Four-arm polypropylene mesh for vaginal vault prolapse-surgical technique and outcomes.

OBJECTIVE: Advanced vaginal vault prolapse (VVP) can occur rarely after any type of hysterectomy. Several types of procedures have been applied to correct this defect, but optimal management is still pending. The aim of this study was to describe the surgical technique and results of four-arm transvaginal mesh (FATVM) application for advanced VVP. STUDY DESIGN: We followed up for 24 months, 160 patients with VVP > II vc (according to the Pelvic Organ Prolapse Quantification Scale (POPQ)), who underwent FAMTVM from 2014 to2017. FAMTVM was inserted with the anterior arms through the obturator foramens and the posterior arms through the ischiorectal fossas and sacrospinal ligaments. Clinical data were prospectively collected in a customized database and retrospectively analyzed. To assess QoL SF 36, KHQ and FSFI questionnaires were used. POPQ was employed to measure degree of VVP. Non-parametric tests (The Wilcoxon signed-rank test) were applied to verify statistical hypotheses. RESULTS: According to SF 36, significant improvement was evident in almost all aspects of general QoL (PCS p = 0.002, MCS p = 0.01). KHQ showed statistically significant improvement in all domains. FSFI scores after surgery indicated significantly improvement in all domains of the questionnaire, apart from lubrication (p = 0.02). Intraoperative bladder injury occurred in 3.75 % (n = 6) of all cases. Five patients (3.1 %) complained of de novo stress urinary incontinence. VVP reoccurred in nine cases (5.6 %). Only two patients (1.25 %) saw mesh exposure after 6 months postoperative recovery. CONCLUSION: We consider FAMTVM for VVP to be safe and effective. Hence, it applied as an optional treatment, especially in patients with contraindications to laparotomy and laparoscopy.

Development and validation of the Polish version of the Urogenital Distress Inventory short form and the Incontinence Impact Questionnaire short form.

OBJECTIVE: The Incontinence Impact Questionnaire (IIQ) measures the impact of urinary incontinence on activities, roles, and emotional states of women, whereas the Urogenital Distress Inventory (UDI) measures how troubling the symptoms are. The aim of this study was to develop and assess the effectiveness of a Polish version of the IIQ and UDI. STUDY DESIGN: The translation into Polish followed standardized procedures. 206 women aged between 31 and 83 years were included into the study. All patients were recruited from women attending the Outpatient Clinic of the 2nd Gynecology Department of the Medical University in Lublin. SUI was observed in 116 cases; OAB in 16 patients and 24 had MUI (confirmed by medical history, bladder diary and urodynamic investigation). 50 healthy women served as control. All patients completed the Polish version of the ICIQ - 'the gold standard' in UI diagnosis - as well as the newly translated Polish versions of the UDI-6 and IIQ-7 questionnaires at baseline. Moreover, 116 women repeated the UDI-6 and IIQ-7 self-assessment again 7days later. RESULTS: The internal consistency was tested by calculating Cronbach's alpha, using baseline scores. The high reliability of the scale indicates a value greater than 0.7. The reliability was calculated by way of the Intraclass Correlation (ICC) and was considered acceptable when ICC was≥0.7. In fact, ICC in all investigated groups was >0.95. The Cronbach's alpha values were as follows: for SUI patients - 0.74; for OAB - 0.78; and for MUI - 0.28 (the UDI-6 total score for the whole study group was 0.72). Cronbach's alpha total score for IIQ-7-0.89 (SUI group - 0.89; OAB group - 0.93; and MUI group - 0.77). Finally, the Cronbach's alpha total score for the ICIQ Questionnaire was 0.73 (SUI group - 0.71; OAB group - 0.65 and MUI group - 0.81). CONCLUSIONS: The Polish versions of the UDI-6 and IIQ-7 Questionnaires are reliable, valid, and responsive instruments for assessing the severity of symptoms and quality of life in females suffering from urinary incontinence.