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Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively

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Abstract

Introduction and hypothesis

Uterine conserving re-suspension surgery has become more popular in recent years. Such surgery may allow preservation of fertility in younger women, but may also have the added benefit of augmenting weak connective tissue and possibly providing stronger apical support than the conventional hysterectomy. Our goal was to evaluate the 1- to 4-year outcome of laparoscopic hysteropexy for the surgical management of uterine prolapse.

Methods

This study was a prospective observational study of 182 consecutive women who underwent laparoscopic hysteropexy, with or without additional vaginal repair, from the beginning of 2007 until the end of 2010. Women were invited to attend a dedicated clinic for interview and their prolapse was assessed using the Patient Global Impression of Improvement (PGI-I), the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (ICIQ-VS) and the pelvic organ prolapse quantification (POP-Q) scale. Wilcoxon signed-rank test was used to compare pre-operative with postoperative data. Complications and women’s satisfaction were also noted.

Results

One hundred and forty women agreed to participate; the mean interval from operation was 2.1 years (range 1–4.4). Eighty-nine percent of women felt that their prolapse is “very much” or “much” better using PGI-I subjective outcome measure. There was significant improvement for all parameters of ICIQ-VS and POP-Q scoring post-surgery (p < 0.001). Six women (4 %) had further apical prolapse; of these, 3 underwent further prolapse surgery. None of the participants had any mesh exposure. Ninety two percent of participants would recommend the operation.

Conclusions

Laparoscopic hysteropexy is a safe and effective treatment. The 1- to 4-year outcome suggests high patient satisfaction and low rates of apical prolapse recurrence. Longer term follow-up and randomized controlled studies are required.

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References

  1. Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S (2011) Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open 1(2):e000206. doi:10.1136/bmjopen-2011-000206

    Article  PubMed Central  PubMed  Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506. doi:10.1016/S0029-7844(97)00058-6

    Article  CAS  PubMed  Google Scholar 

  3. Dallenbach P, Kaelin-Gambirasio I, Dubuisson JB, Boulvain M (2007) Risk factors for pelvic organ prolapse repair after hysterectomy. Obstet Gynecol 110(3):625–632. doi:10.1097/01.AOG.0000278567.37925.4e

    Article  PubMed  Google Scholar 

  4. Zucchi A, Lazzeri M, Porena M, Mearini L, Costantini E (2010) Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol 7(11):626–633. doi:10.1038/nrurol.2010.164

    Article  PubMed  Google Scholar 

  5. Maher CF, Feiner B, DeCuyper EM, Nichlos CJ, Hickey KV, O’Rourke P (2011) Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 204(4):360.e1–360.e7. doi:10.1016/j.ajog.2010.11.016

    Article  Google Scholar 

  6. Smith SR, Solomon M (2010) Functional comparisons between open and laparoscopic rectopexy. Gastroenterol Clin Biol 34(10):505–507. doi:10.1016/j.gcb.2010.08.003

    Article  CAS  PubMed  Google Scholar 

  7. Price N, Slack A, Jackson SR (2010) Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG Int J Obstet Gynecol 117(1):62–68. doi:10.1111/j.1471-0528.2009.02396.x

    Article  Google Scholar 

  8. Price N, Jackson SR, Avery K, Brookes ST, Abrams P (2006) Development and psychometric evaluation of the ICIQ vaginal symptoms questionnaire: the ICIQ-VS. BJOG Int J Obstet Gynecol 113(6):700–712. doi:10.1111/j.1471-0528.2006.00938.x

    Article  CAS  Google Scholar 

  9. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  CAS  PubMed  Google Scholar 

  10. Rahmanou P, Price N, Jackson S (2013) Laparoscopic Hysteropexy- A novel technique for uterine preservation surgery. Int Urogynecol J. doi:10.1007/s00192-013-2129-4

  11. Elneil S, Cutner AS, Remy M, Leather AT, Toozs-Hobson P, Wise B (2005) Abdominal sacrocolpopexy for vault prolapse without burial of mesh: a case series. BJOG Int J Obstet Gynecol 112(4):486–489. doi:10.1111/j.1471-0528.2004.00426.x

