[Multidisciplinary meetings in pelvic floor disease in women: A national survey by the CUROPF among French urologists]. / Réunion de concertation pluridisciplinaire en pelvipérinéologie en France : résultats d'une enquête nationale du CUROPF auprès des urologues français.

INTRODUCTION: Multidisciplinary team meetings (MTMs) in the field of pelvic floor diseases in women tend to generalize, as they are required as mandatory before mid-urethral sling implantation or sacrocolpopexy by recent decrees published by the French health authorities. However, access to these meetings is variable in the French territory. The goal of the present study was to describe the existence and the settings of these kinds of meetings in France. MATERIEL AND METHODS: An on-line survey was conducted between June and July 2020 (stage 1) then between November 2021 and January 2022 (stage 2). A 15-item questionnaire was sent to all members of the Association française d'urologie (AFU). A descriptive analysis was conducted. RESULTS: Three hundred and twenty-two completed questionnaires were sent back during stage 1 and 158 during stage 2. Early 2022, 61.3% of respondents had access to a pelviperineology MTM, with important difference according to geographical areas. Main activity of MTMs was case discussion of complex situations (68% of meetings). At the end of 2021, 22% of the respondents declared willing to stop partially or totally their pelviperineology activity, given the new regulations set in place by the authorities. CONCLUSION: Despite being absolutely mandatory in current clinical practice, MTMs in pelvic floor disease have spread slowly. MTMs implementation was still insufficient in 2022, and variable on the French territory. Some urologists declare having no access to such resources and about 1 out of 5 were considering to voluntary stop of decrease significantly their activity in this difficult context.

Should we perform subtotal hysterectomy associated with sacral colpopexy for genital prolapse to prevent the risk of endometrial cancer?

OBJECTIVE: In a menopausal woman scheduled for curative surgery for pelvic organ prolapse (POP) by sacral colpopexy (SC), the question of concomitant hysterectomy is frequently considered by the surgeon. The risk of endometrial cancer (EC) exists in this population, and increases with age and body mass index. The French college of gynecologists and obstetricians (CNGOF) decided to issue good practice guidelines on subtotal hysterectomy (SH) for postmenopausal women scheduled for SC for POP. METHODS: The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). RESULTS: The prevalence of occult endometrial cancer (EC) found on pathological analysis after SH in this context (concomitant SH associated with SC) is low (<1%) (QE: high). Few studies have assessed the value of preoperative uterine exploration. Performing SH during SC is associated with its own risks, which may diminish the potential "carcinological prevention benefit". Uterine morcellation, performed by laparoscopy or a robot-assisted procedure, is associated with a low risk (<0.6%) of dissemination of an unknown sarcoma/EC (QE: moderate) A risk of dissemination of parasitic myomas (<0.5%) is also possible (QE: moderate). CONCLUSION: It is not recommended to perform a subtotal hysterectomy associated with sacral colpopexy for the sole purpose of reducing the occurrence of endometrial cancer (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be low and the risk-benefit balance was considered not to be favorable).

Safety of Synthetic Glue Used for Laparoscopic Prolapse Treatment.

