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Severe pelvic organ prolapse. Is there a long-term cure?

Authors
  • Athanasiou, Stavros1
  • Zacharakis, Dimitrios2
  • Protopapas, Athanasios1
  • Pitsouni, Eleni1
  • Loutradis, Dimitrios1
  • Grigoriadis, Themos1
  • 1 First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece. , (Greece)
  • 2 First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece. [email protected] , (Greece)
Type
Published Article
Journal
International urogynecology journal
Publication Date
Oct 01, 2019
Volume
30
Issue
10
Pages
1697–1703
Identifiers
DOI: 10.1007/s00192-018-3775-3
PMID: 30255195
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications. This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was "composite surgical success" defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence. The median follow-up was 7 years (range 3-10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit. The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.

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