Search Results (25)

Background: Recurrent apical pelvic organ prolapse (POP) presents significant management challenges, with limited evidence on optimal surgical approaches. This study evaluated the safety and long-term effectiveness of minimally invasive sacrospinous ligament (SSL) fixation using the EnPlace^® device for treating recurrent apical POP. Methods: A cohort analysis was performed on 82 consecutive patients (mean age 65.9 ± 8.6 years) with stage III or IV recurrent symptomatic apical POP. All patients underwent transvaginal SSL fixation using the EnPlace^® device between January 2021 and July 2023. Primary outcomes included anatomical cure rates, patient satisfaction, and complications. Long-term follow-up was conducted via a structured telephone survey in December 2024. Results: The mean interval between primary and recurrent repair was 3.2 ± 2.6 years. Most patients (64.6%) underwent surgery under regional anesthesia with a mean operative time of 24.1 ± 7.1 min and minimal blood loss (23.8 ± 6.5 mL). No intraoperative complications occurred, and 98.8% of patients were discharged the same day. Two early postoperative complications occurred, neither requiring surgical intervention. At six-month follow-up, significant improvements were observed in POP-Q measurements for apical prolapse, cystocele, and rectocele. Long-term follow-up (mean 31.6 ± 8.3 months) revealed that only 11 patients (13.4%) reported mild POP symptoms. Patient satisfaction scores averaged 90.8 ± 17.1, with only 8.5% reporting low satisfaction. Only two patients (2.4%) required additional intervention for recurrent apical POP. Conclusions: Minimally invasive SSL fixation using the EnPlace^® device demonstrates favorable safety and efficacy for recurrent apical POP, offering a viable alternative to more invasive procedures with high patient satisfaction and low recurrence rates. Full article

In recent years, pelvic organ prolapse (POP) cases have been rising, affecting women’s quality of life. Synthetic surgical transvaginal meshes used for POP treatment were withdrawn from the United States market in 2019 due to high risks, including infection, vaginal mesh erosion, and POP reoccurrence. Biodegradable mesh implants with three-dimensional printing technology have emerged as an innovative alternative. In this study, polycaprolactone (PCL) meshes for POP repair were fabricated using melt electrospinning writing (MEW) and mechanically evaluated through uniaxial tensile tests. Following this, they were coated with antibiotics—azithromycin, gentamicin sulfate, and ciprofloxacin—commonly used for genitourinary tract infections. Zone inhibition and biofilm assays evaluated antibiotic effectiveness in preventing mesh infections by Escherichia coli, and methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus. The meshes presented a mechanical behavior closer to vaginal tissue than commercially available meshes. Fourier transform infrared analysis confirmed antibiotic incorporation. Ciprofloxacin demonstrated antibacterial activity against MRSA, with a 92% reduction in metabolic activity and a 99% biomass reduction. Gentamicin and ciprofloxacin displayed inhibitory activity against MSSA and E. coli. Scanning electron microscopy images support these conclusions. This methodology may offer a more effective, patient-friendly solution for POP repair, improving healing and the quality of life for affected women. Full article

Background/Objectives: Pelvic organ prolapse (POP) and urinary incontinence are prevalent conditions among women, significantly affecting their quality of life. Vaginal mesh surgeries, including the use of the Calistar mesh, have become an essential intervention aimed at alleviating symptoms associated with POP and urinary dysfunction. This study evaluates the clinical outcomes of Calistar vaginal mesh surgeries, focusing on pre- and post-operative changes in urinary parameters and prolapse severity. Methods: Data from 180 patients undergoing Calistar procedures were analyzed, revealing significant improvements in anatomical markers (Aa, Ba, C, Ap, and Bp) and urinary distress metrics (UDI-6 and IIQ-7) postoperatively. Results: The results demonstrate that Calistar mesh procedures are effective in reducing urinary frequency, incontinence, and incomplete bladder emptying. Conclusions: Calistar mesh procedures offer a safe and effective surgical option for managing POP and associated urinary dysfunction. The observed anatomical and functional improvements suggest that Calistar mesh significantly enhances patient outcomes and quality of life. Full article

