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Retrospective case series of laparoscopic sacrocervicopexy
August 2004, Vol. 11, No. 3 Supplement TheJournalof the American Association of Gynecologic Laparoscopists
Design. Prospective, open-label trial of RF microremodeling using oral and local anesthesia. Setting. Major academic hospital in Mexico City. Patients. Sixteen women with SUI and bladder outlet hypermobility. Intervention. All women underwent identical nonsurgical RF microremodeling of 36 microscopic, circumferential sites within the bladder neck and proximal urethral submucosa. Before treatment, all women received oral midazolam (0-15.0 mg) and/or oral tramadol/paracetamol (0-2 tablets) and underwent bilateral periurethral local anesthetic block to the level of the bladder outlet using 2% lidocaine with epinephrine (10 mL-20 mL). Ten women (63%) received only 7.5 mg midazolam and 10 mL local anesthesia. Measurements and Main Results. Anesthetic failure was defined as a patient request and/or physician determination that conversion to intravenous sedation was required for treatment completion. None of the 16 procedures required conversion to conscious sedation, a 0% failure rate. Conclusion. This feasibility study suggests that nonsurgical, outpatient RF microremodeling in women with SUI can be performed using limited oral sedation and local anesthesia.
105. Identification and Treatment of Interstitial Cystitis in Adolescent Women with Chronic Pelvic Pain and Failed Treatment for Endometriosis 1SA Grochmal, 2JR Dell. 1Howard University College of Medicine, Washington, D.C.; 2Institute for Female Pelvic Medicine, Knoxville, Tennessee. Study Objective. To evaluate bladder origin of pain in adolescent women with chronic pelvic pain (CPP) after treatment for documented endometriosis. Methods. Total of 42 adolescent women, age 13 to 20, with symptoms of CPP underwent laparoscopic excision of biopsy-confirmed endometriosis followed by medical therapy (average 11 months) with oral contraceptives, danazol or Lupron. After surgical/medical therapy, 33/42 (79%) continued to complain of CPP symptoms including dyspareunia (n = 20); dysmenorrhea (n = 9); suprapubic pain (n = 6); urinary frequency (n = 13) and urgency(n = 4); and rectal pain (n = 3). Urine and genital cultures were negative. The Pelvic Pain and Urgency/Frequency (PUF) questionnaire was administered to 33 patients. In 28/33 (85%), the average PUF score was 14.6 suggesting the possibility of interstitial cystitis (IC). The Potassium Sensitivity Test (PST) was positive in 21/24 (87%) patients. Using the NIDDK criteria, cystoscopy/hydrodistention confirmed IC in 19/23 (83%) patients. Measurements andMain Results. Based on pooled data, 26 patients were evaluated using the PUF, PST and/or cystoscopy with hydrodistention. Positive findings suggestive of IC were noted in 22/26 (87%) patients. Conclusion. This study demonstrates that persistent CPP in adolescent women treated for confirmed endometriosis is actually IC. Bladder origin of pain, especially in patients
that have failed treatment for other suspected causes of CPP, should be considered as a source of pain in these patients. It would be prudent to screen for IC using less invasive techniques (PUF, etc.) before more invasive surgical procedures are contemplated, such as laparoscopy.
106. Retrospective Case Series of Laparoscopic Sacrocervicopexy 1SJ Pulliam, 1AS Weld, 2CR Rardin, 1pL Rosenblatt. 1Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; 2Brown University School of Medicine, Providence, Rhode Island.
Study Objective. To report a series of laparoscopic sacrocervicopexies (LSCx), a uterine sparing alternative to traditional procedures for pelvic organ prolapse. Design. A retrospective case series based on office and operative records. Setting. Community teaching hospital and urogynecology office practice. Patients. All 7 patients (ages 34-51, mean 44.71), who underwent (LSCx) by the same surgeon from August 2002 to February 2004. Intervention. The procedure was performed using a Mersilene mesh (6) or Gynemesh (1) graft, and Gore Tex CV-0 sutures. The mesh was secured to the posterior endopelvic fascia and uterosacral ligaments at their insertion to the cervix, and then attached (using a minimum of three sutures) to the anterior longitudinal ligament of the sacral promontory. Reperitonealization was then performed over the mesh. Measurements and Main Results. Mean body mass index was 23.6 (18.6-29.7). Mean operative time, including concomitant procedures, was 221 minutes (range 176-259). No intraoperative or postoperative complications occurred, including mesh erosion. All had estimated blood loss less than 100 mL, and no cases were converted to laparotomy. Support was evaluated using POP-Q measurements. C ranged from -4 to 0 cm (mean -1.5) preoperatively and -4 to -8 cm (mean -6.1) postoperatively. D ranged from -7 to -8.5 cm (mean -7.6) preoperatively, and -9 to -10 cm (mean -9.4) postoperatively. Aa ranged from 0 to -2 cm (mean -0.86) postoperatively and -3 to -1.5 cm (mean -2.6) postoperatively. Ap ranged from -3 to 1.5 cm (mean -2.3) preoperatively and -3 to -2.5 cm (mean -2.9) postoperatively. Conclusion. Laparoscopic sacrocervicopexy is a safe and effective minimally invasive surgical option for women with pelvic organ prolapse who desire cervicouterine conservation.
