Katerina Maxova

A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse

OBJECTIVE The objective of the study was to compare recurrence and complication rates for sacrospinous fixation (SSF) and prolene mesh techniques for the primary treatment of posthysterectomy vaginal vault prolapse. STUDY DESIGN Patients undergoing surgery for vault prolapse were included in a multicenter, randomized, controlled study comparing SSF or total mesh (Prolift; Gynecare/Ethicon, Somerville, NJ). The examination included pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. RESULTS Of 168 randomized patients, 83 underwent SSF and 85 mesh repair. Prolapse recurrence after 12 months occurred in 39.4% of the SSF group and in 16.9% of the mesh group (P = .003). The mesh exposure rate was 20.8%. No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. CONCLUSION Mesh exposure occurrence was balanced against a lower prolapse recurrence rate in the patients undergoing mesh surgery compared with those undergoing SSF.

Postpartum examination, breastfeeding, and contraception in the postpartum period in the Czech Republic

In the majority of recent textbooks of obstetrics, a routine follow-up examination at the end of the postpartum period is recommended. To date, no studies have been done in the Czech Republic addressing use of contraception and follow-up care in the postpartum period. Questionnaires were sent to 672 participants who gave birth in the year 2008, inquiring about follow-up examinations in the postpartum period and use of contraception. In total, 458 (68.2%) questionnaires were returned. 430 women (93.9%) underwent routine examinations at 6 weeks into the postpartum period. At the time of examination, 36 women were asked about their particular health problems (8.4%). In 130 instances, the question most often addressed by the outpatient gynecologist concerned use of contraception (30.2%). However, only 34 physicians expressed concern about changes in sexual life or other sexually related problems. 426 women (93.0%) were sexually active and 310 women (72.8%) did not use any contraception with the exception of breastfeeding. The current practice of outpatient gynecological visits at 6 weeks postpartum and advice on contraception both seem inadequate.