Skip to main content

Advertisement

SpringerLink
Log in

Management of pelvic organ prolapse in French-speaking Belgium: the EPILAPSUS study

  • Original Article
  • Published:
Gynecological Surgery

Abstract

Management of pelvic organ prolapse (POP) may be conducted by abdominal (laparotomy or laparoscopy) or vaginal approach, with or without mesh repair, mainly depending on the surgeon’s expertise. The aim of this study was to determine the trends in surgical management of POP in French-speaking Belgium. The GGOLFB Gynecologic surgery working group initiated a registry of the patients surgically treated for POP from eight centers in French-speaking Belgium. In this prospective multicentric study, conducted between June 2010 and January 2013, we analyzed the clinical and surgical data, the postoperative results at 4 months, the intra and postoperative complications, and reoperation rates. A total of 394 patients were registered in the database. Surgical POP repair was performed vaginally in 83.5 % of the patients, with prosthetic material in 70.2 % of the cases. In case of abdominal procedure, surgery was mainly (93.5 %) performed by laparoscopic sacrocolpopexy. The most common intraoperative complications were severe bleeding (2.3 %), bladder (2 %), and bowel (0.2 %) injuries. At 4 months, the total reoperation rate was 11.3 %. The anatomical success rate (POP-Q < 2) was 87.5 % with 2.1 % of reoperation for recurrence. Mesh exposure was observed in 9.8 % of the cases. Surgery for stress urinary incontinence (SUI) was reported in 5.1 % of the patients. The analysis of the current urogynecological practice in French-speaking Belgium shows that vaginal mesh repair is the preferential approach used for management of POP in the participating centers. The creation of a national database will help to evaluate the global trends in prolapse surgery and the potential impact of the FDA notification in the management of POP in Belgium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

POP:

Pelvic organ prolapse

SUI:

Stress urinary incontinence

FDA:

Food and Drug Administration

SD:

Standard deviation

References

  1. Boyles SH, Weber AM, Meyn L (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188(1):108–115. doi:10.1067/mob.2003.101

    Article  PubMed  Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506. doi:10.1016/S0029-7844(97)00058-6

    Article  CAS  PubMed  Google Scholar 

  3. Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW (2011) Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 205(3):230 e231–230 e235. doi:10.1016/j.ajog.2011.03.046

    Article  Google Scholar 

  4. Flam F, Soderberg MW (2009) New concepts and trends in vaginal prolapse surgery. Acta Obstet Gynecol Scand 88(3):251–254. doi:10.1080/00016340902730342

    Article  PubMed  Google Scholar 

  5. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014. doi:10.1002/14651858.CD004014.pub5

    PubMed  Google Scholar 

  6. Gadonneix P, Ercoli A, Scambia G, Villet R (2005) The use of laparoscopic sacrocolpopexy in the management of pelvic organ prolapse. Curr Opin Obstet Gynecol 17(4):376–380

    Article  PubMed  Google Scholar 

  7. Jonsson Funk M, Edenfield AL, Pate V, Visco AG, Weidner AC, Wu JM (2013) Trends in use of surgical mesh for pelvic organ prolapse. Am J Obstet Gynecol 208(1):79 e71–79 e77. doi:10.1016/j.ajog.2012.11.008

    Google Scholar 

  8. Jia X, Glazener C, Mowatt G, MacLennan G, Bain C, Fraser C, Burr J (2008) Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG: Int J Obstet Gynaecol 115(11):1350–1361. doi:10.1111/j.1471-0528.2008.01845.x

    Article  CAS  Google Scholar 

  9. Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471. doi:10.1007/s00192-007-0465-y

    Article  CAS  PubMed  Google Scholar 

  10. Feiner B, Jelovsek JE, Maher C (2009) Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG: Int J Obstet Gynaecol 116(1):15–24. doi:10.1111/j.1471-0528.2008.02023.x

    Article  CAS  Google Scholar 

  11. (2011) FDA Safety Communication: UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm262435.htm

  12. Skoczylas LC, Turner LC, Wang L, Winger DG, Shepherd JP (2014) Changes in prolapse surgery trends relative to FDA notifications regarding vaginal mesh. Int Urogynecol J 25(4):471–477. doi:10.1007/s00192-013-2231-7

