Cíl: Cílem práce bylo zhodnotit výskyt stresové inkontinence moči po operaci prolapsu pánevního dna metodou laparoskopické sakrokolpopexe. Jedná se o retrospektivní multicentrickou studii. Metodika: Do studie bylo zařazeno 131 pacientek, které podstoupily laparoskopickou sakrokolpopexi a následně minimálně jednoletý follow-up v podobě klinického vyšetření. Výsledky: Soubor zahrnoval pacientky s průměrným věkem 63,4 let (38–80 let), BMI 26,6 kg/m2 (19,4–36 kg/m2) a paritou 2 (0–4). Před operací vykazovalo stresovou inkontinenci 30 (22,9 %) pacientek, pooperačně 50 (38,2 %), rozdíl byl statisticky signifikantní (p = 0,0007). Následnou antiinkontinenční operaci podstoupilo 30 (22,9 %) pacientek, u 10 (7,6 %) pacientek došlo k významnému zlepšení stresové inkontinence. Závěr: Rekonstrukce prolapsu orgánů pánevního dna laparoskopickou sakrokolpopexí je spojena s rizikem pooperační stresové inkontinence ve 38,2 %, z toho de novo ve 22,9 % případů.

Objective: The aim of the study was to evaluate the occurrence of stress urinary incontinence after pelvic organ prolapse surgery using the laparoscopic sacrocolpopexy method. This is a retrospective multicenter study. Methods: The study included 131 patients who underwent laparoscopic sacrocolpopexy and underwent at least a one-year follow-up in the form of a clinical examination. Results: The group included patients with an average age of 63.4 years (38–80 years), BMI 26.6 kg/m2 (19.4–36 kg/m2), and parity 2 (0–4). Before surgery, 30 (22.9%) patients showed stress incontinence, and after surgery there were 50 (38.2%); the difference was statistically significant (P = 0.0007). Thirty (22.9%) patients underwent subsequent anti-incontinence surgery, while 10 (7.6%) patients experienced significant improvement of stress incontinence. Conclusion: Pelvic organ prolapse reconstruction surgery by laparoscopic sacrocolpopexy is associated with the risk of postoperative stress incontinence in 38.2%, of which de novo in 22.9% of cases.

• MeSH
• gynekologické chirurgické výkony metody   škodlivé účinky   MeSH
• laparoskopie škodlivé účinky   MeSH
• lidé MeSH
• pooperační komplikace etiologie   prevence a kontrola   MeSH
• prolaps pánevních orgánů chirurgie   MeSH
• retrospektivní studie MeSH
• stresová inkontinence moči * chirurgie   etiologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

• MeSH
• diagnostické techniky urologické MeSH
• fekální inkontinence MeSH
• hyperaktivní močový měchýř MeSH
• infekce močového ústrojí MeSH
• inkontinence moči MeSH
• lidé MeSH
• prolaps pánevních orgánů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy 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.

• MeSH
• chirurgické síťky * škodlivé účinky   MeSH
• gynekologické chirurgické výkony * metody   MeSH
• hodnocení výsledků péče pacientem MeSH
• laparoskopie metody   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   epidemiologie   MeSH
• prolaps pánevních orgánů * chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

