Vaginal pessary in advanced pelvic organ prolapse: impact on quality of life.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a highly prevalent dysfunction of the pelvic floor affecting up to 40% of women. The symptoms of POP have a major impact on quality of life. Pessary treatment is a therapy option associated with high levels of satisfaction and few complications. OBJECTIVES: The objective was to assess the impact and efficacy of vaginal pessary use on the quality of life of women with advanced POP stages III and IV. MATERIALS AND METHODS: A multicenter, longitudinal, prospective observational study was conducted at the Urogynecology Sector of the Hospital Ipiranga and the Hospital Central of the Irmandade da Santa Casa de Misericórdia de São Paulo. A sociodemographic questionnaire was employed and two scales validated in Portuguese (ICIQVS and SF 12) were applied before and 6 months after pessary use. Student´s t test, Mann-Whitney test and Fisher´s exact test were applied, adopting a significance level of 0.05. RESULTS: The median age of participants was 71.5 (65-76) years and the median number of pregnancies was 4 (3-5). Deliveries were predominantly vaginal (82.5%). Women sexually active (16.49%) showed improvement in sexual function (78.6%). The participants showed improvement in vaginal symptoms (91.8%) and quality of life (92.8%) (p < 0.01) post-treatment. Of the total 97 women, the sample drop-out rate was 9.3% and 88 participants completed the two stages of the study. CONCLUSIONS: Vaginal pessary use had 90.7% efficacy, a high level of treatment satisfaction (75.3%), and a positive impact on the improvement of vaginal and sexual symptoms, quality of life, and mental health.

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients.

INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

Is urodynamics necessary to identify occult stress urinary incontinence?

PURPOSE: To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods. METHODS: This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction. RESULTS: The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441-.854). CONCLUSION: UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients

Abstract INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings

ABSTRACT Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings.

Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros-pectively collected between 2012 and 2014, and divided in two groups for further comparison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de-mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence / Técnica modificada do sling pubovaginal no tratamento cirúrgico da incontinência urinária de esforço feminina

Objective: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. Methods: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Helth Questionnaire before and after surgery. Results: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. Conclusion: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.

Objetivo: avaliar a aplicação de faixa aponeurótica por técnica modificada com visibilização direta das agulhas em pacientes com incontinência urinária de esforço. Métodos: foi aplicado o questionário Kings Health Questionaire (KHQ) de qualidade de vida, exame ginecológico, exame de urina I e urocultura aproximadamente sete dias antes da realização do estudo urodinâmico (EUD) e PAD test de uma hora submetidas à confecção de faixa aponeurótica com passagem de faixa pela via retropúbica, com agulha sob visibilização direta, PAD test e King´s Helth Questionaire, no pré e pós operatórios. Resultados: a média de idade foi 50,6 anos, 89% da cor branca, IMC de 28 e PPE de 58,5cm de H2O. Quarenta e seis delas tiveram acompanhamento de três e seis meses, 43 de 12 meses. A taxa de cura objetiva, em 12 meses de pós-operatório foi aproximadamente 93,5%. Ao avaliarmos a qualidade de vida das pacientes, observamos a melhora significante em 12 meses de pós-operatório, quando comparada ao pré-operatório. Não foi observada nenhuma lesão uretral/vesical. Como resultados adversos tivemos uma retenção urinária persistente (2,3%), sendo submetida à uretrolíse, estando atualmente sem perda. Conclusão: a operação proposta é segura quanto ao risco de lesões vesicais ou uretrais, promovendo melhora acentuada na qualidade de vida e cura objetiva.

Bacteriuria and urinary tract infection after female urodynamic studies: risk factors and microbiological analysis.

