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Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome.
Dis Colon Rectum. 2016 Oct; 59(10):968-74.DC

Abstract

BACKGROUND

Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques.

OBJECTIVE

This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor.

DESIGN

This was a prospective, observational cohort study.

SETTINGS

The study was conducted in a tertiary care setting.

PATIENTS

All sexually active patients undergoing robot-assisted sacrocolporectopexy at our institution between 2012 and 2014 were included.

INTERVENTION

Robot-assisted sacrocolporectopexy was the study intervention.

MAIN OUTCOME MEASURES

Preoperative and postoperative (12 months) questionnaires using the Urinary Distress Inventory, Pescatori Incontinence Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and Pelvic Floor Impact Questionnaire were completed. In addition Wexner and Vaizey incontinence scores and the Wexner constipation score were recorded postoperatively.

RESULTS

Fifty-one patients underwent robot-assisted sacrocolporectopexy (median follow-up, 12.5 months). The simplified Pelvic Organ Prolapse Quantification improved significantly (p < 0.0005) for all 4 of the anatomic landmarks. Both median fecal (preoperative and postoperative Pescatori 4 vs 3, p = 0.002) and urinary incontinence scores (Urinary Distress Inventory, 27.8 vs 22.2; p < 0.0005) improved significantly at 12 months. Postoperatively median Wexner (3) and Vaizey incontinence (6) and Wexner Constipation (7) scores were noted. A positive effect on sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score 31.8 vs 35.9; p = 0.002) and quality of life for each compartment (p < 0.0005) was observed. One patient (2%) developed mesh erosion. No multicompartment recurrences were detected.

LIMITATIONS

This was a observational study with a limited follow-up, no control group, and no preoperatively validated constipation score.

CONCLUSIONS

Robot-assisted sacrocolporectopexy is a safe and effective technique for multicompartment prolapse in terms of functional outcome, quality of life, and sexual function.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

van Iersel JJ
1 Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands 2 Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands 3 Department of Gynecology, Meander Medical Center, Amersfoort, the Netherlands.
de Witte CJ
No affiliation info available
Verheijen PM
No affiliation info available
Broeders IA
No affiliation info available
Lenters E
No affiliation info available
Consten EC
No affiliation info available
Schraffordt Koops SE
No affiliation info available

MeSH

Digestive System Surgical ProceduresFemaleHumansMaleMiddle AgedNetherlandsPelvic FloorPelvic Organ ProlapsePostoperative ComplicationsProspective StudiesQuality of LifePlastic Surgery ProceduresRecovery of FunctionRectal ProlapseRectumRobotic Surgical ProceduresSexual BehaviorSurgical MeshSurveys and QuestionnairesTreatment Outcome

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27602928

Citation

van Iersel, Jan J., et al. "Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: a Prospective Cohort Study Evaluating Functional and Sexual Outcome." Diseases of the Colon and Rectum, vol. 59, no. 10, 2016, pp. 968-74.
van Iersel JJ, de Witte CJ, Verheijen PM, et al. Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome. Dis Colon Rectum. 2016;59(10):968-74.
van Iersel, J. J., de Witte, C. J., Verheijen, P. M., Broeders, I. A., Lenters, E., Consten, E. C., & Schraffordt Koops, S. E. (2016). Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome. Diseases of the Colon and Rectum, 59(10), 968-74. https://doi.org/10.1097/DCR.0000000000000669
van Iersel JJ, et al. Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: a Prospective Cohort Study Evaluating Functional and Sexual Outcome. Dis Colon Rectum. 2016;59(10):968-74. PubMed PMID: 27602928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome. AU - van Iersel,Jan J, AU - de Witte,Chris J, AU - Verheijen,Paul M, AU - Broeders,Ivo A M J, AU - Lenters,Egbert, AU - Consten,Esther C J, AU - Schraffordt Koops,Steven E, PY - 2016/9/8/entrez PY - 2016/9/8/pubmed PY - 2017/4/8/medline SP - 968 EP - 74 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 59 IS - 10 N2 - BACKGROUND: Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques. OBJECTIVE: This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor. DESIGN: This was a prospective, observational cohort study. SETTINGS: The study was conducted in a tertiary care setting. PATIENTS: All sexually active patients undergoing robot-assisted sacrocolporectopexy at our institution between 2012 and 2014 were included. INTERVENTION: Robot-assisted sacrocolporectopexy was the study intervention. MAIN OUTCOME MEASURES: Preoperative and postoperative (12 months) questionnaires using the Urinary Distress Inventory, Pescatori Incontinence Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and Pelvic Floor Impact Questionnaire were completed. In addition Wexner and Vaizey incontinence scores and the Wexner constipation score were recorded postoperatively. RESULTS: Fifty-one patients underwent robot-assisted sacrocolporectopexy (median follow-up, 12.5 months). The simplified Pelvic Organ Prolapse Quantification improved significantly (p < 0.0005) for all 4 of the anatomic landmarks. Both median fecal (preoperative and postoperative Pescatori 4 vs 3, p = 0.002) and urinary incontinence scores (Urinary Distress Inventory, 27.8 vs 22.2; p < 0.0005) improved significantly at 12 months. Postoperatively median Wexner (3) and Vaizey incontinence (6) and Wexner Constipation (7) scores were noted. A positive effect on sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score 31.8 vs 35.9; p = 0.002) and quality of life for each compartment (p < 0.0005) was observed. One patient (2%) developed mesh erosion. No multicompartment recurrences were detected. LIMITATIONS: This was a observational study with a limited follow-up, no control group, and no preoperatively validated constipation score. CONCLUSIONS: Robot-assisted sacrocolporectopexy is a safe and effective technique for multicompartment prolapse in terms of functional outcome, quality of life, and sexual function. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/27602928/Robot_Assisted_Sacrocolporectopexy_for_Multicompartment_Prolapse_of_the_Pelvic_Floor:_A_Prospective_Cohort_Study_Evaluating_Functional_and_Sexual_Outcome_ DB - PRIME DP - Unbound Medicine ER -