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
• dyspareunie * etiologie   epidemiologie   MeSH
• gynekologické chirurgické výkony * metody   MeSH
• kvalita života * MeSH
• laparoskopie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační období MeSH
• prolaps pánevních orgánů * chirurgie   MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• sexuální chování * MeSH
• vagina chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Cíl: Porovnat subjektivní a objektivní výsledky laparoskopické sakrokolpopexe (LSC) ve vztahu k zavedení poševní tamponády. Metodika: Do studie bylo zařazeno 125 žen po LSC operovaných v letech 2013–2016 s kompletním ročním sledováním. Pacientky se současně provedenou totální hysterektomií byly vyřazeny ze studie. Základní charakteristiky pacientek, předoperační POP-Q, operační protokol a zpráva z roční kontroly byly vyhledány pomocí klinického informačního systému. Subjektivní výsledek operace byl hodnocen pomocí PGI-I (patient global impression of improvement). Objektivní výsledek operace byl hodnocen pomocí kompozitní definice selhání operace na základě POP-Q (Ba ≥ –1, C ≥ –3, Bp ≥ –1). Pacientky byly rozděleny do dvou souborů podle toho, zda měly zavedenou vaginální tamponádu po operaci, či nikoli. Statistické zpracování bylo provedeno pomocí c2, Wilcoxonovým a Fischerovým testem dle rozložení normality. Výsledky: Do studie bylo zařazeno celkem 125 žen; 48 (38,4 %) po LSC, 58 (46,4 %) s konkomitantní supracervikální hysterektomií a 19 (15,2 %) po sakrohysterokolpopexi. Vaginální tamponáda byla zavedena na 24–48 hod po operaci u 86 (68,8 %) žen. Skupiny se nelišily ve věku, indexu tělesné hmotnosti, kouření či předoperačním kvalifikačním prolapsu pánevních orgánů. Nezaznamenali jsme statisticky významné rozdíly v PGI-I rok po operaci. Rozdíl v objektivním selhání operace nedosáhl statistického významu, přestože více selhání bylo ve skupině bez tamponády (12,8 vs. 3,5 %; p = 0,09). Průměrná hodnota bodu C rok po operaci byla nižší ve skupině bez tamponády (–7 vs. –7,5; p < 0,009). Ve sledovaném souboru nebyla zaznamenána extruze síťky či závažná komplikace. Závěr: Vaginální tamponáda po LSC nejspíše nemá vliv na spokojenost pacientek po operaci, nicméně může být spojena s lepším anatomickým výsledkem operace po 1 roce. Výsledky studie je třeba potvrdit podrobnějším prospektivním zhodnocením.

Objective: To compare the subjective and objective results of laparoscopic sacrocolpopexy (LSC) with and without the introduction of a vaginal packing one year after surgery. Methodology: This is a retrospective cohort study of 125 women after laparoscopic sacrocolpopexy operated on in 2013–2016 with complete annual follow-up. Patients with a total hysterectomy were excluded from the study. Basic patient characteristics, preoperative POP-Q and surgery data were collected. The subjective outcome of the surgery was assessed using the PGI-I (patient global impression of improvement). The anatomic outcome of the surgery was evaluated using the composite definition of surgical failure based on POP-Q (Ba ≥ –1, C ≥ –3, Bp ≥ –1). Patients were divided into two groups according to whether or not they had vaginal packing after surgery. Statistical analysis was performed using c2, Wilcoxon and Fischer test according to the distribution of normality. Results: A total of 125 women were enrolled in the study; 48 (38.4%) after LSC, 58 (46.4%) with concomitant supracervical hysterectomy and 19 (15.2%) after sacrohysterocolpopexy. Vaginal packing was introduced for 24–48 hours after surgery in 86 (68.8%) women. The groups did not differ in age, body mass index, smoking or preoperative pelvic organ prolapse quantification system. We did not observe statistically significant differences in PGI-I first year after surgery. The difference in anatomic surgical failure did not reach statistical significance, although more failures were observed in the group without packing (12.8 vs. 3.5%; P = 0.09). The mean C-point value one year after surgery was lower in the non-tamponade group (–7 vs. –7.5; P < 0.009). No mesh extrusion or serious complications were recorded in the monitored group. Conclusion: Vaginal packing after LSC probably does not affect patient satisfaction after surgery, however, it may be associated with better anatomical outcome one year after the surgery. The results of the study must be confirmed by a more detailed prospective evaluation.

