Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study

Christmann-Schmid, Corina; Bruehlmann, Esther; Koerting, Isabell; Krebs, Joerg

doi:10.1016/j.ejogrb.2018.08.009

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…An interesting and unexpected result of our study was the large proportion (60%) of cure of preoperative SUI. A similar improvement of preoperative SUI without concomitant SUI surgery was also observed in a recent LSCP study [30]. We hypothesize that an anterior vaginal mesh, by lifting up vesicovaginal fascia, may improve suburethral hammock suspension.…”

Section: Discussionsupporting

confidence: 85%

Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

et al. 2021

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Abdominal sacral colpopexy/hysteropexy is the gold standard for the treatment of vaginal apex support. However, dissection of the promontory may expose to potentially life-threatening complications. To avoid this risk, laparoscopic lateral suspension with mesh is an alternative. Robotic assistance may be helpful in both techniques. The objective of our study was to evaluate outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical pelvic organ prolapse (POP). From March 2012 to January 2018, 59 consecutive patients underwent RALLS using titanized polypropylene mesh. Between August 2017 and September 2019, all patients were contacted to assess outcome. We performed a clinical exam and asked them to complete the patient global impression of improvement (PGI-I) questionnaire. Fifty-four patients (91.5%) were available for follow-up. Mean age was 58.5 years (28.8–79.8). There were no perioperative complications. The mean follow-up was 33.6 months (11.2–74.1).The objective cure rate (no prolapse beyond hymen) and the subjective cure rate (PGI-I ≤ 2) were 83.3% and 77.2%, respectively. Five women (9.3%) were reoperated for POP recurrence. There was no erosion. Of the 20 women complaining of stress urinary incontinence (SUI) preoperatively, 12 (60%) were cured without any additional SUI procedure. Only two women (10%) required TVT for persistent grade 2 SUI. Two women (5.9%) developed de novo SUI, but none of them required an operation. RALLS repair for POP with mesh is safe and effective and may represent an alternative to sacral colpopexy/hysteropexy.

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Section: Discussionsupporting

confidence: 85%

Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

et al. 2021

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“…In a multicenter randomized trial comparing vaginal prolapse repair with and without MUS among women with preoperative SUI, 26% reported complete resolution of SUI without an MUS, whereas 56% of women with a concomitant MUS had persistent SUI at 1-year follow-up 5 . Other nonrandomized studies of women with prolapse and SUI symptoms undergoing prolapse surgery, including other approaches such as sacrocolpopexy, demonstrated similar findings; resolution of SUI was seen in 30–69% of those without an MUS 6,20 . On the basis of our findings and the previously mentioned summary of the literature, it is plausible that the efficacy of concomitant MUS differs in the setting of anterior vaginal hysteropexy mesh for apical suspension.…”

Section: Discussionsupporting

confidence: 79%

“…5 Other nonrandomized studies of women with prolapse and SUI symptoms undergoing prolapse surgery, including other approaches such as sacrocolpopexy, demonstrated similar findings; resolution of SUI was seen in 30-69% of those without an MUS. 6,20 On the basis of our findings and the previously mentioned summary of the literature, it is plausible that the efficacy of concomitant MUS differs in the setting of anterior vaginal hysteropexy mesh for apical suspension. This suggests that predictive models regarding postoperative SUI should account for the specific prolapse procedure being performed.…”

Section: Discussionsupporting

confidence: 55%

Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings

Giugale

Sridhar

Ferrante

et al. 2022

Female Pelvic Med Reconstr Surg

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ImportanceMany health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement.ObjectivesThe aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling.Study DesignSecondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (α = .05).ResultsThe sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, −5.1; 95% confidence interval [CI], −9.9 to −0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0–0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2–1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups.ConclusionsFive-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.

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“…We believe this saves patients from unnecessary gests and their possible complications. An increasing number of urogynecologists are adopting this strategy with regard to occult urinary stress incontinence, whereby they treat as a second step after repairing the prolapse only if it becomes symptomatic ( 56 , 57 ). It is sustained by our recent studies.…”

Section: Pelvic Organ Prolapse (Pop) and Stress Urinary Incontinence ...mentioning

confidence: 99%

Laparoscopic Lateral Suspension (LLS) for the Treatment of Apical Prolapse: A New Gold Standard?

Dällenbach

2022

Front. Surg.

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Nowadays, the gold standard to treat apical pelvic organ prolapse (POP) is laparoscopic sacrocolpopexy (LSCP). However, LSCP is a difficult procedure associated with rare but potentially severe complications. Promontory dissection may expose to potential life-threatening intraoperative vascular injuries, and sacral roots or hypogastric nerve damage. There are also a few case reports of spondylodiscitis with consecutive lumbar vertebra bone erosion. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical POP repair. It lowers perioperative risks by avoiding sacral promontory preparation. Recent studies show similar anatomical and functional outcomes to LSCP, with the advantage of better preserving the vaginal axis. Moreover, LLS is well suited for hysteropexy which is important as an increasing number of women prefer uterine preservation during POP surgery. In this article, we discuss both techniques, and we share our opinion on a novel perspective in the treatment of apical POP with uterine preservation.

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Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study

Cited by 12 publications

References 24 publications

Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings

Laparoscopic Lateral Suspension (LLS) for the Treatment of Apical Prolapse: A New Gold Standard?

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