Background and Clinical Significance: A vesicocervical fistula is an abnormal connection between the urinary tract and the cervix. With the increased prevalence of cesarean sections in recent years, the incidence of vesicocervical fistulas has also increased. The objective of this study was to evaluate the available evidence regarding the laparoscopic approach and to present a case study of a patient who underwent minimally invasive repair of a vesicocervical fistula after vacuum delivery. Case Presentation: A 32-year-old mother was admitted to our center with symptoms of urine leakage through the cervix uteri 5 days after vacuum-assisted delivery. In particular, the patient had recently undergone a vacuum-assisted delivery and cesarean section. A positive methylene blue staining test and transvaginal ultrasonography demonstrated an anatomical connection between the bladder and the cervix. Surgical repair of the vesicocervical fistula was performed under general anesthesia and a Foley catheter was inserted for 7 days. Urodynamic studies conducted seven days postoperative and six weeks post-surgery showed normal bladder function and capacity. Conclusions: Early detection and surgical correction of vesicocervical fistulas using a minimally invasive approach is crucial for the treatment of this condition. This case report emphasizes the importance of considering vesicocervical fistulas, particularly in patients with a history of cesarean section who have undergone vacuum-assisted delivery. Full article

Introduction: This narrative review aims to investigate the intricacy of human sexuality, the prevalence and effect of pelvic organ prolapse (POP) repair on overall sexual function and dyspareunia, and the subsequent repercussions on body image self-perception and quality of life. Methods: A MEDLINE and PUBMED search was conducted for studies evaluating the effect of POP surgery on sexual function and dyspareunia in sexually active women as well as its impact on body image self-perception and QoL. We included both observational and randomized controlled studies evaluating this subject. We evaluated patients who underwent anterior and/or posterior compartment repair eventually including vaginal hysterectomy. We excluded studies including women with concomitant anti-incontinence surgical correction and/or any vaginal reconstruction with synthetic materials. Results: Women with POP are more likely to diminish sexual activity due to a perceived impact on body image and attractiveness as well as worry of incontinence. Conservative management (such as pelvic floor muscle physiotherapy or pessary use) or surgical intervention via transabdominal or transvaginal routes have been used to treat POP, but concerns remain regarding sexual consequences. Despite a post-surgical positive sexual outcome, there is an inherent risk of de novo dyspareunia regardless of the surgical technique employed with slightly higher risk for the transvaginal approach. Patient counselling prior to surgery has proved to be an important element of POP treatment. Only studies on complications of POP surgery, specifically its impact on female sexuality, dyspareunia, global quality of life, and self-perceived body image, were included and analyzed for this review. We limited our search to the international English language literature published over the last three decades and excluded all studies involving the use of synthetic material in transvaginal POP repair. Discussion and Conclusions: Although no consistent evidence was found that disorders of the pelvic floor in women have a clear adverse effect on sexuality, their anatomical correction using the patient’s native tissues is recommended. Dyspareunia reduced significantly after repair, but the rate remains higher after the transvaginal approach versus the minimally invasive (robot-assisted and laparoscopic) approach used for sacrocolpopexy. Full article

Introduction: Pelvic organ prolapse is a common condition that can affect 50% of parous women. The surgical management can be divided into two approaches: A trans-vaginal and a trans-abdominal approach. In view of current controversies and discrepancies between guidelines, this review aims to scope the historically available data on synthetic meshes in the management of POP mainly on outcomes and complications of the trans-vaginal approach and the trans-abdominal approach. Methods: This study is a narrative review of the use of synthetic meshes in POP surgery. The different indications, the results, and comparisons to other surgical management were collected using MEDLINE and Google Scholar. Results: Regarding the trans-vaginal approach, 31 articles were included. The anatomical success rate is high, around 90%. However, this technique was recently considered cost-ineffective mostly because of high rates of erosions, ranging from 4 to 40% depending on the series. Obesity seems to be the most important risk factor of mesh erosion, followed by age and smoking. Regarding the trans-abdominal approach, 36 articles were included. In the literature, anatomical success is between 70 and 95%, with an erosion rate between 0 and 11%. Minimally invasive sacrocolpopexy and open sacrocolpopexy seem to be equally effective on anatomical outcomes and recurrence rates. Concomitant total hysterectomy might be effective but may be associated with more mesh erosions. Concomitant laparoscopic supracervical hysterectomy may be the preferred option for patients with cervical and uterine lesions but should not be performed for the sole purpose of reducing the occurrence of endometrial carcinoma, especially when uterine preservation seems effective and is associated with less blood loss and shorter operating time. Conclusion: Our review reports limited application for trans-vaginal repair because of high complications rates, leading countries to suspend their utilization. Our review reports a gold standard application for trans-abdominal sacrocolpopexy. The use of synthetic meshes in trans-abdominal sacrocolpopexy for POP repair provide durable cure rates with a lower rate of mesh-related complications and therefore may be considered the gold standard approach. Full article

