DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221937

Selective allocation of patients with vaginal apical prolapse to either mesh augmented open abdominal repair or vaginal sacrospinous colpopexy improve functional and anatomical outcomes

Mahmoud F. Hassan, Osama El-Tohamy, Amr Helmy Yehia, Salha A. Alghanimi, Hessa Al-Enezi, Mahmoud Moussa

Abstract


Background: To evaluate the functional and anatomical outcomes after allocation of patients with apical vaginal prolapse to either mesh augmented abdominal repair or vaginal sacrospinous-colpopexy based on proposed selection criteria.

Methods: A non-randomized trial was conducted at Ain-Shams university maternity hospital on patients with apical vaginal prolapse stage ≥2 based on pelvic organ prolapse quantification system. Certain criteria were proposed for patient selection to either mesh augmented abdominal repair or vaginal sacrospinous-colpopexy. Seventy-eight patients were assigned for sacrospinous-colpopexy and 47-patients for abdominal repair. Primary outcomes were the functional outcome using urogenital distress inventory questionnaire and patient global impression of improvement (PGI-I). Both were measured at 1-year’s follow-up. Secondary outcomes involved the anatomical success (defined as no apical prolapse ≥POP-Q stage 2), perioperative data and long-term complications.

Results: There was improvement in all UDI domains for sacrospinous-colpopexy and abdominal repair groups with genital prolapse domain of median (interquartile range) 0 (0-10), 0 (0-0) respectively. Eighty-nine percent of abdominal repair group and 85% of sacrospinous-colpopexy group reported scale of 1 or 2 on PGI-I scale at 1-year follow-up. PGI-I score and improvements in UDI domains were maintained till 5-year follow-up. The anatomic success rate at 1-year follow-up was 97.9% in abdominal repair group and 78.2% in the sacrospinous-colpopexy group. No long-term mesh complications were detected in mesh augmented abdominal repair over the whole follow-up periods.

Conclusion: The resulting meritorious functional and anatomical outcomes favor adoption of our proposed selection criteria in the initiation of guidelines and recommendations for managing vaginal apical prolapse.


Keywords


Abdominal sacrocolpopexy, Apical prolapse, Sacrospinous colpopexy, Vaginal vault prolapse

Full Text:

PDF

References


Choi KH, Hong JY. Management of pelvic organ prolapse. Korean J Urol. 2014;55(11):693-702.

DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992; 166(1):1717-28.

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5-26.

Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(1):45-51.

Diwadkar GB, Barber MD, Feiner B, Maher C, Jelovsek JE. Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol. 2009;113(1):367-73.

Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;30(4):CD004014.

Coolen AWM, Bui BN, Dietz V, Wang R, van Montfoort APA, Mol BWJ, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767-83.

Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK, et al. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol. 2015;125(1):44-55.

Anand M, Weaver AL, Fruth KM, Gebhart JB. Factors influencing selection of vaginal, open abdominal, or robotic surgery to treat apical vaginal vault prolapse. Female Pelvic Med Reconstr Surg. 2016; 22(4):236-42.

Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardisation of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1):10-7.

Ibrahim A, Eltohamy O, Ibrahim M, Ellaithy MI, Bahaa A, Elkady M, et al. Sacrospinous colpopexy using Masson luethy needle holder. Eur J Obstet Gynecol Reprod Biol. 2014;179:5-10.

Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010; 21(5):523-8.

Van der Vaart CH, de Leeuw JR, Roovers JP, Heintz AP. Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn. 2003; 22(2):97-104.

Roovers JP, van der Blom JG, van der Vaart CH. Hysterectomy does not cause constipation. Dis Colon Rectum. 2008;51(7):1068-72.

Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG. 2004;111(1):50-6.

Tinelli A, Malvasi A, Rahimi S, Negro R, Vergara D, Martignago R, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause. 2010;17(1): 204-12.

Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST) the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795-806.

Coolen ALWM, van Oudheusden AMJ, Mol BWJ, van Eijndhoven HWF, Roovers JWR, Bongers MY. Laparoscopic sacrocolpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial. Int Urogynecol J. 2017;28(10):1469-79.

Illiano E, Giannitsas K, Zucchi A, Di Biase M, Del Zingaro M, Bini V, Costantini E. Sacrocolpopexy for posthysterectomy vaginal vault prolapse: long-term follow-up. Int Urogynecol J. 2016;27(10):1563-9.

Freeman RM, Pantazis K, Omson A, Frappell J, Bombieri L, Moran P, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. 2013;24(3):377-84.

Culligan PJ, Blackwell L, Goldsmith LJ, Graham CA, Rogers A, Heit MH. A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstet Gynecol. 2005;106(1):29-37.

Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190(1):20-6.

Halaska M, Maxova K, Sottner O, Svabik K, Mlcoch M, Kolarik D, et al. A multicenter, randomized , prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse. Am J Obstet Gynecol. 2012;207(4):301.e1-7.

Svabik K, Martan A, Masata J, El-Haddad R, Hubka P. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol. 2014; 43(4):365-71.

Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 2013;309(19):2016-24.

Lo TS, Wang AC. Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: A comparison. J Gynecol Surg. 1998;14(2):59-64.

Serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse: FDA Safety Communication. Available at: https://www.burgsimpson.com/wp-content/uploads/ 2018/03/FDA-safety-communication-pelvic-mesh. pdf. Accessed on 12 March 2018.