Janet Tomezsko

Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation

OBJECTIVE To compare vaginal anatomy and sexual function after the conventional posterior and anterior sacrospinous vault suspension. METHODS A retrospective repeated measures cohort study included all 168 consecutive sacrospinous vault suspension procedures between July 1990 and February 1997. The posterior suspension (n = 92) used a posterior vaginal incision and pararectal dissection. Anterior suspension (n = 76) involved an anterior rather than posterior vaginal incision, retropubic perforation, and dissection of a paravaginal‐paravesical rather than pararectal space to accommodate the vaginal vault. Two polytetrafluoroethylene (00) sutures anchored the anterior vaginal cuff (for the anterior sacrospinous suspension) or the posterior vaginal cuff (for the posterior sacrospinous suspension) to the ligament. Postoperative evaluation included an examination using the pelvic organ prolapse quantitative system, assessment of vaginal width and axis, and symptom questionnaire. RESULTS Total vaginal length and apical suspension were slightly greater after the anterior suspension, and recurrent anterior vaginal relaxation was less likely. No differences were found in maximal dilator size or apical narrowing between the two groups. New onset dyspareunia was reported by two subjects in the anterior vault suspension group, and two in the posterior vault suspension group. Three of these four cases of de novo dyspareunia were attributable to either severe atrophy or recurrent prolapse, and none to vaginal narrowing or shortening. CONCLUSION After anterior sacrospinous vault suspension, vaginal length and apical suspension were slightly increased, and recurrent anterior vaginal prolapse decreased compared with the posterior sacrospinous suspension technique. Upper vaginal caliber and sexual function appear well preserved using either technique.

Abdominal sacrocolpopexy and urinary incontinence: surgical planning based on urodynamics

OBJECTIVE The objective of the study was to evaluate the use of urodynamics to determine the need for incontinence surgery at the time of abdominal sacrocolpopexy (ASC). STUDY DESIGN The records of 441 women undergoing ASC during 2005-2007 were reviewed. Group 1 consisted of 204 women (46.3%) with urodynamic stress incontinence (USI), including occult USI, who underwent incontinence surgery with ASC. Group 2 consisted of 237 women (53.7%) without USI who underwent ASC alone. Primary outcome measures were any complaint of postoperative incontinence (stress or urge) or new-onset urgency/frequency (UF). RESULTS At a mean follow-up of 46.6 weeks, the overall rate of incontinence was low and similar for both groups (13.4% in group 1 and 13.3% in group 2 [P = .967]), as was new-onset UF: 18.6% in group 1 and 11.5% in group 2 (P = .195). CONCLUSION Urodynamic evaluation appears to be useful in determining the need for incontinence surgery at the time of ASC.

Pelvic floor fitness using lay instructors.

OBJECTIVE: Typically, pelvic muscle training for women with pelvic floor disorders is provided by medical personnel. We sought to evaluate the feasibility and symptom improvement after a nonmedical pelvic muscle training class in a prospective cohort. METHODS: Study participants volunteered to participate in an 11-week pelvic fitness and education class taught by a lay instructor at five fitness classrooms in the Chicago area. Participation was limited to adult women who verbally indicated that their pelvic symptoms included a minimum of some urge urinary symptom. Standardized assessments were completed before class, at the end of class, and 1 year after completion of the classes. These assessments included the 12-item short-form, validated pelvic questionnaires (Urogenital Distress Inventory Short Form, Incontinence Impact Questionnaire Short Form, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), and self-reported goals selection and achievement. RESULTS: Eighty-seven of 102 participants provided before and after class data, and 76 also provided 1-year data. Participants had a mean age of 58 years and a mean body mass index of 26.3. Most (91%) were white, and 63% had at least completed college. After class improvements in Urogenital Distress Inventory Short Form bothersomeness ratings were noted for all items and maintained at 1 year for all but pain or discomfort. Significant quality-of-life and sexual function improvements were reported after class and at 1 year. The 12-item short-form responses documented improvements in six areas of general health. The most important self-selected goal was achieved in 71% after class and maintained by 67% at 1 year. CONCLUSION: Nonmedical pelvic fitness classes are promising for pelvic symptom improvement in self-selected participants. LEVEL OF EVIDENCE: II