Transvaginal polypropylene mesh versus sacrospinous ligament fixation for the treatment of uterine prolapse: 1-year follow-up of a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to compare the anatomical and quality of life outcomes of a posterior polypropylene mesh kit versus sacrospinous ligament fixation at the time of hysterectomy for the treatment of uterine prolapse. METHODS: Thirty-two women aged 50 to 75 years with stage III or IV (pelvic organ prolapse quantification system/International Continence Society) uterine prolapse were randomized into two groups (group 1: polypropylene mesh, Nazca R, Promedon, Cordoba, Argentina; group 2: sacrospinous ligament fixation). RESULTS: At 12-month follow-ups, we observed the same anatomical results in both groups. The median operating time, intraoperative blood loss, and perioperative complications were also equal in both groups. There were five cases (35.71%) of mesh erosion, and prolapse of the anterior vaginal wall (cystocele) occurred in 50% of the patients. CONCLUSIONS: Similar anatomical and quality of life outcomes were observed with polypropylene mesh and sacrospinous ligament fixation for the treatment of uterine prolapse. Complication rate was higher in the mesh group.

Small intestinal submucosa patch for extensive vaginal endometriosis resection.

This case report describes use of a porcine small intestinal submucosa patch to prevent vaginal stiffness and retraction after extensive vaginal resection of an endometriosis nodule. A 32-year-old nulliparous woman was referred for surgical treatment of a large rectovaginal nodule that extended from the vaginal to the rectal mucosa. Surgical treatment was performed in 2 steps. Initially, a laparoscopic rectal resection was performed without opening the vagina to reduce the risk of fistula formation; 6 months later, the patient underwent a laparoscopic second-look combined with the vaginal approach to remove remaining disease. A small intestinal submucosa patch was successfully used to prevent vaginal shortening.

Histologic classification of specimens from women affected by superficial endometriosis, deeply infiltrating endometriosis, and ovarian endometriomas.

In this retrospective observational study involving 176 patients and 271 biopsies, the histologic differentiation in superficial endometriosis, deeply infiltrating endometriosis, and ovarian endometriomas was evaluated according to a previously proposed classification system. Results showed a predominance of the undifferentiated glandular pattern (33.5%) and mixed glandular pattern (46.9%) in deeply infiltrating endometriosis lesions, whereas the well-differentiated glandular pattern (41.8%) was most frequently seen in superficial endometriosis lesions, and in ovarian endometriomas a predominance of both the undifferentiated (40.5%) and mixed patterns (37.8%) was observed.

Tela de polipropileno versus correção sítio-especifica no tratamento do prolapso de parede vaginal anterior: resultados preliminares de ensaio clínico randômico / Polypropylene mesh vs. Site-specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial

OBJETIVO: Comparar o uso de tela de polipropileno e correção sitio-específica no tratamento cirúrgico do prolapso vaginal anterior. MÉTODOS: Estudo prospectivo randômico comparativo em que foram operadas 32 pacientes com idades entre 50 e 75 anos, que apresentavam prolapso vaginal anterior estádio III ou IV, ou recidivado. A estática pélvica foi avaliada segundo as recomendações da International Continence Society (ICS), o sistema POP-Q e pelo Índice de Quantificação de Prolapso (POP-Q-I) Absoluto e Relativo. Para o rastreamento da incontinência urinária de esforço oculta todas as pacientes, sintomáticas ou não, foram submetidas a estudo urodinâmico em posição semi-ginecológica e semi-sentada, com redução do prolapso com pinça de Cheron. Registrou-se o tempo cirúrgico, o volume de sangramento intra-operatório e as complicações intra e pós-operatórias. O tempo de seguimento médio do estudo foi de 8,5 meses. RESULTADOS: Em relação aos resultados anatômicos ocorreu melhores resultados com a utilização de tela de polipropileno sobre o reparo sitio-específico. Em relação à morbidade cirúrgica, observou-se menor tempo cirúrgico no grupo em que utilizou-se tela. CONCLUSÃO: Houve superioridade dos resultados anatômicos obtidos com a utilização de tela de polipropileno sobre o reparo sitio-específico.

OBJECTIVE: Pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. Anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. Currently, a woman has an 11 percent risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29 percent chance of being reoperated due to failure in the first surgery. METHODS: A prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. Thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage III or IV, or prolapse recurrence, were operated. Mean follow-up was 8.5 months. RESULTS: The results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. Regarding surgical morbidity, shorter operative time was observed for the mesh group. CONCLUSION: The results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.

Polypropylene mesh vs. site-specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial.

