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The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II‐S (AGREE II‐S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German‐speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous‐hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered. Synopsis: Tailored surgical approach for pelvic organ prolapse respects patient preferences, aligning with diverse international guidelines. [ABSTRACT FROM AUTHOR]

Introduction: and hypothesis. We evaluated different bladder parameters using Transperineal Ultrasound (TPUS) in patients with apical pelvic organ prolapse undergoing lateral suspension or sacropexy. Methods: We included 73 cases with 37 cases in lateral suspension (LS) group and 36 cases in sacropexy group. We enrolled cases with apical prolapse stage 2 or higher according to Pelvic Organ Prolapse Quantification system (POP-Q). Evaluation done of all cases using TPUS preoperatively and at 6, 12 and 18 months follow-up visits. Results: In LS group we found significant differences postoperatively in bladder neck height (Dy distance) at Valsalva and rest (P value < 0.001 in both) and in β angle at Valsalva and rest (P value < 0.001 in both). There was significant improvement in PVR (P value < 0.001). In sacropexy group we found no significant differences postoperatively in bladder neck height at Valsalva (P value 0.07) or in β angle at Valsalva (P value 0.097). There was significant improvement in PVR (P value 0.006). In between the 2 groups, there was better improvement in LS group than sacropexy group in bladder neck height at rest (P value 0.001) and in β angle both at Valsalva and rest (P value < 0.001 & 0.002 respectively). There was no significant difference in PVR, bladder wall thickness or bladder neck funnelling. Conclusion: LS and sacropexy showed good postoperative improvement in some bladder parameters using TPUS with better improvement in bladder neck height in LS. Clinical Trial Registration: Clinical trial ID: NCT03772691. [ABSTRACT FROM AUTHOR]

Objective: To compare objective and subjective outcomes of laparoscopic sacral colpopexy with supracervical hysterectomy (L‐SCP) and robotic sacral hysteropexy (R‐SHP). Methods: This is a multicenter retrospective propensity score matched study. In the period between January 2014 and December 2018, we enrolled 161 patients with apical prolapse stage 2 or above, alone or with multicompartment descensus. Results: After propensity‐match analysis, there were 44 women for each group. Patients of the two groups had similar preoperative characteristics. No difference was found in terms of estimated blood loss, hospital stay, operative time, and intraoperative or postoperative complications. Subjective success rate, 12 months after surgery, was statistically better in the L‐SCP group (P = 0.034): 81.8% and 97.8% women had Patient Global Impression of Improvement scores less than 3, in R‐SHP and L‐SCP, respectively. The objective cure rate was high in both groups without any significant differences in recurrence rate (P = 0.266). Conclusion: Both procedures are safe and effective in pelvic organ prolapse treatment. Patients who no longer desire uterine preservation could be encouraged to consider L‐SCP. R‐SHP is an alternative in women who are strongly motivated to preserve their uterus in the absence of abnormal uterine findings. Synopsis: Robotic sacral hysteropexy represents a good alternative to laparoscopic sacral colpopexy in women who are strongly motivated to preserve their uterus. [ABSTRACT FROM AUTHOR]

BackgroundDetermination of the learning curve of new techniques is essential to improve safety and efficiency. Limited information is available regarding learning curves of different techniques in laparoscopic pelvic floor surgery.ObjectiveThe aim of this study was to compare the learning curve of two operative techniques, laparoscopic lateral suspension (LLS) and laparoscopic sacrocolpopexy (LSC).Material and methodsWe conducted a prospective study to assess the learning curve of LLS and LSC by implementing a structured urogynecologic surgical training program with the use of pelvic trainers for our urogynecology fellow. The fellow was an experienced urogynecologic surgeon, but was laparoscopic suturing and dissection naive at the beginning of the study. She was required to assist in 20 laparoscopic urogynecologic surgeries and undertake laparoscopic suturing and knot tying training with mesh positioning on a laparoscopic trainer for 4 h/week during the trial period. After the completion of this structured training program, the fellow performed LLS and LSC under the supervision of an experienced subspecialist as the primary surgeon. Linear regression analysis was used to compare the data of LLS and LSC learning curves. Subjective pre- and post-operative evaluation of pelvic organ prolapse (POP) and pelvic floor disorders was undertaken preoperatively and 12 months postoperatively using the PFDI-20-Quality of Life validated questionnaire. Follow-up was scheduled 12 months after the surgery and performed by a skilled urogynecologist. Objective cure was defined as Pelvic Organ Prolapse-Qualification (POP-Q) stage

