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Severe pelvic organ prolapse. Is there a long-term cure?

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Abstract

Introduction and hypothesis

Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications.

Methods

This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was “composite surgical success” defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence.

Results

The median follow-up was 7 years (range 3–10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit.

Conclusions

The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.

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Abbreviations

POP:

Pelvic organ prolapse

SCP:

Sacrocolpopexy

VALS:

Vaginally assisted laparoscopic sacrocolpopexy

POP-Q:

Pelvic Organ Prolapse quantification system

ICS:

International Continence Society

UDS:

Multichannel urodynamics

PFDI-20:

Pelvic Floor Distress Inventory

PFIQ-7:

Pelvic Floor Impact Questionnaire

ICIQ-FLUTS:

International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms

PGI-I:

Patient Global Impression of Improvement questionnaire

MUS:

Midurethral sling

UIQ-7:

Urinary Impact Questionnaire-7

POPIQ-7:

Pelvic Organ Prolapse Impact Questionnaire-7

CRAIQ-7:

Colorectal-Anal Impact Questionnaire-7

SUI:

Stress urinary incontinence

UUI:

Urge urinary incontinence

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Authors and Affiliations

  1. First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, “Alexandra” Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece

    Stavros Athanasiou, Dimitrios Zacharakis, Athanasios Protopapas, Eleni Pitsouni, Dimitrios Loutradis & Themos Grigoriadis

Authors
  1. Stavros Athanasiou
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  2. Dimitrios Zacharakis
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  3. Athanasios Protopapas
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  4. Eleni Pitsouni
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  6. Themos Grigoriadis
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Correspondence to Dimitrios Zacharakis.

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Athanasiou, S., Zacharakis, D., Protopapas, A. et al. Severe pelvic organ prolapse. Is there a long-term cure?. Int Urogynecol J 30, 1697–1703 (2019). https://doi.org/10.1007/s00192-018-3775-3

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