CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(09): 983-992
DOI: 10.1055/a-0941-3485
GebFra Science
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up

Uteruserhaltende laparoskopisch-laterale Suspension mit Netzimplantat zur Behandlung des urogenitalen Deszensus: erste Erfahrungen in einem Krankenhaus der Maximalversorgung bei einer mittleren Follow-up-Dauer von 24 Monaten
Murat Yassa
Department of Obstetrics and Gynecology, Health Sciences University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
,
Niyazi Tug
Department of Obstetrics and Gynecology, Health Sciences University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
› Author Affiliations
Clinical Trials Registration: ClinicalTrials.gov NCT03387202
Further Information

Publication History

received 31 March 2019
revised 25 May 2019

accepted 27 May 2019

Publication Date:
05 August 2019 (online)

Abstract

Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations.

Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than − 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter.

Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed.

Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.

Zusammenfassung

Einleitung Die laparoskopisch-laterale Suspension mit Netzimplantat (LLSM) ist eine effektive und weniger invasive Technik zur Behandlung des urogenitalen Deszensus. Die primären Ziele, subjektive Erfolgsquote und Ultraschallergebnisse der Beckenbodenuntersuchungen nach einem gebärmuttererhaltenden LLSM-Eingriff werden hier vorgestellt.

Patientinnen und Methoden Siebzehn Patientinnen, die sich einem gebärmuttererhaltenden LLSM-Eingriff (abdominale Zervikopexie) in einem Krankenhaus der Maximalversorgung unterzogen, wurden in diese prospektive Studie aufgenommen. Die anatomische Heilungsrate wurde als ein Pelvic Organ Prolapse Quantification-(POP-Q-)Wert von weniger als − 1 cm für das apikale und für das anteriore Kompartiment definiert. Die subjektive Heilung wurde als das Fehlen von Ausbuchtungssymptomen definiert. Patientenzufriedenheit, Sexualfunktion, deszensusassoziierte Lebensqualität, Blasenentleerungsstörungen, Nykturie und Obstipation wurden evaluiert. Die Mobilität des anterioren Kompartiments und der anteroposteriore Durchmesser des Hiatus wurden mithilfe des transperinealen Ultraschalls gemessen.

Ergebnisse Die anatomische Heilungsrate betrug 100% für das apikale und 88,2% für das anteriore Kompartiment. Eine Patientin hatte nach dem Eingriff eine symptomatische Zystorektozele 2. Grades, und eine Patientin hatte eine asymptomatische Zystozele 2. Grades. Die subjektive Heilungsrate und der Patientenzufriedenheitswert betrug jeweils 94,12 bzw. 100%. Es gab eine signifikante Verbesserung bei den Orientierungspunkten Ba und C, und die vaginale Verlängerung betrug 10,14 ± 4,19 mm. Der Orientierungspunkt Bp stieg um 5,72 ± 11,27 mm (p = 0,053). Die urethrale Rotation and die retrovesikalen Winkel verkleinerten sich um jeweils 6.24 ± 11.95° bzw. 27 ± 47.2° (p1 = 0,047; p2 = 0,032). Der anteroposteriore Durchmesser des Hiatus verkürzte sich um 4,36% (p = 0,039). Es gab eine signifikante Verbesserung hinsichtlicher der Nykturieepisoden, nicht aber bei der Obstipation. Es gab keinen Fall von Netzerosion.

Schlussfolgerungen Die gebärmuttererhaltende LLSM (abdominale Zervikopexie) erwies sich als effektive Methode für die Korrektur des apikalen und anterioren Deszensus mit hohen Patientenzufriedenheitswerten. Es gab auch signifikante Verbesserungen bei den Symptomen der Dranginkontinenz und der Häufigkeit der Nykturie. Die Ultraschallergebnisse der Beckenbodenmessungen könnten sich als nützlich erwiesen, um dieses Behandlungskonzept mit anderen chirurgischen Eingriffen zu vergleichen.