STUDY OBJECTIVE: We detected mesh erosion and serious postoperative complications in 3 women after performing laparoscopic promontofixation (LPF) using glue for mesh fixation. Glue, largely used in hernia surgery repair, is proposed by some gynecologic surgeons because it saves time and is easier to use than traditional sutures. We report 3 cases of postoperative complications after LPF in which glue had been used and provide research in the published literature about the use of glue in LPF. METHODS: A research of glue use in gynecology mesh fixation was performed through PubMed on October 2016. The search was done using the Medical Subject Heading terms "POP" & "Laparoscopy" & "surgical Mesh" and the word either "glue" or "adhesive. Only 2 articles were found: Willecocq et al [1] and Estrade et al [2]. Neither study focused on postoperative complications. In this publication, we accurately edited video surgeries with an instructive purpose. SETTING: University Hospital of Clermont-Ferrand, France. CASE REPORTS: Patient A, a 65-year-old woman, complained of pelvic pain and vaginal discharge 1 month after LPF (polypropylene mesh and glue had been used). Wall mesh exposure and purulent discharge were noted. She received antibiotics and underwent mesh ablation surgery; debris of the glue was easily identified. Patient B, a 65-year-old lady with previous hysterectomy consulted for a bulging feeling in her vagina (classification: cystocele +2; rectocele +3 stage). An LPF was performed using polypropylene soft nonabsorbable mesh and glue. One month later, an apical defect of vaginal epithelialization was detected; she received long estrogenic local treatment but had to undergo surgery when presenting malodorous discharge and mesh exposure. The exposed mesh was removed, and pieces of glue were identified, having avoided mesh attachment. Patient C had a previous abdominal hysterectomy and promontofixation using a polyester mesh with glue. She consulted to us for vaginal mesh erosion covered with purulent discharge 3.5 years after LPF in another center. At the surgery, 1 cm of the prosthesis was identified in the vagina, dissected, and sutured. One year later, she consulted for dyspareunia and purulent discharge; vaginal rigid mesh exposure with an epithelization defect and inflammatory signs was seen. During laparoscopy, prosthetic exposition and glue debris on the prosthesis were identified. DISCUSSION: In all 3 cases, debris of glue were identified in the no integrated mesh area. The suggested reasons of exposure can be the excessive amount of surgical glue applied. Moreover, a large amount of glue may be impairing tissue ingrowth through the mesh pores, causing low fibrosis and poor tissue integration [3]. CONCLUSION: Glue seems to prevent fibrosis from occurring. Its use in pelvic organ prolapse laparoscopic mesh fixation should be done with caution. No prospective studies reporting long-term comorbidities and results have been published.

Laparoscopic Promontofixation in 10 Steps.

STUDY OBJECTIVE: Laparoscopic promontofixation has all the advantages of a minimally invasive approach for the treatment of urogenital prolapse. The standardization and description of the technique was the main objective of this video. We describe the complete procedure in 10 steps, which could help to understand and perform this procedure simply, easily, and safely. DESIGN: Step-by-step video demonstration of the technique. SETTING: A university tertiary care hospital. PATIENTS: Patients with indication for the laparoscopic treatment of urogenital prolapse. The local institutional review board ruled that approval was not required for this video article. MEASUREMENTS AND MAIN RESULTS: Ten main steps were identified and described in detail during laparoscopic promontofixation: step 1, exposition of the operating field; step 2, dissection of the promontory; step 3, pararectal dissection; step 4, rectovaginal dissection; step 5, vesicovaginal dissection; step 6, supracervical hysterectomy; step 7, fixation of the prosthesis; step 8, peritonization; step 9, fixing the prosthesis to the promontory; and step 10, uterine morcellation. CONCLUSION: Laparoscopic promontofixation is an effective technique for prolapse surgery. The 10 steps help to perform each part of the surgery in logical sequences, making the procedure faster to adopt and easy to learn. Standardization of laparoscopic techniques could help to reduce learning curve.

[Feasibility of outpatient laparoscopic sacrocolpopexy surgery: A pilot study]. / Étude pilote de faisabilité de la promontofixation cœlioscopique en ambulatoire.

OBJECTIVE: To evaluate the feasibility of outpatient laparoscopic sacrocolpopexy surgery. METHODS: A prospective analysis was carried out in one center from May 2014 to July 2015. The main outcome was the success of day care, meaning no hospitalization, consultation to a doctor or emergency during the first 48h following the surgery. Patients requiring laparoscopic sacrocolpopexy with eligibility for day care were included. The patients were not included if they didn't match to the administrative or medical criteria of ambulatory, or if they refused ambulatory surgery. The postoperative consultation was 1 month after surgery, the satisfaction was assessed by phone call two months after surgery. RESULTS: We included 14 patients during the study. One patient stayed the night (7.1%). The median operative time of the surgery was 95minutes (70-168minutes), no complication occurred. Ten patients of 13 (76.9%) were very satisfied or satisfied of day care. CONCLUSION: With 71% of satisfaction and only one patient who stayed the night, outpatient laparoscopic sacrocolpopexy surgery seems to be feasible. LEVEL OF EVIDENCE: 4.

