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Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 23560

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Special Issue Editor

Prof. Dr. Gautier Chene

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Guest Editor

Department of Gynecology, Femme Mère Enfant University Hospital, University Hospital of Lyon, 59 Boulevard Pinel, 69677 Lyon-Bron, France
Interests: pelvic organ prolapse; laparoscopic sacrocolpopexy; sacrospinous colpopexy; cystocele; vaginal mesh; colpoperineorraphy; autologous tissue; transvaginal natural orifice transluminal endoscopic surgery (V-NOTES); endometriosis; leiomyoma

Special Issue Information

Dear Colleagues,

Many countries have banned vaginal mesh implants for women with genital prolapse. However, pelvic organ prolapse symptoms are associated with poorer quality of life scores, suggesting that we should propose innovative and relevant medical or surgical treatments.

Medical management with pessaries and/or pelvic floor muscle training may be the first line therapy in symptomatic patients. Pelvic organ surgery by the vaginal route as well as by the laparoscopic or robotic approach should also be reinvented. New innovative techniques by the transvaginal natural orifice transluminal endoscopic surgery, new vaginal or laparoscopic techniques with autologous tissue, and/or with new specific sling procedures may be effective. Management of symptomatic prolapse may involve a variety of clinicians and specialties, as well as a combined interdisciplinary approach.

We invite both clinicians and scientists to contribute their work in this Special issue focusing on this important clinical entity with the ultimate aim to advance further our understanding and the results of non-surgical and surgical treatments of pelvic organ prolapse.

Prof. Dr. Gautier Chene
Guest Editor

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Keywords

pelvic organ prolapse
laparoscopic sacrocolpopexy
sacrospinous colpopexy
cystocele
vaginal mesh
colpoperineorraphy
autologous tissue
transvaginal natural orifice transluminal endoscopic surgery (V-NOTES)

Published Papers (14 papers)

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Research

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11 pages, 928 KiB

Open AccessArticle

Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series

by Farouk Drissi, Fabien Rogier-Mouzelas, Sebastian Fernandez Arias, Juliette Podevin and Guillaume Meurette

J. Clin. Med. 2023, 12(17), 5751; https://doi.org/10.3390/jcm12175751 - 4 Sep 2023

Cited by 1 | Viewed by 950

Abstract

Introduction: Laparoscopic ventral mesh rectopexy (VMR) is the standard procedure for the treatment of posterior pelvic organ prolapse. Despite significant functional improvement and anatomical corrections, severe complications related to mesh augmentation can occur in a few proportions of patients. In order to decrease the number of rare but severe complications, we developed a variant of the conventional VMR without any rectal fixation and using a robotic approach with biological mesh. The aim of this study was to compare the results of laparoscopic ventral rectopexy with synthetic mesh (LVMRS) to those of robotic ventral rectopexy with biological mesh (RVMRB). Methods: Between 2004 and 2021, patients operated on for VMR in our unit were identified and separated into two groups: LVMRS and RVMRB. The surgical technique for both groups consisted of VMR without any rectal fixation, with mesh distally secured on the levator ani muscles. Results: 269 patients with a mean age of 62 years were operated for posterior pelvic floor disorder: rectocele (61.7%) and external rectal prolapse (34.6%). 222 (82.5%) patients received LVMRS (2004–2015), whereas 47 were operated with RVMRB (2015–2021). Both groups slightly differed for combined anterior fixation proportion (LVMRS 39% vs. RVMRB 6.4%, p < 0.001). Despite these differences, the length of stay was shorter in the RVMRB group (2 vs. 3 days, p < 0.001). Postoperative complications were comparable in the two groups (1.8 vs. 4.3%, p = 0.089) and mainly consisted of minor complications. Functional outcomes were favorable and similar in both groups, with an improvement in bulging, obstructed defecation symptoms, and fecal incontinence (NS in subgroup analysis). In the long term, there were no mesh erosions reported. The overall recurrence rate was 11.9%, and was comparable in the two groups (13% LVMRS vs. 8.5, p = 0.43). Conclusions: VMR without rectal fixation is a safe and effective approach in posterior organ prolapse management. RVMRB provides comparable results in terms of recurrence and functional results, with avoidance of unabsorbable material implantation. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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10 pages, 539 KiB