It has been stated that the effectiveness of pectopexy method for the treatment of pelvic organ prolapse (POP) is similar to sacrocolpopexy. We aimed to search the effects of pectopexy method to the quality of life, sexual function and urinary incontinence. Thirty-one patients who were operated for POP with the technique of laparoscopic pectouteropexy/pectocolpopexy between January 2016 and November 2017 were included the study. Exclusion criteria were pelvic inflammatory disease, suspect of malignancy, pregnancy, prior POP or continence surgery. Quality of life inventories were (P-QOL, PISQ-12, UDI-6, IIQ-7) recorded preoperatively and at the postoperative third month. Results were compared statistically. The percentage of patients with menopause was 67.7% (n=21) and with reproductive term was 32.3% (n=10). Mean prolapse related quality of life inventory (P-QOL) score was 83.45 ± 8.7 (64–98) preoperatively and 8.61 ± 6.4 (0–23) postoperatively (p

Background. Pelvic prolapse is a common reason of gynaecological visits. Predispositions of genital prolapse comprise oestrogen deficiency, vaginal labour, congenital connective tissue dysplasia, etc. Specific approaches and treatments for genital prolapse are priority developments in gynaecological surgery.Objectives. Assessment of the safety and efficacy of variant techniques for pelvic prolapse surgical correction depending on its type and clinical manifestations.Methods. A total of 188 women were examined and treated surgically. The patients were divided in three cohorts by type of prolapse. Cohort 1 contained 108 patients with a pronounced defect of pubocervical fascia having mesh implants; cohort 2 — 65 patients without pronounced fascial defect having urethral slings and native-tissue corrections; cohort 3 — 15 prolapse patients having sacrovaginopexy for longer reproductive health.Results. Two complications were observed: 1000-mL blood loss requiring internal iliac arteries ligation and haemotransfusion; 300-mL blood loss with pelvic haematoma opening and drainage. Postoperative period without peculiarities in all cohorts. Two patients developed vaginal mucosal erosion up to 1 cm in one month. One-year clinical monitoring in all cohorts showed an improvement in functional and anatomical outcomes.Conclusion. Genital prolapse requires a personalised approach, which contributes to patient compliance and reduces postoperative complications and recurrences. Mesh implants improve surgical outcomes in patients with severe defects of pubocervical fascia, and urethral slings are effective in urinary incontinence.

Introduction and hypothesis: The choice of whether or not to preserve the uterus in the case of patients with urogenital prolapse who undergo sacral colpopexy is still debated. We compared objective and subjective outcomes of laparoscopic sacral hysteropexy (LSHP) and laparoscopic sacral colpopexy with concomitant supracervical hysterectomy (LSCP/SCH) in patients with symptomatic pelvic organ prolapse. Methods: This is a multicenter retrospective cohort study conducted at the Urogynecology Department of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome and at the Diaconesses Croix Saint Simon Hospital of Paris. We collected data of 136 patients; 78 underwent LSHP and 58 underwent LSCP/SCH for pelvic organ prolapse between January 2016 and December 2017. Results: Patients of the two groups had similar preoperative characteristics. All patients completed 24-month follow-up evaluation. Overall, anatomical cure rate was 84.6% and 87.9% in the LSHP group and LSCP/SCH group, respectively, without statistically significant differences. In particular, in the LSHP group the anatomical success rate was 94.9%, 92.3% and 92.3% for the apical, anterior and posterior vaginal compartment whereas in the LSHP group LSCP/SCH was 100%, 91.4% and 94.8%, respectively. Subjective success rate was 89.7% among patients who underwent LSHP and 93.1% among women who underwent LSCP/SCH (p = 0.494). The median operative time (OT) was significantly shorter in LSHP. There were no significant differences between the groups in terms of estimated blood loss, conversion to laparotomy and intra- and postoperative complications. Patients' satisfaction was high in both groups without statistical differences. Conclusions: Both laparoscopic procedures are safe and effective in the treatment of pelvic organ prolapse. LSHP can be offered as an alternative in women who are strongly motivated to preserve the uterus in the absence of abnormal uterine findings. [ABSTRACT FROM AUTHOR]