OBJECTIVE: Pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. Anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. Currently, a woman has an 11% risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29% chance of being reoperated due to failure in the first surgery. METHODS: A prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. Thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage III or IV, or prolapse recurrence, were operated. Mean follow-up was 8.5 months. RESULTS: The results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. Regarding surgical morbidity, shorter operative time was observed for the mesh group. CONCLUSION: The results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.

Validation of the Pelvic Organ Prolapse Quantification Index (POP-Q-I): a novel interpretation of the POP-Q system for optimization of POP research.

Even though very precise at describing pelvic organ position, our criticism to the Pelvic Organ Prolapse Quantification (POP-Q) system is its limited ability to quantify the prolapse itself, since it still classifies prolapse into four stages, almost the same way as Baden and Walker (Clin Obstet Gynecol 15(4):1070-1072, 1972) did in 1972. As a result, the same grade can include a wide prolapse intensity range. The objective of this study was to assess inter-observer reliability in the Pelvic Organ Prolapse Quantification Index (POP-Q-I; Lemos et al., Int Urogynecol J 18(6):609-611, 2007) on a prospective randomized trial. Fifty consecutive women were prospectively examined by two members of the urogynecology staff, blinded to each other's results. Spearman's rank correlation was used to assess inter-observer reliability. Excellent correlation coefficients were observed, with an overall coefficient of 96.5% (CI: 0.889-1.042; p < 0.0001). The POP-Q-I is a method that makes POP research more efficient by directly measuring prolapse as a continuous variable, which is statistically more powerful than the categorical variables proposed by the POP-Q system. This study suggests that the POP-Q-I is applicable to clinical POP research.

Estudo urodinâmico da pressão de perda ao esforço, nas posições ortostática e sentada, em mulheres com incontinência urinária / Urodynamic evaluation of leak point pressure under stress, in orthostatic and seating position, in women with urinary incontinency

OBJETIVOS: comparar os resultados obtidos durante o estudo urodinâmico realizado em duas diferentes posições em relação às pressões de perda urinária sob esforço e discutir sua relevância clínica. MÉTODOS: sessenta e quatro pacientes com queixa de incontinência urinária de esforço (IUE) com idades variando entre 25 e 80 anos, atendidas no ambulatório de uroginecologia e cirurgia vaginal, no período de junho 2003 a setembro 2005 foram incluídas neste estudo. As pacientes foram inicialmente submetidas ao estudo urodinâmico de acordo com a técnica preconizada pela International Continency Society (ICS) na posição ortostática e logo depois foram avaliadas na posição sentada. RESULTADOS: diferença significante foi obtida após a avaliação das pressões de perda obtidas nas diferentes posições (99,8 ± 33,3 versus 102,9 ± 32,4; respectivamente, posição sentada e em pé, p < 0,05). Testes de regressão linear com análise de freqüência foram realizados com a finalidade de verificar a porcentagem de pacientes que ficaram dentro dos limites de confiança em relação às PP nas posições sentada e em pé. Uma taxa de 90,6 por cento de compatibilidade foi obtida nesses resultados. Quando três unidades foram somadas aos valores das pressões obtidas no estudo urodinâmico realizado na posição sentada, percebeu-se que 92,2 por cento ficaram inseridas neste intervalo. CONCLUSÕES: estes achados sugerem que o estudo urodinâmico pode ser realizado na posição sentada sem comprometimento diagnóstico e terapêutico proporcionando maior conforto e comodidade às pacientes.

PURPOSE: compare the outcomes verified during urodynamic investigation realized in two different positions related to urinary leak point pressure under stress and to discuss its clinical relevance. METHODS: sixty-four patients with stress urinary incontinency (SUI) aged 25-80 years old, attended, during June 2003 to September 2005 were included in this study. Patients were initially submitted to urodynamic investigation in accordance with International Continence Society (ICS) techniques in orthostatic position and just after were evaluated in seating position. RESULTS: statistical significance was obtained after evaluation of Vasalva leak point pressure (VLPP) obtained in two positions (99,8 ± 33,3 versus 102,9 ± 32,4; respectivamente, posição sentada e em pé, p<0,05). Linear regression test based on frequency analyses was applied with the purpose to verify the patient percentage allocated in confidence interval in terms of Valsalva leak point pressure in seating or orthostatic positions. A rate of 90.6 percent of compatibility was gotten in these results. When three unities were added to VLPP values after urodynamic investigation in seating position, it was noted that 92.2 percent of patients was included in this interval. CONCLUSIONS: these findings suggest that the urodynamic investigation can be realized in seating position without diagnostic a therapeutic impairment allowing higher comfort to the patients.