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Uterine Prolapse [keywords]
- Hysteropexy in the treatment of uterine prolapse stage 2 or higher: a multicenter randomized controlled non-inferiority trial comparing laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy (LAVA-trial, study protocol). [JOURNAL ARTICLE]
- BMC Womens Health 2014 Sep 17; 14(1):112.
Pelvic organ prolapse is a common health problem: the lifetime risk of undergoing surgery for pelvic organ prolapse by the age of 85 years is 19%. Pelvic organ prolapse has significant negative effects on a woman's quality of life. Worldwide, vaginal hysterectomy is the leading treatment method for patients with symptomatic uterovaginal prolapse. Several studies have shown that vaginal sacrospinous hysteropexy and laparoscopic sacrohysteropexy are safe and effective alternatives in treating uterine descent. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Therefore, we conducted the LAVA trial.The LAVA trial is a randomized controlled multicenter non-inferiority trial. The study compares laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy in women with uterine prolapse stage 2 or higher. The primary outcome of this study is surgical success of the apical compartment at 1 and 5 years follow-up. Secondary outcomes are subjective improvement on urogenital symptoms and quality of life (assessed by disease-specific and general quality of life questionnaires), complications following surgery, hospital stay, post-operative recovery, sexual functioning and costs-effectiveness. Evaluation will take place pre-operatively, and 6 weeks, 6 months, 12 months and annually till 60 months after surgery. Validated questionnaires will be used.Analysis will be performed according to the intention to treat principle. Based on comparable recurrence rates of 3% and a non-inferiority margin of 10%, 62 patients are needed in each arm to prove the hypothesis with a 95% confidence interval.The LAVA trial is a randomized controlled multicenter non-inferiority trial that will provide evidence whether the efficacy of laparoscopic sacrohysteropexy is non-inferior to vaginal sacrospinous hysteropexy in women with symptomatic uterine prolapse stage 2 or higher.Trial registration: Netherlands Trial Register (NTR): NTR4029.
- Abdominal sacrohysteropexy--a conservative surgical treatment of uterine prolapse. [Journal Article]
- J Ayub Med Coll Abbottabad 2013 Jul-Dec; 25(3-4):41-3.
The traditional surgical treatment of utero-vaginal prolapse is vaginal hysterectomy. In recent years, the procedure of sacral hysteronpexy is gaining popularity. This study was conducted to determine the frequency of uterine prolapse in young women and to analyze the results of abdominal sacrohysteropexy.This descriptive case series was conducted in department of Gynaecology and obstetrics Unit-II, Liaquat University of Medical and Health Sciences form October 2008 to October 2011. All those women admitted during the study period with uterine prolapse and requiring uterine conservation surgery were included in the study. After evaluation and pre- operative assessment, abdominal sacrohysteropexy was performed. Results of surgery were analyzed in terms of duration of surgery, intra-operative and post-operative complications, need for blood transfusion during surgery and duration of hospital stay. After discharge they were followed for a period of 6 months.A total of 210 cases of uterine prolapse were admitted during the study period. Out of these, abdominal sacrohysteropexy was performed in 33 cases (15.71%). In these 33 cases, 4 (12.12%) were unmarried and 29 (87.87%) were married. In 29 married women, 10 (34.48%) were nulli-para, 12 (41.37%) were para 1 or 2 and 7 (24.13%) were para 3-5. Regarding the age of these women, 7 (21.21%) were less than 25 years, 16 (48.48%) were between 25-34 years and 10 (30.30%) were between 35-45 years. Duration of surgery was between 30-45 minutes in most of the cases (96.96%). Blood loss during surgery was < 100 ml, only in 1 case it was between 100-300 ml, where one unit of blood was transfused. Regarding postoperative complications only 1 case had wound sepsis. Most of the cases (93.93%) were discharged at 3rd or 4th postoperative day. No complaints were found during follow up period of 6 months.Abdominal sacrohysteropexy can be considered as a safe and effective treatment of uterine prolapse in young and in those women who desire to retain the uterus.
- Impact of dynamic transrectal ultrasonography on pelvic organ prolapse. [JOURNAL ARTICLE]
- J Urol 2014 Sep 11.