    Article  PubMed  Google Scholar 

  13. Walter JE, Urogynaecology C, Lovatsis D, Walter JE, Easton W, Epp A, Farrell SA, Girouard L, Gupta CK, Harvey MA, Larochelle A, Robert M, Ross S, Schachter J, Schultz JA, Wilkie DH, Society of O, Gynaecologists of C (2011) Transvaginal mesh procedures for pelvic organ prolapse. J Obstet Gynaecol Canada: JOGC = Journal d’obstetrique et gynecologie du Canada: JOGC 33(2):168–174

    Article  Google Scholar 

  14. Deffieux X, Sentilhes L, Savary D, Letouzey V, Marcelli M, Mares P, Cngof PF (2013) Indications of mesh in surgical treatment of pelvic organ prolapse by vaginal route: expert consensus from the French College of Gynecologists and Obstetricians (CNGOF). Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 42(7):628–638. doi:10.1016/j.jgyn.2013.08.018

    Article  CAS  PubMed  Google Scholar 

  15. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  CAS  PubMed  Google Scholar 

  16. Cosson M, Collinet P, Occelli B, Narducci F, Crepin G (2001) The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Eur J Obstet Gynecol Reprod Biol 95(1):73–80

    Article  CAS  PubMed  Google Scholar 

  17. Kapandji M (1967) Treatment of urogenital prolapse by colpo-isthmo-cystopexy with transverse strip and crossed, multiple layer, ligamento-peritoneal douglasorrhaphy. Ann Chir 21(5):321–328

    CAS  PubMed  Google Scholar 

  18. Dubuisson JB, Yaron M, Wenger JM, Jacob S (2008) Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients. J Minim Invasive Gynecol 15(1):49–55. doi:10.1016/j.jmig.2007.11.003

    Article  PubMed  Google Scholar 

  19. Claerhout F, Verguts J, Werbrouck E, Veldman J, Lewi P, Deprest J (2014) Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps. Int Urogynecol J 25(9):1185–1191. doi:10.1007/s00192-014-2412-z

    Article  PubMed  Google Scholar 

  20. Deprest J, Krofta L, Van der Aa F, Milani AL, Den Boon J, Claerhout F, Roovers JP (2014) The challenge of implementing laparoscopic sacrocolpopexy. Int Urogynecol J 25(9):1153–1160. doi:10.1007/s00192-014-2398-6

    Article  PubMed  Google Scholar 

  21. Maher C (2013) Anterior vaginal compartment surgery. Int Urogynecol J 24(11):1791–1802. doi:10.1007/s00192-013-2170-3

    Article  PubMed  Google Scholar 

  22. Guldberg R, Brostrom S, Hansen JK, Kaerlev L, Gradel KO, Norgard BM, Kesmodel US (2013) The Danish Urogynaecological Database: establishment, completeness and validity. Int Urogynecol J 24(6):983–990. doi:10.1007/s00192-012-1968-8

    Article  PubMed  Google Scholar 

  23. Bjelic-Radisic V, Aigmueller T, Preyer O, Ralph G, Geiss I, Muller G, Riss P, Klug P, Konrad M, Wagner G, Medl M, Umek W, Lozano P, Tamussino K, Tammaa A, Austrian Urogynecology Working G (2014) Vaginal prolapse surgery with transvaginal mesh: results of the Austrian registry. Int Urogynecol J 25(8):1047–1052. doi:10.1007/s00192-014-2333-x

    Article  CAS  PubMed  Google Scholar 

  24. Mascarenhas T, Mascarenhas-Saraiva M Jr, Ricon-Ferraz A, Nogueira P, Lopes F, Freitas A (2014) Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J. doi:10.1007/s00192-014-2480-0

  25. Barber MD, Maher C (2013) Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 24(11):1783–1790. doi:10.1007/s00192-013-2169-9

    Article  PubMed  Google Scholar 

  26. van der Ploeg JM, van der Steen A, Oude Rengerink K, van der Vaart CH, Roovers JP (2014) Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG: Int J Obstet Gynaecol 121(5):537–547. doi:10.1111/1471-0528.12509

    Article  Google Scholar 

  27. Baessler K, Maher C (2013) Pelvic organ prolapse surgery and bladder function. Int Urogynecol J 24(11):1843–1852. doi:10.1007/s00192-013-2175-y

