Quality-of-life improvements in patients after various surgical treatments for pelvic organ prolapse.

OBJECTIVE: To compare the improvements in quality of life of patients with pelvic organ prolapse (POP) treated using various surgical methods. MATERIALS AND METHODS: The PUBMED, MEDLINE and Cochrane Library online databases were searched using the keywords "pelvic organ prolapse", "surgery", "PFDI-20" and "PFIQ-7" for articles published from January 2010 to December 2022 that included quality-of-life scores before and after surgery. RESULTS: Forty-nine articles were include. The mean postoperative PFDI-20 and PFIQ-7 scores decreased by 67.50% and 76.98%, respectively, compared with those before surgery. In 76.9% of patients, this change did not decrease with increased postoperative time. The improvement rate in PFDI-20 scores after colpocleisis did not differ statistically from that after sacrocolpopexy and was significantly higher than that after other procedures. The improvement rate in PFIQ-7 scores after colpocleisis did not statistically differ from that after high uterosacral ligament suspension and was significantly higher than that after other procedures. The improvement rate in PFDI-20 scores after transvaginal mesh-based repair (TVM) did not significantly differ from that after sacrospinous ligament fixation and was significantly lower than that after other procedures except traditional vaginal wall repair. The improvement rate in PFIQ-7 scores after TVM did not significantly differ from that after new procedures and was significantly lower than that after other procedures. CONCLUSIONS: Surgical treatment can significantly improve the quality of life of patients with POP. Colpocleisis may offer more advantages than those of other surgical procedures, and improvement was lower after TVM than after other procedures.

Midterm comparison of laparoscopic high uterosacral ligament suspension and sacrocolpopexy in the treatment of moderate to severe apical prolapse.

INTRODUCTION AND HYPOTHESIS: The objective was to retrospectively analyze the midterm efficacy of laparoscopic high uterosacral ligament suspension (HUS) and sacrocolpopexy (SC) in the treatment of moderate to severe apical prolapse. METHODS: Patients who underwent laparoscopic HUS and SC in our center from 2013 to 2019 with follow-ups were included, consisting of laparoscopic HUS (group A, n=72) or SC (mesh added, group B, n=54). The general data of patients, pelvic organ prolapse quantitative examination (POP-Q) score, Pelvic Floor Distress Inventory short form 20 score (PFDI-20) before and after operation, perioperative conditions, Patient Global Impression of Improvement (PGI-I), and postoperative complications were collected for statistical analysis and comparison between groups. RESULTS: There was no statistical difference in preoperative data between groups. The median follow-up time was 48 months. The objective recurrence rate of group A was higher than that of group B, without statistical significance. One patient in group B had a second operation owing to recurrence. The exposure rate of mesh in group B was 3.70%. There was no significant difference in deviation of POP-Q and PFDI-20 pre- and post-operation. The proportion of new defecation abnormalities in group A was lower. The total hospitalization expenses and surgical consumables in group B were significantly higher than those in group A. CONCLUSIONS: The midterm curative effect of laparoscopic HUS is similar to that of SC in the treatment of moderate to severe apical prolapse. The former has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, lower cost, fewer new defecation abnormalities, and there were no complications related to mesh.

Clinical observation of 2 patients and a literature review of pregnancy outcome after uterine-sparing apical suspension for pelvic organ prolapse.

OBJECTIVE: To observe pregnancy postoperatively and long-term follow-up after uterine-sparing apical suspension for pelvic organ prolapsed (POP). STUDY DESIGN: We report 2 patients who delivered newborns after uterine-sparing apical suspension for pelvic organ prolapse at our center and a literature review on this topic. RESULTS: The patients' ages were 26 and 32 years at their respective times of surgery. The follow-up times were 7 and 8 years. These patients became pregnant at 52 and 46 months after surgery, and delivered by cesarean section at term. There was no re-prolapse at follow-ups of 15 and 10 months postpartum. The results were consistent with those reported in the literature. CONCLUSION: Patients with POP who have reproductive requirements can benefit from surgical treatment, and this benefit is maintained after cesarean section. SYNOPSIS: Observation of 2 patients who delivered newborns after uterine-sparing apical suspension for pelvic organ prolapsed at our center and a literature review.

Outcome of a novel porcine-derived UBM/SIS composite biological mesh in a rabbit vaginal defect model.

INTRODUCTION AND HYPOTHESIS: To investigate the tissue reactions of a novel porcine-derived urinary bladder matrix/small intestinal submucosa (UBM/SIS) biological mesh and SIS mesh implanted in a rabbit vaginal defect model. METHODS: Thirty-two rabbits were implanted with UBM/SIS mesh (Group A) and SIS mesh (Group B), respectively. Rabbits were sacrificed at 7, 14, 60, and 180 days after implantation. The tensile strength, elongation at break, and elastic modulus of the tissue were measured using biomechanical methods. The inflammatory response, cell infiltration, vascularization, and collagen fibers were observed. RESULTS: Compared with Group B, the tensile strength and elongation at break of group A was higher at 14, 60, and 180 days. The elastic modulus of group A was lower at 180 days. Inflammatory response of group A was milder at 14, 60, and 180 days. There was more cell infiltration in group A at 7 and 14 days. Vascularization was higher in group A at 7 days and 14 days. The order of collagen in group A was better at 14, 60, and 180 days. The proportion of thick red fibers in both groups showed an increasing trend. At 14 days, group A had more thick red fibers. CONCLUSIONS: The novel UBM/SIS composite mesh had a milder inflammatory response; earlier induction of cell infiltration, angiogenesis, and collagen regeneration. Collagen fibers had a better order. It has a higher tensile strength and greater elongation at break, and can be used as a potential material for the treatment of pelvic organ prolapse.

Clinical Outcomes of Patients With Heterotopic Pregnancy After Surgical Treatment.

STUDY OBJECTIVE: To review the surgical management and clinical outcomes of patients with heterotopic pregnancy (HP) who underwent in vitro fertilization and embryo transfer (IVF-ET) and surgical treatment between January 2010 and December 2015. DESIGN: Retrospective clinical analysis (Canadian Task Force classification II). SETTING: Assisted Reproductive Technology Center of Peking University Third Hospital. PATIENTS: Fifty-six patients with HP who underwent IVF-ET and surgical treatment between January 2010 and December 2015. INTERVENTIONS: In 56 patients, we retrospectively analyzed general characteristics, diagnostic features, surgical management, and clinical outcomes based on medical records and follow-up telephone interviews. All 56 patients had undergone transvaginal sonography on the day of admission. Fifty-four 54 patients had undergone laparoscopic surgery. Two patients with suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. MEASUREMENTS AND MAIN RESULTS: The incidence of HP was significantly lower in frozen-thawed embryo transfer cycles compared with fresh embryo transfer cycles (29 of 13 128 [0.22%] vs 124 of 22 327 [0.56%]; p = .000). The live birth rate was 75.0% without congenital abnormalities, and the miscarriage rate was 17.86%. There were no significant differences in the rates of miscarriage (p = .08) and preterm delivery (p = .39) among different positions of heterotopic tubal pregnancy. There were no significant differences in general characteristics, diagnostic features, and intraoperative findings between the miscarriage and non-miscarriage groups, or between the preterm and term delivery groups. CONCLUSION: The incidence of HP has risen dramatically with the widespread application of assisted reproductive technology, and the diagnosis and management of HP remain challenging. With increased awareness of HP in patients who have undergone IVF-ET, early diagnosis and appropriate surgical treatment may lead to a favorable prognosis.