BACKGROUND: This study was conducted to determine risk factors for infectious complications after urodynamic study (UDS) in women, which can assist clinicians in identifying high-risk subjects who would benefit from antibiotic prophylaxis before UDS. METHODS: In this prospective cohort study, we studied 232 women who underwent UDS at Santa Casa de São Paulo School of Medical Sciences between June 2013 and June 2014. Women ranging in age from 26 to 84 years who had urinary incontinence, pelvic organ prolapse, or voiding dysfunction were required to collect urine samples at 7 days before, on the day of, and 3-5 days after UDS. Urine cultures with >100,000 CFU/mL were considered positive. Risk factors associated with bacteriuria and urinary tract infection (UTI) after UDS were evaluated using multivariate analysis with multiple logistic regression. RESULTS: Two hundred thirty-two out of 257 women were subjected to further analysis. The incidence of bacteriuria, transient bacteriuria, and UTI after UDS was 11.6%, 7.3%, and 4.3%, respectively. On multivariate analysis, hypothyroidism (P = .04), body mass index (BMI) >30 (P = .025), and advanced pelvic organ prolapse (P = .021) were associated with a significantly increased risk of bacteriuria; however, only BMI >30 (P = .02) was associated with an increased risk for UTI. CONCLUSIONS: The rate of infectious complications after UDS was low, and advanced pelvic organ prolapse and hypothyroidism increased the risk for bacteriuria. However, only BMI >30 was associated with bacteriuria and UTI after UDS.

Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment.

INTRODUCTION AND HYPOTHESIS: This trial aimed to compare the outcomes of native vaginal tissue repair versus polypropylene mesh repair for the treatment of severe genital prolapse. METHODS: This multicenter randomized trial included 184 women, with POP-Q stage 3 or 4. They were randomly assigned to undergo surgical treatment using native tissue repair (n = 90) or synthetic mesh repair (n = 94). Native tissue repair surgery was performed according to site-specific defects, including sacrospinous ligament fixation for apical defects. Mesh repair (Prolift™) was performed in accordance with manufacturer recommendations. Hysterectomy was performed in all cases of uterine prolapse. Statistical tests were used to compare between-group and within-group differences before the surgery and at 1-year follow-up. We considered cure to have occurred when the POP-Q point evaluation was equal to or less than 0 and POP-Q point C better than or equal to half the total vaginal length (TVL) after 1 year. The patients answered the Prolapse Quality-of-Life Questionnaire (PQoL) and the Sexual Quotient Female Version (QS-F) questionnaire. RESULTS: Both groups were homogeneous preoperatively. There were no differences between the groups in operative time, complications or pain. At 1-year follow-up, anatomical cure rates were better in the mesh group in the anterior compartment (p = 0.019). Significant improvement in PQoL scores at 1-year follow up were observed in each group; between-group comparisons of changes in PQoL scores revealed greater improvement in the mesh group. CONCLUSION: Both techniques were effective. Anatomical efficacy was superior in the mesh group regarding the anterior compartment; quality of life changes were also greater in the mesh group. Complications were significantly higher in the mesh group.

Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence.

OBJECTIVE: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. METHODS: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Health Questionnaire before and after surgery. RESULTS: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5 cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. CONCLUSION: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.

The Portuguese validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

INTRODUCTION AND HYPOTHESIS: Sexual well-being is an important aspect of women's life. The objective of this study was to validate the Portuguese-translated version of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire--PISQ-12. METHODS: Sixty-four women were enrolled to participate in the process of validating the PISQ-12 (study group). A further 68 subjects were allocated to a control group for comparison between the group of women with pelvic organ prolapse/urinary incontinence and the asymptomatic group. RESULTS: The PISQ-12 presented good internal consistency (Cronbach's alpha of 0.79 for the study group and 0.80 for the control group). The test-retest reliability using the intraclass correlation coefficient was 0.77. Mean score on the PISQ-12 was significantly higher in the control group than in the study group (42.7 ± 3.9 vs 27.8 ± 9.3) CONCLUSIONS: The Portuguese version of the PISQ-12 was reliable for the assessment of sexual function in women with pelvic organ prolapse/urinary incontinence.