Aims: Apical defect is a pelvic organ prolapse disorder, with 5%‐15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). Methods: A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. Results: A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP‐Q < II stage) was 77%‐100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%‐97.6%, 71.0%‐100%, 66.7%‐87.8%, and 95%‐95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%‐12.8%. Conclusions: Most studies reported anatomical and subjective outcomes, with follow‐up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery. [ABSTRACT FROM AUTHOR]

Objective: To report the perioperative adverse events associated with nerve-preserving sacropexy for pelvic organ prolapse (POP) repair and to identify risk factors that could predict possible adverse events.Materials and Methods: A total of 768 women who underwent sacropexy for POP repair performed by one surgeon using the same technique, beyond the learning curve, over a 10-year period, between January 1st 2007 and December 31st 2016.Methods: The medical records of 768 women were reviewed for age, body mass index (BMI), tobacco use, previous surgeries (for POP and incontinence, abdominal surgeries in general), operating time, duration of hospitalization and perioperative events at time of surgery and 6 weeks postoperatively. Additionally, the complications were classified according to the Clavien-Dindo grading system and the Charlson Age Comorbidity Index (CACI) was evaluated for the patients.Results: Between January 1st 2007 and December 31st 2016, 768 patients underwent sacropexy for POP. 27 (3.5%) adverse events occurred intra- and post-operative within 6 weeks after surgery. In univariate and multivariate analyses, only comorbidity and concomitant posterior colporrhaphy are significantly associated with complications.Conclusions: Surgeon's experience and a standardized technique minimize the risk of perioperative adverse events. The data on complications we found can be used to guide effective consent. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess anatomic outcome and quality of life (QOL) after vaginal sacrocolporectopexy among patients with pelvic organ prolapse.Methods: A noncomparative observational study was conducted at Hanover Medical School, Germany, among patients who underwent vaginal sacrocolporectopexy for uterine or vaginal vault prolapse between May 1, 2006, and October 31, 2012. A validated German version of the Prolapse QOL (P-QOL) questionnaire was sent to eligible patients; respondents were invited for follow-up examination.Results: Overall, 128 patients were enrolled. Concomitant hysterectomy was performed among 82 (64.1%) patients, anterior colporrhaphy among 105 (82.0%), and posterior colporrhaphy among 58 (45.3%). After a mean interval of 26.5 months (range 1.0-81.3 months), seven patients exhibited recurrent vaginal vault prolapse of at least stage 2, giving a success rate of 92.3% (95% confidence interval 85.9%-96.5%). The P-QOL scores were either low (<40) or very low (<20), indicating high QOL. Regarding symptoms related to pelvic organ prolapse, patients reported little or no impact on QOL after vaginal sacrocolporectopexy.Conclusion: Vaginal sacrocolporectopexy seemed safe and feasible, leading to anatomically correct fixation of the vaginal apex, high anatomic success rates, and good QOL. This procedure might be considered as an alternative to laparoscopic or abdominal sacrocolpopexy. [ABSTRACT FROM AUTHOR]

