Skip to main content

Advertisement

SpringerLink
Log in

Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

We compared vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior polyvinylidene fluoride mesh versus abdominal sacrocolpopexy for the treatment of primary apical prolapse in postmenopausal women.

Methods

A prospective, randomized, single-blind, parallel study [Registro Brasileiro de Ensaios Clinicos (REBEC) trial register code RBR-7t6rg2] was performed from October 2015 to May 2016. A total of 71 postmenopausal women with advanced pelvic organ prolapse (POP) and undergoing surgery were randomized to the abdominal sacrocolpopexy (ASC) (n = 36) or the vaginal sacrospinous fixation with anterior mesh (VSF-AM) (n = 35) groups. Pelvic Organ Prolapse Quantification (POP-Q) system classification was performed for objective assessment, and the International Consultation on Incontinence Questionnaire–Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) questionnaires were filled out for subjective evaluation by women before and 1 year after surgery. All procedures were performed by a single surgeon.

Results

Both groups had improvement in almost POP-Q points (except for vaginal length in the VSF-AM group) and all ICIQ scores. The ASC group had a longer operative time (129 versus 117 min, p = 0.0038) and duration for return to activities (103 versus 57 days, p < .05). Four women (11%) in the VSF-AM group were reoperated versus none from the ASC group (p = .05).

Conclusions

Although the study did not achieve the planned recruitment, after 12 months of follow-up, ASC did not differ from VSF-AM in objective and subjective scores (ICIQ questionnaires; POP-Q measurements). Recovery time was longer after open abdominal surgery.

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.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–501.

    Article  CAS  Google Scholar 

  2. Friedman T, Eslick GD, Dietz HP. Risk factors for prolapse recurrence: systematic review and meta-analysis. Int Urogynecol J. 2018;29(1):13–21.

    Article  Google Scholar 

  3. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10:CD012376.

    PubMed  Google Scholar 

  4. de Castro EB, Juliato CR, Piedemonte LA, dos Santos Júnior LC. Impact of sacrospinous colpopexy associated with anterior colporrhaphy for the treatment of dome prolapse on all three vaginal compartments. Rev Bras Ginecol Obstet. 2016;38(7):356–64.

    Article  Google Scholar 

  5. Sze EH, Karram MM. Transvaginal repair of vault prolapse: a review. Obstet Gynecol. 1997;89(3):466–75.

    Article  CAS  Google Scholar 

  6. Morgan DM, Rogers MA, Huebner M, Wei JT, DeLancey JO. Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse: a systematic review. Obstet Gynecol. 2007;109(6):1424–33.

    Article  Google Scholar 

  7. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;30(4):CD004014.

    Google Scholar 

  8. Lo TS, Tan YL, Khanuengkitkong S, Dass AK. Surgical outcomes of anterior transobturato rmesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women. Int Urogynecol J. 2013;24(5):809–16.

    Article  Google Scholar 

  9. Juliato CR, Mazzer MF, Diniz JM, Farias CH, de Castro EB. Sacrospinous ligament suspension with transobturator mesh versus sacral colpopexy for genital prolapse. Clinics. 2016;71(9):487–93.

    Article  Google Scholar 

  10. To V, Hengrasmee P, Lam A, Luscombe G, Lawless A, Lam J. Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal elevate mesh. Int Urogynecol J. 2017;28(12):1825–32.

    Article  Google Scholar 

  11. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. PLoS Med. 2010;357:e1000251.

    Article  Google Scholar 

  12. de Castro EB, Brito LGO, Giraldo PC, Teatin Juliato CR. Does the vaginal flora modify when a synthetic mesh is used for genital prolapse repair in postmenopausal women? A pilot, randomized controlled study. Female Pelvic Med Reconstr Surg. 2018. https://doi.org/10.1097/SPV.0000000000000539.

    Article  Google Scholar 

  13. Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.

