pelvic organ prolapse; prolapse surgery trends; surgical management; vaginal mesh
Abstract :
[en] Management of pelvic organ prolapse (POP) may
be conducted by abdominal (laparotomy or laparoscopy) or
vaginal approach, with or without mesh repair, mainly depending
on the surgeon’s expertise. The aim of this study
was to determine the trends in surgical management of POP
in French-speaking Belgium. The GGOLFB Gynecologic surgery
working group initiated a registry of the patients surgically
treated for POP from eight centers in French-speaking
Belgium. In this prospective multicentric study, conducted
between June 2010 and January 2013, we analyzed the clinical
and surgical data, the postoperative results at 4 months, the
intra and postoperative complications, and reoperation rates.
A total of 394 patients were registered in the database.
Surgical POP repair was performed vaginally in 83.5 % of
the patients, with prosthetic material in 70.2 % of the cases.
In case of abdominal procedure, surgery was mainly (93.5 %)
performed by laparoscopic sacrocolpopexy. The most common
intraoperative complications were severe bleeding
(2.3 %), bladder (2 %), and bowel (0.2 %) injuries. At
4 months, the total reoperation rate was 11.3 %. The anatomical
success rate (POP-Q < 2) was 87.5 % with 2.1 % of
reoperation for recurrence. Mesh exposure was observed in
9.8 % of the cases. Surgery for stress urinary incontinence
(SUI) was reported in 5.1 % of the patients. The analysis of
the current urogynecological practice in French-speaking
Belgium shows that vaginal mesh repair is the preferential
approach used for management of POP in the participating
centers. The creation of a national database will help to evaluate
the global trends in prolapse surgery and the potential
impact of the FDA notification in the management of POP
in Belgium.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
DE LANDSHEERE, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > Service de gynécologie-obstétrique (CHR)
Boyles SH, Weber AM, Meyn L (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188(1):108–115. doi:10.1067/mob.2003.101
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506. doi:10.1016/S0029-7844(97)00058-6
Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW (2011) Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 205(3):230 e231–230 e235. doi:10.1016/j.ajog.2011.03.046
Flam F, Soderberg MW (2009) New concepts and trends in vaginal prolapse surgery. Acta Obstet Gynecol Scand 88(3):251–254. doi:10.1080/00016340902730342
Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014. doi:10.1002/14651858.CD004014.pub5
Gadonneix P, Ercoli A, Scambia G, Villet R (2005) The use of laparoscopic sacrocolpopexy in the management of pelvic organ prolapse. Curr Opin Obstet Gynecol 17(4):376–380
Jonsson Funk M, Edenfield AL, Pate V, Visco AG, Weidner AC, Wu JM (2013) Trends in use of surgical mesh for pelvic organ prolapse. Am J Obstet Gynecol 208(1):79 e71–79 e77. doi:10.1016/j.ajog.2012.11.008
Jia X, Glazener C, Mowatt G, MacLennan G, Bain C, Fraser C, Burr J (2008) Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG: Int J Obstet Gynaecol 115(11):1350–1361. doi:10.1111/j.1471-0528.2008.01845.x
Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471. doi:10.1007/s00192-007-0465-y
Feiner B, Jelovsek JE, Maher C (2009) Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG: Int J Obstet Gynaecol 116(1):15–24. doi:10.1111/j.1471-0528.2008.02023.x
(2011) FDA Safety Communication: UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm262435.htm
Skoczylas LC, Turner LC, Wang L, Winger DG, Shepherd JP (2014) Changes in prolapse surgery trends relative to FDA notifications regarding vaginal mesh. Int Urogynecol J 25(4):471–477. doi:10.1007/s00192-013-2231-7
