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Comparison of different surgical techniques for pelvic floor repair in elderly women: a multi-institutional study

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The prevalence of pelvic organ prolapse (POP) is increasing. The number of women aged 70–80 years requiring surgical management for POP is also increasing. The purpose of this study was to compare the complications associated with three pelvic organ prolapse repair methods, sacrocolpopexy (SCP), native tissue repair (NTR), and vaginal mesh repair (VMR), in women aged 70–80 years.

Methods

We performed a multi-institutional retrospective analysis of 213 women who underwent POP surgical repairs between December 2012 and December 2017. Treatment-related complications were classified using the ClavienDindo grading system and compared among the three groups. Perioperative data, anatomical success rates, patient satisfaction, and postoperative complication data were collected during the follow-up period, which lasted up to 12 months.

Results

Of 213 patients, 70 (33%) underwent SCP, 85 (40%) underwent NTR, and 58 (28%) underwent VMR. By postoperative day 30, the all-inclusive complication rate was lower in the SCP group than in the NTR or VMR group; however, there was no between-group difference in complication grade. The VMR group underwent fewer concomitant hysterectomies than the other groups, and operative time was the longest for SCP. Overall, recovery time, anatomical success rate, and patient satisfaction were comparable for all three repairs.

Conclusions

All three surgical techniques were equivalent in patient satisfaction, anatomical success rate, and complication rate. SCP should be recommended to elderly women who meet criteria for prolonged general anesthesia, as it was associated with fewer perioperative complications than NTR and VMR.

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Abbreviations

ASA:

American Society of Anesthesiology

BMI:

Body mass index

ICS:

International Continence Society

LAM:

Levator ani muscle

NTR:

Native tissue repair

POP:

Pelvic organ prolapse

POP-Q:

Pelvic Organ Prolapse Quantification

QOL:

Quality of life

SCP:

Sacrocolpopexy

SSQ-8:

Surgical Satisfaction Questionnaire

TVT:

Tension free vaginal tape

VMR:

Vaginal mesh repair

References

  1. Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20–59 years of age and possible related factors. Am J Obstet Gynecol 180:299–305

    Article  CAS  PubMed  Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506

    Article  CAS  PubMed  Google Scholar 

  3. Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP, Charlson ME (1995) Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA 274:44–50

    Article  CAS  PubMed  Google Scholar 

  4. Luber KM, Boero S, Choe JY (2001) The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 184:1496–1501 (discussion, 1501–1503)

    Article  CAS  PubMed  Google Scholar 

  5. Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraison FR, Walters D (2005) Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol 192:1630–1636

    Article  PubMed  Google Scholar 

  6. Tabata T, Yamawaki T, Ida M, Nishimura K, Nose Y, Yabana T (2001) Clinical value of dilatation and curettage for abnormal uterine bleeding. Arch Gynecol Obstet 264:174–176

    Article  CAS  PubMed  Google Scholar 

  7. Hornemann A, Kamischke A, Luedders DW, Beyer DA, Diedrich K, Bohlmann MK (2010) Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women. Arch Gynecol Obstet 281:59–64

    Article  PubMed  Google Scholar 

  8. Sabbagh R, Mandron E, Piussan J, Brychaert PE, Tu LM (2010) Long-term anatomical and functional results of laparoscopic promontofixation for pelvic organ prolapse. BJU Int 106:861–866

    Article  PubMed  Google Scholar 

  9. Gerten KA, Markland AD, Lloyd LK, Richter HE (2008) Prolapse and incontinence surgery in older women. J Urol 179:2111–2118

    Article  PubMed  PubMed Central  Google Scholar 

  10. Visco AG, Visco AG, Wei JT, McClure LA, Handa VL, Nygaard IE (2003) Effects of examination technique modifications on pelvic organ prolapse quantification (POP-Q) results. Int Urogynecol J Pelvic Floor Dysfunct 14:136–140

    Article  PubMed  Google Scholar 

  11. Giuly J, Cravello L, D’Ercole C, Roger V, Porcu G, Blanc B (1997) Richter’s spinofixation in vaginal prolapse. Chir Mem Acad Chir 122:430–434 (French)

    CAS  Google Scholar 

  12. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  13. Murphy M, Sternschuss G, Haff R, van Raalte H, Saltz S, Lucente V (2008) Quality of life and surgical satisfaction after vaginal reconstructive vs obliterative surgery for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol 198:573

    Article  PubMed  Google Scholar 

  14. King SW, Jefferis H, Jackson S, Marfin AG, Price N (2017) Laparoscopic uterovaginal prolapse surgery in the elderly: feasibility and outcomes. Gynecol Surg 14:2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL (2006) Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol 194:1411–1417

