Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction.

OBJECTIVE: The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus. MATERIALS AND METHODS: This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient's satisfaction. RESULTS: Sixty-six patients with pelvic organ prolapse stage 3, including uterine prolapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at -6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus. CONCLUSIONS: Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.

Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia.

OBJECTIVE: To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS) procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A) without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI) cure rate in patients with mixed urinary incontinence (MUI), intra and post-operative complications and patient satisfaction. RESULTS: Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective) were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10) and from the local anesthesia. Visual analog scale (VAS) rating was low during and after the procedure (2.38 and 2.69 respectively). CONCLUSIONS: The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

[ALLEN-MASTERS SYNDROME AS A CAUSE FOR CHRONIC PELVIC PAIN: DIAGNOSIS, TREATMENT AND LONG TERM FOLLOW-UP].

Chronic pelvic pain is one of the main causes for repeated ambulatory and hospital visits. The main findings on exploratory laparoscopy performed for these complaints are endometriosis and adhesions, while in more than 50% of cases, no cause for the pain is found. In 1955, Allen and Masters reported pain associated with traumatic labor. They reported retroverted and hyper-mobile uterus in all women and during operation, tears in the posterior serosa of the broad igament. A few therapeutic options have been discussed, including repair of the tears, but without long term follow-up and significant relief of symptoms. Tightening of the utero-sacral ligaments following peritoneal resection of the Douglas as a long effective treatment was initially suggested in France in 1972. In 1997, von Theobald showed that it could be conducted by laparoscopy with long term follow-up. We report 3 cases of women diagnosed with Allen-Masters Syndrome, the surgical treatment performed and the long follow-up of these patients. We also discuss the ways to diagnose the syndrome and the preferred modality of treatment.

Mesh pullout force: comparative study of different deployment techniques in a sheep model.

INTRODUCTION AND HYPOTHESIS: Pullout force of mesh from tissue is one of the important mechanical properties of an implanted mesh to repair pelvic organ prolapse (POP). The EndoFast Reliant™ system kit allows mesh attachment with soft-tissue fasteners. The aim of this study was to compare the pullout force that developed in mesh that was attached by EndoFast Reliant fasteners to mesh that was attached by trocar-based methods (tunnel, pocket) in a sheep model. METHODS: Six sheep underwent mesh attachment with three methods (EndoFast Reliant, tissue pocket, tissue tunnel), and each method was repeated five times in both thighs of the same sheep. The pullout force was measured at different time intervals from surgery: 0, 3, 7, 15, 30, and 45 days. Statistical analysis was performed by using the appropriate one-way analysis of variance (ANOVA) for each time interval and a general linear model for repeated measures using IBM® SPSS® software version 20.0.0. RESULTS: During the immediate postoperative period (0-3 days), pullout force was significantly higher with EndoFast Reliant than with tissue pocket or tissue tunnel. At day 7, this trend continues without statistical significance. Pullout force increased progressively until day 15, when the force caused the mesh to tear; it was similar in all three groups. ANOVA showed significant effect of time and study group. CONCLUSIONS: The EndoFast Reliant system provides significantly stronger attachment in the immediate postoperative period (0-3 days) compared with trocar-based techniques, and this difference disappeared at day 15 postsurgery.

Safety and efficacy of spider anchoring device for apical repair in laparoscopic sacrocolpopexy: Retrospective cohort study.

OBJECTIVE: The aim of the study was to assess safety and efficacy of apical support when using the soft-tissue metal fasteners of EndoFast Reliant™ SCP during laparoscopic sacrocolpopexy (LSCP). STUDY DESIGN: This is a single-center, retrospective cohort study including all patients which underwent LSCP between 2015 and 2017. Safety outcome included the procedure and the device related complications. Effectiveness outcomes included the anatomical success of apical repair and the functional results as were obtained from the clinic and from a Quality of life questionnaire (PFDI-20). RESULTS: Eighty-four patients, 54% with grade III and IV prolapse were included in the study. Uterus was preserved in 68% of patients with uterus. Mean follow-up period for the clinic visit was 4.5 ± 4 months. Short term anatomical success was achieved for 98.8% of the patients. Marked improvement was observed in the related symptoms including urinary incontinence. Three intra-operative complications occurred: 1 case of bladder injury, 1 case of intra-abdominal bleeding, and 1 case of post-operative vaginal bleeding. Later complications included only two patients (2.3%) complained of chronic abdominal pain. There were no cases of mesh erosion or de-novo dyspareunia. The mean follow-up period for the PFDI-20 questionnaire was 15.6 months. 75% of patients had no bulge symptoms at all. Quarter of the patients had some bulge symptoms, bothers them between somewhat to moderately according to the questionnaire grading. CONCLUSIONS: The use of Endofast SCP fasteners for laparoscopic promonto-fixation is a safe and effective surgery. Longer follow-up and larger studies should be performed to establish the results.

Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction

ABSTRACT Objective: The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus. Materials and Methods: This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient's satisfaction. Results: Sixty-six patients with pelvic organ prolapse stage 3, including uterine pro-lapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at −6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus. Conclusions: Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.

Medium-term results of mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS) procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI). Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A) without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI) cure rate in patients with mixed urinary incontinence (MUI), intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective) were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10) and from the local anesthesia. Visual analog scale (VAS) rating was low during and after the procedure (2.38 and 2.69 respectively). Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.