Open AccessArticle

Long-Term Results after Bilateral Sacrospinous Colposuspension: A Prospective Study

by Gautier Chene, Emanuele Cerruto, Stephanie Moret and Erdogan Nohuz

J. Clin. Med. 2023, 12(14), 4691; https://doi.org/10.3390/jcm12144691 - 14 Jul 2023

Viewed by 742

Abstract

The loss of apical support is usually present in patients with pelvic organ prolapse. An effective correction for the vaginal apex may be an essential part of a durable repair for these women. Apical suspension of the sacrospinous ligament is likely one of the best treatments by the vaginal route. We proposed the evaluation of the functional and anatomical long-term results of an ultralight and macroporous sling. In this prospective study, bilateral sacrospinous colposuspension was performed in 32 patients with a specific mesh. Functional assessment with several validated quality of life questionnaires and pelvic examination was performed at 1, 6, 12, and 24 months after surgery. Pelvic examination using the POP-Q classification showed a very good efficacy of the BSC mesh with only three prolapse recurrences at 24 months after surgery. All the following QoL scores were significantly improved by two years: PFIQ-7 (p < 0.0001), PFDI-20 (p < 0.0001), and SF-12 (p < 0.0001). No improvement was achieved by the PISQ12 questionnaire. This vaginal minimally invasive procedure is effective, quick, reproducible, and easy. It may be a relevant option for a vaginal vault or cervical or uterine prolapse. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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10 pages, 947 KiB

Open AccessArticle

Mid-Term Results of a New Transobturator Cystocele Repair by Vaginal Patch Plastron without Mesh

by Gautier Chene, Emanuele Cerruto, Stephanie Moret and Erdogan Nohuz

J. Clin. Med. 2023, 12(14), 4582; https://doi.org/10.3390/jcm12144582 - 10 Jul 2023

Viewed by 2331

Abstract

Cystoceles are the most common prolapses. Limitation of the use of synthetic mesh has led to the comeback of native tissue repair procedures. We have developed a new transobturator technique with native tissue based on a mix of a vaginal plastron technique and the transobturator procedure. We present the functional and anatomical mid-term results. In this retrospective study, the vaginal plastron technique and the transobturator procedure were performed in 32 patients. Functional assessment with several validated quality-of-life questionnaires (SF-12, PFIQ-7, PFDI-20, PISQ12) and anatomical evaluation with pelvic examination were performed at 1, 6, and 12 months after surgery. The anatomical success rate was 94.4% at 12 months. There was one Clavien–Dindo grade 2 postoperative complication (one urinary tract infection). All of the quality-of-life scores were statistically significantly improved at one year follow-up. The transobturator technique combined with the vaginal plastron seems to be a promising, effective, innovative, and relevant technique for the repair of high-stage cystoceles. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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10 pages, 261 KiB

Open AccessArticle

Comparison of Early Postoperative Outcomes for Vaginal Anterior Sacrospinous Ligament Fixation with or without Transvaginal Mesh Insertion

by Louis-Edouard Galan, Stéphanie Bartolo, Céline De Graer, Sophie Delplanque, Marine Lallemant and Michel Cosson