Pubococcygeal activity on perineal ultrasound in incontinent women.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the applicability and reproducibility of perineal ultrasound (US) in the evaluation of the pubococcygeal muscle (PCM) activity in urinary incontinent women. METHODS: Thirty women were assessed twice by two examiners who measured the angle between the lateral bundles of the PCM. The 2D US on coronal view evaluated the PCM performance during squeezing, straining, and resting. RESULTS: There was significant correlation (p ≤ 0.001) in all measurements to both examiners, except for the contraction on their second assessment. The images showed asymmetries of muscle volume and activity. Five women (16.7%) had difficulty to rest after squeezing or straining, six (20%) first opened the muscle bundles when asked to squeeze them, and eight (26.7%) had no movement during different moments. CONCLUSIONS: The 2D perineal US on coronal view is useful to evaluate PCM activity. It is easily applicable and reproducible.

Transvaginal polypropylene mesh versus sacrospinous ligament fixation for the treatment of uterine prolapse: 1-year follow-up of a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to compare the anatomical and quality of life outcomes of a posterior polypropylene mesh kit versus sacrospinous ligament fixation at the time of hysterectomy for the treatment of uterine prolapse. METHODS: Thirty-two women aged 50 to 75 years with stage III or IV (pelvic organ prolapse quantification system/International Continence Society) uterine prolapse were randomized into two groups (group 1: polypropylene mesh, Nazca R, Promedon, Cordoba, Argentina; group 2: sacrospinous ligament fixation). RESULTS: At 12-month follow-ups, we observed the same anatomical results in both groups. The median operating time, intraoperative blood loss, and perioperative complications were also equal in both groups. There were five cases (35.71%) of mesh erosion, and prolapse of the anterior vaginal wall (cystocele) occurred in 50% of the patients. CONCLUSIONS: Similar anatomical and quality of life outcomes were observed with polypropylene mesh and sacrospinous ligament fixation for the treatment of uterine prolapse. Complication rate was higher in the mesh group.

Small intestinal submucosa patch for extensive vaginal endometriosis resection.

This case report describes use of a porcine small intestinal submucosa patch to prevent vaginal stiffness and retraction after extensive vaginal resection of an endometriosis nodule. A 32-year-old nulliparous woman was referred for surgical treatment of a large rectovaginal nodule that extended from the vaginal to the rectal mucosa. Surgical treatment was performed in 2 steps. Initially, a laparoscopic rectal resection was performed without opening the vagina to reduce the risk of fistula formation; 6 months later, the patient underwent a laparoscopic second-look combined with the vaginal approach to remove remaining disease. A small intestinal submucosa patch was successfully used to prevent vaginal shortening.

[Sexuality evaluation in women submitted to hysterectomy for the treatment of uterine leiomyoma]. / Avaliação da sexualidade em mulheres submetidas à histerectomia para tratamento do leiomioma uterino.

PURPOSE: To evaluate the impact of hysterectomy on the sexuality of women with uterine leiomyoma. METHODS: Prospective study including 33 sexually active women, with ages from 35 to 50 years old, with orgasmic experience and with a fit stable partner. All the women were submitted to two instruments for the evaluation or their sexuality: Sexual Quotient - Female Version (SQF) and Sexual Satisfaction Inventory - Female Version (SSIF). Both instruments were applied by the same examiner, before and six months after the hysterectomy. RESULTS: The SQF has shown that 39.4% of the patients presented deterioration in the sexual intercourse, even though there has not been found an association between the SQF results before and after hysterectomy (chi2= 0.6; degree of freedom=12; p=0.05). The mean scores obtained after the application of the SSIF have shown significant deterioration in the following parameters: sexual satisfaction (p=0.03); expression of feminine sensuality (p=0.01); vaginismus/dyspareunia (p=0.02) and an orgasmia (p=0.04). CONCLUSIONS: It seems that hysterectomy has a negative impact on women's sexual life, with reports of decreased libido, arousal and orgasmic capacity.