107. Small Bowel Obstruction as a Complication of Laparoscopic Sacrocolpopexy V Sabella. Lone Star Ob/Gyn Associates, San Antonio, Texas. Study Objective. We present a case of a partial small bowel obstruction occurring 3 months after an uneventful laparoscopic sacrocolpopexy. Intervention. The patient had to undergo an exploratory laparotomy with lysis of intestinal adhesions but without
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Design. Prospective, open-label trial of RF microremodeling using oral and local anesthesia. Setting. Major academic hospital in Mexico City. Patients. Sixteen women with SUI and bladder outlet hypermobility. Intervention. All women underwent identical nonsurgical RF microremodeling of 36 microscopic, circumferential sites within the bladder neck and proximal urethral submucosa. Before treatment, all women received oral midazolam (0-15.0 mg) and/or oral tramadol/paracetamol (0-2 tablets) and underwent bilateral periurethral local anesthetic block to the level of the bladder outlet using 2% lidocaine with epinephrine (10 mL-20 mL). Ten women (63%) received only 7.5 mg midazolam and 10 mL local anesthesia. Measurements and Main Results. Anesthetic failure was defined as a patient request and/or physician determination that conversion to intravenous sedation was required for treatment completion. None of the 16 procedures required conversion to conscious sedation, a 0% failure rate. Conclusion. This feasibility study suggests that nonsurgical, outpatient RF microremodeling in women with SUI can be performed using limited oral sedation and local anesthesia.
105. Identification and Treatment of Interstitial Cystitis in Adolescent Women with Chronic Pelvic Pain and Failed Treatment for Endometriosis 1SA Grochmal, 2JR Dell. 1Howard University College of Medicine, Washington, D.C.; 2Institute for Female Pelvic Medicine, Knoxville, Tennessee. Study Objective. To evaluate bladder origin of pain in adolescent women with chronic pelvic pain (CPP) after treatment for documented endometriosis. Methods. Total of 42 adolescent women, age 13 to 20, with symptoms of CPP underwent laparoscopic excision of biopsy-confirmed endometriosis followed by medical therapy (average 11 months) with oral contraceptives, danazol or Lupron. After surgical/medical therapy, 33/42 (79%) continued to complain of CPP symptoms including dyspareunia (n = 20); dysmenorrhea (n = 9); suprapubic pain (n = 6); urinary frequency (n = 13) and urgency(n = 4); and rectal pain (n = 3). Urine and genital cultures were negative. The Pelvic Pain and Urgency/Frequency (PUF) questionnaire was administered to 33 patients. In 28/33 (85%), the average PUF score was 14.6 suggesting the possibility of interstitial cystitis (IC). The Potassium Sensitivity Test (PST) was positive in 21/24 (87%) patients. Using the NIDDK criteria, cystoscopy/hydrodistention confirmed IC in 19/23 (83%) patients. Measurements andMain Results. Based on pooled data, 26 patients were evaluated using the PUF, PST and/or cystoscopy with hydrodistention. Positive findings suggestive of IC were noted in 22/26 (87%) patients. Conclusion. This study demonstrates that persistent CPP in adolescent women treated for confirmed endometriosis is actually IC. Bladder origin of pain, especially in patients
that have failed treatment for other suspected causes of CPP, should be considered as a source of pain in these patients. It would be prudent to screen for IC using less invasive techniques (PUF, etc.) before more invasive surgical procedures are contemplated, such as laparoscopy.
106. Retrospective Case Series of Laparoscopic Sacrocervicopexy 1SJ Pulliam, 1AS Weld, 2CR Rardin, 1pL Rosenblatt. 1Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; 2Brown University School of Medicine, Providence, Rhode Island.
Study Objective. To report a series of laparoscopic sacrocervicopexies (LSCx), a uterine sparing alternative to traditional procedures for pelvic organ prolapse. Design. A retrospective case series based on office and operative records. Setting. Community teaching hospital and urogynecology office practice. Patients. All 7 patients (ages 34-51, mean 44.71), who underwent (LSCx) by the same surgeon from August 2002 to February 2004. Intervention. The procedure was performed using a Mersilene mesh (6) or Gynemesh (1) graft, and Gore Tex CV-0 sutures. The mesh was secured to the posterior endopelvic fascia and uterosacral ligaments at their insertion to the cervix, and then attached (using a minimum of three sutures) to the anterior longitudinal ligament of the sacral promontory. Reperitonealization was then performed over the mesh. Measurements and Main Results. Mean body mass index was 23.6 (18.6-29.7). Mean operative time, including concomitant procedures, was 221 minutes (range 176-259). No intraoperative or postoperative complications occurred, including mesh erosion. All had estimated blood loss less than 100 mL, and no cases were converted to laparotomy. Support was evaluated using POP-Q measurements. C ranged from -4 to 0 cm (mean -1.5) preoperatively and -4 to -8 cm (mean -6.1) postoperatively. D ranged from -7 to -8.5 cm (mean -7.6) preoperatively, and -9 to -10 cm (mean -9.4) postoperatively. Aa ranged from 0 to -2 cm (mean -0.86) postoperatively and -3 to -1.5 cm (mean -2.6) postoperatively. Ap ranged from -3 to 1.5 cm (mean -2.3) preoperatively and -3 to -2.5 cm (mean -2.9) postoperatively. Conclusion. Laparoscopic sacrocervicopexy is a safe and effective minimally invasive surgical option for women with pelvic organ prolapse who desire cervicouterine conservation.
107. Small Bowel Obstruction as a Complication of Laparoscopic Sacrocolpopexy V Sabella. Lone Star Ob/Gyn Associates, San Antonio, Texas. Study Objective. We present a case of a partial small bowel obstruction occurring 3 months after an uneventful laparoscopic sacrocolpopexy. Intervention. The patient had to undergo an exploratory laparotomy with lysis of intestinal adhesions but without
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