We hereby developed a new method to evaluate POP dynamically in supine and standing position using transrectal ultrasonography (TRUS). The aim of this study is to visualize descending and prolapsing of pelvic organs in real-time using dynamic TRUS. And, the obtained findings of dynamic TRUS were compared with intraoperative findings.A prospective analysis was carried out including 31 women with symptomatic POP. Before the surgical repair for POP, TRUS was performed by the operator separated from the surgeon, and the findings of TRUS were compared with the intraoperative findings focused on diagnosis of POP. The patients were put on the fluoroscopic tilting table for passive postural change from spine to standing position. After injection of sonographic jelly into the vaginal lumen, ultrasound probe was inserted into the rectum. As getting up the patient passively using the fluoroscopic tilting table, descent and prolapse of pelvic organs were dynamically evaluated in real-time.Cystocele, uterine prolapse, and rectocele were dynamically observed in this procedure. Morphological detail of POP, such as movement, sliding, eversion, descent, and looseness of vaginal wall and bladder wall were successfully demonstrated in most of the cases. In total, dynamic TRUS showed the high values of sensitivity (85.0%), specificity (81.1%), positive predict value (77.3%), and negative predict value (87.8%).We successfully demonstrated morphological conditions and dynamic changes of pelvic organs during passive postural change using dynamic TRUS in real-time. Dynamic TRUS can be a useful modality to visualize POP preoperatively.
- Functional outcome after pelvic floor reconstructive surgery with or without concomitant hysterectomy. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Sep 9.
When counseling patients about surgical alternatives for pelvic organ prolapse (POP) repair, numerous things have to be considered. Uterine preservation vs. hysterectomy is one relevant issue. Hysterectomy has been traditionally performed for POP, but its benefit regarding outcome has never been proven. Furthermore, a growing number of women ask for uterine preservation.In this retrospective cohort study, 384 patients who had undergone surgery for POP between 2000 and 2012 at Freiburg University Medical Center were included. Using a standardized questionnaire, further surgeries, urinary incontinence, recurrent POP, pessary use, and satisfaction with the surgical outcome were evaluated. The functional results after uterine preservation vs. concomitant hysterectomy were compared using t test.196 (51.04 %) women were available for follow-up and agreed to participate (n = 122 with hysterectomy, n = 72 with uterine-preserving surgery, respectively). After a mean follow-up time of 67 months, vaginal bulge symptoms and urinary incontinence did not differ between treatment groups. We observed higher success rates and satisfaction scores in the uterine-preserving group. Regarding satisfaction with surgery and whether the patients thought it had been successful, we observed a trend toward better results in the uterine-preserving group (mean satisfaction score: 8.45 ± 2.15 vs. 7.76 ± 2.91, range 0-10, p = 0.061; success: 91.4 vs. 81.7 %, p = 0.087).There was no difference with regard to functional outcome between patients with or without concomitant hysterectomy. Satisfaction with the operation was slightly higher after uterus preserving surgery. Therefore, uterine-preserving surgery is a valuable option unless there are contraindications.
- Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Sep 9.
This trial aimed to compare the outcomes of native vaginal tissue repair versus polypropylene mesh repair for the treatment of severe genital prolapse.This multicenter randomized trial included 184 women, with POP-Q stage 3 or 4. They were randomly assigned to undergo surgical treatment using native tissue repair (n = 90) or synthetic mesh repair (n = 94). Native tissue repair surgery was performed according to site-specific defects, including sacrospinous ligament fixation for apical defects. Mesh repair (Prolift™) was performed in accordance with manufacturer recommendations. Hysterectomy was performed in all cases of uterine prolapse. Statistical tests were used to compare between-group and within-group differences before the surgery and at 1-year follow-up. We considered cure to have occurred when the POP-Q point evaluation was equal to or less than 0 and POP-Q point C better than or equal to half the total vaginal length (TVL) after 1 year. The patients answered the Prolapse Quality-of-Life Questionnaire (PQoL) and the Sexual Quotient Female Version (QS-F) questionnaire.Both groups were homogeneous preoperatively. There were no differences between the groups in operative time, complications or pain. At 1-year follow-up, anatomical cure rates were better in the mesh group in the anterior compartment (p = 0.019). Significant improvement in PQoL scores at 1-year follow up were observed in each group; between-group comparisons of changes in PQoL scores revealed greater improvement in the mesh group.Both techniques were effective. Anatomical efficacy was superior in the mesh group regarding the anterior compartment; quality of life changes were also greater in the mesh group. Complications were significantly higher in the mesh group.
- Patient beliefs regarding hysterectomy in women seeking surgery for pelvic organ prolapse: findings in a predominantly Hispanic population. [Journal Article]
- Female Pelvic Med Reconstr Surg 2014 Sep-Oct; 20(5):267-71.
This study aimed to determine the proportion of women who opt for hysterectomy when seeking care for pelvic organ prolapse and the factors important in their decision making.One hundred twenty-four patients from July 2011 through August 2012 seeking care for pelvic organ prolapse were recruited to complete a questionnaire regarding their beliefs about uterine preservation at the time of prolapse repair, as well as the PFDI-7 and PSIQ-12. Patients completed a questionnaire before physician consultation that included demographic data, beliefs regarding the social, sexual, and emotional impact of hysterectomy, and sources of information.The women were predominantly Hispanic (77.4%), postmenopausal (65.3%), and sexually active (42.7%). Almost half of the women had a limited education level, defined as no high school degree (49.2%), and the majority of the women had an annual income of less than $25,000 (66.9%). Thirty-one percent of patients desired to retain their uterus at the time of prolapse repair when given the choice. Most patients received information from their health care provider and family members, very few from the Internet or media sources.Thirty-one percent of the largely Hispanic women with lower income in this study would choose to preserve their uterus at the time of prolapse repair, a proportion lower than what was reported from previous studies performed in white women with higher income.
- Laparoscopic Reconstructive Surgery is Superior to Vaginal Reconstruction in the Pelvic Organ Prolapse. [Journal Article]
- Int J Med Sci 2014; 11(11):1082-8.
Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse.Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ≥ 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and χ(2)-test or the Fisher exact test as appropriate.There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, p< 0.001) and the length of postoperative hospitalization (6.4 ± 2.1 vs 5.0 ± 1.9 days, p <0.001) were significantly longer in vaginal approach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p <0.001) in laparoscopic approach group.Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy.
- [Method and significance of ultrasonographic assessment of the uterine weight before pelvic floor reconstruction]. [English Abstract, Journal Article]
- Zhonghua Fu Chan Ke Za Zhi 2014 Jun; 49(6):437-40.
To investigate the accuracy of ultrasonographic assessment of the total uterine weight and the feasibility of using this method in the pelvic floor reconstruction.Firstly, 81 cases with hysterectomy due to benign uterine diseases or uterine prolapse were studied. The preoperative dimensions and gravities of corpus uteri and cervix were calculated by formulas, and were then compared with the postoperative measurements. Subsequently, 46 cases with pelvic floor reconstruction and preserved the uterus were subjected to retrospectively analysis of uterine measurement parameters.There were no statistically differences between the preoperative and postoperative diameters of corpus uteri and cervix (P > 0.05), and no statistically differences between the weight of corpus uteri and cervix estimated by the formulas [(87 ± 55), (32 ± 6) g] and the true weight [(88 ± 57), (33 ± 6) g; P > 0.05]. In 46 cases that underwent the pelvic floor reconstruction by transvaginal mesh repair and preserved the uterus, 42 cases were successful treated and the average weight of total uterus was (49 ± 13) g (95%CI: 39.90-49.88 g); the 4 relapsed cases were treated with hysterectomy and the weight of total uterus were 85.24, 82.69, 92.67 and 120.06 g which were consistent with the weights estimated by the formulas (87.36, 82.00, 90.88, 123.12 g; all P > 0.05).The uterine weight might be a significant factor for uterus preservation in pelvic floor reconstruction, while ultrasonographic assessment can accurately estimate the uterine weight preoperatively. All these raised the feasibility of assessing uterine weight preoperatively in pelvic floor reconstruction.
- [Preliminary study on clinical application of robotic sacral hysteropexy in treatment of uterine prolapse]. [English Abstract, Journal Article]
- Zhonghua Fu Chan Ke Za Zhi 2014 Jun; 49(6):428-31.
To study the clinical efficacy of robotic sacral hysteropexy in treatment of uterine prolapse.From January 2012 to December 2013, 3 patients undergoing robotic sacral hysteropexy in treatment of uterine prolapse in General Hospital of People's Liberation Army were studied retrospectively. Operation time, blood loss and postoperative recovery exhaust time and pelvic organ prolapse quantification (POP-Q) staging were evaluated.Three patients were treated by robotic sacral hysteropexy successfully. The mean operation time was 221 minutes (210-240 minutes), mean blood loss was 45 ml. One case with II degree perineal laceration patients simultaneously perineal repair, neither intra-nor post-operative complications occurred. The mean postoperative recovery exhaust time was 16 hours. At three months of follow-up, all 3 patients got satisfaction. Although one patient at the first six months of postoperation had leakage of urine when coughing, instruct exercise pelvic floor muscle function and acupuncture one month their symptoms disappear.Robotic sacral hysteropexy pave the way for an effective option in the management of uterine prolapse.
- Knowledge on uterine prolapse among married women of reproductive age in Nepal. [Journal Article]
- Int J Womens Health 2014.:771-9.
Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women's awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics.Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15-49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge.Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women.Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities.