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Effects of sacrocolposuspension on the lower urinary tract
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Citations from the literature /International Jour~l of Gynecology & Obstetrics 54 (19%) 81-91
Mlnllaparotomy for the ambal8tory managementof ovariml cysts Flynn M.; Niloff J.M.; Gallup D.G. USA AM. J. OBSTET. GYNECOL. 1995 173/6(1727-1730) OBJECTIVE: The goal of this study was to assess the feasibility, safety, and cost effectivenessof minilaparotomy for the outpatient surgical management of ovarian cysts. STUDY DESIGN Twenty-four consecutive patients 50 years old with 28 complex or persistent ovarian cysts 10 cm in maximum size underwent cystectomy or oophorectomy by minilaparotomy. Bupivacaine hydrochloride was injected in the wounds and ketoralac tromethamine (Toradol) administered systemically. The ovaries were reconstructed. RESULTS: All 24 patients were discharged on the day of surgery. There were no readmissions. Mean operative time was 45 min. The only complication was a single caseof urinary retention managedon an outpatient basis.CONCLUSION: Minilaparotomy is a safe,cost-effective alternative to laparoscopy for the outpatient surgical management of ovarian cysts. Modified Le Fort partial colpocleisiswith Kelly uretbd plic&ioo and postdur colpoperheophsty io the mfdically compromised elddy: A cumpulson wltb vaginal hysterectomy, anterior colparbrpbY9 and posterior ~bwriaeoplpsty Denehy T.R.; Choe J.Y.; Gregori CA.; Breen J.L.; Elkins T. USA AM. J. OBSTET. GYNECOL. 1995 173/6(1697-1702) OBJECTIVE: Our purpose was to evaluate and compare the Le Fort partial colpocleisis and posterior colpoperineoplasty with conventional surgical repair in the medically compromised elderly population. STUDY DESIGN: A retrospective sequential series of 21 elderly women with complete uterovaginal prolapse and severemedical illnesses,having failure of conservative management, underwent a modification of the Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty. The patients’ ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses,complications, and follow-up were assessedand compared with those of a retrospective group of 42 women with complete uterovaginal prolapse who had a vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty performed by the same surgical team during the same period. RESULTS: The median age of Le Fort partial colpocleisis was 82 years (range 65 to 91 years), whereasmedian age in the vaginal hysterectomy group was 66 years (range 39 to 80 years) (p < 0.00). The median time under anesthesia of Le Fort partial colpocleisis was 75 min (range 35 to 120mitt) compared with the vaginal hysterectomy median time of 150 mitt (range 90 to 210 min) (p < 0.00). The median hospital stay for both Le Fort partial colpocleisis and vaginal hysterectomy was 5 days (range, Le Fort partial colpocleisis 4 to 42 days, vaginal hysterectomy4 to 14days). The median decreasein hemoglobin in the Le Fort partial colpocleisis group was 2.2 @dl (range 0.2 to 3.6 gm/dl) and 2.8 gm/dl (range 0.9 to 4.5 gm/dl) @ = 0.51).The complications were comparable with the exception of one postoperative death in the Le Fort partial colpocleisis group. A total of 95% (19/20) of Le Fort partial
colpocleisis patients had excellent results with a median followup of 25 months (range 4 to 40 months). CONCLUSION: In this preliminary assessmentthe modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty offers significant advantages in a select population of elderly, medically compromised patients in whom conservative management is not feasible. Sacroeolpopcxy and tbc anterior compartmentz Support and funetlun Brubaker L.; Porges R.F. USA AM. J. OBSTET. GYNECOL. 1995 173/6(1690-1696) OBJECTIVES: This report analyses the functional and anatomic results of the anterior compartment when Burch retropubic urethropexy or paravaginal repair are performed at the time of sacrocolpopexy. STUDY DESIGN: A retrospective chart review of 65 women undergoing sacrocolpopexy for repair of symptomatic prolapse was performed. Pertinent subjective and objective parameters were abstracted preoperatively and postoperatively. History, including symptoms, physical findings, and urodynamic testing were performed in an identical manner preoperatively and 3 months postoperatively. RESULTS: Sixty-five women (mean age 62 years [range 29 to 89 years]) underwent sacrocolpopexy. Preoperative and postoperative symptomsincluded protrusion (100%and 3%, respectively), stress urinary incontinence (68% and 16%), urge incontinence (51% and 28%), and voiding dysfunction (14% and 3%). Anterior and apical prolapse protruded beyond the hymen in 85% of patients preoperatively and in 3% postoperatively. Urodynamics diagnoses were assessedpreoperatively and postoperatively: genuine stress incontinence (80% and 13%,respectively) and detrusor instability (41% and 42%). The location of cystocele defects preoperatively and postoperatively was combined (38 and 10,respectively), pure lateral (24 and 1), pure midline (2 and 18),and none (1 and 46). Conclusions: Abnormalities in lower urinary tract function commonly exist in patients with apical support loss. A high cure rate for genuine stress incontinence can be obtained with retropubic repositioning. Cure rates for apical support are excellent, although anterior wall recurrences occur. The preoperative diagnosis of cystocele location appears problematic and warrants further study. Effects of saerocolpowrPpensioo 00 tbc lower urinary tract Vamer R.E.; Plessala K.J.; Richter H.; Kohom E.J. USA AM. J. OBSTET. GYNECOL. 