Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study.

INTRODUCTION AND HYPOTHESIS: Uterosacral ligament suspension at the time of primary prolapse repair represents a well-established surgical option. Our aim was to compare the effectiveness, complications rate, and functional results of modified McCall culdoplasty and Shull suspension. METHODS: Patients who underwent vaginal hysterectomy and cuff suspension for pelvic organ prolapse were retrospectively analyzed. McCall culdoplasty (group A) or Shull suspension (group B) were performed according to surgeon choice based on age and sexual activity. Perioperative data, objective, and subjective cure rate were noted. RESULTS: A total of 339 patients (215 in group A and 124 in group B) completed follow-up. Operating time and blood loss were slightly higher in group B. The complications rate was similar in the two groups. Anatomical outcomes in terms of recurrence and reoperation rate did not show any statistically significant differences. POP-Q items analysis revealed only a different total vaginal length between groups (8 mm longer in group B). Functional outcomes were similar in the two groups as was patient satisfaction. CONCLUSION: Both uterosacral ligament suspension procedures were shown to be safe and effective. There were no clinically significant differences with regard to surgical data, complications, anatomical, functional, and subjective outcomes between modified McCall culdoplasty and Shull suspension.

Iliococcygeus fixation or abdominal sacral colpopexy for the treatment of vaginal vault prolapse: a retrospective cohort study.

INTRODUCTION AND HYPOTHESIS: To compare the efficacy and safety of iliococcygeus fixation (ICG) and abdominal sacral colpopexy (SCP) in the treatment of vaginal vault prolapse. METHODS: Patients with symptomatic vaginal vault prolapse after hysterectomy were considered in this analysis. Surgical outcomes, i.e., the capacity to restore the anatomy of the vaginal cuff and improvement in the prolapse-related symptoms were compared. Continuous variables were compared using the Student's t test, while non-continuous variables using a Chi-squared test or Fisher's exact test. RESULTS: Sacrocolpopexy was performed in 41 patients, while ICG fixation was carried out in 36 patients. Operative time was significantly shorter (78 vs 140 min, p < 0.001) and median blood loss higher in the ICG group (150 ml vs 100 ml, p=0.01). The rates of postoperative complications of the two groups were not statistically different. Relapse rate was similar in the two groups (15 % in the SCP and 22 % in the ICG group respectively, p=0.36). Considering the POP-Q score, both SCP and ICG achieved a significant and comparable correction of vaginal prolapse. The evaluation of postoperative subjective symptoms revealed a significant improvement in voiding and vaginal bulging related to pelvic organ prolapse in both groups. CONCLUSIONS: Both ICG fixation and SCP are effective in restoring normal anatomy in patients with vaginal vault prolapse and in relieving associated symptoms. Owing to its lower morbidity and to the advantage of not using a synthetic device, ICG might be an excellent option for the treatment of recurrent vaginal vault prolapse following hysterectomy.

Three-dimensional ultrasound assessment and middle term efficacy of a single-incision sling.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the functional outcome of a single-incision sling procedure for the treatment of female stress urinary incontinence (SUI) and to correlate the cure rate with a pelvic floor ultrasound examination METHODS: Fifty-seven patients treated with a single-incision sling procedure between January 2009 and September 2010 were included in the study. Functional outcome was evaluated as objective cure rate assessed with stress test and subjective cure rate determined by the International Consultation on Incontinence-Short Form and Patient Global Impression of Improvement scores. Women underwent perineal ultrasound examination by a combined 2D translabial and 3D transvaginal approach to assess bladder neck and tape mobility, tape position along the urethral axis, and tape anchorage. According to the position of self-fixating tips, we divided patients into group A (both tips crossed the obturator membrane), group B (only one tip crossed the obturator membrane) and group C (none of the tips crossed the obturator membrane). Objective cure rate and type of anchorage were compared with all ultrasound parameters. RESULTS: At an average follow-up of 13 months objective cure rate was 87.7 % with a significant subjective improvement. A significant difference in tape mobility was noted between group A and group C. Bladder neck mobility significantly increased in failures. Sling was significantly closer to mid-urethra in cured than in failures. CONCLUSIONS: In 77 % of patients MA didn't reach the obturator membrane on both sides. This feature conditioned significantly bladder neck mobility but not the efficacy of the procedure. Tape position seems to be the most important factor for success.

Reproductive prognosis in women with endometriosis after conservative surgery: a single-center experience.

BACKGROUND: To evaluate the reproductive prognosis in women subjected to conservative surgical treatment for endometriosis seeking pregnancy during the first three years after surgery. We tried to identify operative findings which negative influences prognosis. METHODS: A total of 140 patients were retrospectively analyzed, who had a diagnosis of endometriosis, based on surgical and histological criteria and without other male or female infertility factors who underwent surgery between 01/2002 and 01/2012. For each patient, anatomic and surgical data, stage according to the revised classification of American Fertility Society (AFS), months of pregnancy research and the use of assisted reproductive technology (ART) after surgery were collected. A total of 109 patients had been diagnosed preoperatively as being infertile (group 1), 31 cases tried to conceive only after surgery (group 2). The study was approved by the Ethics Committee of San Gerardo Hospital, Monza. RESULTS: The pregnancy rate among infertile women (group 1) was 53% (58/109, 48 occurring naturally and 10 with ART), and 71% (22/31, 3 with ART) in patients of group 2. The overall cumulative probability of pregnancy at 3 years was 60% for group 1 and 76% for group 2. The prognosis was independent by the stage, presence of monolateral or bilateral endometriomas, tubal adhesions or superficial lesions while it is inversely correlated to Douglas' pouch obliteration (DPO) (P=0.05). CONCLUSIONS: Surgery improves the reproductive prognosis in infertile women with endometriosis. In the studied population DPO obliteration had a high prevalence and it influenced negatively the pregnancy outcome.