Introduction and hypothesis
The aim of this study was to determine the reoperation rate for sling placement or revision in patients who had primary continence procedures based on prolapse reduction ...stress testing (RST) prior to laparoscopic sacral colpoperineopexy (LSCP).
Methods
This was a retrospective cohort study of women who had RST prior to LSCP for symptomatic pelvic organ prolapse. Patients with positive test (Pos RST) had a concomitant midurethral sling procedure and those with negative test (Neg RST) did not. Variables were compared with either Student’s
t
test or Fisher’s exact test.
Results
In Neg RST group (
n
= 70), the rate of surgery for de novo urodynamic stress incontinence was 18.6%. In Pos RST group (
n
= 82), the rate of sling revision for bladder outlet obstruction was 7.3%. Overall, 88% of patients did not require a second surgery.
Conclusions
The use of RST to recommend concomitant continence procedures during LSCP results in a single surgery for the majority of our patients.
The purpose of this study was to evaluate the association of constipation symptoms and anal incontinence with vaginal wall and pelvic organ descent in a general gynecologic population.
In this ...multicenter, cross-sectional study, 1004 women attending routine gynecologic healthcare underwent pelvic organ prolapse quantification (POPQ) measurements, and were surveyed regarding anal incontinence, digitation, <2 bowel movements (BMs)/week, and >25% frequency of: straining, hard/lumpy stools, and incomplete emptying. Constipation scores reflected the sum of positive responses. Associations between POPQ measurements (Ba, C, Bp, gh+pb), constipation scores, and anal incontinence were evaluated using multivariable regression.
Of 119 women with Bp ≥−1.00, 47% reported no constipation symptoms. Hard/lumpy stools (26%), incomplete emptying (24%), and straining (24%) were more prevalent; fewer women reported <2 BMs/week (15%) or digitation (7%). Constipation scores were weakly correlated with Bp, gh+pb (both r < .1,
P < .02). Women reporting ≥2 symptoms had greater gh+pb measurements than women reporting 0 or 1 symptom (
P
=
.03). Women with anal incontinence had greater gh+pb and gh values than women without anal incontinence (
P < .01). POPQ measurements were regressed separately onto (1) total constipation scores, (2) dichotomized scores, and (3) individual symptoms, with BMI, age, number of vaginal deliveries (NVD), weight of largest vaginal delivery (WLVD), race, hysterectomy, study site, and income included as covariates. Total constipation scores and dichotomized scores were nonsignificant in all models. With regard to individual symptoms, straining at stool was significant in the models for Ba and gh+pb, with greater Ba and gh+pb measurements among strainers relative to nonstrainers.
Most associations between bowel symptoms and vaginal or pelvic organ descent were weak. After controlling for important covariates, straining at stool remained associated with anterior vaginal wall and perineal descent.
Background: Total Prolift® is a pelvic floor repair system that is performed transvaginally and can be carried out with or without the uterus in situ.
Aim: To compare surgical outcomes following ...total Prolift colpopexy (TPC) and total Prolift hysteropexy (TPH).
Methods: This was a retrospective cohort study of women that underwent TPC (n = 65) or TPH (n = 24). Outcomes were compared between groups using Student’s t‐test, ANCOVA and Fisher’s exact tests (P ≤ 0.05).
Results: There were no significant differences between TPC and TPH for all peri‐operative variables. Patients were followed 6–12 months after surgery. Post‐operatively, TPC patients had significantly higher pelvic organ prolapse – quantification (POP‐Q) point C measurements (P = 0.05); however, all other POP‐Q measurements were similar, including POP‐Q apical stage of prolapse, with 99% in the TPC group and 92% in the TPH group at stage I or less. Post‐operative mesh erosion, prolapse symptoms, surgical satisfaction, sexual activity and dyspareunia rates did not significantly differ between groups.
Conclusions: This study showed that TPC and TPH have similar surgical outcomes, except for vaginal vault measurements reflected by POP‐Q point C.
Introduction and hypothesis
Laparoscopic sacral colpoperineopexy (LSCP) involves posterior graft extension to the perineum for improved posterior support. The objective of this study was to determine ...whether posterior measurements differed between those that had graft extension done abdominally (A-LSCP) or abdomino-vaginally (AV-LSCP).
Methods
This was a retrospective cohort study of patients that underwent A-LSCP (
n
= 17) and AV-LSCP (
n
= 51). Pre-, peri-, and postoperative variables were compared using Student’s
t
, Fisher’s exact, and analysis of covariance tests.