Objetivo: describir la histerosacropexia por laparoscopia y sus resultados a corto plazo, en una serie de pacientes con prolapso apical puro y contraindicación para histerectomía. Institución: UnidaddeCirugíaEndoscópicaGinecológica, Clínica del Prado, Medellín, Colombia. Diseño: reporte de cuatro pacientes con prolapso apical puro y deseo de conservación uterina. Variables para medir: edad, indicación de cirugía, tiempo quirúrgico, sangrado estimado, complicaciones intraoperatorias, tiempo de hospitalización, incidencia de disfunción urinaria, defecatoria o sexual, aparición de incontinencia urinaria posoperatoria, complicaciones atribuibles a la malla, incidencia de recaídas, tasa de curación subjetiva, tasa de curación objetiva, satisfacción con el procedimiento, incidencia de embarazos después de cirugía. Resultados: edad promedio: 53 años; tiempo quirúrgico: 67 minutos (60-75); pérdida sanguínea: 30 cc (10-50); tiempo promedio de hospitalización: 15 horas (6-24); no hubo complicaciones intraoperatorias. En el seguimiento durante 12 meses en promedio (8-17) no hay recidivas ni signos de disfunción urinaria, defecatoria o coital en las pacientes sexualmente activas. No hay casos de incontinencia urinaria posoperatoria. Las pacientes están satisfechas con la intervención realizada. Aún no hay ningún embarazo. Conclusiones: la histerosacropexia laparoscópica podría ser una alternativa viable en nuestro medio para el tratamiento de pacientes con prolapso apical puro y contraindicación para histerectomía. Se requieren series mayores para determinar su papel en la práctica clínica.Objective: describing the laparoscopic hysterosacropexy technique and short-term results in 4 patients with apical prolapse in whom hysterectomy was contraindicated. Setting: gynecological endoscopy unit, Clínica del Prado, Medellín, Colombia. Sample: four patients with apical prolapse wishing for uterine conservation or having contraindication for hysterectomy. Methods: reviewing medical records, follow-up visits and telephone questionnaire. Main outcomes: age, indication for surgery, operating time, estimated blood loss, intra-operative complications, hospitalization time, incidence of postoperative urinary, defecatory or sexual dysfunction, developing urinary incontinence, mesh-derived complications, prolapse recurrence, subjective cure rate, objective cure rate, satisfaction, pregnancies after surgery. Results: mean age was 53 (39-71), 67 minutes mean time(60-75) spent in surgery, 30 cc mean estimated blood loss (10-50) and 15 hours mean hospitalisation time (6-24). There were no intra-operation complications. There have been no recurrences of prolapse or any evidence of urinary, defecatory or costal dysfunctions in sexually-active patients during mean follow-up period (12 months). All patients were completely satisfied with the operation result. No pregnancies have been recorded to date. Conclusions: laparoscopic hysterosacropexy could be a valid alternative in our setting for treating patients suffering apical prolapse having contraindication for hysterectomy. Further studies are needed for establishing its role in clinical practice.

Introduction: Despite the increasing success of surgery for pelvic organ prolapse, recurrent vaginal vault prolapse is not rare. We present a step-by-step laparoscopic approach with a sacral colpopexy (SC) for treatment of recurrent vault prolapse. Materials and Methods: From 2006, 25 women presenting with symptomatic recurrent vault prolapse were prospectively evaluated and treated with laparoscopic SC. This article briefly describes all of the steps that are required to conduct a proper surgery in such cases. Results: After previous abdominal sacropexy, both the dissection of adherences and restoration of normal pelvic anatomy were challenging. As result, the overall operating time was longer in patients who had undergone abdominal sacropexy vs. vaginal route, p = 0.032. No significant peri- or postoperative complications were observed. At a mean follow-up of 41 months, all women presented with less than stage 2 prolapse and high levels of satisfaction. Conclusions: Despite the need for an intraoperative step-by-step surgical safety checklist, the laparoscopic repair of recurrent vault prolapse is technically feasible, safe and effective. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pelvic organ prolapse shows an increasing prevalence (3-50 %). The gold standard treatment for apical prolapse is sacrocolpopexy, which can be performed via minimal access (conventional laparoscopy or robotic surgery) or open sacrocolpopexy. The objective is to appraise the effectiveness and safety of robotic surgery compared with laparoscopic sacropexy in the treatment of apical prolapse. Methods: Keywords were searched in: CINAHL, MEDLINE, CENTRAL, Cochrane MDSG Trials Register, Cochrane Library, Current Controlled Trials, ClinicalTrials.gov, WHO International Trials Registry Platform search portal, LILACS, and Google Scholar. A hand-search was also performed from IUJ and JMIG. Randomised and non-randomised controlled trials evaluating all women who underwent robotic sacropexy (RSC) or laparoscopic sacropexy (LSC) were included. A data extraction tool was used for data collection. RSC was compared with LSC. Narrative analysis and meta-analysis (RevMan) were conducted where appropriate. Results: Nine papers compared RSC with LSC, involving 1,157 subjects. No significant difference was found between approaches for anatomical outcomes, mortality, hospital stay (MD: −0.72/95 % CI 1.72, 0.28], p = 0.16), and postoperative quality of life. However, robotic sacropexy had more postoperative pain and longer operating times, although fewer overall complications when performed concomitantly with hysterectomy (OR 0.35; 95 % CI 0.19-0.64). Conclusions: Robotic sacropexy was related to more postoperative pain and longer operating times. However, no significant differences were found regarding anatomical outcomes, mortality, hospital stay or postoperative quality of life. Cautious interpretation of results is advised because of the risk of bias caused by the inclusion of non-randomised studies. More research comparing RSC with LSC is mandatory, particularly draw conclusions regarding estimated blood loss and complication rate. [ABSTRACT FROM AUTHOR]