    Article  Google Scholar 

  12. Srikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 21(5):523–528. doi:10.1007/s00192-009-1069-5

    Article  PubMed  Google Scholar 

  13. Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, Swift S, Whitmore K, Ghoniem G, de Ridder D (2012) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J 23(5):527–535. doi:10.1007/s00192-012-1726-y

    Article  PubMed  Google Scholar 

  14. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26. doi:10.1007/s00192-009-0976-9

    Article  PubMed  Google Scholar 

  15. Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, Dwyer PL, Fatton B, Kocjancic E, Lee J, Maher C, Petri E, Rizk DE, Sand PK, Schaer GN, Webb RJ (2011) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J 22(1):3–15. doi:10.1007/s00192-010-1324-9

    Article  PubMed  Google Scholar 

  16. Dietz V, de Jong J, Huisman M, Schraffordt Koops S, Heintz P, van der Vaart H (2007) The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct 18(11):1271–1276. doi:10.1007/s00192-007-0336-6

    Article  PubMed  Google Scholar 

  17. Leron E, Stanton SL (2001) Sacrohysteropexy with synthetic mesh for the management of uterovaginal prolapse. BJOG Int J Obstet Gynecol 108(6):629–633

    Article  CAS  Google Scholar 

  18. Stanford EJ, Cassidenti A, Moen MD (2012) Traditional native tissue versus mesh-augmented pelvic organ prolapse repairs: providing an accurate interpretation of current literature. Int Urogynecol J 23(1):19–28. doi:10.1007/s00192-011-1584-z

    Article  CAS  PubMed  Google Scholar 

  19. Shippey SH, Quiroz LH, Sanses TV, Knoepp LR, Cundiff GW, Handa VL (2010) Anatomic outcomes of abdominal sacrocolpopexy with or without paravaginal repair. Int Urogynecol J 21(3):279–283. doi:10.1007/s00192-009-1013-8

    Article  PubMed  Google Scholar 

  20. De Boer TA, Milani AL, Kluivers KB, Withagen MI, Vierhout ME (2009) The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication. Int Urogynecol J Pelvic Floor Dysfunct 20(11):1313–1319. doi:10.1007/s00192-009-0945-3

    Article  PubMed Central  PubMed  Google Scholar 

  21. DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166(6 Pt 1):1717–1724; discussion 1724–1718

    Article  CAS  PubMed  Google Scholar 

  22. Prodigalidad LT, Peled Y, Stanton SL, Krissi H (2013) Long-term results of prolapse recurrence and functional outcome after vaginal hysterectomy. Int J Gynecol Obstet Off Organ Int Fed Gynaecol Obstet 120(1):57–60. doi:10.1016/j.ijgo.2012.07.022

    Google Scholar 

  23. Maher CM, Feiner B, Baessler K, Glazener CM (2011) Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22(11):1445–1457. doi:10.1007/s00192-011-1542-9

    Article  PubMed  Google Scholar 

  24. Visco AG, Weidner AC, Barber MD, Myers ER, Cundiff GW, Bump RC, Addison WA (2001) Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol 184(3):297–302. doi:10.1067/mob.2001.109654

    Article  CAS  PubMed  Google Scholar 

  25. Pakbaz M, Mogren I, Lofgren M (2009) Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care. BMC Womens Health 9:9. doi:10.1186/1472-6874-9-9

    Article  PubMed Central  PubMed  Google Scholar 

  26. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren LK, Zhang M, Meikle S (2013) Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 309(19):2016–2024. doi:10.1001/jama.2013.4919

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Glazener C (2013) Vault or uterine prolapse surgery evaluation: The VUE study. http://isrctn.org/ISRCTN86784244

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Conflicts of interest

None.

Details of ethics approval

No ethical approval was required for this investigation as it was a simple observational study (clinical audit). Approval was obtained from the regional audit committee.

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Correspondence to Philip Rahmanou.

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A related video article can be found at 10.1007/s00192-013-2129-4.

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Rahmanou, P., White, B., Price, N. et al. Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively. Int Urogynecol J 25, 131–138 (2014). https://doi.org/10.1007/s00192-013-2209-5

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  • DOI: https://doi.org/10.1007/s00192-013-2209-5

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