Background: The Minimally Invasive Prolapse System (MIPS) device, a novel single-incision transvaginal mesh, represents recent advancements in mesh technology, providing lightweight, biocompatible support for pelvic organ prolapse while reducing erosion, allowing for customization and improving surgical outcomes. This study aimed to identify factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair using the Minimally Invasive Prolapse System device. Methods: Two hundred and eighteen women with symptomatic stage II to IV POP underwent TVM. Preoperative and postoperative assessments included urinalyses and pelvic examinations using the POP quantification (POP-Q) staging system. Results: During a follow-up period of 12–46 months, 7 of 218 (3.2%) women experienced POP recurrence. Univariate analysis was conducted to identify predictors of surgical failure, revealing no significant differences in body mass index, POP stage, or preoperative urinary symptoms between the recurrence and success groups (p > 0.05). However, functional urethral length <20 mm based on urodynamics (p = 0.011), ICI-Q scores ≥7 (p = 0.012), and the first 60 surgical cases (p = 0.018) were significant predictors of surgical failure. Multivariate logistic regression confirmed these findings. Conclusions: Functional urethral length <20 mm, ICI-Q scores ≥7, and limited surgical experience were significant predictors of TVM failure using the Minimally Invasive Prolapse System kit. POP recurrence after mesh repair is less likely beyond the learning curve. Full article

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure–flow and pressure–volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019–December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure–volume loop (Apv). Post-operative results showed a significant reduction in Rvod (p < 0.001, N = 15), Pvod (p = 0.021, N = 15), and Apv (p = 0.006, N = 15), along with an increase in Fvod (p = 0.003, N = 15) and a decrease in Tvod (p < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, p = 0.004, r = 0.717, p = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, p = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, p = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, p = 0.029, N = 15) but not with ΔVvod (r = 0.353, p = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder’s workload. Full article

Vaginal vault prolapse is one of the main reasons for reoperation in patients with pelvic organ prolapse. Effective correction of the vaginal apex is essential for lasting repair for these women. Apical suspension of the sacrospinous ligament is probably one of the main vaginal treatments still offered to patients today. We proposed an evaluation of the functional and anatomical results of long-term sacrospinous ligament fixation. Objective: The purpose of this study was to evaluate the 10-year results of sacrospinous ligament suspension as primary repair for apical prolapse and to evaluate long-term side effects. Materials and Methods: A retrospective study analyzed 10-year follow-up after prolapse repair using sacrospinous ligament suspension. A subjective recurrence was identified as the postoperative occurrence of swelling symptoms based on a particular item on the Italian Prolapse Quality of Life (P-QoL) questionnaire. An objective recurrence was defined as a postoperative decline to stage II or below in any compartment based on the POP-Q system or the requirement for additional surgery. The assessment of postoperative subjective satisfaction was conducted using the Patient Global Impression of Improvement (PGI-I) score. Results: In total, 40 patients underwent sacrospinous ligament fixation. Objective recurrence was remarkably high, as it was observed in 17 (56.7%) patients. Subjective recurrence was reported by ten (33.3%) women, and reintervention occurred in two (6.7%) of patients. From the point of view of quality of life, according to the PGI-I, twenty-three (76.7%) patients described some degree of improvement after surgery, four (13.3%) described their status as unmodified, and three (10%) reported some form of worsening after primary treatment. Conclusions: Transvaginal repair with sacrospinous fixation is a long-lasting option for prolapse repair, with improvement in every POP-q parameter. Some degree of anterior recurrence, recurrence of symptoms with swelling, or an overall worsening of quality of life after surgery is possible. Full article