J. Clin. Med. 2023, 12(11), 3667; https://doi.org/10.3390/jcm12113667 - 25 May 2023

Cited by 1 | Viewed by 921

Abstract

Pelvic organ prolapse affects one in three women, and cystocele accounts for 80% of the indications for surgery. Following the withdrawal of transvaginal mesh from the market, the objective of the present before-and-after study was to compare of the previous reference technique (Uphold^TM (Boston Scientific, Marlborough, MA, USA) mesh insertion) with anterior sacrospinous ligament fixation with suturing in terms of the outcomes 2 months after surgery. We performed a retrospective, observational, before-and-after study at Lille University Medical Center (Lille, France) by including consecutive patients operated on between 2011 and 2018 for Uphold^TM mesh insertion and between 2018 to 2020 for anterior sacrospinous ligament fixation. The primary outcome was the early recurrence of prolapse, and the secondary outcomes were the occurrence of early per-operative or post-operative complications and the development of de novo stress urinary incontinence. Here, 466 patients were included in the study (382 in the Uphold^TM group and 84 in the anterior sacrospinous ligament fixation group). The failure rate at 2 months was 6.0% (5 out of 84) for anterior sacrospinous ligament fixation and 1.3% (5 out of 382) for Uphold^TM (p < 0.01). The prevalence of acute urinary retention was significantly lower in the anterior sacrospinous ligament fixation group (3.6%) than in the Uphold^TM group (14.1%; p < 0.01), as was the de novo stress urinary incontinence rate (11.9% vs. 33.8%, respectively; p < 0.01). Anterior sacrospinous ligament fixation appears to be an effective, safe alternative to mesh insertion in the management of cystocele via the vaginal approach; the early complication rate was slightly lower, but the early failure rate was slightly higher. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

11 pages, 250 KiB

Open AccessArticle

Anterior and Apical Prolapse: Comparison of Vaginal Mesh Surgery to Vaginal Surgery with No Mesh

by Charlotte Cassagne, Francoise Perriard, Arnaud Cornille, Jennifer Salerno and Laure Panel

J. Clin. Med. 2023, 12(6), 2212; https://doi.org/10.3390/jcm12062212 - 13 Mar 2023

Cited by 1 | Viewed by 1278

Abstract

Aim of the study: The aim of this study was to evaluate the anatomical results after an anterior sacrospinous ligament fixation (ASSLF) with native tissue repair (anterior colporraphy and apical suspension with prolene) compared to mesh repair for the correction of anterior prolapse at 12 months after surgery. Materials and methods: A monocentric prospective study comparing two similar cohorts who underwent ASSLF was conducted. The primary endpoint was the gain in the position of the Ba point relative to its position before surgery and twelve months after surgery. The secondary endpoints consisted of objective results, which were assessed using validated questionnaires. Results: Fifty-three women were included in the native tissue repair group between June 2019 and March 2020. They were compared to 53 women operated on with anterior and apical mesh. There was no difference with respect to the Ba point after 1 year between the two groups (−2 [−3; 1.5]; −2 [−3; 1], p = 0.9789). The apex was significantly better corrected in the native tissue repair group (−7 vs. −6, p = 0.0007). There was also a better correction on the rectocele in the native tissue repair group (−3 vs. −2, p = 0.0178). The rate of Stage 2 anterior vaginal prolapse at one year was approximately 30% in both groups (no statistical difference). Conclusions: ASSFL without mesh does not increase the risk of cystocele recurrence at 1 year after surgery. A future prospective comparison of this native tissue repair technique with mesh suspension is necessary to explore these preliminary findings. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

9 pages, 645 KiB

Open AccessArticle

Identification of Key Factors Influencing the Choice of the Type of Vaginal Pessary for Women Presenting with Pelvic Organ Prolapse: Semi-Directive Interviews and Development of an Algorithm

by Marie-Amélie Le Quoy, Odile Cotelle, Renaud de Tayrac, Florence Happillon, Antoine Pelhuche, Valérie Wenner-Vidal, Blandine Liagre, Florence Cour, Camille Armengaud, Gautier Chene, Emilie Cerutti, Fabienne Doucet, Anne-Cécile Pizzoferrato and Xavier Deffieux