Results
Follow-up was 6 to 12 months. There were no differences between A-LSCP and AV-LSCP for any vaginal measurements or stage of prolapse (
P
> 0.05). Although not statistically different, A-LSCP patients had lower rates of mesh erosion and dyspareunia (
P
> 0.05). AV-LSCP patients had fewer prolapse symptoms (
P
= 0.01), but both groups had similar surgical satisfaction (
P
= 0.8).
Conclusions
A-LSCP and AV-LSCP had comparable effects on posterior vaginal measurements; however, mesh erosion and subjective outcomes differed between the two approaches.
Objective: Our purpose was to compare pelvic organ support in nulliparous pregnant and nonpregnant women at a single institution. Study Design: This was a case-control study. Pregnant patients and ...nonpregnant control subjects were matched according to age and race. Subjects underwent pelvic organ support evaluation by use of the pelvic organ prolapse quantification (POPQ) examination as part of routine prenatal or gynecologic care.The Pearson χ2 statistic was used for statistical analysis, with a P value of 5% set for significance. Results: A total of 21 pregnant and 21 nonpregnant nulliparous women between the ages of 18 and 29 years were included. All patients in the nonpregnant group had a POPQ stage of 0 or 1, whereas 47.6% of the pregnant subjects had POPQ stage 2 (P <.001). Individual components of the POPQ examination were compared. Significant differences were noted for points Aa and Ba, Ap and Bp, and PB and TVL. Conclusions: In nulliparous women, pregnancy is associated with increased POPQ stage compared with nonpregnant control subjects. (Am J Obstet Gynecol 2002;187:99-102.)
Up to 50% of patients are unable to void immediately after midurethral sling (MUS) procedures. The objective of this study was to present our case series of use of suprapubic tube (SPT) to assess ...voiding function after MUS procedures.
This was a retrospective cohort study of patients who underwent MUS procedures along with insertion of SPT between January 2007 and August 2010.
A total of 123 patients were identified. Among the patients who met criteria for SPT removal within 4 weeks, the mean number of days of SPT use was 6 (4.6) days. One major complication involved a urinoma after SPT removal.
The use of SPT after MUS procedures is practical. In our cohort of patients, it took up to 1 week for voiding function to return to normal.
Purpose
The occurrence of stress urinary incontinence and pelvic organ prolapse can often coexist resulting in the need for concomitant surgical procedures to treat both conditions. The purpose of ...this study was to determine if tension-free vaginal tape (TVT
®
) at the time of laparoscopic sacral colpoperineopexy (LSCP) had an effect on distal anterior vaginal wall support.
Methods
This was a retrospective cohort study of patients that had LSCP between January 2005 and December 2007 (
n
= 121). These patients were divided according to those with (
n
= 63) and without TVT (
n
= 58) at the time of LSCP. Pre- and postoperative information was compared between groups using Student’s
t
tests, ANCOVA, and Fisher’s exact tests (
P
≤ 0.05).
Results
Preoperatively, there were no significant differences between groups for all demographic and anatomic variables (
P
> 0.05). Patients were followed-up until 12 months after surgery. Patients with and without TVT had similar postoperative anterior vaginal wall measurements (points Aa and Ba) and stage of prolapse (
P
> 0.05). There were also no differences between groups with regard to recurrent prolapse symptoms or surgical satisfaction (
P
> 0.05).
Conclusions
Tension-free vaginal tape at the time of LSCP did not improve postoperative distal anterior vaginal support.
Micro-Abstract This cross-sectional observational study measured symptoms of pelvic floor disorders (PFDs) and their effect on quality of life in 25 women returning for postoperative care at least 6 ...months after total abdominal hysterectomy for endometrial cancer. Pelvic floor symptoms and impact were assessed using the short-form versions of 2 validated quality of life questionnaires: the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7). Pelvic symptoms were reported at a much higher rate (84%) than in the general public, with a mean “bother” score in the mild range: 26.4 ± 64.5. Although the degree of bother most commonly was mild, patients should be counseled that these embarrassing symptoms are possible and potentially screened for after surgical intervention.
Financial and time constraints have limited graduating residents' operative experience, making the use of models a necessary adjunct to a complete surgical curriculum. Models are useful tools to ...teaching surgical skills outside the operating room. They can be very realistic and complex, or they can be simple and economical. Models are developed to represent the anatomic arrangements seen in human patients, and to reproduce the biomechanical tasks necessary to complete a surgical case. Bench model laboratories are well-received by trainees and steepen the learning curve in the operating room.
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