Introduction: Medical advancements are expected to lead to a substantial increase in the population of women aged 80 and older by 2050. Consequently, a significant number of individuals undergoing corrective prolapse surgery will fall into the elderly-patient category. The research indicates a notable rise in complications associated with prolapse surgery in patients older than 80, irrespective of frailty and other risk factors. Despite these challenges, the vaginal approach has been identified as the safest surgical method for pelvic organ prolapse (POP) repair in the elderly population. For this reason, we aimed to investigate the efficacy, complication rate, and functional outcomes associated with vaginal hysterectomy and an apical suspension/high uterosacral ligaments suspension as a primary technique for prolapse repair, both within a cohort of elderly patients. Methods: We retrospectively analyzed patients who underwent transvaginal hysterectomy plus an apical suspension procedure for stage ≥ II and symptomatic genital prolapse between January 2006 and December 2013. Anatomical and functional outcomes were evaluated. The Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. Results: Sixty-five patients were included in the analysis. The median age was 81.3 years. All individuals exhibited an anterior compartment prolapse stage II or higher, and the majority also a central prolapse stage II or higher. Notably, all participants reported symptoms of vaginal bulging. Over half of the population (58.6%) complained of incomplete bladder emptying. The intervention for all participants involved a vaginal hysterectomy with an apical suspension. Sixty-three patients (96.9%) and forty-four patients (67.6%) underwent a simultaneous anterior or posterior repair, respectively. Long-term complications (>30 days from surgery) were observed during follow-up, with a median duration of 23 ± 20 months. Seven (10.7%) anatomical recurrences were recorded, five (7.69%) concerning the anterior compartment, one (1.5%) the central, and three (4.6%) the posterior. Nevertheless, none of them necessitated further surgical intervention due to symptoms. Significant anatomical improvements for the anterior, central, and posterior compartments were noticed, compared to preoperative assessment (p < 0.001 for Aa and Ba, p < 0.001 for Ap and Bp, and p < 0.001 for C). PGI-I values established that 100% of patients were satisfied (PGI-I ≥ 2), with a median score of 1.12. Consequently, objective and subjective cure rates were 89.5% and 100%, respectively. Conclusion: Vaginal hysterectomy combined with apical suspension, particularly high uterosacral ligaments suspension, is a safe and effective primary surgical approach, even in elderly patients. Full article

Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault prolapse repair through high uterosacral ligaments suspension is limited. Consequently, with this study, we aimed to assess the efficiency, complications frequency, and functional results of native-tissue repair through USLs in vaginal vault prolapse. Materials and Methods: This was a retrospective study. Women with symptomatic vaginal vault prolapse (≥stage 2) who underwent surgery with transvaginal native-tissue repair by high uterosacral ligaments were included. Patient characteristics, preoperative assessment, operative data, postoperative follow-up visits, and re-interventions were collected from the hospital’s record files. High uterosacral ligament suspension was performed according to the technique previously described by Shull. A transverse apical colpotomy at the level of the post-hysterectomy scar was performed in order to enter the peritoneal cavity. USLs were identified and transfixed from ventral to dorsal with three absorbable sutures. Sutures were then passed through the vaginal apex and tightened to close the transverse colpotomy and suspend the vaginal cuff. At the end of the surgical time, a diagnostic cystoscopy was performed in order to evaluate ureteral bilateral patency. Using the POP-Q classification system, we considered an objective recurrence as the descensus of at least one compartment ≥ II stage, or the need for a subsequent surgery for POP. The complaint of bulging symptoms was considered the item to define a subjective recurrence. We employed PGI-I scores to assess patients’ satisfaction. Results: Forty-seven consecutive patients corresponding to the given period were analyzed. No intraoperative complications were observed. We observed one postoperative hematoma that required surgical evacuation. Thirty-three patients completed a minimum of one-year follow-up (mean follow-up 21.7 ± 14.6 months). Objective cure rate was observed in 25 patients (75.8%). No patients required reintervention. The most frequent site of recurrence was the anterior compartment (21.2%), while apical compartment prolapse relapsed only in 6% of patients. An improvement in all POP-Q parameters was recorded except TVL which resulted in a mean 0.5 cm shorter. Subjective recurrence was referred by 4 (12.1%) patients. The mean satisfaction assessed by PGI-I score was 1.6 ± 0.8. Conclusion: This analysis demonstrated that native-tissue repair through high USL suspension is an effective and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse. Objective, subjective, functional, and quality of life outcomes were satisfactory, with minimal complications. Full article