J. Clin. Med. 2023, 12(4), 1548; https://doi.org/10.3390/jcm12041548 - 15 Feb 2023

Cited by 2 | Viewed by 1391

Abstract

(1) Background: Pelvic organ prolapse (POP) can be managed using a vaginal pessary. However, the decision-making process whereby health professionals choose the right pessary is unclear. The objective of this study was to focus on the experience of experts in pessary use and to propose an algorithm. (2) Methods: A prospective study, based on face-to-face semi-directive interviews and group discussions, was conducted on a multidisciplinary panel of professional experts specialized in pessary prescriptions. A consensual algorithm was established, and its accuracy was assessed by expert and non-expert panels. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were used. (3) Results: 17 semi-directive interviews were conducted. The parameters involved in the decision-making process regarding the choice of vaginal pessaries were: desire for self-management (65%), associated urinary stress incontinence (47%), POP type (41%), and POP stage (29%). The algorithm was developed step by step (4 iterations) using the Delphi technique. Most of the expert panel (76%) rated the relevance of the algorithm as 7 or more out of 10 on a visual analog scale according to their own experience (reference activity). Finally, most (81%) of the non-expert panel (n = 230) rated the usefulness of this algorithm as 7 or more out of 10 on a visual analog scale. (4) Conclusions: This study provides an expert panel-based algorithm that may help in the prescription of pessaries for POP. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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10 pages, 1243 KiB

Open AccessArticle

Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

by Xavier Fritel, Marion Ravit, Anne-Cécile Pizzoferrato, Sandrine Campagne-Loiseau, Georges Bader, Perrine Capmas, Michel Cosson, Philippe Debodinance, Xavier Deffieux, Hervé Fernandez, Philippe Ferry, Olivier Garbin, Bernard Jacquetin, Guillaume Legendre, Christian Saussine, Renaud de Tayrac, Laurent Wagner, Jean-Philippe Lucot, Arnaud Fauconnier and the PROSPERE team

J. Clin. Med. 2023, 12(4), 1332; https://doi.org/10.3390/jcm12041332 - 7 Feb 2023

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Abstract

Women’s preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women’s hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women’s hopes covered seven themes, and women’s fears eleven. Women’s hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women’s fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women’s expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman’s expectations before pelvic-floor repair. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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9 pages, 1142 KiB

Open AccessArticle

Serious Complications and Recurrence following Sacrospinous Ligament Fixation for the Correction of Apical Prolapse

by Susie De Gracia, Brigitte Fatton, Michel Cosson, Sandrine Campagne-Loiseau, Philippe Ferry, Jean-Philippe Lucot, Philippe Debodinance, Laure Panel, Xavier Deffieux, Olivier Garbin, Géry Lamblin, Caroline Carlier-Guérin, Rajeev Ramanah, Arnaud Fauconnier, Chris Serrand, Xavier Fritel and Renaud de Tayrac

J. Clin. Med. 2023, 12(2), 468; https://doi.org/10.3390/jcm12020468 - 6 Jan 2023

Cited by 2 | Viewed by 1598

Abstract

Objective: To evaluate the rates of serious complications and reoperation for recurrence following sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse. Methods: This was a national registry ancillary cohort comparative study. The VIGI-MESH registry includes data from 24 French health centers prospectively collected between May 2017 and September 2021. Time to occurrence of a serious complication or reoperation for genital prolapse recurrence was explored using the Kaplan–Meier curve and Log-rank test. The inverse probability of treatment weighting, based on propensity scores, was used to adjust for between-group differences. Results: A total of 1359 women were included and four surgical groups were analyzed: Anterior SSLF with mesh (n = 566), Anterior SSLF with native tissue (n = 331), Posterior SSLF with mesh (n = 57), and Posterior SSLF with native tissue (n = 405). Clavien–Dindo Grade III complications or higher were reported in 34 (2.5%) cases, with no statistically significant differences between the groups. Pelvic organ prolapse recurrence requiring re-operation was reported in 44 (3.2%) women, this was higher following posterior compared with anterior SSLF (p = 0.0034). Conclusions: According to this large database ancillary study, sacrospinous ligament fixation is an effective and safe surgical treatment for apical prolapse. The different surgical approaches (anterior/posterior and with/without mesh) have comparable safety profiles. However, the anterior approach and the use of mesh were associated with a lower risk of reoperation for recurrence compared with the posterior approach and the use of native tissue, respectively. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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11 pages, 1043 KiB