[Laparoscopic sacrocolpopexy for pelvic organ prolapse: guidelines for clinical practice]. / Traitement du prolapsus génital par promontofixation laparoscopique : recommandations pour la pratique clinique.

INTRODUCTION: Open sacrocolpopexy have demonstrated its efficiency in surgical treatment of pelvic organ prolapse with an important backward on a large number of patients. Laparoscopic sacrocolpopexy reproduced the same surgical technique with reduced morbidity and may benefits from the recent development of robotic. Numerous technical variants have been developped around the original procedure but results seems not ever equivalent. Our objectives are to establish practical recommendations issues from the data of the litterature on the various technical aspects of this technique. METHODS: This work leans on an exhaustive lecture of the literature concerning meta analyses, randomized tries, registers, controlled studies and the largest non controlled studies published on the subject. Recommendations were developed by a multidisciplinary workgroup then reread and amended by an also multidisciplinary group of proofreaders (urologists, gynecologists, gastroenterologists and surgeons). The methodology follows at best the recommendations of the HAS with a scientific argument for every question (accompanied with the level of proof, NP) and the recommendations, the officers (In, B, C and agreement of experts) and validated at the end of the phase of review. RESULTS: Surgical treatment of uro-genital prolapse by abdominal route classically associated hystero and anterior vaginopexy on the sacral ligament with a synthethic mesh. There are no argument to systematically associated a posterior vaginopexy to prevent secondary rectocele (level C). The consensual indication of laparoscopic rectopexy is represented by symptomatic rectal prolapse, the anatomical and functional results of which are the best estimated (level C). The surgical treatment of rectocele, elytrocele and enterocele with a posterior vaginopexy is not well estimated (level 3). Thus, it is not possible to conclude on the results of a posterior vaginal fixation with a mesh in these indications (AP). In the absence of colpocèle, the interest brought by the posterior vaginal mesh is not established (level 3). There is no comparative studies which allows to conclude on the type and mode of fixation of the prostheses of sacrocolpopexy. We would only report the most common practices without other conclusion. The anterior mesh is usually fixed upper on the anterior part of uterus cervix and lower on the anterior vaginal wall. These fixations are most of the time made by suture and on the promontory with non absorbable suture. The great majority of the authors recommend to make a peritonisation of prostheses to limit the risk of post-operative occlusion. It is now recommended to use only 2 kind of not absorbable prostheses: type I (macroporous polypropylene) or type III (polyester) and not to use any more prostheses type II (PTFE, Silicone) (level C) because of a high rate of mesh erosion: PTFE (9 %) or Silicone (19%) (level 3). Biological prostheses are no more recommended, because of short and medium-term lower anatomical results (level B). Anatomical and functional results are not stastistically differents between laparotomy and coelioscopy (NP1) but the comparison of tong-term results between both ways is not yet established. Coelioscopy allows significant reduction of blood losses, hospital stay and return to normal activity (level 1). Furthemore, there is a higher level of post-operative complications in laparotomy (level 1). When sacrocolpopexy is indicated, coelioscopy is thus recommended (level B). During coelioscopic sacrocolpopexy, anatomical and functional result have not shown any significance difference when using or no a robotics assistance but real randomised studies does not exist (level 2). In comparison to coelioscopy, robotic seems not to improve post-operative consequences and not to decrease the rate of complications of sacrocolpopexy (level 3). Robotic assistance cannot be yet recommended when a coelioscopic sacrocolpopexy is indicated (rank B). CONCUSION: Sacrocolpopexy using not absorbable meshes allows to cure pelvic organ prolapses with very good results with few complications in terms of prothetic exposure and infection and thus is now considered as the referent prothetic surgical technique in this indication. Thus, it seems very important to establish clear recommendations on the numerous operating technical variants which developed around the original technique. © 2016 Published by Elsevier Masson SAS.