• Klíčová slova
• sakrokolpopexe, vaginální tamponáda,
• MeSH
• gynekologické chirurgické výkony * metody   MeSH
• hysterektomie metody   MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• prolaps pánevních orgánů * chirurgie   MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

OBJECTIVES: We set out to assess long-term anatomical and functional outcomes in women after laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse. METHODS: All women with a history of pelvic organ prolapse surgery operated between 2005 and 2022 were enrolled in this retrospective observational study. The indication for recurrent POP surgery was a symptomatic stage II and above pelvic organ prolapse. The data from objective urogynecologic examination and subjective patient assessment using validated questionnaires were collected. The last follow-up information was evaluated. The outcomes were compared with preoperative state using Student t-test and Wilcoxon test, p<0.05 was considered significant. RESULTS: 39 women were enrolled in the study. The rate of perioperative complications was very low; no significant hemorrhage, ureteral damage or conversion to laparotomy were observed. The mean follow-up was 40 ± 26.8 months. The postoperative course was not complicated by bowel incarceration, pelvic infection or mesh exposure. We observed a statistically significant elevation of all POP-Q points and decrease in all mean scores of PFDI, PFIQ, Wexner and VAS prolapse bother postoperatively. Improvement in stress urinary incontinence, anal incontinence and constipation was found. CONCLUSIONS: Laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse is a safe and effective surgery regardless of the type of the original repair performed. It provides good subjective and anatomical outcomes with a lasting effect on the quality of life in a long-term follow-up.

• MeSH
• kvalita života MeSH
• laparoskopie * MeSH
• lidé MeSH
• prolaps pánevních orgánů * chirurgie   MeSH
• stresová inkontinence moči * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

INTRODUCTION AND HYPOTHESIS: Injury of the levator ani muscle (LAM) is a significant risk factor for pelvic organ prolapse (POP). The puborectalis (PRM) and pubovisceral (PVM) subdivisions are level III vaginal support structures. The null hypothesis was that there is no significant difference in patterns of LAM subdivisions in healthy nulliparous women. Secondarily, we evaluated the presence of different LAM injury in a POP-symptomatic cohort. METHODS: This retrospective magnetic resonance imaging study included: 64 nulligravidae without any pelvic floor dysfunction (PFD) and 526 women of various parity with symptomatic POP. Primary outcome was PVM and PRM morphology on the axial planes: the attachment site on the pubic bone, and the visible separation/border between the PVM and PRM. The attachment was scored as "normal" or "abnormal". The "abnormal" attachment was divided in two types: "type I"-loss of the muscle substance, but preservation of the overall muscle architecture-and "type II"-muscle detachment from the pubic bone. RESULTS: The puboanal muscle (PAM) subdivision was evaluated as a representative part of the PVM. The PAM and PRM attachments and separation were distinguished in all asymptomatic nulliparae. PAM and PRM attachments did not significantly differ. POP group characteristics were parity 1.9 ± 0.8, instrumental delivery 5.6%, hysterectomy or POP surgery 60%, all Pelvic Organ Prolapse Quantification (POP-Q) stages, LAM defect 77.6% (PRM: 77.1%; PAM: 51.3%). Type I injuries were more frequent (PRM 54.7%; PAM 53.9%) compared with type II (PRM 29.4%; PAM 42.1%). CONCLUSIONS: A LAM defect was present in 77.6% of women with symptomatic POP. In PRM and PAM subdivisions type I injury was more frequent than type II.

• MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• pánevní dno zranění   MeSH
• prolaps pánevních orgánů * diagnostické zobrazování   etiologie   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• vagina * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION AND HYPOTHESIS: Long-term durability and functional outcome of laparoscopic sacrohysteropexy (LSH) remains to be confirmed. We set out to assess the development of surgical outcome in women with increasing minimal follow-up. METHODS: All women after LSH with anterior and posterior mesh extension operated for advanced apical uterine prolapse at Geoffroy Saint-Hilaire clinic from July 2005 to June 2020 were enrolled in this retrospective study. Last known follow-up information was used for the analysis and allocation into groups. The surgical success was defined as no prolapse beyond hymen, no symptomatic recurrence or no retreatment. Functional outcome was evaluated from validated questionnaires and presence of pelvic floor disorders. The outcomes were compared with preoperative state using chi-square and Fisher's test; p < 0.05 was considered significant. RESULTS: In total, 270 patients after LSH with a follow-up of up to 14.5 years were enrolled and divided into groups according to their last follow-up length: ≥ 1 year 242, ≥ 3 years 112, ≥ 5 years 76, ≥ 7 years 45 and ≥ 10 years 18 women. Increase of minimal follow-up was associated with gradual decrease in surgical success. Rates of stress urinary incontinence were unchanged by the surgery, while anal incontinence and constipation rates decreased significantly; 14.5% of women were operated on for SUI in the follow-up. The PFDI-20, PFIQ-7 and VAS bother scores decreased significantly regardless of minimal follow-up length. CONCLUSIONS: LSH with anterior and posterior mesh extension is a safe, effective and durable surgery with a positive long-term effect on quality of life. Although the surgical success gradually decreases, LSH remains a surgical success in most women.

• MeSH
• chirurgické síťky MeSH
• gynekologické chirurgické výkony MeSH
• kvalita života MeSH
• laparoskopie * MeSH
• lidé MeSH
• prolaps pánevních orgánů * chirurgie   MeSH
• retrospektivní studie MeSH
• vagina chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• anální fisura diagnóza   etiologie   terapie   MeSH
• dítě MeSH
• enterobióza diagnóza   farmakoterapie   MeSH
• hemoroidy diagnóza   farmakoterapie   prevence a kontrola   MeSH
• kolorektální chirurgie * klasifikace   metody   MeSH
• kondylomata akuminata diagnóza   farmakoterapie   klasifikace   mikrobiologie   MeSH
• lidé MeSH
• pilonidální sinus diagnóza   klasifikace   MeSH
• prolaps rekta diagnóza   farmakoterapie   prevence a kontrola   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

Sestup pánevních orgánů (POP – pelvic organ prolaps) je častou dia gnózou s incidencí v populaci až 50 %. POP způsobuje omezení v běžném životě a snižuje kvalitu života pacientek. Terapie je buď konzervativní v podobě fyzioterapie nebo užití různých typů pesarů, event. při nevhodnosti či selhání konzervativní léčby je zvoleno operační řešení. Avulzní poranění musculus levator ani (MLA) patří mezi nejvýznamnější faktory pro vznik POP. Nezanedbatelná část pacientek podstupuje operace pro sestup opakovaně. Studie ukazují, že stadium POP a avulzní poranění levátoru je spojeno se zvýšeným rizikem rekurence sestupu. Ultrazvuková diagnostika poranění MLA může lépe předpovědět riziko rekurence POP. Hodnocení funkce pánevního dna je důležité pro volbu operačního řešení POP.

Pelvic organ prolapse (POP) is a common diagnosis with an incidence in the population of up to 50%. POP causes restrictions in everyday life and reduces patients’ quality of life. Therapy is either conservative in the form of physiotherapy or the use of different types of pessaries, possibly. in case of inappropriateness or failure of conservative treatment, an operative solution is chosen. Avulsion injury of the levator ani muscle (MLA) is a strong factor in the development of POP. Some patients undergo repeated surgeries for POP, negatively impacting their quality of life. Studies show that the stage of POP and avulsion injury is associated with an increased risk of recurrence after index prolapse surgery. Ultrasound diagnosis of MLA injuries might help in predicting the risk of recurrence. Assessment of pelvic floor function is crucial for the success of surgical management of POP.

• MeSH
• lidé MeSH
• odds ratio MeSH
• pánevní dno * zranění   MeSH
• prolaps pánevních orgánů * chirurgie   etiologie   MeSH
• recidiva MeSH
• reoperace MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH