INTRODUCTION AND HYPOTHESIS: Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy. METHODS: This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05). RESULTS: Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12 months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively. CONCLUSIONS: Although the overall rate of sexually active women and sexual desire declined 12 months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased.
- MeSH
- Dyspareunia * etiology epidemiology MeSH
- Gynecologic Surgical Procedures * methods MeSH
- Quality of Life * MeSH
- Laparoscopy * methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Period MeSH
- Pelvic Organ Prolapse * surgery MeSH
- Prospective Studies MeSH
- Surveys and Questionnaires MeSH
- Aged MeSH
- Sexual Behavior * MeSH
- Vagina surgery MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Východiska: Současné operační postupy umožňují zachování dělohy při operaci prolapsu pánevních orgánů (POP), nicméně nesnižují onkogynekologické riziko. Cíl: Cílem studie bylo zhodnotit úspěšnost ultrazvuku v záchytu nepředpokládaných děložních a adnexálních patologií u žen referovaných k POP operaci. Dále zhodnotit dodatečný přínos expertního onkogynekologického ultrazvuku. Soubor a metodika: Do studie jsme zařadili všechny ženy po hysterektomii s adnexektomií, či bez adnexektomie v rámci operace POP na Gynekologicko-porodnické klinice FN Plzeň v letech 2013–2018, u kterých byl proveden předoperační ultrazvuk (USG). Ženy s opakovaným postmenopauzálním krvácením, abnormální cervikální cytologií, užívající tamoxifen či ženy s předem diagnostikovaným patologickým nálezem na děloze či adnexech byly vyřazeny. Výsledky: Do studie bylo zařazeno 289 žen – 157 (54,3 %) expertní USG vs. 132 (45,7 %) neexpertní USG. Abnormální sonografické nálezy byly popsány v jednom případě na cervixu (neexpertní USG), na endometriu ve 30 (10,4 %) případech – 13 (8,3 %) expertní vs. 17 (12,9 %) neexpertní USG, na adnexech ve třech (2,3 %) případech (vždy neexpertní USG), na myometriu nebylo žádné podezření z malignity. Ultrasonografické vyšetření bylo falešně negativní ve čtyřech (1,4 %) případech – dva (1,3 %) expertní vs. dva (1,5 %) neexpertní USG. Naopak falešně pozitivní bylo USG vyšetření ve 34 (11,8 %) případech – 13 (8,3 %) expertní vs. 21 (15,9 %) neexpertní USG. Závěr: Riziko nepředpokládaných patologických nálezů na děloze či adnexech při POP rekonstrukční operaci je 1,4 %. Shoda ultrazvuku s histologickým benigním, abnormálním či maligním vyšetřením je 87,2 %. Provedení expertního USG snižuje počet falešně pozitivních abnormálních nálezů, ale nezvyšuje úspěšnost záchytu patologií.
Objective: Current urogynaecology practice allows preservation of the uterus in pelvic organ prolapse (POP) surgery, thus not reducing oncologic risk. Aim: The aim of the study was to evaluate the efficacy of ultrasound (USG) in diagnosing unexpected uterine and adnexal pathologies in women referred for POP. Furthermore, the benefit of USG examination by a specialist in gynaecology-oncology ultrasound was assessed. Materials and methods: All women after a hysterectomy with or without adnexectomy in the course of a POP surgery at our tertiary centre in 2013–2018 with preoperative USG were enrolled in the study. Women with recurrent uterine bleeding, abnormal cytology, using tamoxifen, or women with already diagnosed uterine or adnexal pathology were excluded. Results: 289 women were enrolled in the study – 157 (54.3%) expert USG vs. 132 (45.7%) non-expert USG. Abnormal findings were observed on the cervix in one case (non-expert USG), the endometrium 30 (10.4%) cases – 13 (8.3%) expert vs. 17 (12.9%) non-expert USG, the adnexa three (2.3%) cases (all non-expert USG), and no suspicion of malignancy on myometrium was observed. USG was false negative in four (1.4%) cases – two (1.3%) expert vs. two (1.5%) non-expert USG. Conversely, the examination was false positive in 34 (11.8%) cases – 13 (8.3%) expert vs. 21 (15.9%) non-expert USG. Conclusion: The risk of unexpected uterine or adnexal pathologies in POP surgery was 1.4%. The agreement between USG and histopathological benign, abnormal or malign findings was 87.2%. A sonographer specialized in oncologic sonography is able to reduce the number of false positive findings; however, this does not increase the sensitivity of the ultrasound.
INTRODUCTION AND HYPOTHESIS: It is reported that almost one in five women will need some form of pelvic organ prolapse surgery in their lifetime, with anterior wall repair accounting for nearly half of these. Cystoceles occur secondary to defect(s) in one or more of the vaginal wall support mechanisms, including its lateral paravaginal attachments. Paravaginal defects are very common in women presenting with cystocele, thus highlighting the importance of paravaginal defect repair for optimal cystocele correction in the majority of cases. Although there are several paravaginal defect repair procedures, some entail complex techniques, whereas others rely on the use of transvaginal mesh, which is currently not permitted in many countries. METHODS: In this video article we present a novel trans-obturator native tissue paravaginal defect repair for the management of cystocele. RESULTS: This procedure has the advantages of avoiding complex transabdominal paravaginal defect repair, the controversial use of transvaginal mesh, or a single-point fixation to an arcus tendineus fasciae pelvis that might be difficult to identify. CONCLUSION: We believe that the trans-obturator cystocele repair procedure offers several advantages over existing paravaginal defect repair alternatives.
- MeSH
- Abdomen MeSH
- Surgical Mesh MeSH
- Cystocele * surgery MeSH
- Fascia MeSH
- Humans MeSH
- Pelvic Organ Prolapse * surgery MeSH
- Vagina surgery MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Video-Audio Media MeSH
- Journal Article MeSH
