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[Comparison outcomes of three surgical procedures in treatment of severe pelvic organ prolapse and analysis of risk factors for genital prolapse recurrence].
Zhonghua Fu Chan Ke Za Zhi. 2011 Feb; 46(2):94-100.ZF

Abstract

OBJECTIVE

To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital (MPFR) in treatment of severe pelvic organ prolapse (POP) by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures: traditional total vaginal hysterectomy with anterior-posterior colporrhaphy (TVH-APC) and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy (TVH-LC-SSLF-VBR-EP).

METHODS

Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients (group A) were treated by MPFR with polypropylene mesh application, 58 (group B) were treated by TVH-APC, and 29 patients (group C) were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied.

RESULTS

(1) No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery (P > 0.05). (2) Cost hospitalization was (11 448 ± 3049) Yuan in group A, which was significantly higher than (7262 ± 1607) Yuan in group B and (7140 ± 1817) Yuan in group C (P < 0.05). (3) The length of vaginal cuff of (7.5 ± 1.4) cm in group A and (5.6 ± 1.1) cm in group C were significantly longer than (7.1 ± 0.6) cm in group B (P < 0.05). The width of vaginal cuff of (4.3 ± 0.3) cm in group A was larger than (3.4 ± 0.3) cm in group B and (3.3 ± 0.4) cm in group C (P < 0.05). (4) The recurrence rate at 12 months after surgery was 12.8% (11/86) in group A, which was similar with 17.2% (5/29) in group C (P > 0.05) and significantly less than 36.2% (21/58) in group B (P < 0.05). The rate of active sexual life of 16.3% (14/86) in group A was significantly higher than 1.7% (1/58) in group B and 0 in group C (P < 0.05). The index of life quality improvement at 12 months after surgery was 48 ± 12 in group A, which was no less than 53 ± 16 in group C (P > 0.05) and higher than 27 ± 9 in group B (P < 0.05). (5) Mesh rejection was observed in 6 patients in group A within 3 months after surgery, while the posterior vaginal wall was exclusively involved. No difference was found in urinary retention or urinary incontinence among three groups (P > 0.05). (6) The severe degree of POP, type of surgical procedure (TVT-APC), anterior compartment defect of pelvic floor, and early days of performing pelvic floor reconstruction surgeries were high risk factors for POP recurrence (P < 0.05).

CONCLUSIONS

MPFR has a better curative effect and lower recurrence rate on patients with POP. It can help patients regain integrity of anatomical structure and functions of pelvic floor. TVH-LC-SSLF-VBR-EP is also effective.

Links

Publisher Full Text

Authors+Show Affiliations

Hu CD
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Chen YS
No affiliation info available
Yi XF
No affiliation info available
Ding JX
No affiliation info available
Feng WW
No affiliation info available
Yao LQ
No affiliation info available
Huang J
No affiliation info available
Zhang Y
No affiliation info available
Hu WG
No affiliation info available
Zhu ZL
No affiliation info available
Hua KQ
No affiliation info available

MeSH

AdultAgedAged, 80 and overFemaleFollow-Up StudiesGynecologic Surgical ProceduresHumansHysterectomy, VaginalLigamentsMiddle AgedPelvic FloorPelvic Organ ProlapsePolypropylenesPostoperative ComplicationsQuality of LifeRandomized Controlled Trials as TopicSecondary PreventionSeverity of Illness IndexSurgical MeshTreatment OutcomeUrinary IncontinenceUterine ProlapseUterusVagina

Pub Type(s)

Comparative Study
English Abstract
Journal Article
Research Support, Non-U.S. Gov't