Genital prolapse and its associated pathological manifestations represent a significant health problem among elderly female population. Posterior vaginal fornix syndrome belongs to the category of mistreated or ignored pathologies, and it has a significant negative impact on the patients' quality of life. Posterior vaginal fornix syndrome symbolizes a complex pathophysiological manifestations classically defined by the triad: micturition imperiosity, nocturia and chronic pelvic pain. Clinical and paraclinical examination allows a proper identification of the perineal defect which leads to the symptomatolgy appereance. Modern treatment of posterior vaginal fornix syndrome is the reconstructive surgery of the perineum that restores the perineal anatomy. Reconstructive surgical techniques final objectives are an improvement in urinary and feces continence, disappearance of the chronic pelvic pain and an improved sexual life of the patients. [ABSTRACT FROM AUTHOR]

Purpose: Sacral colpopexy is a well established method of vaginal prolapse correction. Although it is capable of restoring the physiologic axis of the vagina, this method also bears some serious operative risks []. The aim of the study was to compare the laparoscopic sacral colpopexy with a laparoscopic bilateral fixation of the vagina/cervix to the iliopectineal ligaments via a PVDF-mesh (pectopexy). Methods: This part of a single-center randomized prospective clinical trial (Canadian Task Force Classification) compared the short-term operative outcome of laparoscopic sacropexy and pectopexy. We evaluated the operating time, blood loss, hospital stay duration, occurrence of major complications, episodes of constipation, urinary retention, de novo urinary incontinence, urinary tract infections, body mass index and postoperative Creactive protein values. The 1-year follow up examination will be carried out to evaluate the occurrence of relapse as well as late complications. Local symptoms and sexual activity will be evaluated using a German version of the ICIQ Vaginal Symptoms Questionnaire. Results: We carried out 43 pectopexies and 40 sacropexies in conjunction with other laparoscopic and/or vaginal procedures, as indicated. No major complications occurred in both groups during the hospital stay. There were no significant differences in the body mass index, average age, hospital stay duration and occurrence of constipation. The average operating time (43.1 vs. 52.1 min) and blood loss (4.6 vs. 15.3 ml) were significantly lower in the pectopexy group ( p < 0.001). Conclusion: Although laparoscopic pectopexy cannot yet be generally recommended as an alternative to sacropexy until the follow-up data is obtained, the new method can be considered in patients where the presacral preparation bears a higher risk of injury. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: The aim of our study is to describe the course of the autonomic nerves in the presacral space and to find the best nerve-preserving approach for sacrocolpopexy. Study design: The autonomic nerves of the presacral space were dissected on six specially preserved female cadavers. Results: The superior hypogastric plexus is located in front of the abdominal aorta and its bifurcation and deviates to the left of the midsagittal plane. At the level of the promontory, or just below, the superior hypogastric plexus branches into two hypogastric nerves that run in front of the sacrum. In the presacral space the parasympathetic pelvic splanchnic nerves from the ventral rami of the sacral spinal nerves (S2–S3) join the hypogastric nerves, forming the inferior hypogastric plexus on both sides. From the inferior hypogastric plexus, nerve fibres spread out bilaterally to the pelvic organs. In two of the six cadavers sacral splanchnic nerves could be identified leading from the sacral sympathetic ganglion S1 of the sympathetic trunk to the inferior hypogastric plexus. Conclusion: Longitudinal incision of the peritoneum along the right common iliac artery and above the promontory allows for a safe approach for sacrocolpopexy. After exposing the vascular structure (e.g. medial sacral vessels) above the promontory, the anterior longitudinal ligament becomes visible and can be prepared for the fixation of the mesh for vaginal suspension. By protecting the superior hypogastric plexus and the part of the presacral area below the promontory we can preserve the hypogastric nerves, the sacral and pelvic splanchnic nerves and thus the autonomic innervation of the pelvic organs. Awareness of the course of the autonomic nerves in the presacral space will significantly improve the functional outcome of sacrocolpopexy and reduce bowel, urinary and sexual dysfunctions. [ABSTRACT FROM AUTHOR]

