Factors influencing the outcome of surgery for pelvic organ prolapse

Bohlin, Katja Stenström; Ankardal, Maud; Nüssler, Emil; Lindkvist, Håkan; Milsom, Ian

doi:10.1007/s00192-017-3446-9

Cited by 30 publications

(30 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings were similar to those of previous studies which found no difference in post-operative outcomes between patients with and without obesity after digestive tract surgery [10,48,59,60], gynecologic surgery [61,62], vascular surgery [63,64], neurosurgery [9], or orthopedic surgery [12,65,66], even among those admitted in intensive care unit [67]. In most of these studies, a minimal invasive surgical method was used like in studies included in the current meta-analysis, allowing less Elsewhere, an increased risk of morbidity in postoperative period in patients with obesity has been widely documented in recent years in both oncology and nononcology surgery.…”

Section: Discussionsupporting

confidence: 92%

Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis

2020

View full text Add to dashboard Cite

Background: Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. Methods: We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. Results: Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I 2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I 2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I 2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I 2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I 2 = 19.5%). Conclusions: This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.

show abstract

Section: Discussionsupporting

confidence: 92%

Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis

2020

View full text Add to dashboard Cite

show abstract

“…A study published in 2018 by Bohlin et al reported on factors influencing outcomes of anterior and posterior vaginal wall prolapse surgery, based on data from the GynOp register. 117 Patients were considered "cured" if they reported vaginal bulging sensation "never", "hardly ever" or "1-3 times per month" at 1 year after surgery (we categorized 1-3 times per month into "non-cured"). Recently published studies have shown that factors associated with prolapse recurrence are: preoperative degree of prolapse, 118,119 levator ani injuries, 119,120 family history, 119,120 age (inverse correlation), 120 BMI, 117,120,121 parity, 118 co-morbidities 118 and preoperative degree of bulging symptoms 117 .…”

Section: Post Publication Sensitivity Analyses Of Study Imentioning

confidence: 99%

“…We initially chose to categorize 1-3 times per month into treatment failure, whereas Bohlin et al categorized this into "no prolapse". 117 One could also question the choice of vaginal bulging being our primary outcome when assessing cure after posterior colporrhaphy, since vaginal bulging might not be as specific for women with posterior prolapse. Common problems associated with a rectocele are symptoms related to obstructive defecation.…”

Section: Selection Bias and Misclassificationmentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

show abstract

“…BMI was calculated by dividing body mass (in kg) by the square of height (m 2 ) and categorized as eutrophic, overweight and obese [19]. BMI was the anthropometric variable chosen because it is the most widely used variable in the literature to define overweight and obesity in women with PFMD [25][26][27][28]. Thus, comparisons between different populations could be performed.…”

Section: E T H O D Smentioning

confidence: 99%

Pelvic, anorectal and urinary symptoms according to the nutritional status of adult women: A cross-sectional study

et al. 2019

View full text Add to dashboard Cite

To review the occurrence of pelvic, anorectal and urinary symptoms according to the nutritional status of adultwomen. Methods This is a cross-sectional study with 54 women, aged 18 to 35 years, divided into normal weight (<25kg/m2), overweight (25kg/m2 to 29.99kg/m2) and obesity (≥30kg/m2) according to the body mass index. The presence of pelvic floor muscle dysfunction symptoms was assessed by the Pelvic Floor Distress Inventory and the impact of these symptoms by the Pelvic Floor Impact Questionnaire. Descriptive and inferential statistics were used, with a significance level of 5%. Results Pelvic Floor Distress Inventory total score was 22.95 (SD=26.11) in the eutrophic group and 59.67 (SD=47.80) in the obesity group (p=0.01). Considering the scales, urinary symptoms were higher in obese women than in the eutrophic group (p=0.01). In the assessment of patients with each symptom, a difference (p<0.01) was observed in incomplete bowel emptying, in which the highest frequency occurred in overweight women (47.4%) compared to eutrophic and obese women (both 26.3%). Urinary incontinence symptoms (18.2% in eutrophic women, 27.3% overweight and 54.5% obese), stress urinary incontinence (8.3% eutrophic, 41.7% overweight and 50.0%, obese) and difficulty in emptying the bladder (0.0% eutrophic, 33.3% overweight and 66.7% obese) exhibited higher frequencies (p=0.03; p<0,01 and p=0.02, respectively) in obese women. Conclusion Symptoms of pelvic floor muscles dysfunction, especially urinary tract muscles, occur more frequently in obese adult women when compared to eutrophic women.

show abstract

Factors influencing the outcome of surgery for pelvic organ prolapse

Cited by 30 publications

References 28 publications

Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis

Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Pelvic, anorectal and urinary symptoms according to the nutritional status of adult women: A cross-sectional study

Contact Info

Product

Resources

About