Pilsner Modification of Mesh Sacrohysterocolpopexy (PiMMS): An Initial Report on Safety and Efficacy
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Comparative Study
Grant support
Cooperatio program
lékařská fakulta Univerzity Karlovy
research area MATC
lékařská fakulta Univerzity Karlovy
Cooperatio program
Lékařská Fakulta v Plzni, Univerzita Karlova
research area MATC
Lékařská Fakulta v Plzni, Univerzita Karlova
PubMed
38691124
DOI
10.1007/s00192-024-05780-w
PII: 10.1007/s00192-024-05780-w
Knihovny.cz E-resources
- Keywords
- Anterior compartment, Hysteropexy, Laparoscopy, Mesh, Prolapse, Sacrohysteropexy,
- MeSH
- Surgical Mesh * adverse effects MeSH
- Gynecologic Surgical Procedures * methods MeSH
- Patient Reported Outcome Measures MeSH
- Laparoscopy methods adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Complications etiology epidemiology MeSH
- Pelvic Organ Prolapse * surgery MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
INTRODUCTION AND HYPOTHESIS: It is reported that up to 60% of women would prefer to spare their uterus during pelvic organ prolapse (POP) repair surgery. A reliable hysteropexy technique is therefore crucial. We aimed to describe the safety profile and initial core patient-reported and clinical outcomes of the Pilsner modification of laparoscopic mesh sacrohysterocolpopexy (PiMMS) in comparison with the laparoscopic sacrohysterocolpopexy technique (standard laparoscopic sacrohysterocolpopexy [sLSH]) previously used in our unit. METHODS: This was a retrospective cohort study conducted in a single tertiary referral urogynecological center. All patients who underwent laparoscopic mesh sacrohysterocolpopexy between 1 January 2015, and 31 January 2022 were included in the study. Follow-up clinical, patient-reported, and imaging outcomes at the 12-month follow-up time point are presented. RESULTS: A total of 87 patients were included. Of these, 49 (56.3%) and 38 (43.7%) underwent sLSH and PiMMS respectively. Low numbers of perioperative complications were found in both groups with no mesh-related complications reported following PiMMS up to 12 months postoperatively. There were no apical compartment failures in either group. There were 8 (17.0%) vs 1 (2.7%) anterior compartment failures (Ba ≤ -1) in the sLSH and PiMMS groups respectively (p = 0.07) at 12 months. At the 1-year follow-up, 42 (89.4%) patients reported a Patient Global Impression of Improvement score of ≤ 2 in the sLSH groups compared with 35 (94.6%) patients following PiMMS. CONCLUSIONS: The PiMMS technique seems to have comparable safety profile and patient-reported outcomes with the sLSH technique. However, there is a trend toward reduced anterior compartment failures with this modification. The findings of this preliminary report need to be re-evaluated in a well-powered prospective study.
Biomedical Centre Faculty of Medicine in Pilsen Charles University Staré Město Czechia
Center for Pelvic Floor Disorders Pilsen Czechia
Department of Gynecology and Obstetrics Faculty Hospital Trenčín Slovakia
Department of Gynecology and Obstetrics University Hospital Pilsen Czechia
See more in PubMed
Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24:1783–90. https://doi.org/10.1007/s00192-013-2169-9 . PubMed DOI
Smith FJ, Holman CDJ, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116:1096–100. https://doi.org/10.1097/AOG.0b013e3181f73729 . PubMed DOI
Miller BJ, Seman EI, O’Shea RT, et al. Recent trends in the management of pelvic organ prolapse in Australia and New Zealand. Aust N Z J Obstet Gynaecol. 2019;59:117–22. https://doi.org/10.1111/ajo.12835 . PubMed DOI
Jha S, Cutner A, Moran P. The UK national prolapse survey: 10 years on. Int Urogynecol J. 2018;29:795–801. https://doi.org/10.1007/s00192-017-3476-3 . PubMed DOI
Lyatoshinsky P, Fünfgeld C, Popov A, et al. Pelvic organ prolapse patients’ attitudes and preferences regarding their uterus: comparing German- and Russian-speaking women. Int Urogynecol J. 2019;30:2077–83. https://doi.org/10.1007/s00192-019-03918-9 . PubMed DOI PMC
Van IJsselmuiden MN, Detollenaere RJ, Gerritse MBE, et al. Dutch women’s attitudes towards hysterectomy and uterus preservation in surgical treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2018;220:79–83. https://doi.org/10.1016/j.ejogrb.2017.11.016 . PubMed DOI
Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013;209:470.e1–6. https://doi.org/10.1016/j.ajog.2013.08.003 . PubMed DOI
Urdzík P, Kalis V, Blaganje M, et al. Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey). BMC Womens Health. 2020;20:241. https://doi.org/10.1186/s12905-020-01105-3 . PubMed DOI PMC
Maher C, Yeung E, Haya N, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2023;7(7):CD012376. https://doi.org/10.1002/14651858.CD012376.pub2 . PubMed DOI
Rahmanou P, White B, Price N, Jackson S. Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively. Int Urogynecol J. 2014;25:131–8. https://doi.org/10.1007/s00192-013-2209-5 . PubMed DOI
Gutman RE, Rardin CR, Sokol ER, et al. Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study. Am J Obstet Gynecol. 2017;216:38.e1–11. PubMed DOI
Kalis V, Rusavy Z, Ismail KM. Laparoscopic sacrohysteropexy: the Pilsner modification. Int Urogynecol J. 2020;31:1277–80. https://doi.org/10.1007/s00192-019-04150-1 . PubMed DOI
Kalis V, Smazinka M, Rusavy Z, et al. Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study. Eur J Obstet Gynecol Reprod Biol. 2020;244:60–5. https://doi.org/10.1016/j.ejogrb.2019.10.049 . PubMed DOI
Gagyor D, Kalis V, Smazinka M, et al. Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study). BMC Womens Health. 2021;21:72. https://doi.org/10.1186/s12905-021-01208-5 . PubMed DOI PMC
Gracia M, Perellõ M, Bataller E, et al. Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: a pilot study. Neurourol Urodyn. 2015;34:654–8. https://doi.org/10.1002/nau.22641 . PubMed DOI
Illiano E, Giannitsas K, Costantini E. Comparison between laparoscopic sacrocolpopexy with hysterectomy and hysteropexy in advanced urogenital prolapse. Int Urogynecol J. 2020;31:2069–74. https://doi.org/10.1007/s00192-020-04260-1 . PubMed DOI
Haylen BT, Maher CF, Barber MD, et al. Erratum to: an International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27:655–84. https://doi.org/10.1007/s00192-016-3003-y . PubMed DOI
Smazinka M, Kalis V, Havir M, et al. Obesity and its long-term impact on sacrocolpopexy key outcomes (OBELISK). Int Urogynecol J. 2020;31:1655–62. https://doi.org/10.1007/s00192-019-04076-8 . PubMed DOI
Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185:1388–95. https://doi.org/10.1067/mob.2001.118659 . PubMed DOI
Avery K, Donovan J, Peters TJ, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–30. https://doi.org/10.1002/nau.20041 . PubMed DOI
Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8. https://doi.org/10.1007/s00192-009-1069-5 . PubMed DOI
Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22:3–15. https://doi.org/10.1007/s00192-010-1324-9 . PubMed DOI
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae . PubMed DOI PMC
Izett-Kay ML, Aldabeeb D, Kupelian AS, et al. Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study. Int Urogynecol J. 2020;31:2595–602. https://doi.org/10.1007/s00192-020-04396-0 . PubMed DOI PMC
Nightingale G, Phillips C. Long-term safety and efficacy of laparoscopically placed mesh for apical prolapse. Int Urogynecol J. 2021;32:871–7. https://doi.org/10.1007/s00192-020-04374-6 . PubMed DOI
Fitzgerald JJ, Sokol ER, Rardin CR, et al. Long-term outcomes after vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study (eVAULT). Female Pelvic Med Reconstr Surg. 2022;28:E215–21. PubMed DOI
Campagna G, Vacca L, Panico G, et al. Laparoscopic sacral hysteropexy versus laparoscopic sacral colpopexy plus supracervical hysterectomy in patients with pelvic organ prolapse. Int Urogynecol J. 2022;33:359–68. https://doi.org/10.1007/s00192-021-04865-0 . PubMed DOI
Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database of Systematic Reviews 2018;8(8):CD013108.
Anglim B, O’Sullivan O, O’Reilly B. How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse? Int Urogynecol J. 2018;29:1075–9. https://doi.org/10.1007/s00192-018-3685-4 . PubMed DOI
Rusavy Z, Grinstein E, Gluck O, et al. Long-term development of surgical outcome of laparoscopic sacrohysteropexy with anterior and posterior mesh extension. Int Urogynecol J. 2023;34:191–200. https://doi.org/10.1007/s00192-022-05102-y . PubMed DOI