• Objective: The results of sacrocolpopexy operation for treatment of vaginal vault prolapsus were evaluated. • Material and Method: Fourty-seven patients with vaginal vault prolapsus were included into the study group. Patients with descensus uteri, total prolapsus, subtotal prolapsus and stumpf prolapsus were underwent sacrocolpopexy operation by abdominal route with mersilene sutures or prolene meshs. Burch operations were performed because of urinary stress incontinence in five patients. Patients were reevaluated for postoperative complaints. • Results: Post operative relaps occu red in one (2%) patient. Post operative complaints included; cystocele (6 patients, 12%), dysparaunia (7 patients, 14%), pelvic pain (10 patients, 21%). • Conclusion: We conclude that sacrocolpopexy operation for vaginal vault prolapsus can be accepted as a safe and effective operative treatment. [ABSTRACT FROM AUTHOR]

Abstract: Pelvic organ prolapse results from the failure of muscular and fascial supports of the pelvis. Symptoms of prolapse overlap with the dysfunction of other pelvic organs such as the bowel and the bladder. Some degree of prolapse is common in most parous women, but treatment is required only for the symptomatic patients. The past decade has seen several innovations in the treatment of prolapse due to greater understanding of pelvic anatomy and pathophysiology. This review focuses on the clinical assessment of prolapse and the current available evidence on treatment of various compartments. [Copyright &y& Elsevier]

Objectives: To evaluate results of laparoscopic sacropexy with introital and vaginal ultrasonography, that is to observe dynamic behavior of the mesh, to measure precisely its position and to conclude on the feasibility of this exam. Patients and methods: The surgery was a laparoscopic subtotal hysterectomy and a suspension of the cervix with an anterior vesicovaginal mesh and a posterior rectovaginal mesh. These meshes are joined together and fixed on the sacrum. Ultrasound was performed in fifteen patients to see in the sagital plane the position of the mesh. The distance anterior mesh–bladder neck and the distance posterior mesh–anal sphincter were measured at rest, during straining and during retaining. The spreading out and the dynamic behavior of the mesh were studied. Results: The distance anterior mesh–bladder neck is 12mm at rest, 15mm during straining and 13mm during retaining. The distance posterior mesh–anal sphincter is 30mm at rest, 26mm during straining and 31mm during retaining. The mesh is always seen as spread out, or folded, but never strained. Video recording shows that sacropexy does not block pelvic dynamics. Discussion and conclusion: Ultrasound imaging appears in this study as a simple and efficient exam to study and measure prosthesis. It could be a good help for clinical examination to explain failure or complication of surgery. [Copyright &y& Elsevier]

Abstract: Objectives: This prospective, randomised study investigated whether a prophylactic procedure, performed during colposacropexy for prolapse repair, prevents ex novo postoperative incontinence. Sixty-six consecutive continent patients with advanced prolapse were randomised into two groups: group A underwent sacropexy combined with a Burch colposuspension; no anti-incontinence procedure was performed in group B patients. Methods: Work-up included clinical assessment (Halfway System and International Continence Society [ICS] classification for prolapse and Ingelman Sunderberg scale for incontinence), the Urogenital Distress Inventory and Impact Incontinence Quality of Life questionnaires, urogynaecologic ultrasound scans, and complete urodynamic testing that included the urethral pressure profile and Valsalva leak point pressure with reduced prolapse. Check-ups were done at 3, 6, 12 mo postoperatively and then yearly. Mean follow-up time was 39.5 mo. Results: The mean age (± standard deviation) was 62±9 yr. All patients presented with grade (G) 3–4 prolapse. Postoperative incontinence was present in 12 of the 34 patients in group A: 7 G1; 4 G2, and 1 G3. Postoperative incontinence was present in 3 of the 32 patients in group B: 2 G1, 1 G3. The frequency of postoperative incontinence was significantly greater in patients who had undergone colposuspension (p <0.05). Conclusions: These preliminary data cast doubt on whether colposuspension should be performed during sacropexy for severe urogenital prolapse as prophylaxis for postoperative incontinence because it seems to emerge as overtreatment. Incontinence developed ex novo in 35% of continent patients treated with colposuspension combined with sacropexy. [Copyright &y& Elsevier]

