Safety of an anchor-based device for sacrospinous ligament fixation: A pilot case-control study.

INTRODUCTION AND HYPOTHESIS: Sacrospinous ligament fixation (SSLF) is a popular surgical technique for treating apical prolapse. The use of suture-capturing devices (SCD), or the more recently introduced anchor-based device (ABD), is useful for a posterior approach but essential for an anterior one. The aim of our study was to assess the safety of the ABD, which was recently introduced to our unit, compared to the traditionally used SCD. METHODS: This was a pilot case-control study of 40 patients who had a SSLF, 20 of these represented all the patients who had the procedure with the aid of the ABD and 20 patients who had the procedure using the SCD over approximately the same duration. The main safety endpoints of this pilot study were patient reported postoperative pain scores and perioperative complications rate. RESULTS: The population characteristics were similar. The mean postoperative pain scores differed significantly only on postoperative day 1 in favor of the suture capturing device (3.40 [2.60] vs 1.60 [1.64], p = 0.013). The mean highest pain score was similar in both groups. Peri-operative complications rates were low and comparable between both groups. According to POPQ at 6 weeks follow-up the median Ba point was higher in the ABD group and this difference was significant (-3.00 [-3.00; -2.25] vs. -2.00 [-3.00; -1.50]; p = 0.03). CONCLUSION: The anchor-based device for sacrospinal ligament fixation seems to have comparable safety profile to the traditionally used suture capturing devices.

["Do uro-gynecology multidisciplinary team meeting modify therapeutic management?"] / « Les réunions de concertation pluridisciplinaire de pelvi-périnéologie modifient-elles les prises en charges thérapeutiques ? ¼.

INTRODUCTION: Since the banning of trans-vaginal meshes for pelvic organ prolapse treatment by the FDA in 2019, French authorities have been gradually regulating the use of prosthetic materials in urogynecology. The decision to fit a mid-urethral sling or a reinforcement implant for the cure of prolapse, as well as the management of complex genital prolapse and serious post-implant complications, must be the subject of multidisciplinary consultation and a shared medical decision. To comply with these regulations, multidisciplinary team meetings (MDTMs) have been set up. The aim of the study was to evaluate the impact of these meetings on patient management. MATERIAL: We carried out a retrospective study in a tertiary hospital in France on all cases presented in MDTM of urogynecology over the year 2022. MDTMs were held weekly, with a "Prosthesis MDTM" focusing on slings, sacrocolpo/hysteropexies and prosthetic complications, lead by the urology team, and a "Prolapse MDTM" focusing on pelvic organ prolapse and complex prolapses, lead by the gynecology team. We compared the initial proposal of the patient's referring physician versus the final proposal of the MDTM. RESULTS: Three hundred and seventy-five cases were presented in our center in 2022: 188 in Prosthetic MDTM and 187 in Prolapse MDTM. The Prosthetic and Static MDTMs agreed with the initial proposal in 83 and 64% of cases respectively, while the therapeutic strategy was questioned in 12 and 36% of cases respectively. CONCLUSION: For almost a quarter (24%) of patients, the MDTM of urogynecology opted for a different management from that proposed by the referring physician. The presentation of cases to the MDTM is a legal obligation in specific indications. It also plays an educational role, enabling shared decision-making and responsibility, which is an asset in functional surgery.

[Photobiomodulation and vulvovaginal disorders after anticancer treatments]. / Photobiomodulation et troubles vulvovaginaux après traitements anticancéreux.

Anticancer treatments induce vulvovaginal complications that alter the quality of life and sexuality of patients. New technologies, such as photobiomodulation, could address this problem, for which few effective therapeutic solutions exist. The objective of this study was to describe the characteristics of patients seeking treatment and to observe the effects of photobiomodulation. This is a prospective cohort of patients treated for cancer, in failure of first-line medical treatment, managed at the University Hospital of Nîmes. The history, symptoms and impact of the disorders on their quality of life were collected. At follow-up, improvement was assessed using the PGI-I and FSFI questionnaires. Twenty-eight patients were treated. They were all menopausal, half of them after anticancer treatments [chemotherapy (78%), radiotherapy (36%), hormone therapy (36%)]. The main symptom reported was vaginal dryness (72%). Seventy-one percent of patients (n=20) felt that their daily life was affected≥8/10. All patients had sexual dysfunction. Twenty-two patients received at least 6 sessions of photobiomodulation. Seventy-two percent (n=18) of patients felt better or much better after treatment (PGI-I≤2). The median improvement estimated by the patients was 65% (Q1=50%; Q3=72.5%). There was also a significant clinical improvement. No serious adverse events were reported. Due to the small number of patients in a heterogeneous population with no control group, we cannot extrapolate our results. However, the objective was to assess the status of these pathologies and the contribution of photobiomodulation in patients who have failed first-line treatment; and these results are encouraging.

Anterior bilateral sacrospinous ligament fixation with concomitant anterior native tissue repair: a pilot study.

INTRODUCTION AND HYPOTHESIS: Anterior bilateral sacrospinous ligament fixation (ABSSLF) was first described in 2000 but only evaluated in a limited number of studies. However, due to the FDA's ban on transvaginal mesh, interest in this technique has re-emerged. The SSLF procedure is known for its inherent high risk for anterior compartment failure; hence, in our center we started performing a preemptive concomitant anterior repair with the intention to reduce such risk. The aim of this study was to review the feasibility and clinical outcomes of this innovative technique. METHODS: We performed a retrospective cohort study of all the women who had an ABSSLF and a concomitant anterior native tissue repair between May 2019 and July 2020 in a tertiary hospital in France. Our primary endpoint was surgical feasibility, while as secondary endpoints we wanted to explore the perioperative morbidities and clinical outcomes associated with this technique. RESULTS: A total of 50 women were operated on in the studied period. The median follow-up time was 10 [8.5] months. It was feasible to perform the combined ABSSLF and concomitant anterior native tissue repair in all cases. The most frequent perioperative complications reported were urinary tract infection (14%) and difficulty in resuming voiding (16%). Anatomical and functional results were improved. The rate of anterior compartment recurrence was 37%. CONCLUSIONS: ABSSLF with a concomitant anterior native tissue repair is feasible and relatively safe for treating anterior and apical pelvic prolapse. However, anterior compartment failure rate is still a limitation. Further larger studies with long-term anatomical and functional results comparing this technique to alternative transvaginal surgical approaches are needed.