INTRODUCTION AND HYPOTHESIS: Rectocervical fistula after a urogynecological surgery has never been described. In this video article, we present occurrence of this complication after laparoscopic supracervical hysterectomy and laparoscopic sacrocervicopexy (LSCH + LSC) and how it was treated. METHODS: This was a case of a 47-year-old patient who had a laparoscopic supracervical hysterectomy and laparoscopic sacrocervicopexy (LSCH + LSC) for stage two pelvic organ prolapse. Within 3 months after the surgery, the patient complained of an odorous brownish vaginal discharge. On examination, this discharge was identified to be from the cervical canal. A provisional diagnosis of a rectocervical fistula was postulated and later confirmed by ultrasonography and colonoscopy. Consequently, a laparoscopic fistula repair with concomitant partial explantation of the mesh followed by removal of the cervix and transposition of an omental flap between the vaginal and rectal suture lines. The patient made an uneventful recovery. The resulting rectocele was repaired by a colpoperineorrhaphy 2 years after the surgery. CONCLUSION: Rectocervical fistula is a rare complication after laparoscopic sacrocervicopexy with concomitant supracervical hysterectomy. We demonstrated the feasibility of repairing this fistula laparoscopically. We opted for mesh explantation and removal of the cervix at the time of the fistula repair to mitigate the risk of recurrence.

• Keywords
• Laparoscopy, Mesh explantation, Rectocervical fistula, Sacrocolpopexy, Supracervical hysterectomy,
• MeSH
• Cervix Uteri surgery   MeSH
• Gynecologic Surgical Procedures * methods   adverse effects   MeSH
• Hysterectomy * adverse effects   methods   MeSH
• Laparoscopy * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Uterine Cervical Diseases * surgery   etiology   MeSH
• Postoperative Complications * surgery   etiology   MeSH
• Pelvic Organ Prolapse surgery   MeSH
• Rectal Fistula * surgery   etiology   MeSH
• Intestinal Fistula * surgery   etiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Video-Audio Media MeSH
• Journal Article MeSH
• Case Reports 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.

• 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: 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.

• Keywords
• Dyspareunia, Mesh, PISQ-12, PISQ-IR, Sacrocolpopexy, Sexuality,
• 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

BACKGROUND: Abdominal and laparoscopic sacro-colpopexy (LSC) is considered the standard surgical option for the management of a symptomatic apical pelvic organ prolapse (POP). Women who have their uterus, and for whom an LSC is indicated, can have a laparoscopic sacro-hysteropexy (LSH), a laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH + LSC) or a total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH + LSC). The main aim of this study was to compare clinical and patient reported outcomes of uterine sparing versus concomitant hysterectomy LSC procedures. METHODS: A retrospective analysis of clinical, imaging and patient reported outcomes at baseline, 3 and 12 months after LSH versus either LSCH + LSC or TLH + LSC between January 2015 and January 2019 in a tertiary referral urogynecology center in Pilsen, the Czech Republic. RESULTS: In total, 294 women were included in this analysis (LSH n = 43, LSCH + LSC n = 208 and TLH + LSC n = 43). There were no differences in the incidence of perioperative injuries and complications. There were no statistically significant differences between the concomitant hysterectomy and the uterine sparing groups in any of the operative, clinical or patient reported outcomes except for a significantly lower anterior compartment failure rate (p = 0.017) and higher optimal mesh placement rate at 12 months in women who had concomitant hysterectomy procedures (p = 0.006). CONCLUSION: LSH seems to be associated with higher incidence of anterior compartment failures and suboptimal mesh placement based on postoperative imaging techniques compared to LSC with concomitant hysterectomy.

• Keywords
• Cervicopexy, Compartment, Hysteropexy, LSC, LSCH + LSC, LSH, Laparoscopic, Mesh, PFDI, PGI-I, POP-Q, Sacrocolpopexy, TLH + LSC,
• MeSH
• Gynecologic Surgical Procedures MeSH
• Hysterectomy MeSH
• Cohort Studies MeSH
• Laparoscopy * MeSH
• Humans MeSH
• Pelvic Organ Prolapse * surgery   MeSH
• Retrospective Studies MeSH
• Uterus MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. METHODS: A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia. RESULTS: A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. CONCLUSIONS: The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

• Keywords
• Attitude, Hysterectomy, Preference, Prolapse, Sparing surgery, Survey,
• MeSH
• Surgical Mesh MeSH
• Hysterectomy methods   statistics & numerical data   MeSH
• Organ Sparing Treatments methods   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Obstetric Surgical Procedures adverse effects   methods   MeSH
• Pelvic Organ Prolapse surgery   MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Slovenia MeSH