Uterine Prolapse [keywords]
- Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 10-years' outcomes from the randomized EMMY trial. [JOURNAL ARTICLE]
- Am J Obstet Gynecol 2016 Jul 5.
Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled trials reported outcomes in terms of health related quality of life, clinical outcomes, efficacy and cost effectiveness after 1, 2 and 5 years of follow-up.The purpose of this study was to compare clinical outcome and health related quality of life 10-years after uterine artery embolization or hysterectomy in the treatment of heavy menstrual bleeding caused by uterine fibroids in a randomized controlled trial.Twenty- eight Dutch hospitals recruited patients with symptomatic uterine fibroids who were eligible for hysterectomy. Patients were 1:1 randomly assigned to uterine artery embolization or hysterectomy. The outcomes assessed at 10 years post-intervention were re-intervention rates, health related quality of life and patient satisfaction which were obtained through validated questionnaires. Study outcomes were analyzed according to original treatment assignment (intention to treat).177 patients were randomized between 2002 and 2004. Eventually 81 uterine artery embolization and 75 hysterectomy patients underwent the allocated treatment shortly after randomization. The remaining patients withdrew from the trial. The 10 years questionnaire was mailed when the last included patient had been treated 10 years earlier. The mean duration of follow up was 133 months (SD: 8.58) accompanied by a mean age of 57 years (SD:4.53). Questionnaires were received from 131/156 patients (84%). 10 years after treatment 5 patients underwent secondary hysterectomy resulting in a total of 28/81 (35%) (24/77 (31%) after successful uterine artery embolization). Secondary hysterectomies were performed for persisting complaints in all cases but one (1 for prolapse). After the initial treatment health related quality of life improved significantly. After 10 years generic health related quality of life remained stable, without differences between both groups. The urogenital distress inventory and the defecation distress inventory showed a decrease in both groups, probably related to increasing age, without significant differences between study arms. Satisfaction in both groups remained comparable. The majority of patients declared to be (very) satisfied about the received treatment, i.e. in 78% of the uterine artery embolizationgroup versus 87% in the hysterectomy group.In about two-third of uterine artery embolization treated patients with symptomatic uterine fibroids a hysterectomy can be avoided. Health related quality of life 10 years after uterine artery embolization or hysterectomy remained comparably stable. Uterine artery embolization is a well-documented less invasive alternative to hysterectomy for symptomatic uterine fibroids on which eligible patients should be counseled.
- Expression of VEGF isoforms and their receptors in uterine myomas. [Journal Article]
- Ginekol Pol 2016; 87(3):166-77.
The aim of the study was to determine the expression of VEGF (vascular endothelial growth factor) isoforms and their receptors in uterine myomas.The study included 40 women with myomas of reproductive age and 40 perimenopausal women (the study group). Myometrial samples (the control group) were taken from 10 women undergoing hysterectomy for ovarian tumors and 10 older women undergoing hysterectomy for uterine prolapse.A significantly increased expression of VEGF-A has been found in myomas, both small and large, in the younger women, which may by a sign of increased angiogenesis and intensive tumor growth. In perimenopausal women, the increase of VEGF expression was observed only in the endothelium and vascular smooth muscle.An important conclusion of this study is that angiogenesis is independent of myoma size, which may suggest intensive tumor growth and the related increased angiogenesis. High expression of VEGF-A and VEGF-R1 receptors in large myomas can probably cause malignant transformation and more extensive growth, regardless of patient age.
- Corrections to Report of a Trial of Burch Colposuspension. [Comment, Letter]
- N Engl J Med 2016 Jun 9; 374(23):2295.
- Laparoscopic wrap round mesh sacrohysteropexy for the management of apical prolapse. [JOURNAL ARTICLE]
- Int Urogynecol J 2016 Jun 1.
Interest in uterine-conserving surgery for apical prolapse is growing. Laparoscopic sacrohysteropexy is one of the conservative surgical options, although different surgical approaches have been described. We report medium-term outcome data using a bifurcated mesh implant, employing 'wrap round' uterine attachment.All procedures undertaken at our unit were reviewed. Study inclusion was contingent on the collection of baseline and 3-month anatomical and symptomatic outcome data. Medium-term follow-up data were collected by telephone review. Anatomical outcome was reported using the Pelvic Organ Prolapse Quantification scale. Symptom prevalence and treatment response were assessed using validated instruments including the Patient Global Impression of Improvement scale (PGI-I), and the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI) and Vaginal Symptoms (ICIQ-VS) questionnaires. Patient satisfaction was reported using Kaplan-Meier survival analysis.Data were available for 110 patients. Of 80 patients providing PGI-I data at 3 months, 75 (94 %) described their prolapse symptoms as 'much better' or 'very much better'. Anatomical success in the apical compartment was 98 %. ICIQ-UI and ICIQ-VS responses demonstrated significant improvement. Despite a concurrent vaginal repair in only 11 % of patients, satisfaction at a mean follow-up of 2.6 years was 96 %. Repeat surgery for vaginal wall prolapse was required in only 5 % of patients. No safety concerns or graft complications were recorded.This surgical variant of laparoscopic sacrohysteropexy is safe and highly effective. These data also cast doubt on the need for correction of modest vaginal wall prolapse at the time of surgery, and imply that apical prolapse may play a dominant role in the generation of symptoms.
