Patient-reported outcomes after sacrospinous fixation of vault prolapse with a suturing device: a retrospective national cohort study.

INTRODUCTION AND HYPOTHESIS: Innovations in suturing devices have facilitated sacrospinous ligament fixation (SSF) for the correction of vaginal vault prolapse. It is uncertain if outcomes using suturing devices differ from those using a traditional suturing technique. We hypothesize that no difference exists in the efficacy and safety 1 year after SSF for vault prolapse performed with suturing devices or using a traditional technique. The objective was to compare SSF using a suturing device with traditional SSF for the treatment of vault prolapse, regarding symptoms of prolapse recurrence, patient satisfaction, incidence of re-operation, and complications 1 year postoperatively. METHODS: We carried out a retrospective cohort study using register-based national data from 2006 to 2013. The Swedish Quality Register of Gynecological Surgery includes assessments pre-operatively, at hospital admittance, surgery, discharge, and questionnaires at 8 weeks and 1 year after surgery. Demographic variables and surgical methods were included in multivariate logistic regression analyses. RESULTS: In the suturing device group (SDG, n = 353), 71.5% were asymptomatic of recurrence after 1 year compared with 78.7% in the traditional SSF group (TSG, n = 195); risk difference - 7.3% (95%CI -15.2%; 0.7%). Adjusted odds ratio (aOR) for being asymptomatic 1 year postoperatively was 0.56 (95%CI 0.31; 1.02, p = 0.057). Patient satisfaction was similar in SDG and TSG (78.1% vs 78.4%). Reoperation occurred in 7.4% in the SDG compared with 3.6% in the TSG, risk difference 3.8% (95%CI 0.0%; 7.5%), aOR 3.55 (95%CI 1.10; 11.44, p = 0.03). CONCLUSIONS: Patient satisfaction was similar 1 year after SSF, despite symptoms of recurrence being more likely and reoperation more common after using a suturing device compared with a traditional technique. The methods did not differ with regard to surgical complications.

Does anesthetic method influence vaginal bulge symptoms and patient satisfaction after vaginal wall repair surgery?

INTRODUCTION AND HYPOTHESIS: Surgery for pelvic organ prolapse (POP) under local anesthesia has been advocated for several reasons such as lower costs and application in multimorbid patients. The aim of this study was to investigate how the anesthetic method influences the rate of recurrent prolapse and patient satisfaction with POP surgery. METHODS: In this retrospective study 4,936 women operated for single-compartment prolapse between 2006 and 2011 were included from the Swedish National Register for Gynecological Surgery. The feeling of vaginal bulge 1 year after surgery indicated presence of recurrent prolapse. Multivariate logistic regression analyses were used to identify independent factors affecting the outcomes, presented as adjusted odds ratios (aOR) with 95 % confidence interval (CI). RESULTS: After surgery for single-compartment prolapse patients with cystocele were at a higher risk of feeling a vaginal bulge than patients with rectocele (1.62, CI 1.28-2.06). Applied anesthesia was no independent predictor of bulge symptoms in the cystocele/rectocele population. In the cystocele group local anesthesia compared with general or regional anesthesia implied an increased risk of vaginal bulge symptoms (1.32, CI 1.03-1.68) as well as POP-Q-stage III-IV (1.30, CI 1.09-1.55), and a higher BMI class (1.22, CI 1.03-1.46), while a higher age class decreased the risk (0.79, CI 0.70-0.89). Choice of anesthesia had no impact on bulge symptoms in the rectocele group and no influence on patient satisfaction in any of the groups. CONCLUSION: Patients operated for cystocele under local anesthesia were at a higher risk of experiencing vaginal bulge symptoms 1 year after surgery compared with general or regional anesthesia.

The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures. METHODS: Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI). RESULTS: Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33-0.73), in diabetics (0.50; CI 0.35-0.74) and women aged > 80 years (0.18; CI 0.06-0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI < 25. Smoking did not influence any of the outcome variables. CONCLUSIONS: The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI < 25. Smoking did not impact on any of the studied outcome variables.