Abstract
Introduction and hypothesis
The aim of the study was to evaluate hysterectomized and non-hysterectomized patients with prolapse and incontinence. Laparoscopic sacrohysteropexy (LSHP) and minimally invasive sacrocolpopexy (LMSCP) were done in combination with transobturator tape (TOT) and native tissue repair of the anterior and posterior vaginal compartments in patients with pelvic organ prolapse (POP) and occult, stress, or urinary incontinence (SUI). The hypothesis is that both methods are successful.
Methods
A total of 81 patients with POP were evaluated: 44 had vaginal vault prolapse (POPQ points Ba, C, and Bp were 1.2, 2.6, and 0.4, respectively) and 37 had uterine prolapse (POPQ points Ba, C, and Bp were 1.8, 1.7, and 1.3, respectively). LMSCP (which means less dissection of the vagina in its upper third and avoiding possible collision with the ureters anteriorly or the rectum posteriorly) was performed in patients with vault prolapse, whereas patients with uterine prolapse underwent LSHP. Transobturator tape (TOT) was placed in all patients to treat symptomatic and occult urinary incontinence. Systematic anterior and posterior colporrhaphy was performed in both groups.
Results
Both groups showed anatomic (p < 0.0001) and symptomatic improvement (p < 0.001–p < 0.05). Voiding was significantly improved after surgery without postoperative incontinence (p < 0.001). There was no significant difference between groups regarding duration of surgery (p = 0.06), hospital stay (p = 0.13), blood loss (0.83), Clavien-Dindo grade 3 (p = 0.87), and Clavien-Dindo grade 1–2 (p = 0.92) complications.
Conclusion
Minimally invasive LSCP or LSHP combined with TOT and native tissue repair of the anterior and posterior vaginal compartment is a successful treatment for POP.
Similar content being viewed by others
References
Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:1201–6. https://doi.org/10.23736/S0026-4784.16.04011-9.
Geynisman-Tan J, Kenton K. Surgical updates in the treatment of pelvic organ prolapse. Rambam Maimonides Med. 2017;8:e007-17. https://doi.org/10.5041/RMMJ.10294.
Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse July 2011; https://www.fda.gov/media/81123/download
Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. Int J Gynaecol Obstet. 2007;97:31–4. https://doi.org/10.1016/j.ijgo.2006.12.011.
Leone Roberti Maggiore U, Finazzi Agrò E, Soligo M, et al. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2017;28:1119–30. https://doi.org/10.1007/s00192-017-3275-x.
Jefferis H, Price N, Jackson S. Laparoscopic hysteropexy: 10 years' experience. Int Urogynecol J. 2017;28:1241–8. https://doi.org/10.1007/s00192-016-3257-4.
Meister MR, Sutcliffe S, Lowder JL. Definitions of apical vaginal support loss: a systematic review. Am J Obstet Gynecol. 2017;216(232):e1-232.e14. https://doi.org/10.1016/j.ajog.2016.09.078.
Olsen A, Smith V, Bergstrom J, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. https://doi.org/10.1016/S0029-7844(97)00058-6.
DeLancey JO. What's new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol. 2016;28:420–9. https://doi.org/10.1097/GCO.0000000000000312.
Lucot JP, Cosson M, Bader G, et al. Safety of vaginal mesh surgery versus laparoscopic mesh Sacropexy for cystocele repair: results of the prosthetic pelvic floor repair randomized controlled trial. Eur Urol. 2018;74:167–76. https://doi.org/10.1016/j.eururo.2018.01.044.
Berger MB, Kolenic GE, Fenner DE, et al. Structural, functional, and symptomatic differences between women with rectocele versus cystocele and normal support. Am J Obstet Gynecol. 2018;218:510.e1–8. https://doi.org/10.1016/j.ajog.2018.01.033.
Kaser DJ, Kinsler EL, Mackenzie TA, et al. Anatomic and functional outcomes of sacrocolpopexy with or without posterior colporrhaphy. Int Urogynecol J. 2012;23:1215–20. https://doi.org/10.1007/s00192-012-1695-1.
Chang OH, Davidson ERW, Thomas TN, et al. Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy? [ published online ahead of print, 2020 mar 7]. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-020-04268-7.
Kanter G, Jeppson PC, McGuire BL, et al. Perineorrhaphy: commonly performed yet poorly understood. A survey of surgeons. Int Urogynecol J. 2015;26:1797–801. https://doi.org/10.1007/s00192-015-2762-1.
Lowder JL. Apical vaginal support: the often forgotten piece of the puzzle. Mo Med. 2017;114:171–5.
O'Sullivan OE, Matthews CA, O'Reilly BA. Sacrocolpopexy: is there a consistent surgical technique? Int Urogynecol J. 2016;27:747–50. https://doi.org/10.1007/s00192-015-2880-9.
Cosson M, Rajabally R, Bogaert E, et al. Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures. JSLS. 2002;6:115–9.
Wattiez A, Nasir R, Al Maamari B, et al. Laparoscopic prolapse surgery: types and evidence. Curr Opin Obstet Gynecol. 2016;28:430–4. https://doi.org/10.1097/GCO.0000000000000316.
Unger CA, Paraiso MF, Jelovsek JE, et al. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211:547.e1–8. https://doi.org/10.1016/j.ajog.2014.07.054.
Matthews CA. Minimally invasive sacrocolpopexy: how to avoid short- and long-term complications. Curr Urol Rep. 2016;17:81. https://doi.org/10.1007/s11934-016-0638-7.
Jeanditgautier E, Mayeur O, Brieu M, et al. Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system. Int Urogynecol J. 2016;27:951–7. https://doi.org/10.1007/s00192-015-2917-0.
Deffieux X, Letouzey V, Savary D, et al. Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol. 2012;165:170–80. https://doi.org/10.1016/j.ejogrb.2012.09.001.
Gutman RE. Does the uterus need to be removed to correct uterovaginal prolapse? Curr Opin Obstet Gynecol. 2016;28:435–40. https://doi.org/10.1097/GCO.0000000000000307.
Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. Pelvic floor disorders network. N Engl J Med. 2012;366:2358–67. https://doi.org/10.1056/NEJMoa1111967.
Van der Ploeg JM, van der Steen A, et al. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121:537–47. https://doi.org/10.1111/1471-0528.12509.
Burkhard (Chair) FC, Bosch JLHR, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A. EAU Guidelines on urinary Incontinence, 2020.
Fusco F, Abdel-Fattah M, Chapple CR, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2017;72:567–91. https://doi.org/10.1016/j.eururo.2017.04.026.
Chartier-Kastler E, Reus C. Are slings still the gold standard for female stress urinary incontinence? Eur Urol Focus. 2019;5:315–6. https://doi.org/10.1016/j.euf.2019.01.017.
Pan K, Cao L, Ryan NA, Wang Y, Xu H. Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J. 2016;27:93–101. https://doi.org/10.1007/s00192-015-2775-9.
Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6. https://doi.org/10.1001/jama.300.11.1311.
Acknowledgments
The paper is supported by the Ministry of Science of the Republic of Serbia project 175092.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Paper is supported by the Ministry of Science, project 175092, Republic of Serbia.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ignjatovic, I., Potic, M., Basic, D. et al. Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair of the vaginal compartments in patients with advanced pelvic organ prolapse and incontinence. Int Urogynecol J 32, 967–974 (2021). https://doi.org/10.1007/s00192-020-04519-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-020-04519-7