Walter JE, Urogynaecology C, Lovatsis D, Walter JE, Easton W, Epp A, Farrell SA, Girouard L, Gupta CK, Harvey MA, Larochelle A, Robert M, Ross S, Schachter J, Schultz JA, Wilkie DH, Society of O, Gynaecologists of C (2011) Transvaginal mesh procedures for pelvic organ prolapse. J Obstet Gynaecol Canada: JOGC = Journal d’obstetrique et gynecologie du Canada: JOGC 33(2):168–174
Deffieux X, Sentilhes L, Savary D, Letouzey V, Marcelli M, Mares P, Cngof PF (2013) Indications of mesh in surgical treatment of pelvic organ prolapse by vaginal route: expert consensus from the French College of Gynecologists and Obstetricians (CNGOF). Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 42(7):628–638. doi:10.1016/j.jgyn.2013.08.018
Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17
Cosson M, Collinet P, Occelli B, Narducci F, Crepin G (2001) The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Eur J Obstet Gynecol Reprod Biol 95(1):73–80
Kapandji M (1967) Treatment of urogenital prolapse by colpo-isthmo-cystopexy with transverse strip and crossed, multiple layer, ligamento-peritoneal douglasorrhaphy. Ann Chir 21(5):321–328
Dubuisson JB, Yaron M, Wenger JM, Jacob S (2008) Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients. J Minim Invasive Gynecol 15(1):49–55. doi:10.1016/j.jmig.2007.11.003
Claerhout F, Verguts J, Werbrouck E, Veldman J, Lewi P, Deprest J (2014) Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps. Int Urogynecol J 25(9):1185–1191. doi:10.1007/s00192-014-2412-z
Deprest J, Krofta L, Van der Aa F, Milani AL, Den Boon J, Claerhout F, Roovers JP (2014) The challenge of implementing laparoscopic sacrocolpopexy. Int Urogynecol J 25(9):1153–1160. doi:10.1007/s00192-014-2398-6
Maher C (2013) Anterior vaginal compartment surgery. Int Urogynecol J 24(11):1791–1802. doi:10.1007/s00192-013-2170-3
Guldberg R, Brostrom S, Hansen JK, Kaerlev L, Gradel KO, Norgard BM, Kesmodel US (2013) The Danish Urogynaecological Database: establishment, completeness and validity. Int Urogynecol J 24(6):983–990. doi:10.1007/s00192-012-1968-8
Bjelic-Radisic V, Aigmueller T, Preyer O, Ralph G, Geiss I, Muller G, Riss P, Klug P, Konrad M, Wagner G, Medl M, Umek W, Lozano P, Tamussino K, Tammaa A, Austrian Urogynecology Working G (2014) Vaginal prolapse surgery with transvaginal mesh: results of the Austrian registry. Int Urogynecol J 25(8):1047–1052. doi:10.1007/s00192-014-2333-x
Mascarenhas T, Mascarenhas-Saraiva M Jr, Ricon-Ferraz A, Nogueira P, Lopes F, Freitas A (2014) Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J. doi:10.1007/s00192-014-2480-0
Barber MD, Maher C (2013) Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 24(11):1783–1790. doi:10.1007/s00192-013-2169-9
van der Ploeg JM, van der Steen A, Oude Rengerink K, van der Vaart CH, Roovers JP (2014) Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG: Int J Obstet Gynaecol 121(5):537–547. doi:10.1111/1471-0528.12509
Baessler K, Maher C (2013) Pelvic organ prolapse surgery and bladder function. Int Urogynecol J 24(11):1843–1852. doi:10.1007/s00192-013-2175-y
Schierlitz L, Dwyer PL, Rosamilia A, De Souza A, Murray C, Thomas E, Hiscock R, Achtari C (2014) Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial. Int Urogynecol J 25(1):33–40. doi:10.1007/s00192-013-2150-7
Collinet P, Belot F, Debodinance P, Ha Duc E, Lucot JP, Cosson M (2006) Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors. Int Urogynecol J Pelvic Floor Dysfunct 17(4):315–320. doi:10.1007/s00192-005-0003-8
Deffieux X, Letouzey V, Savary D, Sentilhes L, Agostini A, Mares P, Pierre F, French College of O, Gynecology (2012) Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 165(2):170–180. doi:10.1016/j.ejogrb.2012.09.001
de Tayrac R, Sentilhes L (2013) Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J 24(11):1859–1872. doi:10.1007/s00192-013-2177-9
Diwadkar GB, Barber MD, Feiner B, Maher C, Jelovsek JE (2009) Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 113(2 Pt 1):367–373. doi:10.1097/AOG.0b013e318195888d