Surgical management of female pelvic organ prolapse with and without urinary incontinence

Abstract

The study reports a single center experience with surgical management of female pelvic organ prolapse (POP) with and without urinary incontinence.Between January 2006 and July 2016, 93 consecutive patients with anterior and/or apical symptomatic POP underwent abdominal sacrocolpopexy (ASC) or laparoscopic sacrocolpopexy (LSC) or pubovaginal cystocele sling (PCS); 25 patients had concomitant stress urinary incontinence (SUI). Subjective outcome was assessed by the Pelvic Floor Impact Questionnaire (short form) (PFIQ-7) investigating bladder, bowel and vaginal functions, sexual activity, and daily life. Objective outcomes included the POP anatomic correction by Baden Walker HWS classification, urinary tract infection (UTI) rates, urge urinary incontinence (UUI), and SUI rates. Data were prospectively collected.Forty-three patients underwent PCS, 29 ASC, and 21 LSC. Mean follow-up was 54.88 ± 33.1, 28.89 ± 23.5, and 16.8 ± 11.3 months for PCS, ASC, and LSC, respectively. POP recurrence occurred in 10.5%, 7.5%, and 0% while de novo (ie, in untreated compartment/s) POP occurred in 15.8%, 7.4%, and 4.8% of patients who have undergone PCS, ASC, and LSC, respectively. Kaplan–Meier estimates of POP-free survival showed no difference among the 3 procedures. All procedures significantly reduced PFIQ-7 scores improving quality of life and the rates of recurrent UTIs and concomitant UUI. PCS cured all cases with concomitant SUI; de novo SUI occurred only in 7.4% and 4.8% of patients who have undergone ASC and LSC, respectively. Mean surgical time was significantly shorter for PCS compared to ASC and LSC (P = .0001), and for ASC compared to LSC (P = .004); there was no difference in postoperative pain and hospital stay. Compared to ASC/LSC, PCS involved a higher rate (27.9% vs 6%; P = .01) of minor complications, mainly transient urinary retention, and a lower rate (0% vs 8%; P = .06) of complications requiring surgery.In this single center experience, PCS was not only provided similar subjective and objective results than ASC and LSC but also able to correct concomitant SUI without causing de novo SUI and was safer than other 2 techniques, in female POP repair.

A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence

“…[ 6 , 7 ] Some urologists also made many attempts such as using autologous fascia sling as an alternative method to mesh sling to treat SUI with pelvic organ prolapse. [ 8 ]…”

Reliability of the application of transvaginal color Doppler ultrasound in the identification of pelvic tumors in women of childbearing age

“…The distribution of malignant tumors is characterized by multivessel diffuse distribution inside the septum or solid components, while the number of blood vessels in benign tumors is lower than that of malignant tumor, with the blood vessels of benign tumors being mainly located around the lesion. Benign tumors may also be characterized by a lack of blood flow (14,15). Celiesiute et al (16) and other researchers have found that benign and malignant pelvic tumors have their own characteristics in terms of blood vessel formation and blood supply.…”

Magnetic stimulation for female patients with stress urinary incontinence, a meta-analysis of studies with short-term follow-up

“…A large number of patients had pelvic organ prolapse (POP) associated to SUI. [33] MS could be considered as a conservative and noninvasive treatment for concomitant SUI and de novo SUI. To determine the efficacy of MS for SUI in the presence of POP, a prospective study is needed.…”