1995 17316(1684-1689) OBJECTIVE: Urinary incontinence and micturition disorders have been reported to be common in patients who have had sacrocolposuspensionprocedures for vaginal vault prolapse. From interviews with 213 patients who had this prccedure in Birmingham from 1986to 1992,it was found that 53% related complaints of someurine leakage and 44% related other complaints, including frequency, urgency, and voiding dysfunction. It is also well known that frequently urinary symptoms accompany severedefects in pelvic support. Our purpose was to
Citations from the literature/International Journal of Gynecology & Obstetrics 54 (19%) 81-91 determine whether sacrocolposuspensionand cul-de-sac obliteration, with or without retropubic suspensionand posterior colporrhaphy, had a causal relationship to lower urinary tract dysfunction or symptoms. STUDY DESIGN: Forty-five patients who had the procedures were felt to be evaluable on the basis of preoperative documentation of a history of lower urinary tract symptoms and an evaluation. Four to eighty months after surgery (mean 31 months, median 24 months) these patients were interviewed by use of a verbally administered questionnaire assessingsymptoms, and 24 patients underwent urodynamic testing. Preoperative and postoperative data collected subjectively and objectively were analyzed with Fisher’s exact test (two-tailed) or paired t test analysis. RESULTS: Lower urinary tract symptoms or dysfunction occurred in 8?% of patients before and 49% of patients after sacrocolposuspensionfor vaginal vault prolapse in spite of cor-
91
rection of bladder support defects. Stressurinary incontinence was effectively treated in 92% of patients who underwent ap propriate bladder neck suspension procedures. There was no evidence that subjective or objective voiding dysfunction, urinary frequency, urgency or urge incontinence, or subjective and objective stressincontinence increasedafter the above procedures.None of the sevenpatients who had no urinary symptoms preoperatively had new-onset lower urinary tract symptoms postoperatively that could be attributed to the surgery. Conclusions: (1) Lower urinary tract dysfunction is common in patients with significant pelvic relaxation. (2) Careful evaluation of the lower urinary tract is essential for treatment choice and to effectively counsel patients with total prolapse. (3) Sacrocolposuspensionin itself does not significantly affect lower urinary tract function or symptoms.
Citations from the literature /International Jour~l of Gynecology & Obstetrics 54 (19%) 81-91
Mlnllaparotomy for the ambal8tory managementof ovariml cysts Flynn M.; Niloff J.M.; Gallup D.G. USA AM. J. OBSTET. GYNECOL. 1995 173/6(1727-1730) OBJECTIVE: The goal of this study was to assess the feasibility, safety, and cost effectivenessof minilaparotomy for the outpatient surgical management of ovarian cysts. STUDY DESIGN Twenty-four consecutive patients 50 years old with 28 complex or persistent ovarian cysts 10 cm in maximum size underwent cystectomy or oophorectomy by minilaparotomy. Bupivacaine hydrochloride was injected in the wounds and ketoralac tromethamine (Toradol) administered systemically. The ovaries were reconstructed. RESULTS: All 24 patients were discharged on the day of surgery. There were no readmissions. Mean operative time was 45 min. The only complication was a single caseof urinary retention managedon an outpatient basis.CONCLUSION: Minilaparotomy is a safe,cost-effective alternative to laparoscopy for the outpatient surgical management of ovarian cysts. Modified Le Fort partial colpocleisiswith Kelly uretbd plic&ioo and postdur colpoperheophsty io the mfdically compromised elddy: A cumpulson wltb vaginal hysterectomy, anterior colparbrpbY9 and posterior ~bwriaeoplpsty Denehy T.R.; Choe J.Y.; Gregori CA.; Breen J.L.; Elkins T. USA AM. J. OBSTET. GYNECOL. 1995 173/6(1697-1702) OBJECTIVE: Our purpose was to evaluate and compare the Le Fort partial colpocleisis and posterior colpoperineoplasty with conventional surgical repair in the medically compromised elderly population. STUDY DESIGN: A retrospective sequential series of 21 elderly women with complete uterovaginal prolapse and severemedical illnesses,having failure of conservative management, underwent a modification of the Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty. The patients’ ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses,complications, and follow-up were assessedand compared with those of a retrospective group of 42 women with complete uterovaginal prolapse who had a vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty performed by the same surgical team during the same period. RESULTS: The median age of Le Fort partial colpocleisis was 82 years (range 65 to 91 years), whereasmedian age in the vaginal hysterectomy group was 66 years (range 39 to 80 years) (p < 0.00). The median time under anesthesia of Le Fort partial colpocleisis was 75 min (range 35 to 120mitt) compared with the vaginal hysterectomy median time of 150 mitt (range 90 to 210 min) (p < 0.00). The median hospital stay for both Le Fort partial colpocleisis and vaginal hysterectomy was 5 days (range, Le Fort partial colpocleisis 4 to 42 days, vaginal hysterectomy4 to 14days). The median decreasein hemoglobin in the Le Fort partial colpocleisis group was 2.2 @dl (range 0.2 to 3.6 gm/dl) and 2.8 gm/dl (range 0.9 to 4.5 gm/dl) @ = 0.51).The complications were comparable with the exception of one postoperative death in the Le Fort partial colpocleisis group. A total of 95% (19/20) of Le Fort partial
colpocleisis patients had excellent results with a median followup of 25 months (range 4 to 40 months). CONCLUSION: In this preliminary assessmentthe modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty offers significant advantages in a select population of elderly, medically compromised patients in whom conservative management is not feasible. Sacroeolpopcxy and tbc anterior compartmentz Support and funetlun Brubaker L.; Porges R.F. USA AM. J. OBSTET. GYNECOL. 1995 173/6(1690-1696) OBJECTIVES: This report analyses the functional and anatomic results of the anterior compartment when Burch retropubic urethropexy or paravaginal repair are performed at the time of sacrocolpopexy. STUDY DESIGN: A retrospective chart review of 65 women undergoing sacrocolpopexy for repair of symptomatic prolapse was performed. Pertinent subjective and objective parameters were abstracted preoperatively and postoperatively. History, including symptoms, physical findings, and urodynamic testing were performed in an identical manner preoperatively and 3 months postoperatively. RESULTS: Sixty-five women (mean age 62 years [range 29 to 89 years]) underwent sacrocolpopexy. Preoperative and postoperative symptomsincluded protrusion (100%and 3%, respectively), stress urinary incontinence (68% and 16%), urge incontinence (51% and 28%), and voiding dysfunction (14% and 3%). Anterior and apical prolapse protruded beyond the hymen in 85% of patients preoperatively and in 3% postoperatively. Urodynamics diagnoses were assessedpreoperatively and postoperatively: genuine stress incontinence (80% and 13%,respectively) and detrusor instability (41% and 42%). The location of cystocele defects preoperatively and postoperatively was combined (38 and 10,respectively), pure lateral (24 and 1), pure midline (2 and 18),and none (1 and 46). Conclusions: Abnormalities in lower urinary tract function commonly exist in patients with apical support loss. A high cure rate for genuine stress incontinence can be obtained with retropubic repositioning. Cure rates for apical support are excellent, although anterior wall recurrences occur. The preoperative diagnosis of cystocele location appears problematic and warrants further study. Effects of saerocolpowrPpensioo 00 tbc lower urinary tract Vamer R.E.; Plessala K.J.; Richter H.; Kohom E.J. USA AM. J. OBSTET. GYNECOL. 1995 17316(1684-1689) OBJECTIVE: Urinary incontinence and micturition disorders have been reported to be common in patients who have had sacrocolposuspensionprocedures for vaginal vault prolapse. From interviews with 213 patients who had this prccedure in Birmingham from 1986to 1992,it was found that 53% related complaints of someurine leakage and 44% related other complaints, including frequency, urgency, and voiding dysfunction. It is also well known that frequently urinary symptoms accompany severedefects in pelvic support. Our purpose was to
Citations from the literature/International Journal of Gynecology & Obstetrics 54 (19%) 81-91 determine whether sacrocolposuspensionand cul-de-sac obliteration, with or without retropubic suspensionand posterior colporrhaphy, had a causal relationship to lower urinary tract dysfunction or symptoms. STUDY DESIGN: Forty-five patients who had the procedures were felt to be evaluable on the basis of preoperative documentation of a history of lower urinary tract symptoms and an evaluation. Four to eighty months after surgery (mean 31 months, median 24 months) these patients were interviewed by use of a verbally administered questionnaire assessingsymptoms, and 24 patients underwent urodynamic testing. Preoperative and postoperative data collected subjectively and objectively were analyzed with Fisher’s exact test (two-tailed) or paired t test analysis. RESULTS: Lower urinary tract symptoms or dysfunction occurred in 8?% of patients before and 49% of patients after sacrocolposuspensionfor vaginal vault prolapse in spite of cor-
91
rection of bladder support defects. Stressurinary incontinence was effectively treated in 92% of patients who underwent ap propriate bladder neck suspension procedures. There was no evidence that subjective or objective voiding dysfunction, urinary frequency, urgency or urge incontinence, or subjective and objective stressincontinence increasedafter the above procedures.None of the sevenpatients who had no urinary symptoms preoperatively had new-onset lower urinary tract symptoms postoperatively that could be attributed to the surgery. Conclusions: (1) Lower urinary tract dysfunction is common in patients with significant pelvic relaxation. (2) Careful evaluation of the lower urinary tract is essential for treatment choice and to effectively counsel patients with total prolapse. (3) Sacrocolposuspensionin itself does not significantly affect lower urinary tract function or symptoms.