Abstract
Introduction and hypothesis
We aimed to collect long-term follow-up data and report on both objective and subjective outcome, including morbidity, reinterventions, and sexual function following four-defect repair (FDR) as surgical correction of symptomatic anterior vaginal wall prolapse with or without stress urinary incontinence (SUI).
Methods
Consecutive patients who underwent FDR between 1999 and 2005 were included in this study. We performed a retrospective analysis to evaluate anatomical and functional outcome by reviewing medical charts and sending validated questionnaires (Urogenital Distress Inventory and Defecatory Distress Inventory) to all patients. We also sent a self-developed, nonvalidated questionnaire to assess sexual function and inform the patient about reinterventions for pelvic floor dysfunction.
Results
Two hundred and twenty-nine (60 %) of the 381 patients who underwent FDR participated. At a median follow-up of 40 months (range 5–88), 21 % of patients reported bothersome prolapse symptoms, and 11 % reported bothersome SUI. Temporary postoperative urinary retention occurred in 23 %. During follow-up, posterior vaginal wall prolapse was observed in 14 % of patients. Overall surgical reintervention rates were 15 % and 4 % for (all types of) pelvic organ prolapse and SUI, respectively; dyspareunia was reported by 30 %.
Conclusions
Functional cure rates of FDR as surgical treatment for anterior vaginal wall prolapse with or without SUI are satisfying. Nevertheless, given the negative side effects of FDR (urinary retention, high reintervention rate for posterior vaginal wall prolapse, high risk of sexual dysfunction), we question the superiority of FDR over standard anterior colporrhaphy in patients with anterior vaginal wall prolapse only.
Similar content being viewed by others
Abbreviations
- POP:
-
Pelvic organ prolapse
- FDR:
-
Four-defect repair
- SUI:
-
Stress urinary incontinence
- UI:
-
Urgency incontinence
- UDI:
-
Urogenital Distress Inventory
- DDI:
-
Defecatory Distress Inventory
- DSQOL:
-
Disease-specific quality of life
- VH:
-
Vaginal hysterectomy
- SSF:
-
Sacrospinous ligament fixation
- IVS:
-
Intravaginal sling
- PVDR:
-
Paravaginal defect repair
- RCT:
-
Randomized controlled trial
References
Jelevsek JE, Maher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369:1027–38
Sand PK, Koduri SD, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ, Goldberg R (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1364
Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrpahy: A randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–306
Chmielewski L, Walters MD, Weber AM, Barber MD (2011) Reanalysis of a randomized trial of three surgical techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet and Gynecol 204: 69.e1-69.e8
Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C, Nordic Transvaginal Mesh Group (2011) Anterior Colporraphy versus transvaginal mesh for pelvic organ prolapse. NEJM 364:1826–36
Safir MH, Gousse AE, Rovner ES, Ginsberg DA, Raz S (1999) 4-defect repair of grade 4 cystocele. J Urol 161:587–594
Bruce RG, El-Galley RES, Galloway NTM (1999) Paravaginal repair in the treatment of female stress urinary incontinence and cystocele. Urol 54:647–651
Bai SW, Jeon JD, Chung KA, Kim JY, Kim SK, Park KH (2002) The effectiveness of modified six-corner suspension in patients with paravaginal defect and stress urinary incontinence. Int Urogynecol J 13:303–307
Miklos JR, Kohli N (2000) Laparoscopic paravaginal repair plus burch colposuspension: review and descriptive technique. Urology 56:64–69
Burch JC (1961) Urethrovaginal fixation to Cooper’s ligament for correction of stress incontinence, cystocele and prolapse. Am J Obstet Gynecol 81:281
Raz S, Klutke CG, Golomb J (1989) Four-corner bladder and urethral suspension for moderate cystocele. J Urol 142:712–715
Colombo M, Vitobello D, Proietti F, Milani R (2000) Randomised comparison of burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. BJOG 107:544–551
Burch JC (1968) Cooper’s ligament urethrovesical suspension for stress incontinence. Am J Obstet Gynecol 100:764
Sekine H, Kojima S, Igarashi K, Toyoshima T, Hayashi T, Shimoji Y (1999) Burch bladder neck suspension for cystocele repair: the necessity of combined vaginal procedures for severe cases. Int J Urol 6:1–6
Dmochowski RR, Zimmern PE, Ganabathu K, Sirls L, Leach GE (1997) Role of the four-corner suspension to correct stress incontinence with mild to moderate cystocele. Urology 49:35–40
Miyazaki FS, Miyazaki DW (1994) Raz four-corner suspension for severe cystocele: poor results. Int Urogynecol J 5:94–97
Zimmern P, Leach GE (1990) A prospective evaluation of four-corner bladder neck suspension for grade II/II cystocele repair. Neurourol 9:213
Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JOL, Klarskow P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–7
van der Vaart CH, de Leeuw JRJ, Roovers JPWR, Heintz APM (2003) Measuring health-related quality of life in women with urogenital dysfunction: The Urogenital Distress Inventory and Incontinence Impact Questionnaire revisited. Neurourol Urodyn 22:97–104
van Brummen JH, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH (2006) efecatory symptoms during and after the firts pregnancy: prevalences and associated factors. Int Urogynecol J 17:224–230
Raz S (1981) Modified bladder neck suspension for female stress incontinence. Urol volume 17, number 1
Golomb J, Goldwasser B, Mashiach S (1994) Raz bladder neck suspension in women younger than sixty-five years compared with elderly women: three years’ experience. Urol volume 43, number 1
Glazener CMA, Cooper K (2004) Bladder neck suspension for urinary incontinence in women. Cochrane database of systematic reviews, issue 2, art. No.: CD003636
Bosman G, Vierhout ME, Huikeshove FJ (1993) A modified Raz bladder neck suspension operation. Results of a one to three years follow-up investigation. x 72:47–49
Costantini E, Pajoncini C, Zucchi A, Lombi R, Bini V, Mearini E, Porena M (2003) Four-corner colposuspension: clinical and functional results. Int Urogynecol J 14:113–118
Ross JW, Preston M (2005) Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol 12(3):221–6
Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, Coremans G, Deprest J (2009) Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol 55(6):1459–67
Rodriquez LV, Bukkapatnam R, Shah SM, Raz S (2005) Transvaginal paravaginal repair of high-grade cystocele central and lateral defects with concomitant suburethral sling: report of early results, outcomes, and patient satisfaction with a new technique. Urol 66:57–65
Mahran MA, Herath RP, Sayed AT, Oligbo N (2011) Laparoscopic management of genital prolapse. Arch Gynecol Obstet 283:1015–1020
Acknowledgments
Conflict of interest
DR: consultant/affiliation AMS, Bard, J&J, Dynamesh.
JD: consultant/affiliation AMS, Ethicon, FEG.
Dr. J.P.W.R. Roovers is participating in clinical studies that are co-funded by an unrestricted research grant provided by American Medical Systems, Inc. (AMS).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thys, S.D., de Ridder, D., Everaerts, W. et al. Four-defect repair in women with symptomatic anterior compartment prolapse: a large cohort study. Int Urogynecol J 25, 1243–1250 (2014). https://doi.org/10.1007/s00192-014-2386-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-014-2386-x