 
  • References

  • 1 Ghetti C, Skoczylas LC, Oliphant SS. et al. The emotional burden of pelvic organ prolapse in women seeking treatment: a qualitative study. Female Pelvic Med Reconstr Surg 2015; 21: 332
  • 2 Wu JM, Matthews CA, Conover MM. et al. Lifetime risk of stress incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014; 123: 1201
  • 3 Rooney K, Kenton K, Mueller ER. et al. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 2006; 195: 1837-1840
  • 4 Dubuisson J, Chapron C. Laparoscopic iliac colpo-uterine suspension for the treatment of genital prolapse using two meshes: A new operative laparoscopic approach. J Gynecol Surg 1998; 14: 153-159
  • 5 Kapandji M. [Treatment of urogenital prolapse by colpo-isthmo-cystopexy with transverse strip and crossed, multiple layer, ligamento-peritoneal douglasorrhaphy]. Ann Chir 1967; 21: 321-328
  • 6 Veit-Rubin N, Dubuisson J-B, Lange S. et al. Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients. Int Urogynecol J 2016; 27: 491-493
  • 7 Veit-Rubin N, Dubuisson J-B, Gayet-Ageron A. et al. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J 2017; 28: 1685-1693
  • 8 Meriwether KV, Antosh DD, Olivera CK. et al. Uterine preservation vs. hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol 2018; 219: 129-146.e2
  • 9 Shek K, Dietz HP. Assessment of pelvic organ prolapse: a review. Ultrasound Obstet Gynecol 2016; 48: 681-692
  • 10 Dubuisson JB, Chapron C, Fauconnier A. et al. Laparoscopic management of genital prolapse: lateral suspension with two meshes. Gynaecological Endoscopy 2000; 9: 363-368
  • 11 Dubuisson J, Eperon I, Dällenbach P. et al. Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh. Arch Gynecol Obstet 2013; 287: 307-312
  • 12 Dubuisson J-B, Yaron M, Wenger J-M. et al. Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients. J Minim Invasive Gynecol 2008; 15: 49-55
  • 13 Veit-Rubin N, Dubuisson J, Constantin F. et al. Uterus preservation is superior to hysterectomy when performing laparoscopic lateral suspension with mesh. Int Urogynecol J 2019; 30: 557-564
  • 14 Yassa M, Tug N. Uterus-preserving lateral mesh suspension with minor modification. Eur J Obstet Gynecol Reprod Biol 2019; 234: e236
  • 15 Swift S, Morris S, McKinnie V. et al. Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system. Int Urogynecol J 2006; 17: 615-620
  • 16 Cam C, Sakalli M, Ay P. et al. Validation of the prolapse quality of life questionnaire (P-QOL) in a Turkish population. Eur J Obstet Gynecol Reprod Biol 2007; 135: 132-135
  • 17 Özengin N, Kaya S, Orhan C. et al. Turkish adaptation of the Pelvic Organ Prolapse Symptom Score and its validity and reliability. Int Urogynecol J 2017; 28: 1217-1222
  • 18 Verit FF, Verit A. Validation of the female sexual function index in women with chronic pelvic pain. J Sex Med 2007; 4: 1635-1641
  • 19 Sargın MA, Yassa M, Taymur BD. et al. Adaptation and validation of the Michigan incontinence severity index in a Turkish population. Patient Prefer Adherence 2016; 10: 929
  • 20 Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 2010; 21: 523-528
  • 21 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
  • 22 Chantarasorn V, Dietz H. Diagnosis of cystocele type by clinical examination and pelvic floor ultrasound. Ultrasound Obstet Gynecol 2012; 39: 710-714
  • 23 Dietz H, Lekskulchai O. Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms. Ultrasound Obstet Gynecol 2007; 29: 688-691
  • 24 Ganatra AM, Rozet F, Sanchez-Salas R. et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 2009; 55: 1089-1105
  • 25 Good MM, Abele TA, Balgobin S. et al. Preventing L5-S1 discitis associated with sacrocolpopexy. Obstet Gynecol 2013; 121: 285-290
  • 26 Akladios CY, Dautun D, Saussine C. et al. Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve. Eur J Obstet Gynecol Reprod Biol 2010; 149: 218-221
  • 27 Ceci F, Spaziani E, Corelli S. et al. Technique and outcomes about a new laparoscopic procedure: the Pelvic Organ Prolapse Suspension (POPS). G Chir 2013; 34: 141-144
  • 28 Huang WC, Yang SH, Yang JM. Clinical importance and surgical outcomes of green type III cystocele in women with anterior vaginal prolapse. J Ultrasound Med 2015; 34: 2279-2285
  • 29 Liedl B, Inoue H, Sekiguchi Y. et al. Update of the integral theory and system for management of pelvic floor dysfunction in females. European Urology Supplements 2017; DOI: 10.1016/j.eursup.2017.01.001.
  • 30 Andrew BP, Shek KL, Chantarasorn V. et al. Enlargement of the levator hiatus in female pelvic organ prolapse: cause or effect?. Aust N Z J Obstet Gynaecol 2013; 53: 74-78