the importance of assessing various quality of life indicators is snow-balling, yet our efforts to do so have been hampered by the absence of good, easy to administrate, reliable and valid tools. The short form of the PISQ is an eagerly awaited tool that fills this void. From a research prospective, information derived from responses to this questionnaire will allow us to understand the effect of various treatments on sexual function, arguably one of the most important and least investigated domains of quality of life. When completed by patients in a clinical setting, the PISQ-12 provides a template for clinicians to discuss sexuality with patients, and to suggest appropriate interventions. In developing the long and short forms of this instrument, the authors have set a high standard for others developing quality of life instruments to strive for.Study supported by NCRR-GCRC Grant # M01 RR00997Presented at American Urogynecologic Society annual meeting in Hilton Head, South Carolina, USA, 2000An erratum to this article can be found at     

Does vaginal reconstructive surgery with or without vaginal hysterectomy or trachelectomy improve sexual well being? A prospective follow-up study

Objective: To compare sexual well being in women with pelvic organ prolapse before and after vaginal reconstructive surgery. Methods: Sixty-seven women, mean age 61 (36–85) years, who underwent vaginal reconstructive surgery, were asked to complete detailed questionnaires before and after surgery. In addition, they underwent a physical examination using the Pelvic Organ Prolapse Quantification (POPQ), before surgery and at follow-up. Results: Mean duration of follow-up was 14.4 months (6.6–27.6 months). The overall satisfaction with the operation was high with a mean of 7.5 on a visual analogue scale from 0 to 10. There was a significant improvement of dyspareunia after vaginal reconstructive surgery. The ability to have intercourse, the satisfaction with intercourse as well as the frequency of intercourse also improved although not significantly. Urine loss during intercourse improved significantly. Conclusion: Vaginal reconstructive surgery for pelvic organ prolapse has a positive effect on the sexual well being of the afflicted women.     

腹腔镜下阴道残端腹壁悬吊术联合阴道前后壁修补术治疗重度子宫脱垂的疗效观察

目的:探讨腹腔镜下阴道残端腹壁悬吊术联合阴道前后壁修补术治疗重度子宫脱垂的临床效果.方法:回顾分析2017年12月至2019年12月63例重度子宫脱垂(Ⅲ度)患者的手术资料,其中30例行阴道前后壁修补术(A组),33例行腹腔镜下阴道残端腹壁悬吊术联合阴道前后壁修补术(B组).对比分析两组手术指标、不同时点阴道残端水平、...     

A randomized controlled trial comparing anatomical and functional outcome between vaginal colposuspension and transvaginal mesh

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.     

Self-retaining support implant: an anchorless system for the treatment of pelvic organ prolapse—2-year follow-up

Introduction and hypothesis

The search for an improved vaginal mesh prompted the development of a new anchorless implant. The objective was to report on outcome after 2 years of a technique using a self-retaining support (SRS) implant.

Methods

Patients with anterior vaginal wall prolapse, with/without apical prolapse, were recruited. Participants underwent surgical repair using the SRS device. Demographic data, pre-surgical Pelvic Organ Prolapse Quantification (POP-Q) scoring, quality of life (QoL) questionnaires (Pelvic Floor Distress Inventory Short Form 20 [PFDI-20], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire 12 [PISQ-12]), and surgical data were collected. Patients were followed at 2 weeks, 2, 6, 12, and 24 months after surgery. Objective anatomical success was defined using the NIH criteria.

Results

Twenty women were recruited for the study with an average age of 62.1 years and an average parity of 4.0 deliveries. Average BMI was 28. Pre-operative mean POP-Q measurements were Aa =1.40 (?1 to 3) cm, Ba = 2.3 (?1 to 6) cm and C = 0.4 (?7 to 6) cm. Surgical time averaged 31.2 min. Estimated blood loss averaged 165 ml. No intra-operative complications were observed. One case (5%) of frame erosion was documented 8 months after surgery. At 2 years’ follow-up, mean POP-Q measurements were: Aa = ?2.95 (?3 to ?2) cm, Ba = ?2.85 (?3 to ?2) cm, and C point ?6.90 (?10 to ?3) cm. Seventeen (85%) patients had stage 0 and 3 patients (15%) had stage 1. No mesh erosions or chronic pelvic pain were documented at follow-up. The total PFDI score at follow-up was decreased by 92.8 points (p < 0.0001).

Conclusions

At 2 years’ follow-up, the SRS implant was found to be safe, showing no intra-operative or immediate post-operative complications. All women presented with POP-Q measurements of the anterior and apical compartment at normal value (Ba ≤ ?2 cm) and statistically significant subjective improvement.