- Efficacy and pregnancy outcomes of laparoscopic single sheet mesh sacrohysteropexy. [JOURNAL ARTICLE]
- Neurourol Urodyn 2016 May 25.
To evaluate outcomes following laparoscopic single sheet mesh sacrohysteropexy for the management of uterine prolapse.One hundred and fifty-nine women underwent the procedure between August 2010 and August 2014. One hundred and forty-four patients completed the follow up assessment. At each visit, the prolapse symptoms were assessed using the prolapse quality-of-life (P-QOL) questionnaire and objectively with the use of the Pelvic Organ Prolapse Quantification (POPQ) score. The subjective outcomes were also evaluated with the use of the Patient Global Impression of Improvement (PGII) questionnaires. Perioperative complications and further surgery for prolapse were evaluated. Women who conceived following the procedure were evaluated for pregnancy outcomes and prolapse recurrence.Pre-operatively, 85% (135/159) had uterine prolapse ≥ stage 2. Postoperatively, 95.1% (137/144) of women had anatomical success rate defined as stage 0 uterine descent. Eighty-two percent (118/144) of women reported cure of prolapse symptoms and feeling "much better" or "very much better" on postoperative PGII assessment. Eight women (5%) became pregnant following the laparoscopic sacrohysteropexy- seven had full term pregnancies and one had a miscarriage. Six out of the seven (86%) had stage 0 apical prolapse and PGII of "much better" at 6 months postpartum. One patient had symptomatic prolapse recurrence and underwent perineorrhaphy at 3 years.Laparoscopic single sheet mesh sacrohysteropexy is associated with subjective and objective improvement in prolapse symptoms and QoL that is maintained up to 48 months. Laparoscopic sacrohysteropexy can be offered to women desiring future fertility; however, further research is needed to advise on best surgical approach in women of childbearing age. Neurourol. Urodynam. © 2016 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc.
- Uterine prolapse in a primigravid woman. [Journal Article]
- Obstet Gynecol Sci 2016 May; 59(3):241-4.
Uterine prolapse during pregnancy is an uncommon condition. It can cause preterm labor, spontaneous abortion, fetal demise, maternal urinary complication, maternal sepsis and death. We report the case of uterine prolapse in a 32-year-old healthy primigravid woman. She had no risk factors associated with uterine prolapse. She was conservatively treated, resulting in a successful vaginal delivery. This report is a very rare case of uterine prolapse in a young healthy primigravid woman, resulting in a successful vaginal delivery.
- Transvaginal uterosacral ligament hysteropexy: a retrospective feasibility study. [JOURNAL ARTICLE]
- Int Urogynecol J 2016 May 19.
Uterine-sparing procedures could be attractive in patients concerned about preservation of fertility and change in corporeal image and sexuality. Transvaginal uterosacral hysteropexy can provide an alternative mesh-free technique for uterine suspension. This study aimed to evaluate the feasibility of transvaginal uterine suspension to uterosacral ligaments in terms of operative data, complications, midterm efficacy, and patient satisfaction.This retrospective study analyzed the first 20 cases of transvaginal hysteropexy through bilateral high uterosacral ligaments (modified Shull technique) performed in our Institution.Mean follow-up was 33.2 months. The procedure was performed in 84 ± 19 min ,and blood loss was 228 ± 139 ml. Three mild complications (15 %) were observed. Recurrence [Pelvic Organ Prolapse Quantification system (POP-Q) stage ≥ II was observed in five patients (25 %), and three of them (15 %) required reintervention. Mean Patient Global Impression of Improvement score was "much improved." Two woman (40 %) who had not fulfilled their childbearing desire obtained a pregnancy. Both underwent elective caesarean section at term.Transvaginal uterosacral hysteropexy appears a feasible mesh-free technique for apical support. This procedure can be indicated in women with the desire of preserving fertility or who prefer a uterine-sparing surgical option.