    Article  PubMed  Google Scholar 

  16. Leung JM, Dzankic S (2001) Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 49:1080–1085

    Article  CAS  PubMed  Google Scholar 

  17. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004014.pub5

    Article  PubMed  Google Scholar 

  18. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Greer JA, Northington GM, Harvie HS, Segal S, Johnson JC, Arya LA (2013) Functional status and postoperative morbidity in older women with prolapse. J Urol 190:948–952

    Article  PubMed  Google Scholar 

  20. Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X, Vallancien G (2009) The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 55:1089–1103

    Article  PubMed  Google Scholar 

  21. Keys T, Campeau L, Badlani G (2012) Synthetic mesh in the surgical repair of pelvic organ prolapse: current status and future directions. Urology 80:237–243

    Article  PubMed  Google Scholar 

  22. Belot F, Collinet P, Debodinance P, Duc H, Lucot JP, Cosson M (2005) Risk factors for prosthesis exposure in treatment of genital prolapse via the vaginal approach. Gynecol Obstet Fertil 33:970–974

    Article  CAS  PubMed  Google Scholar 

  23. Maher CF, Feiner B, DeCuyper EM, Nichlos CJ, Hickey KV, O’Rourke P (2011) Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 204:360

    Article  PubMed  Google Scholar 

  24. Agarwala N, Hasiak N, Shade M (2007) Laparoscopic sacral colpopexy with Gynemesh as graft material—experience and results. J Minim Invasive Gynecol 14:577–583

    Article  PubMed  Google Scholar 

  25. Su TH, Lau HH, Huang WC, Hsieh CH, Chang RC, Su CH (2014) Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study. Int Urogynecol J 25:901–908

    Article  PubMed  Google Scholar 

  26. Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203:235

    Article  PubMed  Google Scholar 

  27. Moore RD, Miklos JR (2009) Vaginal repair of cystocele with anterior wall mesh via transobturator route: efficacy and complications with up to 3-year followup. Adv Urol 78:15. https://doi.org/10.1155/2009/743831

    Article  Google Scholar 

  28. Lee U, Wolff EM, Kobashi KC (2012) Native tissue repairs in anterior vaginal prolapse surgery: examining definitions of surgical success in the mesh era. Curr Opin Urol 22:265–270

    Article  PubMed  Google Scholar 

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Funding

There was no funding obtained for this study.

Author information

Authors and Affiliations

  1. Department of Urology, Hôpital Pasteur 2, CHU Nice, University of Nice-Sophia Antipolis, 30 Voie Romaine, 06000, Nice, France

    Brannwel Tibi, Matthieu Durand, Imad Bentellis, Youness Ahallal & Daniel Chevallier

  2. Department of General Surgery and Gynecology, Diaconesses-Croix Saint Simon Hospital Paris, Paris, France

    Brannwel Tibi, Etienne Vincens, Delphine Salet-Lizee, Aminata Kane, Pierre Gadonneix & Richard Villet

  3. Department of Public Health, University Hospital of Strasbourg, Strasbourg, France

    François Severac

Authors
  1. Brannwel Tibi
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  2. Etienne Vincens
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  3. Matthieu Durand
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  7. Pierre Gadonneix
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  9. Youness Ahallal
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Contributions

BT: Project development, data collection, and manuscript writing; EV: Project development and reviewing of the manuscript; MD: Reviewing and editing of the manuscript; DSL: Project development and manuscript reviewing and editing; AK: Project development; PG: Project development; IB: Editing of the manuscript; FS: Data analysis; YA: Editing of the manuscript; DC: Project development; RV: Supervisor, Study validation.

Corresponding author

Correspondence to Brannwel Tibi.

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Conflict of interest

The authors affirm that they have no conflicts of interest to declare.

Research involving human participants and/or animals

All procedures performed in these studies that involved human participants were conducted in accordance with the ethical standards of our institutional ethics review committee and adhered to the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by our institutional ethics review board.

Clinical Trial

NCT03445442.

Informed consent

All patients were notified about the use of their de-identified medical data in our retrospective analysis.

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Tibi, B., Vincens, E., Durand, M. et al. Comparison of different surgical techniques for pelvic floor repair in elderly women: a multi-institutional study. Arch Gynecol Obstet 299, 1007–1013 (2019). https://doi.org/10.1007/s00404-019-05076-1

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  • DOI: https://doi.org/10.1007/s00404-019-05076-1

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