[Are there selection criteria between abdominal approach and vaginal route for genital prolapse surgical management?]. / Existe-t-il des critères de choix entre les voies abdominale et vaginale dans la cure du prolapsus génital ?

INTRODUCTION: The never ending debate over the surgical approach of genital prolapse repair (abdominal versus vaginal route) is as passionate as ever. The available literature may support a multidisciplinary analysis of our expert daily practice. OBJECTIVE: Our purpose was to define selection criteria for surgical approach between abdominal and vaginal route in the management of genital prolapse by reviewing the literature. MATERIAL AND METHODS: Systematically review of the literature concerning comparative anatomical and functionnal results of surgery of pelvic organ prolaps by vaginal or abdominal route. RESULTS: We were confronted to the lack of data in the literature, with few prospective randomized comparative studies. Many limitations were identified such as small populations in the studies, no description of sub-population, multiplicity of surgical procedures. Moreover, vaginal route was compared to sacral colpopexy by open abdominal approach, whereas laparoscopic sacrocolpopexy is now recommended. Only one prospective randomized comparative trial assessed laparoscopic sacrocolpopexy and vaginal approach, in which was used a mesh withdrawn from the market. CONCLUSION: The lack of available randomized trials makes it impossible to define HAS compliant guidelines on this topic. However, selection criteria for each surgical approach and technique were drawn from experts' advices. © 2016 Published by Elsevier Masson SAS.

[Impact of laparoscopic sacrocolpopexy, with or without a midurethral sling, on lower urinary tract symptoms]. / Impact de la promonto-fixation cœlioscopique, avec ou sans bandelette sous-urétrale, sur les symptômes du bas appareil urinaire.

OBJECTIVE: To evaluate the impact of laparoscopic sacrocolpopexy, with or without simultaneous midurethral sling (MUS), on urinary symptoms and health-related quality of life of patients. MATERIALS: A prospective analysis was carried out including 83 women with symptomatic pelvic organ prolapse who had laparoscopic sacrocolpopexy between 2009 and 2011. Patients were classified according to the preoperative clinical examination (stress test). Thirty patients with patent (group A) stress urinary incontinence (SUI) and 15 patients with occult SUI (group B) had a MUS associated with sacrocolpopexy. Thirty-eight patients with negative stress test (group C) were treated by sacrocolpopexy without MUS, even if they had history of SUI. At each visit, urinary symptoms (UDI-6) and their impact on quality of life (UIQ-7) were evaluated using validated self-questionnaires, Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. RESULTS: After 3years of mean follow-up, SUI was improved in 22/30 (77%) of patients in group A and only one patient needed a second MUS. Dysuria was cured in 9/12 (75%), 5/7 (71%) and 16/19 (84%) of patients of groups A, B, C respectively and urge urinary incontinence in 13/19 (68%), 2/2 (100%) and 4/6 (67%) of patients. The rate of de novo urge incontinence was respectively 1/11 (9%), 2/13 (15%) and 6/32 (19%). De novo SUI appeared in 6/32 (19%) of patients in group C, but only 2 of them secondarily needed a MUS. After 3 years, our study showed a significant decrease of UDI-6 of 62, 63 and 48% comparing with preoperative score and of UIQ-7 of 77, 54 and 81%. CONCLUSION: Laparoscopic sacrocolpopexy associated with MUS for patent stress urinary incontinence improves significantly stress and urgency urinary incontinence. Laparoscopic sacrocolpopexy without MUS, when physical exam shows a negative stress test, significantly reduces voiding difficulties with very few cases of de novo stress and urge incontinence. LEVEL OF EVIDENCE: 4.

[Impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality: A 3-year prospective study]. / Impact de la promontofixation cœlioscopique sur les symptômes pelviens, la qualité de vie et la sexualité : résultats à 3ans d'une étude prospective.

OBJECTIVES: To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality after a 36 month-follow-up. We also reported anatomical outcomes and reoperation rate. PATIENTS AND METHODS: A prospective monocentric study was carried out including 82 women with symptomatic Pelvic Organ Prolapse (POP) stage≥2 according to Pelvic Organ Prolapse Quantification classification. Symptoms were evaluated using the Pelvic Floor Distress Inventory (PFDI-20) and health-related quality of life by the Pelvic Floor Impact Questionnaire (PFIQ-7). Sexual function was evaluated using the Pelvic Incontinence Sexual Questionnaire (PISQ-12). Measurements were recorded at the preoperative examination, then at 3, 12 and 36 months after surgery. RESULTS: PFDI-20 scores were significantly improved at 3 months (91.9 vs. 31.8, P<0.05) and PFIQ-7 scores also (60.8 vs. 16, P<0.05). This scores improvement remained significant at 12 months. There was no significant difference between results obtained at 12 and 36 months for PFDI-20 (36.8 vs. 42.2, P>0.05) and for PFIQ-7 (18.4 vs. 24.7, P>0.05). PISQ-12 score remained significantly improved at 3, 12 and 36 months compared to baseline (34.8, 35.3, 38.5 and 38.5, respectively). Ten patients (12.8%) had anatomical recurrence at 36 months for posterior compartment, 4 (5.1%) for anterior compartment and 1 (1.2%) for medium compartment. Four patients (4.9%) required reintervention. CONCLUSION: Laparoscopic sacrocolpopexy improved early functional outcome that remained significant after at least a 36 months follow up. LEVEL OF EVIDENCE: 4.

[Does hysterectomy modifies the anatomical and functional outcomes of prolapse surgery?: Clinical Practice Guidelines]. / L'hystérectomie modifie-t-elle les résultats anatomiques et fonctionnels de la cure de prolapsus ? : Recommandations pour la pratique clinique.

OBJECTIVE: Provide guidelines for clinical practice concerning hysterectomy during surgical treatment of pelvic organ prolaps, with or without mesh. METHODS: Systematically review of the literature concerning anatomical and functionnal results of uterine conservation or hysterectomie during surgical treatment of pelvic organ prolaps. RESULTS: Sacrospinous hysteropexy is as effective as vaginal hysterectomy and repair in retrospective comparative studies and in a meta-analysis with reduced operating time, blood loss and recovery time (NP2). However, in a single RCT there was a higher recurrence rate associated with sacrospinous hysteropexy compared with vaginal hysterectomy. Sacrospinous hysteropexy with mesh augmentation of the anterior compartment was as effective as hysterectomy and mesh augmentation (NP2), with no significant difference in the rate of mesh exposure between the groups (NP3). Sacral hysteropexy is as effective as sacral colpopexy and hysterectomy in anatomical outcomes; however, the sacral colpopexy and hysterectomy were associated with increase operating time and blood loss (NP1). Performing hysterectomy at sacral colpopexy was associated with a higher risk of mesh exposure compared with sacral colpopexy without hysterectomy (NP3). There is no sufficient data in the literature to affirm that the uterine conservation improve sexual function (NP3). CONCLUSION: While uterine preservation is a viable option for the surgical management of uterine prolapse the evidence on safety and efficacy is currently lacking. © 2016 Published by Elsevier Masson SAS.

The 26-Minute Laparoscopic Sacral Colpopexy: Do We Really Need Robotic Technology?

STUDY OBJECTIVES: To demonstrate the technical steps of a laparoscopic sacral colpopexy (LSC), demonstrate the efficiency of LSC, review the comparative LSC and robotic-assisted sacral colpopexy (RSC) literature, and challenge surgeons' conventional wisdom regarding RSC. DESIGN: Use of a time-stamped video with a step-by-step explanation of the technique and slides of comparative trials and benefits of robotic surgery. SETTING: Sacral colpopexy remains the gold standard surgical procedure for treating vaginal vault prolapse. It can be performed via laparotomy, laparoscopically with or without robotic assistance. Robotic technology has been marketed based on unsubstantiated claims, including better visualization, smaller incisions, less blood loss, and greater efficiency. Conventional wisdom suggests that robotic-assisted laparoscopic surgery is easier and thus faster for the practicing surgeon. INTERVENTION: A time-stamped video of LSC in a woman with vaginal vault prolapse was performed in 26 minutes using 14 sutures in the vagina and 2 sutures in the presacral ligament. The stopwatch began after placement of the scope in the abdomen and before placement of the 3 accessory posts and ended with peritoneal closure over the sacral colpopexy mesh. The patient signed a consent and release form for the use of her video for educational purposes. CONCLUSION: A review of the literature suggests that the average RSC takes 260 minutes; the average is 200 minutes with the conventional LSC technique, realizing a time savings of at least 60 minutes. Our 26-minute LSC supports this finding.

[Day case laparoscopic sacral colpopexy for genital prolapse]. / Prise en charge ambulatoire de la promontofixation laparoscopique pour prolapsus génital.

OBJECTIVE: To demonstrate the feasibility of day case laparoscopic sacral colpopexy with the help of a fast tracking protocol. METHODS: Three motivated patients suffering from external cystocele have been strictly selected from September 2011 to October 2011 according to criteria such as Body Mass Index, ASA score, comorbidities et French day case rules. Laparoscopic sacral colpopexies consisted in anterior and posterior polyesther meshes sutured with non-resorbable wires. We are used to proceed through a SILS(©) unique ombilical port. We have used standard and straight laparoscopic instruments and laparoscope. The bladder catheter has been removed two hours after surgery, the patients have been encouraged to stand up and they have received a light meal before Chung score has been quoted. The patients have been discharged in the evening before 7 pm. RESULTS: The patients are 65, 67 and 66 years old, two of them had a past history of pelvic surgery. We did not deplore any complication during the procedure, no blood loss, no laparoscopic conversion (additional trocar); the procedures durations were 92, 120 and 124 min. These three patients have not been readmitted. Clinical examination has been scheduled between 6 and 8 weeks after surgery. We did not describe any pelvic or parietal complication, no early recurrence. CONCLUSION: We have demonstrated here the feasibility in good security conditions of day case laparoscopic sacral colpopexy for genital prolapse. A fast tracking protocol is essential and selecting the patients is required.

[Consequences of coelioscopic sacrocolopoxy on the sexuality of the couple]. / Impact des cures de prolapsus pelviens par promontofixation laparoscopique sur la sexualité du couple.

AIM: To assess the impact on the sexuality of the couple of pelvic organ prolapse repair with coelioscopic sacrocolopoxy. MATERIAL: Pilot, prospective, monocentre study conducted in Nîmes university hospital. Consecutive patients undergoing coelioscopic sacrocolpopexy and their partner were invited to participate. Women attended a pre-surgical visit and a 6-month post-surgery visit where pelvic organ prolapse status was clinically assessed. In the same time, they and their partner filled general quality of life and specific sexual quality of life questionnaires (questionnaires PISQ12, PFDI-20 in women, medical history, IIEF, modified PISQ12 questionnaires in men). RESULTS: From May to December 2010, 25 couples were assessed. Anatomical success rates (POPQ<2) in the middle, anterior and posterior compartments were respectively of 100%, 95.4% and 66.7%. After surgery, 65.2% of pairs (n=15) reported an at least hebdomadal frequency of sexual intercourse, as compared with 54.2% (n=13) of pairs before surgery (P<0.001). Two cases of decrease of sexual intercourses frequency were reported and appeared partner-related. There was an overall non-significant improvement in sexual quality of life in men and women. General pelvic organ distress, urinary incontinence and specific pelvic organ prolapse distresses were significantly improved after surgery. CONCLUSION: Coelioscopic sacrocolpopexy does not impair couple's sexuality, assessed as sexual intercourses frequency and could even improve it. Partner's assessment can bring important information with respect to the interpretation of functional sexual results of surgery.

Comparison of functional outcomes with purely laparoscopic sacrocolpopexy and robot-assisted sacrocolpopexy in obese women.