Language

chi

PubMed ID

21426765

Citation

Hu, Chang-dong, et al. "[Comparison Outcomes of Three Surgical Procedures in Treatment of Severe Pelvic Organ Prolapse and Analysis of Risk Factors for Genital Prolapse Recurrence]." Zhonghua Fu Chan Ke Za Zhi, vol. 46, no. 2, 2011, pp. 94-100.
Hu CD, Chen YS, Yi XF, et al. [Comparison outcomes of three surgical procedures in treatment of severe pelvic organ prolapse and analysis of risk factors for genital prolapse recurrence]. Zhonghua Fu Chan Ke Za Zhi. 2011;46(2):94-100.
Hu, C. D., Chen, Y. S., Yi, X. F., Ding, J. X., Feng, W. W., Yao, L. Q., Huang, J., Zhang, Y., Hu, W. G., Zhu, Z. L., & Hua, K. Q. (2011). [Comparison outcomes of three surgical procedures in treatment of severe pelvic organ prolapse and analysis of risk factors for genital prolapse recurrence]. Zhonghua Fu Chan Ke Za Zhi, 46(2), 94-100.
Hu CD, et al. [Comparison Outcomes of Three Surgical Procedures in Treatment of Severe Pelvic Organ Prolapse and Analysis of Risk Factors for Genital Prolapse Recurrence]. Zhonghua Fu Chan Ke Za Zhi. 2011;46(2):94-100. PubMed PMID: 21426765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Comparison outcomes of three surgical procedures in treatment of severe pelvic organ prolapse and analysis of risk factors for genital prolapse recurrence]. AU - Hu,Chang-dong, AU - Chen,Yi-song, AU - Yi,Xiao-fang, AU - Ding,Jing-xin, AU - Feng,Wei-wei, AU - Yao,Liang-qing, AU - Huang,Jian, AU - Zhang,Ying, AU - Hu,Wei-guo, AU - Zhu,Zhi-ling, AU - Hua,Ke-qin, PY - 2011/3/24/entrez PY - 2011/3/24/pubmed PY - 2012/1/20/medline SP - 94 EP - 100 JF - Zhonghua fu chan ke za zhi JO - Zhonghua Fu Chan Ke Za Zhi VL - 46 IS - 2 N2 - OBJECTIVE: To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital (MPFR) in treatment of severe pelvic organ prolapse (POP) by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures: traditional total vaginal hysterectomy with anterior-posterior colporrhaphy (TVH-APC) and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy (TVH-LC-SSLF-VBR-EP). METHODS: Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients (group A) were treated by MPFR with polypropylene mesh application, 58 (group B) were treated by TVH-APC, and 29 patients (group C) were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied. RESULTS: (1) No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery (P > 0.05). (2) Cost hospitalization was (11 448 ± 3049) Yuan in group A, which was significantly higher than (7262 ± 1607) Yuan in group B and (7140 ± 1817) Yuan in group C (P < 0.05). (3) The length of vaginal cuff of (7.5 ± 1.4) cm in group A and (5.6 ± 1.1) cm in group C were significantly longer than (7.1 ± 0.6) cm in group B (P < 0.05). The width of vaginal cuff of (4.3 ± 0.3) cm in group A was larger than (3.4 ± 0.3) cm in group B and (3.3 ± 0.4) cm in group C (P < 0.05). (4) The recurrence rate at 12 months after surgery was 12.8% (11/86) in group A, which was similar with 17.2% (5/29) in group C (P > 0.05) and significantly less than 36.2% (21/58) in group B (P < 0.05). The rate of active sexual life of 16.3% (14/86) in group A was significantly higher than 1.7% (1/58) in group B and 0 in group C (P < 0.05). The index of life quality improvement at 12 months after surgery was 48 ± 12 in group A, which was no less than 53 ± 16 in group C (P > 0.05) and higher than 27 ± 9 in group B (P < 0.05). (5) Mesh rejection was observed in 6 patients in group A within 3 months after surgery, while the posterior vaginal wall was exclusively involved. No difference was found in urinary retention or urinary incontinence among three groups (P > 0.05). (6) The severe degree of POP, type of surgical procedure (TVT-APC), anterior compartment defect of pelvic floor, and early days of performing pelvic floor reconstruction surgeries were high risk factors for POP recurrence (P < 0.05). CONCLUSIONS: MPFR has a better curative effect and lower recurrence rate on patients with POP. It can help patients regain integrity of anatomical structure and functions of pelvic floor. TVH-LC-SSLF-VBR-EP is also effective. SN - 0529-567X UR - https://www.unboundmedicine.com/medline/citation/21426765/[Comparison_outcomes_of_three_surgical_procedures_in_treatment_of_severe_pelvic_organ_prolapse_and_analysis_of_risk_factors_for_genital_prolapse_recurrence]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&amp;issn=0529-567X&amp;year=2011&amp;vol=46&amp;issue=2&amp;fpage=94 DB - PRIME DP - Unbound Medicine ER -