Avaliação da sexualidade em mulheres submetidas à histerectomia para tratamento do leiomioma uterino / Sexuality evaluation in women submitted to hysterectomy for the treatment of uterine leiomyoma

OBJETIVO: avaliar o impacto da histerectomia sobre a sexualidade de mulheres portadoras de leiomioma uterino. MÉTODOS: estudo prospectivo, no qual foram incluídas 33 mulheres sexualmente ativas, com idade de 35 a 50 anos, experiência orgástica e parceiro fixo capacitado para o coito. Todas as mulheres foram submetidas a dois instrumentos para avaliação da sexualidade: Quociente Sexual - Versão Feminina (QS-F) e Inventário de Satisfação Sexual - Versão Feminina (GRISS). Os mesmos instrumentos foram aplicados pelo mesmo examinador antes da histerectomia e seis meses após o procedimento. RESULTADOS: o QS-F apontou que 39,4 por cento das pacientes apresentaram piora no relacionamento sexual, apesar de não ter sido encontrada associação entre os resultados obtidos no QS-F antes e depois da histerectomia (χ2=10,6; grau de liberdade=12; p=0,05). Os escores médios obtidos após a aplicação do questionário de GRISS mostraram piora significante nos parâmetros "satisfação sexual" (p=0,03); "expressão da sensualidade feminina" (p=0,01); "vaginismo/dispareunia" (p=0,02) e "anorgasmia" (p=0,04). CONCLUSÕES: a histerectomia parece impactar negativamente a vida sexual das mulheres, sendo referida pela diminuição do desejo, da excitação e da capacidade orgásmica.

PURPOSE: to evaluate the impact of hysterectomy on the sexuality of women with uterine leiomyoma. METHODS: prospective study including 33 sexually active women, with ages from 35 to 50 years old, with orgasmic experience and with a fit stable partner. All the women were submitted to two instruments for the evaluation or their sexuality: Sexual Quotient - Female Version (SQF) and Sexual Satisfaction Inventory - Female Version (SSIF). Both instruments were applied by the same examiner, before and six months after the hysterectomy. RESULTS: the SQF has shown that 39.4 percent of the patients presented deterioration in the sexual intercourse, even though there has not been found an association between the SQF results before and after hysterectomy (χ2= 0.6; degree of freedom=12; p=0.05). The mean scores obtained after the application of the SSIF have shown significant deterioration in the following parameters: sexual satisfaction (p=0.03); expression of feminine sensuality (p=0.01); vaginismus/dyspareunia (p=0.02) and anorgasmia (p=0.04). CONCLUSIONS: it seems that hysterectomy has a negative impact on women's sexual life, with reports of decreased libido, arousal and orgasmic capacity.

Tela de polipropileno versus correção sítio-especifica no tratamento do prolapso de parede vaginal anterior: resultados preliminares de ensaio clínico randômico / Polypropylene mesh vs. Site-specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial

OBJETIVO: Comparar o uso de tela de polipropileno e correção sitio-específica no tratamento cirúrgico do prolapso vaginal anterior. MÉTODOS: Estudo prospectivo randômico comparativo em que foram operadas 32 pacientes com idades entre 50 e 75 anos, que apresentavam prolapso vaginal anterior estádio III ou IV, ou recidivado. A estática pélvica foi avaliada segundo as recomendações da International Continence Society (ICS), o sistema POP-Q e pelo Índice de Quantificação de Prolapso (POP-Q-I) Absoluto e Relativo. Para o rastreamento da incontinência urinária de esforço oculta todas as pacientes, sintomáticas ou não, foram submetidas a estudo urodinâmico em posição semi-ginecológica e semi-sentada, com redução do prolapso com pinça de Cheron. Registrou-se o tempo cirúrgico, o volume de sangramento intra-operatório e as complicações intra e pós-operatórias. O tempo de seguimento médio do estudo foi de 8,5 meses. RESULTADOS: Em relação aos resultados anatômicos ocorreu melhores resultados com a utilização de tela de polipropileno sobre o reparo sitio-específico. Em relação à morbidade cirúrgica, observou-se menor tempo cirúrgico no grupo em que utilizou-se tela. CONCLUSÃO: Houve superioridade dos resultados anatômicos obtidos com a utilização de tela de polipropileno sobre o reparo sitio-específico.