Abstract: Purpose:: The aim of this study was to determine whether or not abdominal or vaginal access is the best choice for treating genital prolapse in term of anatomical postoperative results, using an MRI pre and postoperative assessment. Materials and methods:: Prospective study was conducted on 43 consecutive patients planned for surgery for genital prolapse from October 2001 to February 2002. The patients were studied with dynamic and static MRI sequence 4 months after surgery to indicate surgical effects on organ position. The position was evaluated with respect to the pubo coccygeal line in a dynamic sequence. Results:: Fifteen patients had their prolapse corrected by laparotomy always associated with sub-total hysterectomy, anterior and posterior prosthetic mesh with promontory fixation to the prevertebral ligament. Sixteen others were subjected to vaginal route with vaginal hysterectomy, paravaginal suspension followed in all cases by suspension of the vaginal cuff using Richter''s technique and myorraphy of the levators. Finally, 12 patients benefited from a suspension of a sacrospinous suspension and myorraphy of the levators, without paravaginal suspension. Measure of the MRI organ location showed no significant difference except for bladder position in vaginally operated women (P =0.02). Vaginal length and axis were comparable in all groups. Conclusion:: Our study confirmed the objective effectiveness of the anatomical prolapse corrections conducted by abdominal route using sacropexy or by vaginal route using sacrospinous fixation. The correction provided by vaginal route always results in a return of the bladder and the vaginal fundus to their normal positions, which clearly demonstrates the short-term effectiveness of these surgical suspensions. Prolapse corrections by vaginal route did not result in any shortening of the vagina or postoperative change in vaginal orientation. Further evaluations will be needed to assess the long-term results. [Copyright &y& Elsevier]

Sacropexy is the gold standard surgery for the management of apical genital prolapse, registering a high success rate for anatomical correction. Objective. We aimed to evaluate the intraoperative incidents and the remote results regarding sacropexy. Materials and method. The prospective study was carried out between April 2012 and August 2018, and included 156 cases. We have performed abdominal sacropexy with three attachment point varieties of the mesh: vaginal cuff, cervical cuff, and cervix in cases with uterus preservation. Results. The mean patient age was 66.69±6.4 years old (39-81 years old). The intraoperative incidents were difficult posterior detachment of the peritoneum due to endometriosis or chronic inflammation – 15 cases, low aortic bifurcation with reduced attachment area to the presacral space – 24 cases, thin presacral ligament – 7 cases, presacral bleeding – 20 cases, and ureter near the margin of the presacral peritoneal breach. The immediate postoperative complications included: one occlusion after four days (epigastric hernia), one case of subperitoneal vaginal cuff hematoma, and one patient with mesh externalization one month after surgery, following sexual intercourse. Out of 31 patients with preoperative stress incontinence, 14 had a simultaneous suburethral sling surgery with sacropexy. Three cases needed subsequent suburethral sling fixation. Remote results: one case of deep posterior pain, a 73-year-old patient with mesh erosion, and three cases at 6 and 12 months with central anterior compartment prolapse. Conclusions. The preoperative patient counseling is important. The possibility of erosion caused by the mesh and the anatomical failure over time are not confirmed by this study. We observed three relapse cases – anterior compartment prolapse. We suggest postponing the procedure for urinary incontinence. [ABSTRACT FROM AUTHOR]

We report the first case of rejection of prosthetic mesh after laparoscopic sacropexy using a Roticulator stapler. The risk of this complication is extremely low if simple precautions are observed. Our experience suggests that the use of staples to attach the mesh to the vaginal apex should be avoided. At the end of the procedure a careful assessment should be made to ensure that the vaginal wall is intact and not penetrated by staples. [ABSTRACT FROM AUTHOR]