Open AccessArticle

Long-Term Assessment of Pelvic Organ Prolapse Reoperation Risk in Obese Women: Vaginal and Laparoscopic Approaches

by Marine Lallemant, Géraldine Giraudet, Victoire Delporte, Hélène Behal, Chrystele Rubod, Sophie Delplanque, Yohan Kerbage and Michel Cosson

J. Clin. Med. 2022, 11(22), 6867; https://doi.org/10.3390/jcm11226867 - 21 Nov 2022

Viewed by 1294

Abstract

The aim of this study was to compare reoperation risks after pelvic organ prolapse repair at 5-year follow-up between obese, overweight, and normal-weight women and to assess these risks accounting for the surgical procedure. We performed a retrospective chart review of all the women who underwent POP repair by transvaginal mesh surgery between January 2005 and January 2009 or laparoscopic sacrocolpopexy between January 2003 and December 2013 at the Gynecologic Surgery Department of the Lille University Hospital. During the study period, 744 women who underwent POP repair were divided into three groups: 382 (51%), 240 (32%), and 122 (16%) in the nonobese group (BMI < 25 kg/m²), overweight group (25 kg/m² ≤ BMI < 30 kg/m²), and obese group (BMI ≥ 30 kg/m²), respectively. The primary outcome was global reoperation. The median duration of follow-up was 87 months. The risks of global reoperation did not significantly differ between the three BMI groups (adjusted HR (95% CI): 1.12 (0.69 to 1.82) for overweight women and 0.90 (0.46 to 1.74) for obese women compared to normal-weight women, adjusted p = 0.80), nor among the women who underwent transvaginal mesh surgery or laparoscopic sacrocolpopexy. The risks of reoperation for POP recurrence, stress urinary incontinence, or mesh-related complications did not significantly differ between the three BMI groups in the overall population nor accounting for the surgical procedure. In conclusion, obesity does not seem to be a risk factor of reoperation for POP recurrence, SUI, or mesh-related complications in the long term regardless of the surgical approach. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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11 pages, 496 KiB

Open AccessArticle

The Vaginal Patch Plastron Associated to the Anterior Sacrospinous Ligament Fixation for the Treatment of Advanced Anterior Vaginal Wall Prolapse

by Alessandro Ferdinando Ruffolo, Benjamin Lambert, Marine Lallemant, Massimo Candiani, Stefano Salvatore and Michel Cosson

J. Clin. Med. 2022, 11(22), 6684; https://doi.org/10.3390/jcm11226684 - 11 Nov 2022

Cited by 3 | Viewed by 2027

Abstract

Background: this study aims to compare the efficacy and safety of vaginal patch plastron (VPP) associated to anterior sacrospinous ligament fixation (SSLF-A) with SSLF-A associated or not to the anterior colporrhaphy (AC) for cystocele treatment. Methods: single-center retrospective study in women with cystocele ≥ III stage submitted to surgery. The primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at follow-up > 6 months. The secondary outcome was to describe peri- and postoperative complications and risk factors for cystocele objective relapse. Results: 75 women were submitted to SSLF-A and 61 women to VPP. VPP objective and subjective relapse (6.5%, 4/61 and 1.1%, 1/61) were lower than SSLF-A (26.7%, 20/75 and 20%, 15/75; p = 0.002 and p = 0.001, respectively). SSLF-A had a higher reintervention rate, but not significantly (6.6%, 5/75 vs. 0%, 0/61; p = 0.06). Previous hysterectomy was a risk factor (HR 4; 1.3–12.1) while VPP was protective factor (HR 0.2; 0.1–0.9) for cystocele anatomical relapse. Postoperative buttock pain was more prevalent in VPP (57.4%, 35/75 vs. 34.7%, 26/61; p = 0.01). Conclusions: VPP is effective and safe for advanced cystocele treatment, with lower objective and subjective relapse rates in comparison to isolated SSLF-A or associated with the AC. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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9 pages, 774 KiB