OBJECTIVE: Pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. Anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. Currently, a woman has an 11 percent risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29 percent chance of being reoperated due to failure in the first surgery. METHODS: A prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. Thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage III or IV, or prolapse recurrence, were operated. Mean follow-up was 8.5 months. RESULTS: The results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. Regarding surgical morbidity, shorter operative time was observed for the mesh group. CONCLUSION: The results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.

Estudo randômico da correção cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando histerectomia versus preservação uterina / A randomized comparison of two vaginal procedures for the treatment of uterine prolapse using polypropylene mesh: histeropexy versus histerectomy

OBJETIVO: Comparar os resultados anatômicos pós-operatórios de pacientes portadoras de prolapso uterino tratadas utilizando tela de polipropileno para correção dos defeitos do assoalho pélvico, comparando histerectomia vaginal com a preservação do útero. MÉTODO: Estudo randomizado com 31 mulheres portadoras de prolapso uterino estádio III ou IV (POP-Q) divididas em dois grupos: Grupo HV- 15 mulheres submetidas à histerectomia vaginal e reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) e Grupo HP- 16 mulheres mulheres submetidas à reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) preservando o útero. Raça, urgência miccional, constipação intestinal, dor sacral, sangramento e tempo de operação foram os parâmetros analisados. RESULTADOS: O tempo de seguimento médio foi de nove meses. Não se observou diferença entre os grupos nas complicações funcionais. O tempo cirúrgico foi 120 minutos para grupo HV versus 58.9 minutos para grupo HP ( p < 0.001 ) e o volume de perda sanguínea intraoperatória foi 120 mL no grupo HV versus 20 mL para grupo HP ( p < 0.001*). A taxa de sucesso objetivo foi 86.67 por cento para grupo HV e 75 por cento para grupo HP (p = 0,667). A taxa de erosão de tela foi 20 por cento (3/15) de extrusão no grupo HV versus 18,75 por cento (3/16) no grupo HP (p = 1,000). CONCLUSÃO: A correção cirúrgica do assoalho pélvico com telas nas portadoras de prolapso uterino apresentaram similaridade quer sendo ela feita com histeropexia quer com histerectomia. Contudo, o tempo cirúrgico e o volume da perda sanguínea foram significantemente maiores no grupo com histerectromia (HV). Operações vaginais com telas são procedimentos efetivos para a correção do prolapso.

OBJECTIVES: To compare surgical morbidity and time, as well as anatomical outcomes between vaginal histerectomy and uterine preservation in the treatment of uterine prolapse using a mesh kit (Nazca ®). METHODS: Randomized controled trial with 31 women with uterine prolapse POP-Q stage 3 or 4 pelvic organ prolapse who underwent vaginal surgery using tipe I polypropilene mesh (Nazca ®). They were randomized in two groups: group HV: hysterectomy and pelvic reconstruction floor with mesh (n=15); group HP: hysteropexy and pelvic reconstruction floor with mesh (n=16). Race, miccional urgency, intestinal constipation, sacral pain were assessed as well as the amount of bleeding and time of operation. RESULTS: Median follow-up was nine months on both groups. No difference was observed on complication rates and functional outcomes. Operation time was 120 minutes on group HV, versus 58.9 minutes on group HP (X² = 17.613*, p < 0.001 ) and intraoperative blood loss was 120 mL on group HV versus 20 mL on group HP (X² = 19.425*; p < 0.001). There was no differences in relationship to anatomical cure rates. Objective success rate was 86.67 percent to group HV and 75 percent to group HP (p=0,667) at nine months of follow-up. The anatomical results were similar between the two groups. CONCLUSION: The anatomic results between histeropexy and hysterectomy were similar. However, surgical time and blood loss were greater in group with histerectomies. The erosion rate were also similar. Vaginal surgery using mesh is an effective procedure for pelvic organ prolapse.