Effects of unilateral apical sling and laparoscopic sacrocolpopexy on the outcome in women with apical prolapse: randomised trial.

OBJECTIVES: The purpose of this study was to compare the use of unilateral apical sling versus laparoscopic sacrocolpopexy in the treatment of the apical form of pelvic organ prolapse in women. M: aterial and methods:A prospective, single-center randomized trial included 100 patients who were alternately assigned to treatment. Each patient had a ≥ III stage of apical or anterior-apical prolapse determined by the POP-Q system. 45 accepted for unilateral apical sling (UAS)and 55 accepted for laparoscopic sacrocolpopexy (LS). Data were compared by the One-way ANOVA test using IBM SPSS stats 19. RESULTS: Mean operating time was significantly greater in the LS group versus UAS group, 194.6 vs 42.4 minutes, respectively (p < 0.05). The amount of intraoperative bleeding was significantly higher in the UAS group, compared to the LS group (p = 0.01). Within the follow-up period, 2 patients in UAS group and 3 patients in LS group (4.4% vs 5.4%, respectively; p = 0.9) had recurrent cystocoele. HRQoL and sexual outcomes did not differ significantly between the two treatment groups. CONCLUSION: s:Our data demonstrate the non-superiority one on each other of the two different approaches, except in terms of shorter operating time and higher intraoperative bleeding when UAS used. These findings raise questions about the need for long-term results of quality of life outcomes for women with genital prolapse, especially in resource-limited settings similar to Kazakhstan.

Full-thickness vascularized vaginal flap as the fixation point in the surgical treatment of vaginal vault prolapse.

INTRODUCTION AND HYPOTHESIS: Post-hysterectomy vaginal vault prolapse is quite frequent and at the same time a challenging surgery for pelvic organ prolapse. METHODS: One of the most popular methods of treatment is sacrospinous fixation, including its mesh modification. RESULTS: Despite the high efficiency in the apical compartment, the incidence of the anterior compartment prolapse is quite high. Erosion remains an unsolved problem. A 44-year-old patient with grade IV post-hysterectomy prolapse underwent a sacrospinous fixation procedure with mesh according to the described technique. Surgery was performed successfully without complications. The duration of the operation was 40 min. A year after the operation, the recurrence of POP was not recorded in any compartments of the pelvic floor. It was possible to maintain the length of the vagina. Dyspareunia and vaginal erosion were not detected. The patient also noted a significant improvement in her quality of life. CONCLUSION: The demonstrated approach allows performing minimally invasive reconstruction of all three compartments of the pelvic floor. Moreover, the use of a full-thickness vascularized vaginal flap allows safely fixing the mesh to the vaginal vault, minimizing the risk of erosion and pain syndrome due to excessive tension.

The resurrection of sacrospinous fixation: unilateral apical sling hysteropexy.

INTRODUCTION AND HYPOTHESIS: The apical compartment is a keystone in POP treatment. Sacrospinous fixation, suggested half a century ago, today is still one of the most popular and efficient methods of colpo-hysteropexy. However, it has specific side effects: chronic pain syndrome, dyspareunia and а high rate of cystocele de novo. We aimed to evaluate the efficacy and safety of unilateral sacrospinous hysteropexy with a synthetic apical sling combined with anterior subfascial colporrhaphy. METHODS: Following the suggested technique, 174 women with anterior-apical prolapse underwent surgery. The follow-up period took 12 months. Pre- and postoperative examination included: urogynecological examination (POP-Q), uroflowmetry, ultrasound of the bladder and filling in of validated questionnaires (PFDI-20, PISQ-12). RESULTS: The mean surgery time was 26 ± 7.84 min. No cases of damage of the bladder or rectum or of intraoperative clinically significant bleeding were noted. At the 12-month follow-up, the recurrence rate in the apical compartment was 0.7% (1/147) and in the anterior compartment 7.4% (11/147). The efficacy of the surgery reached 96.5%. During 12 months of follow-up, no cases of mesh exposure or chronic pelvic pain syndrome were detected. The incidence of dyspareunia de novo was observed in just one patient. CONCLUSIONS: A unilateral sacrospinous fixation with a synthetic mesh (apical sling) combined with anterior subfascial colporrhaphy enhances the anatomical efficacy of surgery. It also helps to avoid specific side effects of traditional sacrospinous fixation.

The novel technique of post-hysterectomy vaginal vault prolapse repair: Apical sling and "neocervix" formation.

OBJECTIVE: We primarily aimed to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling combined with "neocervix" formation in surgical treatment of post - hysterectomy vaginal vault prolapse. The secondary objective was to estimate the impact of the surgery on voiding function and quality of life. STUDY DESIGN: This prospective study involved 61 women suffering from post-hysterectomy prolapse. We used the following criteria to evaluate the results of surgical treatment: results of vaginal examination (POP-Q system), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment. RESULTS: Mean operation time was 35min. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted.At 12-month follow-up anatomical cure rate (≤stage I, POP-Q) was 100%, 94,4% and 100% for vaginal apex, anterior and posterior vaginal walls, respectively. The following long-term complications were noted stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4,9%, respectively. Statistically significant (P<0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. CONCLUSION: The novel technique: combination of the apical sling and purse-string "neocervix" formation appears to be effective and safe method for treatment patients with vaginal vault prolapse. The technique improves voiding function and quality of life.

The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.

INTRODUCTION AND HYPOTHESIS: The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy. MATERIALS AND METHODS: This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12 months after the treatment. RESULTS: At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%. CONCLUSION: The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.

Apical sling: an approach to posthysterectomy vault prolapse.

INTRODUCTION AND HYPOTHESIS: This video demonstrates a transvaginal technique for vaginal vault suspension using an apical sling suspended from the sacrospinous ligaments. METHODS: This was a retrospective review of apical sling procedures performed from July 2013 to November 2014. The technique is started by marking the vaginal apex. A posterior dissection is performed and the sacrospinous ligaments are identified after dissection into the pararectal space. A 10-cm piece of monofilament, inelastic polypropylene tape is attached to the underside of the vaginal apex. Polypropylene sutures are placed into the sacrospinous ligament and threaded though the lateral edges of the apical sling and tied down, restoring apical support. Finally, the vaginal epithelium is closed. RESULTS: A total of 67 women underwent an apical sling procedure with 70 % (47/67) completing 6 months follow-up. The subjective cure rate ("cured" or "greatly improved") was 78.7 % and the objective cure rate (anatomical success, defined as apical prolapse stage ≤1) was 100 % (47 patients). CONCLUSIONS: Our apical sling sacrospinous ligament fixation approach is a unique, minimal mesh approach using a tape commonly used for midurethral slings to suspend the vaginal apex. We achieved high anatomical success and patient satisfaction.