Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction

Shull, Bobby L.; Capen, Charles V.; Riggs, Mark; Kuehl, Thomas J.

doi:10.1016/0002-9378(92)91567-t

Cited by 200 publications

(79 citation statements)

References 4 publications

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“…However, in 43% of the patients in group B the anterior colporrhaphy was combined with an SSLF. This procedure is known to potentially promote the development of a cystocele [15,16] due to the distorting of the vaginal axis posteriorly, whereby the anterior vaginal wall is exposed to excessive pressures [11] with the risk of subsequent recurrent prolapse of the anterior compartment [17]. We ascribe to this mechanism that the better anatomical outcome (postoperative Ba) of group A (as opposed to the overall group B) is diminishing to just a marginal level, lacking statistical significance, after correction of group B for sacrospinous fixation.…”

Section: Discussionmentioning

confidence: 99%

The Extended Reconstruction of the Pubocervical Layer Appears Superior to the Simple Plication of the Bladder Adventitia concerning Anterior Colporrhaphy: A Description of Two Techniques in an Observational Retrospective Analysis

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Dooren²,

Wieringa³

2011

Gynecol Obstet Invest

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Aims: This observational retrospective analysis was done to compare the plication of the bladder adventitia with the reconstruction of the pubocervical layer concerning the reoperation rate for recurrent cystocele. Methods: Sixty-five patients underwent an anterior vaginal wall repair using traditional techniques. In 11 patients, the prolapse was corrected by simply plicating the adventitia of the posterior bladder wall (group A), and in 54 patients the pubocervical layer was rebuilt using structures of the endopelvic fascia following far lateral dissection of the vaginal flaps (group B). The anatomical state was documented via the Pelvic Organ Prolapse Quantification system. Results: The overall reoperation rate of cystoceles was 6% after a mean follow-up of 2 years. Three out of 11 patients of group A and 1/54 patients of group B underwent repeat surgery (p < 0.005). No complications were observed in group A (0/11). In contrast, seven complications were related to the reconstruction of the pubocervical layer (7/54, p > 0.05). Two patients presented with ureteral obstruction, one of them requiring temporary nephrostomy. Conclusion: Compared with the plication of the bladder adventitia, the reoperation rate after reconstruction of the pubocervical layer is diminished. However, because of potential risks of ureteral injury, the procedure demands serious precaution.

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Section: Discussionmentioning

confidence: 99%

The Extended Reconstruction of the Pubocervical Layer Appears Superior to the Simple Plication of the Bladder Adventitia concerning Anterior Colporrhaphy: A Description of Two Techniques in an Observational Retrospective Analysis

Link

Dooren²,

Wieringa³

2011

Gynecol Obstet Invest

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“…All are based on known anatomy and known principles of wound repair, and build on existing methods and concepts [1,[6][7][8][9]. It is intended that the operations presented be indicative only of the generic surgical principles behind them, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…The recurrence of cystocele in 2 patients in a site anterior to the site of cystocele repair, indicates that these are compromised tissues, and that even a strong repair such as the 'double breast' repair can have the effect of diverting intra-abdominal pressure, causing 'blowout' of subclinically weakened tissue already present in other parts of the vagina, much like a perished bicycle tube. Indeed, it is well known [8] that vaginal repairs in one segment of the vagina are frequently followed by herniations in another part. The continuous running suture used to approximate the vaginal flaps may reconnect the broken segments of the fascia of Denonvilliers, the continuous fascial layer sited below the posterior vaginal wall epithelium.…”

Section: Surgical Application Of Connective Tissue and Wound Repair Cmentioning

confidence: 99%

“…Repair thereof was therefore omitted, as incontinence symptoms were beyond the scope of this paper. The anatomical concepts described previously [1,[6][7][8][9] helped define the surgical concepts underlying this work. The surgical principles themselves were based on known characteristics of wound repair The arrows represent the three-directional muscles forces of the pelvic floor [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Development of generic models for ambulatory vaginal surgery — a preliminary report

Petros

1998

Int Urogynecol J

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Generic guidelines are applied to reconstructive vaginal operations, so as to convert them to ambulatory procedures. Prototype operations are described and analyzed. These included conceptualizing vaginal prolapse as a type of intussusception caused by vaginal and ligamentous laxity in the middle or posterior parts of the vagina; the avoidance of vaginal excision, excessive tension, and refashioning excess vaginal tissue from width to length or into a partial double-layered repair; the creation of artificial neoligaments; the prevention of urinary retention by avoiding tightness in the bladder neck area; local anesthetic infiltration; and buttressing vaginal tissue during wound healing. A total of 108 patients underwent vaginal surgery on an ambulatory or overnight stay basis, 72 under local anesthesia/midazolam. Minimal postoperative pain and the absence of catheterization reduced hospital stay from a statewide mean of 8 days to 1 day, and return to normal activities from 6 weeks to 7-10 days. Cure rates (18 months) were: uterovaginal prolapse 22/22, infracoccygeal sacropexy 21/23, rectocele 36/38, cystocele/anterior vaginal wall prolapse 21/25. Applied as prototypes to reconstructive vaginal surgery, the operations appear to be as effective as traditional techniques but far less invasive. They have the potential to assist working mothers, the old and infirm, and save the community up to $5,500 per patient. It is hoped that the generic models presented may act as a basis for the future development of ambulatory vaginal surgical techniques.

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“…In a comparison of these two procedures, the ASC was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the SSLF [3]. The SSLF demonstrated a higher rate of failure, and resulted in de novo cystocele formation, which was assumed to have resulted from a change in vaginal axis [4][5][6][7]. The vaginal approach may be a desirable alternative for elderly patients with multiple comorbidities or younger patients who desire a faster return to daily activities.…”

Section: Introductionmentioning

confidence: 99%

Short-term efficacy and complications of posterior intravaginal slingplasty

et al. 2007

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This study was performed to evaluate the efficacy and complications of the posterior intravaginal slingplasty (IVS). A retrospective chart review was performed. Ninety IVS procedures were performed from January 2004 to June 2005. The group consisted of predominantly nonsmoking, Caucasian, postmenopausal women with a median age of 62 years and a median parity of 3. The mean follow-up was 33 +/- 23.2 weeks with a median of 31.9 weeks. There were no intraoperative bladder, bowel, or vascular injuries. Overall, 11 out of 90 patients developed recurrent or de novo prolapse; 4.4% of these had recurrent apical prolapse. There was a 17.8% incidence of mesh erosion. Only 1 of the 11 patients with recurrent prolapse had concomitant mesh erosion. The procedure demonstrated an unacceptably high erosion rate. The adoption of newer mesh techniques based on the slingplasty concept or the use of the multifilament polypropylene tape should be scrutinized.

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Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction

Cited by 200 publications

References 4 publications

The Extended Reconstruction of the Pubocervical Layer Appears Superior to the Simple Plication of the Bladder Adventitia concerning Anterior Colporrhaphy: A Description of Two Techniques in an Observational Retrospective Analysis

The Extended Reconstruction of the Pubocervical Layer Appears Superior to the Simple Plication of the Bladder Adventitia concerning Anterior Colporrhaphy: A Description of Two Techniques in an Observational Retrospective Analysis

Development of generic models for ambulatory vaginal surgery — a preliminary report

Short-term efficacy and complications of posterior intravaginal slingplasty

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