    Article  CAS  Google Scholar 

  14. Price N, Jackson SR, Avery K, Brookes ST, Abrams P. Development and psychometric evaluation of the ISIQ vaginal symptoms questionnaire: the ICIQ-VS. BJOG. 2006;113(6):700–12.

    Article  CAS  Google Scholar 

  15. Tamanini JT, Almeida FG, Girotti ME, Riccetto CL, Palma PC, Rios LA. The Portuguese validation of the international consultation on incontinence questionnaire-vaginal symptoms (ICIQ-VS) for Brazilian women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(10):1385–91.

    Article  Google Scholar 

  16. Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.

    Article  Google Scholar 

  17. Tamanini JT, Dambros M, D’Ancona CA, Palma PC, Rodrigues Netto N Jr. Validation of the “international consultation on incontinence questionnaire-short form” (ICIQ-SF) for Portuguese. Rev Saude Publica. 2004;38(3):438–44.

    Article  Google Scholar 

  18. International Consultation on Incontinence Modular Questionnaire. ICIQ-overactive bladder: ICIQ-OAB [Internet]. Bristol Urological Institute [cited 2009 Out 16]. Available from: <http://www.iciq.net/ICIQ.OABmodule.html>.

  19. Pereira SB, Thiel RRC, Riccetto C, Silva JM, Pereira LC, Herrmann V, et al. Validation of the international consultation on incontinence questionnaire overactive bladder (ICIQ-OAB) for Portuguese. Rev Bras Ginecol Obstet. 2010;32(6):273–8.

    Article  Google Scholar 

  20. Benson J, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996;175:1418–22.

    Article  CAS  Google Scholar 

  21. Juliato CR, Santos Júnior LC, Haddad JM, Castro RA, Lima M, Castro EB. Mesh surgery for anterior vaginal wall prolapse: a meta-analysis. Rev Bras Ginecol Obstet. 2016;38(7):356–64.

    Article  Google Scholar 

  22. Tan YL, Lo TS, Khanuengkitkong S, Krishna Dass A. Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women. Taiwan J Obstet Gynecol. 2014;53(3):348–54.

    Article  Google Scholar 

  23. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190:20–6.

    Article  Google Scholar 

  24. Baessler K, Maher C. Pelvic organ prolapse surgery and bladder function. Int Urogynecol J. 2013;24(11):1843–52.

    Article  Google Scholar 

  25. Balsamo R, Illiano E, Zucchi A, Natale F, Carbone A, Sio M, et al. Sacrocolpopexy with polyvinylidene fluoride mesh for pelvic organ prolpase: mid term comparative outcomes with polypropylene mesh. Eur J Obstet Gynecol Reprod Biol. 2018;220:74–8.

    Article  CAS  Google Scholar 

  26. Barski D, Arndt C, Gerullis H, Yang J, Boros M, Otto T, et al. Transvaginal PVDF-mesh for cystocele repair: a cohort study. Int J Surg. 2017;39:249–54.

    Article  Google Scholar 

  27. Eisenberg VH, Callewaert G, Sindhwani N, Housmans S, van Schoubroeck D, Lowenstein L, et al. Ultrasound visualization of sacrocolpopexy polyvinylidene fluoride meshes containing paramagnetic Fe particles compared with polypropylene mesh. Int Urogynecol J. 2018. https://doi.org/10.1007/s00192-018-3728-x.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank all patients who participated in this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil

    Edilson Benedito de Castro, Luiz Gustavo O. Brito & Cassia Raquel T. Juliato

Authors
  1. Edilson Benedito de Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luiz Gustavo O. Brito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cassia Raquel T. Juliato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cassia Raquel T. Juliato.

Ethics declarations

Conflicts of interest

None. FEG Textiltechnik donated the synthetic mesh (Dynamesh®) but had no influence regarding the study design and data collection/analysis.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Castro, E.B., Brito, L.G.O. & Juliato, C.R.T. Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study. Int Urogynecol J 31, 365–372 (2020). https://doi.org/10.1007/s00192-019-03948-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-03948-3

Keywords

Search

Navigation