Open AccessArticle

Long-Term Outcomes after Pelvic Organ Prolapse Repair in Young Women

by Marine Lallemant, Yasmine Clermont-Hama, Géraldine Giraudet, Chrystèle Rubod, Sophie Delplanque, Yohan Kerbage and Michel Cosson

J. Clin. Med. 2022, 11(20), 6112; https://doi.org/10.3390/jcm11206112 - 17 Oct 2022

Cited by 4 | Viewed by 2544

Abstract

The aim of the study was to describe the long-term outcomes of Pelvis Organ Prolapse (POP) repair in women under 40 years old. A retrospective chart review of all POP repairs performed in women ≤40 years old between January 1997 and December 2015 in the Gynecologic Surgery Department of Lille University Hospital was performed. Inclusion criteria were all women ≤40 years old who underwent a POP repair with a stage ≥2 POP according to the Baden and Walker classification. The study population was separated into three groups: a sacrohysteropexy group, a vaginal native tissue repair (NTR) group, and a transvaginal mesh surgery (VMS) group. The primary outcome was reoperation procedures for a symptomatic recurrent POP. Secondary outcomes were other complications. During the study period, 43 women ≤ 40 years old who underwent a POP repair were included and separated into three groups: 28 patients (68%), 8 patients (19%), and 7 patients (16%) in the sacrohysteropexy, VMS, and NTR groups respectively. The mean followup time was 83 ± 52 months. POP recurrence, reoperated or not, was essentially diagnosed in the VMS group (87.5%) and the NTR group (50%). POP recurrence repairs were performed for nine patients (21%): 7%, 62.5%, and 25% in the sacrohysteropexy, VMS, and NTR groups, respectively. Global reoperation concerned 10 patients (23%) whatever the type of POP surgery, mainly patients from the VMS group (75%) and from the NTR group (25%). It occurred in only 7% of patients from the sacrohysteropexy group. Two patients (4%) presented a vaginal exposure of the mesh (in the VMS group). De novo stress urinary incontinence was encountered by nine patients (21%): 29% and 12.5% in the sacrohysteropexy and NTR groups, respectively. Despite the risk of recurrence, POP repair should be proposed to young women in order to restore their quality of life. Vaginal native tissue repair or sacrohysteropexy should be performed after explaining to women the advantages and disadvantages of each procedure. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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13 pages, 512 KiB

Open AccessArticle

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

by Siegfried Nebel, Christian Creveuil, Michel Briex, Raffaèle Fauvet, Anne Villot and Anne-Cécile Pizzoferrato

J. Clin. Med. 2022, 11(19), 5972; https://doi.org/10.3390/jcm11195972 - 10 Oct 2022

Cited by 3 | Viewed by 1589

Abstract

Background: The non-surgical solution for Pelvic Organ Prolapse (POP) typically consists of a pessary fitting. We aimed to assess patient satisfaction and symptom improvement 6 months after a pessary fitting and to identify risk factors associated with pessary failure. Methods: Six months after a pessary fitting, patient satisfaction was assessed by the PGII score; symptoms and quality of life were assessed using validated questionnaires (PFDI-20, ICIQ-SF, PISQ-12, USP, and PFIQ-7). Results: Of the 190 patients included in the study (mean age of 66.7 years), 141 (74%) and 113 (59%) completed the follow-up questionnaires at 1 and 6 months, respectively. Nearly all the women were menopausal (94.6%) and 45.2% declared being sexually active at inclusion. The satisfaction rate was 84.3% and 87.4% at 1 and 6 months, respectively. The global symptom score PFDI-20 had significantly improved at 6 months. A high body mass index (RR = 1.06, CI_95%: [1.02–1.09]), as well as high PFDI-20 (1.05 [1.01–1.09]), PFIQ7 (1.04 [1.01, 1.08]), and PISQ12 scores at inclusion (0.75 [0.60, 0.93]), as well as higher GH and GH/TVL measurements (1.49 [1.25–1.78] and 1.39 [1.23–1.57], respectively) were associated with pessary failure. Conclusions: Pessary seems to be an effective treatment for POP with high patient satisfaction. Higher BMI, higher symptom scores, and greater genital hiatus measurements before insertion are risk factors for failure at 6 months. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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9 pages, 9943 KiB