    Article  PubMed  Google Scholar 

  28. Schierlitz L, Dwyer PL, Rosamilia A, De Souza A, Murray C, Thomas E, Hiscock R, Achtari C (2014) Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial. Int Urogynecol J 25(1):33–40. doi:10.1007/s00192-013-2150-7

    Article  PubMed  Google Scholar 

  29. Collinet P, Belot F, Debodinance P, Ha Duc E, Lucot JP, Cosson M (2006) Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors. Int Urogynecol J Pelvic Floor Dysfunct 17(4):315–320. doi:10.1007/s00192-005-0003-8

    Article  PubMed  Google Scholar 

  30. Deffieux X, Letouzey V, Savary D, Sentilhes L, Agostini A, Mares P, Pierre F, French College of O, Gynecology (2012) Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 165(2):170–180. doi:10.1016/j.ejogrb.2012.09.001

    Article  PubMed  Google Scholar 

  31. de Tayrac R, Sentilhes L (2013) Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J 24(11):1859–1872. doi:10.1007/s00192-013-2177-9

    Article  PubMed  Google Scholar 

  32. Diwadkar GB, Barber MD, Feiner B, Maher C, Jelovsek JE (2009) Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 113(2 Pt 1):367–373. doi:10.1097/AOG.0b013e318195888d

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the following participating investigators: Jean-Louis Pestiaux and Sylvie Hollemaert, for their contribution in the registry data collection. We also thank Dr. Jean-Marc Durieux and Veronique Hougardy for their assistance on statistical analysis and data collection.

Authors’ participation in the manuscript ( from the GGOLFB gynecologic surgery working group )

L. De Landsheere: data collection, statistical analysis, manuscript writing and editing

S. Smajda: protocol/project development, manuscript writing and editing

D. Oberweis: protocol/project development, manuscript writing and editing

H. Keuller: manuscript writing and editing S. Dehon: manuscript writing and editing

M. Smets: protocol/project development, manuscript writing and editing

Pastijn: protocol/project development, manuscript writing and editing

M Nisolle: protocol/project development, manuscript writing and editing

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n 1, 4000, Liège, Belgium

    Laurent de Landsheere & Michelle Nisolle

  2. Department of Obstetrics and Gynecology, Clinique Ste-Anne St-Remi, Boulevard Graindor, n 66, 1070, Bruxelles, Belgium

    Stefan Smajda

  3. Department of Obstetrics and Gynecology, ISPPC, CHU André Vésale, route de Gozée, n 706, 6110, Montigny-le-tilleul, Belgium

    Didier Oberweis & Sylvie Dehon

  4. Department of Obstetrics and Gynecology, ISPPC, CHU de Charleroi, Boulevard Zoé Drion, n 1, 6000, Charleroi, Belgium

    Hania Keuller & Sylvie Dehon

  5. Department of Obstetrics and Gynecology, Cliniques Universitaires St-Luc, Avenue Hippocrate, n 10, 1200, Bruxelles, Belgium

    Mireille Smets

  6. Department of Obstetrics and Gynecology, CHU St-Pierre, Rue Haute, n 322, 1000, Bruxelles, Belgium

    Ann Pastijn

Authors
  1. Laurent de Landsheere
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Smajda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Didier Oberweis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hania Keuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvie Dehon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mireille Smets
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ann Pastijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michelle Nisolle
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the GGOLFB Gynecologic Surgery Working Group

Corresponding author

Correspondence to Laurent de Landsheere.

Ethics declarations

Conflicts of interest

Laurent de Landsheere, Didier Oberweis, Hania Keuller, Sylvie Dehon, Mireille Smets, Ann Pastijn, and Michelle Nisolle declare that they have no conflicts of interest. Stefan Smajda is consultant for Coloplast.

Ethical approval

This study, involving human participants, was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

GGOLFB = Groupement des Gynécologues et Obstétriciens de Langue Française.

The objective of this study was to determine the trends in surgical management of POP in French-speaking Belgium.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Landsheere, L., Smajda, S., Oberweis, D. et al. Management of pelvic organ prolapse in French-speaking Belgium: the EPILAPSUS study. Gynecol Surg 13, 165–172 (2016). https://doi.org/10.1007/s10397-016-0948-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10397-016-0948-2

Keywords

Search

Navigation