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Graft interposition colpocleisis, perineorrhaphy, and tension-free sling for pelvic organ prolapse and stress urinary incontinence in elderly patients.
J Minim Invasive Gynecol. 2007 Nov-Dec; 14(6):740-5.JM

Abstract

STUDY OBJECTIVE

We sought to describe the outcome of combined colpocleisis, perineorrhaphy, and tension-free sling procedure for advanced uterovaginal prolapse and stress urinary incontinence in patients who are elderly and medically compromised.

DESIGN

Prospective analysis.

SETTING

University hospital.

PATIENTS

Thirty-nine women were enrolled. Median age of patients was 82 years (76-94 years).

INTERVENTIONS

All patients had advanced uterovaginal prolapse with perineal relaxation and incontinence and each wore a large pessary.

MEASUREMENTS AND MAIN RESULTS

Median estimated blood loss was 42 mL (range 10-65 mL), median operating time was 58 minutes (range 45-76 minutes), and median hospital stay was 8 hours (range 0-3 days). Thirty procedures were accomplished without general anesthesia. Le Fort colpocleisis was reinforced with excessive mesh strips from the sling by placing mesh between anterior and posterior vaginal walls at the time of closure. No intraoperative complications occurred and none had postoperative voiding difficulty or significant discomfort. One patient required hospitalization for cardiac arrhythmias and 3 others for observation purposes only. Median follow-up has been 24 months. Follow-up physical examinations were performed for postoperative evaluation. One patient required reoperation for minor posterior compartment prolapse and another has started to show some apical prolapse again. Neither patient had a perineorrhaphy at the time of initial procedure. Two patients required some graft excision as a result of exposure from the side without any loss of support or discomfort. In all, 37 patients (37 of 39) are extremely pleased with the prolapse repair and 35 patients (35 of 39) report significant improvement of stress incontinence.

CONCLUSION

Concomitant severe pelvic organ relaxation and stress urinary incontinence can be surgically treated safely and rapidly using a tension-free sling and colpocleisis with perineorrhaphy under local anesthesia and sedation, thereby eliminating potential risks of general anesthesia and invasive surgery. A novel technique of graft interposition colpocleisis has been used.

Authors+Show Affiliations

University of Nebraska Medical Center, Omaha, NE 68198-3255, USA. nagarwala@unmc.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

17980336

Citation

Agarwala, Neena, et al. "Graft Interposition Colpocleisis, Perineorrhaphy, and Tension-free Sling for Pelvic Organ Prolapse and Stress Urinary Incontinence in Elderly Patients." Journal of Minimally Invasive Gynecology, vol. 14, no. 6, 2007, pp. 740-5.
Agarwala N, Hasiak N, Shade M. Graft interposition colpocleisis, perineorrhaphy, and tension-free sling for pelvic organ prolapse and stress urinary incontinence in elderly patients. J Minim Invasive Gynecol. 2007;14(6):740-5.
Agarwala, N., Hasiak, N., & Shade, M. (2007). Graft interposition colpocleisis, perineorrhaphy, and tension-free sling for pelvic organ prolapse and stress urinary incontinence in elderly patients. Journal of Minimally Invasive Gynecology, 14(6), 740-5.
Agarwala N, Hasiak N, Shade M. Graft Interposition Colpocleisis, Perineorrhaphy, and Tension-free Sling for Pelvic Organ Prolapse and Stress Urinary Incontinence in Elderly Patients. J Minim Invasive Gynecol. 2007 Nov-Dec;14(6):740-5. PubMed PMID: 17980336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Graft interposition colpocleisis, perineorrhaphy, and tension-free sling for pelvic organ prolapse and stress urinary incontinence in elderly patients. AU - Agarwala,Neena, AU - Hasiak,Nancye, AU - Shade,Marcia, PY - 2007/04/17/received PY - 2007/06/04/revised PY - 2007/06/09/accepted PY - 2007/11/6/pubmed PY - 2007/12/19/medline PY - 2007/11/6/entrez SP - 740 EP - 5 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 14 IS - 6 N2 - STUDY OBJECTIVE: We sought to describe the outcome of combined colpocleisis, perineorrhaphy, and tension-free sling procedure for advanced uterovaginal prolapse and stress urinary incontinence in patients who are elderly and medically compromised. DESIGN: Prospective analysis. SETTING: University hospital. PATIENTS: Thirty-nine women were enrolled. Median age of patients was 82 years (76-94 years). INTERVENTIONS: All patients had advanced uterovaginal prolapse with perineal relaxation and incontinence and each wore a large pessary. MEASUREMENTS AND MAIN RESULTS: Median estimated blood loss was 42 mL (range 10-65 mL), median operating time was 58 minutes (range 45-76 minutes), and median hospital stay was 8 hours (range 0-3 days). Thirty procedures were accomplished without general anesthesia. Le Fort colpocleisis was reinforced with excessive mesh strips from the sling by placing mesh between anterior and posterior vaginal walls at the time of closure. No intraoperative complications occurred and none had postoperative voiding difficulty or significant discomfort. One patient required hospitalization for cardiac arrhythmias and 3 others for observation purposes only. Median follow-up has been 24 months. Follow-up physical examinations were performed for postoperative evaluation. One patient required reoperation for minor posterior compartment prolapse and another has started to show some apical prolapse again. Neither patient had a perineorrhaphy at the time of initial procedure. Two patients required some graft excision as a result of exposure from the side without any loss of support or discomfort. In all, 37 patients (37 of 39) are extremely pleased with the prolapse repair and 35 patients (35 of 39) report significant improvement of stress incontinence. CONCLUSION: Concomitant severe pelvic organ relaxation and stress urinary incontinence can be surgically treated safely and rapidly using a tension-free sling and colpocleisis with perineorrhaphy under local anesthesia and sedation, thereby eliminating potential risks of general anesthesia and invasive surgery. A novel technique of graft interposition colpocleisis has been used. SN - 1553-4650 UR - https://www.unboundmedicine.com/medline/citation/17980336/Graft_interposition_colpocleisis_perineorrhaphy_and_tension_free_sling_for_pelvic_organ_prolapse_and_stress_urinary_incontinence_in_elderly_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(07)00257-9 DB - PRIME DP - Unbound Medicine ER -