Background: Pelvic organ prolapse constitutes a prevalent condition associated with a considerable impact on the quality of life. The utilization of transvaginal mesh surgery for managing POP has been a subject of extensive debate. Globally, trends in TVM surgery experienced significant shifts subsequent to warnings issued by the FDA. Methods: This study aims to explore temporal patterns in transvaginal mesh surgery in the German healthcare system. A comprehensive analysis was conducted on in-patient data from the German Federal Statistical Office spanning 2006 to 2021. A total of 1,150,811 operations, each associated with specific codes, were incorporated into the study. Linear regression analysis was employed to delineate discernible trends. Results: The trends in transvaginal mesh surgery within the anterior compartment exhibited relative stability (p = 0.147); however, a significant decline was noted in all other compartments (posterior: p < 0.001, enterocele surgery: p < 0.001). A subtle increasing trend was observed for uterine-preserving transvaginal mesh surgery (p = 0.045). Conclusion: Surgical trends over the specified timeframe demonstrate how POP management has evolved globally. Notably, despite observed fluctuations, transvaginal mesh surgery remains a viable option, particularly for specific cases with a high risk of relapse and contraindications to alternative surgical approaches. Full article

(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh^®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh^®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women. Full article

Background: This study evaluated the effectiveness, safety, and possible changes in bowel symptoms after multicompartment prolapse surgery by comparing two different surgical approaches, transvaginal mesh surgery with levatorplasty (TVMLP) and robot-assisted sacrocolpopexy (RSC). Methods: All patients underwent pelvic (POP-Q staging system) and rectal examination to evaluate anal sphincter tone in the lithotomy position with the appropriate Valsalva test. The preoperative evaluation included urodynamics and pelvic magnetic resonance defecography. Patient Global Impression of Improvement (PGI-I) at follow-up measured subjective improvement. All patients completed Agachan–Wexner’s questionnaire at 0 and 12 months of follow-up to evaluate bowel symptoms. Results: A total of 73 cases were randomized into the RSC group (36 cases) and TVMLP group (37 cases). After surgery, the main POP-Q stage in both groups was stage I (RCS 80.5% vs. TVMLP 82%). There was a significant difference (p < 0.05) in postoperative anal sphincter tone: 35%. The TVMLP group experienced a hypertonic anal sphincter, while none of the RSC group did. Regarding subjective improvement, the median PGI-I was 1 in both groups. At 12 months of follow-up, both groups exhibited a significant improvement in bowel symptoms. Conclusions: RSC and TVMLP successfully corrected multicompartment POP. RSC showed a greater improvement in the total Agachan–Wexner score and lower bowel symptoms. Full article

Although trans-vaginal mesh (TVM) offers a successful anatomical reconstruction and can subjectively relieve symptoms/signs in pelvic organ prolapse (POP) patients, its objective benefits to the voiding function of the bladder have not been well established. In this study, we investigated the therapeutic advantage of TVM on bladder function by focusing on the thermodynamic workload of voiding. The histories of 31 POP patients who underwent TVM repair were retrospectively reviewed. Cystometry and pressure volume analysis (PVA) of the patients performed before and after the operation were analyzed. TVM postoperatively decreased the mean voiding resistance (mRv, p < 0.05, N = 31), reduced the mean and peak voiding pressure (mPv, p < 0.05 and pPv, p < 0.01, both N = 31), and elevated the mean flow rate (mFv, p < 0.05, N = 31) of voiding. While displaying an insignificant effect on the voided volume (Vv, p < 0.05, N = 31), TVM significantly shortened the voiding time (Tv, p < 0.05, N = 31). TVM postoperatively decreased the loop-enclosed area (Apv, p < 0.05, N = 31) in the PVA, indicating that TVM lessened the workload of voiding. Moreover, in 21 patients who displayed postvoiding urine retention before the operation, TVM decreased the residual volume (Vr, p < 0.01, N = 21). Collectively, our results reveal that TVM postoperatively lessened the workload of bladder voiding by diminishing voiding resistance, which reduced the pressure gradient required for driving urine flow. Full article