Surgical challenges in the treatment of perimenopausal and postmenopausal endometriosis.

Endometriosis is classically defined as a chronic, recurrent and progressive disease. It is known to be estrogen-dependent, but can still be observed during the peri- and postmenopausal periods. Medical management of endometriosis is palliative symptomatic relief. Surgery when properly and timely performed for the right person may treat endometriosis. However, there is always a risk of possible major or minor surgical complications, as well as loss of some functions due to nerve damage. Management of endometriosis in the woman approaching the end of her reproductive life may require special attention both due to the potential for recurrence and transformation into various endometriosis-associated malignancies.

Native tissue repair versus mesh repair in pelvic organ prolapse surgery.

In pelvic organ prolapse, the anatomical defects develop at the anterior (anterior vaginal wall), the posterior (posterior vaginal wall) and the apical (the uterus/cervix or the apex of the vagina, vaginal vault or cuff scar after hysterectomy) compartments. These defects occur in more than one compartment. Treatment of pelvic organ prolapse is commonly surgical, aiming to restore the anatomy of structures supporting the pelvic organs. The surgical repair techniques are classified as 'native tissue repair (NTR)' when only pelvic organ support tissues are used and 'augmented repair (AR)' when some other material (prosthesis or graft) is used to reinforce the defective support system. In this review, issues related to the basic science of meshes, and NTR versus mesh or graft AR procedures for pelvic organ prolapse are discussed while considering the varying risks and benefits according to the prolapsed compartment.

Unilateral sacrospinous ligament fixation (USLF) with a mesh stabilizing anchor set: clinical outcome and impact on quality of life.

UNLABELLED: Genital prolapse is one of the most significant problems which lowers the quality of life measures of middle and older aged women. A continuously growing number of women are being operated due to this indication. OBJECTIVE: This study intends to asses the clinical outcome and the impact on quality of life of uterine sacrospinous ligament fixation (USLF) conducted with a mesh stabilizing anchor set in the present clinic following vaginal hysterectomy. MATERIALS AND METHODS: Twenty-one patients, diagnosed with genital prolapse and for whom vaginal hysterectomy and (USLF) with the Surelift nesh stabilizing anchor set were performed from April 2010 to June 2013, were assesed in this study. Posterior colporrhaphy was performed in all cases, as well. The cuff level was used to asses the anatomical recovery one year following the surgery. Postoperative relaxation of the vaginal cuff line below the hymenal level was defined as failure. Quality of life (P-QOL) questionarries validated for Turkish women were used preoperatively and on their first year to asses patient satisfaction. Clinical outcome and impact on quality of life were analyzed in all these cases by using t-test for paired samples. RESULTS: The mean age of the patients was 67.4 (min-max:43-84) years; mean parity 5.4 (min-max: 2-13). The mean operation time was 56 ± 12 minutes. The mean postoperative follow-up period was 21.4 months. Preoperative mild bleeding (two), postoperative severe pain (three), and micturition problems (one) were found. Therapeutic results and patint satisfaction were evaluated in the 12th month postoperavely: In 18/21 (85%) patients, the cuff was located above the hymenal ring. P-QOL scores validated for Turkish women were 52.5 ± 12.9 preoperatively and 11.08 ± 7.9 postoperatively (t-test for paired samples revealed a significant difference; (p = 0.04). CONCLUSION: The treatment of genital prolapse through the abdominal route includes the sacrocolpopexy operation with or without hysterectomy. This method, most of the time, requires a laparotomy if not performed by a specifically trained laparoscopist. It has a longer operation time and mesh erosions are feared complications compared to vaginal route. In sacrospinous fixation cases added to vaginal hysterectomy, operation times are shorter and especially preferable in patients where medical problems coexist. Operative success and patients' satisfaction seems to be provided by this technique.