Aleksandra Bartuzi

Transvaginal Prolift(®) mesh surgery due to advanced pelvic organ prolapse does not impair female sexual function: a prospective study.

OBJECTIVES To evaluate sexual function among women with advanced pelvic organ prolapse (POP) before and after Prolift(®) vaginal reconstructive mesh surgery. STUDY DESIGN Assessments were performed preoperatively and 12-18 months after the surgery, including physical examination using the Pelvic Organ Prolapse Quantification (POP-Q) scale as well as the Female Sexual Function Index (FSFI) questionnaire. RESULTS Fifty-nine sexually active patients who underwent vaginal reconstructive surgery due to advanced POP between June 2008 and January 2010 were included in the study. Analysis of the FSFI questionnaire showed no statistically significant differences after surgery, despite proper anatomical results. When comparing the group of women who underwent additional surgical restoration of the perineal body with patients without this procedure we also did not observe any differences in FSFI scores. CONCLUSIONS Surgical treatment of advanced POP with the Prolift(®) system does not negatively influence sexual function, but patients should not expect a significant improvement after this type of operation. Additionally performed surgical restoration of perineal body does not reduce sexual function, either.

Tape Fixation: An Important Surgical Step to Improve Success Rate of Anti-Incontinence Surgery

PURPOSE Mid urethral slings are effective surgical treatment for stress urinary incontinence. However, 5% to 20% of patients still experience surgical failure with clinically significant recurrent or persistent stress urinary incontinence. Since a subset of these failures may be caused by improper tape position, we elucidated whether additional paraurethral fixation of a tape to prevent displacement during tensioning could improve the transobturator sling outcome. MATERIALS AND METHODS The study was done in 463 patients with stress urinary incontinence who were randomly allocated to treatment with a standard transobturator intravaginal monofilament sling procedure (232) or to an intravaginal transobturator monofilament sling with additional 2-point tape fixation (231). Another 2 absorbable sutures parallel to the urethra were added to fix the tape and prevent displacement during tape tensioning. Outcome was assessed by a cough test and a 1-hour pad test at 12 months. RESULTS Clinical efficacy of the procedure with fixation was significantly higher with 195 women (95.12%) cured or improved compared to the 199 (88.73%) cured or improved with the standard sling (chi-square 5.71, p = 0.0169). There was no increase in intraoperative or postoperative complications. Also, among patients with intrinsic sphincter deficiency we noted a significantly better outcome in the fixation group than in the control group, that is 39 of 41 patients (95.1%) cured or improved vs 31 of 42 (73.8%) (chi-square 10.65, p = 0.0011). CONCLUSIONS Tape fixation significantly increases the clinical efficacy of the transobturator sling, especially in patients with intrinsic sphincter deficiency.

Self-perceived quality of life after pelvic organ prolapse reconstructive mesh surgery: prospective study

OBJECTIVE To assess the self-perceived quality of life in women with advanced pelvic organ prolapse before and after mesh surgery. STUDY DESIGN Women with symptomatic pelvic organ prolapse (stage III-IV according to pelvic organ prolapse quantification (POP-Q)) were invited to participate in the study. All enrolled patients underwent prolapse surgery using the transvaginal mesh technique. Success was defined as ICS POP-Q stage 0 and I. The SF36v2 questionnaire was used as a subjective outcome measure. RESULTS 113 patients were available for follow-up at 6-8 weeks and 16-18 months. Overall anatomic success rates were 87.6%. Statistically significant improvements in the self-perceived quality-of-life were found in 3 individual domains (general health (GH), vitality (V) and mental health (MH)) and in one summary domain (MCS) at 6-8 weeks post-op. In one individual and one summary domain (role - physical (RP) and physical component summary (PCS)) the scores were significantly lower. At the end of the study statistically significant improvement was observed in four out of eight individual domains (vitality (V), menthal health (MH), physical functioning (PF), social functioning (SF)) as well as in both summary scores (PCS and MCS). CONCLUSIONS Reconstructive mesh surgery improved significantly various self-perceived quality of life dimensions. Therefore, women should expect significant improvement in their general quality of life after this type of operation. The assessment of urogenital well-being should be a routine attitude when counseling menopausal women.