OBJECTIVE: To compare the functional outcomes and complication rates following laparoscopic sacrocolpopexy (LS) with those occurring in robot-assisted laparoscopic sacrocolpopexy (RALSCP) in obese women. PATIENTS AND METHODS: A comparative retrospective multicentre study was made, involving 39 obese women (BMI≥30 kg/m2) who underwent LS, and 17 obese women who underwent RASCLP. The operative parameters (length of operation, associated procedures, complication rate and length of hospitalization) and the objective and subjective results were evaluated at 12 months follow-up. RESULTS: The median (IQR) BMI was 30.5 kg/m2 (30-32) in the LS group vs 31.6 kg/m2 (30-34) in the RALSCP group (P=0.402). The anatomical results were comparable in both groups (LS vs RALSCP): post-operative stage of prolapse (POP-Q-ICS): stage 0-1: 34/39 (88%) vs 16/17 (94.1%), P=0.7; stage 2: 4/39 (10%) vs 0/17 (0%), P=0.7; stage 3-4: 1/39 (2%) vs 1/17 (5.9%), P=0.7. The complication rate was similar in both groups (LS vs RALSCP): bladder injury 2.5% (1/39) vs 0% (0/17), P=0.6, laparoconversion 5.1% (2/39) vs 5.9% (1/17), P=0.5. The overall reoperation rate was (LS vs RALSCP): 18% (7/39) vs 5.9% (1/17), P=0.4. CONCLUSION: Laparoscopic sacrocolpopexy and robot-assisted laparoscopic sacrocolpopexy have equal results in obese women. The complication rates and outcomes appear to be similar in both groups of obese women. LEVEL OF EVIDENCE: 3.

["Do uro-gynecology multidisciplinary team meeting modify therapeutic management?"] / « Les réunions de concertation pluridisciplinaire de pelvi-périnéologie modifient-elles les prises en charges thérapeutiques ? ¼.

INTRODUCTION: Since the banning of trans-vaginal meshes for pelvic organ prolapse treatment by the FDA in 2019, French authorities have been gradually regulating the use of prosthetic materials in urogynecology. The decision to fit a mid-urethral sling or a reinforcement implant for the cure of prolapse, as well as the management of complex genital prolapse and serious post-implant complications, must be the subject of multidisciplinary consultation and a shared medical decision. To comply with these regulations, multidisciplinary team meetings (MDTMs) have been set up. The aim of the study was to evaluate the impact of these meetings on patient management. MATERIAL: We carried out a retrospective study in a tertiary hospital in France on all cases presented in MDTM of urogynecology over the year 2022. MDTMs were held weekly, with a "Prosthesis MDTM" focusing on slings, sacrocolpo/hysteropexies and prosthetic complications, lead by the urology team, and a "Prolapse MDTM" focusing on pelvic organ prolapse and complex prolapses, lead by the gynecology team. We compared the initial proposal of the patient's referring physician versus the final proposal of the MDTM. RESULTS: Three hundred and seventy-five cases were presented in our center in 2022: 188 in Prosthetic MDTM and 187 in Prolapse MDTM. The Prosthetic and Static MDTMs agreed with the initial proposal in 83 and 64% of cases respectively, while the therapeutic strategy was questioned in 12 and 36% of cases respectively. CONCLUSION: For almost a quarter (24%) of patients, the MDTM of urogynecology opted for a different management from that proposed by the referring physician. The presentation of cases to the MDTM is a legal obligation in specific indications. It also plays an educational role, enabling shared decision-making and responsibility, which is an asset in functional surgery.

[Influence of body mass index on the outcomes of robotic-assisted laparoscopic sacrocolpopexy: a comparative retrospective study]. / Impact de l'indice de masse corporelle sur les résultats de la promontofixation robot-assistée : étude comparative rétrospective.

OBJECTIVE: The aim of our study was to assess the impact of body mass index (BMI) on a robot-assisted laparoscopic sacrocolpopexy (RALS) to treat genital prolapse. METHODOLOGY: The study focused on a group of 56 women who went through a robot-assisted laparoscopic sacrocolpopexy (RALS) between 2009 and 2013. Patients were divided into 3 groups according to their BMI (kg/m(2)): BMI<25 (n=28), 25≤BMI<30 (n=16), BMI≥30 (n=12). The operating parameters, results and short-term complications were analysed according to the patients' BMI. RESULTS: The median BMI was 22.5kg/m(2) in group 1, 26.1kg/m(2) in group 2, and 31.6kg/m(2) in group 3 (P<0.001). The operation time was respectively 250 minutes (130-380), 230 minutes (150-410) and 255 minutes (170-370), for groups 1, 2 and 3 (P=0.689). The 3 groups spent 4 days in the hospital (P=0.562). Only one laparotomy in group 3 was reported (P=0.214). The rate of early complications was similar in groups 1, 2 and 3 with 3/28, 0/16 and 0/12 respectively. Anatomical short-term results were identical in the 3 groups with a satisfactory anatomical correction in 100% of all cases (ICS POP-Q<2). CONCLUSION: In this small group, we observed that the BMI had no impact neither on the operation time nor on the rate of complication.

Spondylodiscitis via enterospinal fistula after promontofixation.

Spondylodiscitis on enterospinal fistula after promontofixation. A case report and other spondylodiscitis etiologies.

A Case of Spondylodiscitis Fistulating Into the Vagina 15 Years after Promontofixation.

Promontofixations can be a rare cause of spondylodiscitis due to the material used getting infected. We present here a case of a 75-year-old woman who underwent a subtotal hysterectomy, followed by a trachelectomy, and presented 15 years later with lumbago and fever. After thorough examination, haemocultures and imaging were performed. This led to the diagnosis of spondylodiscitis of L5-S1, likely due to S. constellatus, with a fistula into the vagina. The patient received surgical treatment. This case is unusual due to the time lapse between the hysterectomy and the infection as well as the probable pathogen. Teaching Point: Promontofixation material can remain despite hysterectomy and can be a source of infection many years after the operation has taken place.

Infectious complications of promontofixation, a systematic review of the literature.

INTRODUCTION: Surgery for genitourinary prolapse may be complicated, with postoperative infections. While promontofixation is recommended and widely used, the impact of postoperative infections has received little study. We consequently decided to review the literature to identify risk factors for infection. MATERIAL AND METHOD: We conducted a systematic review of the literature. PubMed, Medline and the Cochrane databases up until August 2019 were examined. The keywords were: "promontofixation", "colpopexy", "sacral colpopexy", "sacrocolpopexy". The primary outcome consisted in infectious complications. We also performed a meta-analysis using RevMan software. RESULTS: Fifty-two among 1624 articles were selected. Infectious complications following promontofixation are infrequent. While few factors have been definitively associated with the occurrence of postoperative infections, associated procedures such as rectopexia or hysterectomy increase the risk of the latter. However, type of approach does not seem to affect the rate of occurrence of infectious complications. CONCLUSION: This review of the literature underscores a lack of descriptive, statistical and therapeutic data on post-promontofixation infections, which are certainly underestimated. On the other hand, it helps to identify the association of certain factors with the occurrence of postoperative infections.

Pregnancy management in laparoscopic promontofixation patients: a challenging situation with no clear recommendations.

Uterine-sparing prolapse surgery offers fertility preservation; however, available data on the safety of pregnancy after surgery and the effects of pregnancy on surgical outcome are limited. Authors report herein reflections on the case of a 39-year-old woman with pelvic organ prolapse who underwent laparoscopic promontofixation. Pregnancy was diagnosed 2 weeks post-surgery. The main target of this research is to focus on pregnancy management before and after promontofixation due to the lack of data on the safety of pregnancy following surgery and the effect of pregnancy on surgical outcome. It seems preferable to us to operate patients in the first part of the cycle, if not after a dosage of beta-HCG and to provide effective contraception for at least 12 months.