Open AccessArticle

How Women Perceive Severity of Complications after Pelvic Floor Repair?

by Anne-Cécile Pizzoferrato, Stéphanie Ragot, Louis Vérité, Nicolas Naiditch and Xavier Fritel

J. Clin. Med. 2022, 11(13), 3796; https://doi.org/10.3390/jcm11133796 - 30 Jun 2022

Cited by 1 | Viewed by 1023

Abstract

Background: The Clavien-Dindo classification, used to describe postoperative complications, does not take into account patient perception of severity. Our main objective was to assess women’s perception of postoperative pelvic floor repair complications and compare it to the classification of Clavien-Dindo. Methods: Women and surgeons participating in the VIGI-MESH registry concerning pelvic floor repair surgery were invited to quote their perception of complication severity through a survey based on 30 clinical vignettes. For each vignette, four grades of severity were proposed: “not serious”, “a little serious”, “serious”, “very serious”. Results: Among the 1146 registered women, we received 529 responses (46.2%) and 70 of the 141 surgeons (49.6%) returned a completed questionnaire. A total of 25 of the 30 vignettes were considered classifiable according to the Clavien-Dindo classification. The women’s classification was concordant with Clavien-Dindo for 52.0% (13/25) of the classifiable vignettes. The women’s and surgeons’ responses were discordant for 20 of the 30 clinical vignettes (66.7%). Loss of autonomy (self-catheterization, long-term medication use) or occurrence of sequelae (organ damage or severe persistent pain) were perceived by women as more serious than Clavien-Dindo classification or than surgeons’ perceptions. Conclusions: Women’s perception of pelvic floor repair surgery seems different from the Clavien-Dindo classification. Lack of repair and long-term disability seem to be two major factors in favor of perception of the surgical complication as serious. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

Review

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13 pages, 1570 KiB

Open AccessReview

Summary: 2021 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse

by Renaud de Tayrac, Danielle D. Antosh, Kaven Baessler, Cecilia Cheon, Xavier Deffieux, Robert Gutman, Joseph Lee, Charles Nager, Alexis Schizas, Vivian Sung and Christopher Maher

J. Clin. Med. 2022, 11(20), 6106; https://doi.org/10.3390/jcm11206106 - 17 Oct 2022

Cited by 9 | Viewed by 3732

Abstract

(1) Background: There is wide variation in the reported prevalence rates for pelvic organ prolapse (POP). There is also wide variation in the rate at which surgical interventions for pelvic organ prolapse are performed, as well as the type of interventions undertaken. As part of the International Consultation on Incontinence (ICI), our committee was tasked to produce evidence-based pathways for the surgical management of POP, any associated stress urinary incontinence (SUI), and bowel dysfunction. (2) Methods: To enable us to generate such evidence, we undertook a thorough search for the POP surgery-related, English-language scientific literature published up to April 2021. (3) Results: The committee evaluated the literature and made recommendations based on the Oxford grading system. (4) Conclusions: This review serves to provide a summary of the 2021 ICI surgical management of an evidence-based prolapse pathway and outline the evidence used to inform this guidance. Full article

(This article belongs to the Special Issue Advances in Non-surgical and Surgical Treatments of Pelvic Organ Prolapse)

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