Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair
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ORIGINAL ARTICLE
Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair of the vaginal compartments in patients with advanced pelvic organ prolapse and incontinence Ivan Ignjatovic 1
&
Milan Potic 1 & Dragoslav Basic 1 & Ljubomir Dinic 1 & Aleksandar Skakic 1
Received: 30 April 2020 / Accepted: 24 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The aim of the study was to evaluate hysterectomized and non-hysterectomized patients with prolapse and incontinence. Laparoscopic sacrohysteropexy (LSHP) and minimally invasive sacrocolpopexy (LMSCP) were done in combination with transobturator tape (TOT) and native tissue repair of the anterior and posterior vaginal compartments in patients with pelvic organ prolapse (POP) and occult, stress, or urinary incontinence (SUI). The hypothesis is that both methods are successful. Methods A total of 81 patients with POP were evaluated: 44 had vaginal vault prolapse (POPQ points Ba, C, and Bp were 1.2, 2.6, and 0.4, respectively) and 37 had uterine prolapse (POPQ points Ba, C, and Bp were 1.8, 1.7, and 1.3, respectively). LMSCP (which means less dissection of the vagina in its upper third and avoiding possible collision with the ureters anteriorly or the rectum posteriorly) was performed in patients with vault prolapse, whereas patients with uterine prolapse underwent LSHP. Transobturator tape (TOT) was placed in all patients to treat symptomatic and occult urinary incontinence. Systematic anterior and posterior colporrhaphy was performed in both groups. Results Both groups showed anatomic (p < 0.0001) and symptomatic improvement (p < 0.001–p < 0.05). Voiding was significantly improved after surgery without postoperative incontinence (p < 0.001). There was no significant difference between groups regarding duration of surgery (p = 0.06), hospital stay (p = 0.13), blood loss (0.83), Clavien-Dindo grade 3 (p = 0.87), and Clavien-Dindo grade 1–2 (p = 0.92) complications. Conclusion Minimally invasive LSCP or LSHP combined with TOT and native tissue repair of the anterior and posterior vaginal compartment is a successful treatment for POP. Keywords Anterior colporrhaphy . Posterior colporrhaphy . Laparoscopic minimally invasive colposacropexy . Laparoscopic hysteropexy . Pelvic organ prolapse . Posterior colporrhaphy . Transobturator tape
* Ivan Ignjatovic [email protected] Milan Potic [email protected] Dragoslav Basic [email protected] Ljubomir Dinic [email protected] Aleksandar Skakic [email protected] 1
Clinic of Urology, Clinical Center Nis, Bulevar Zorana Djindjica 48, Nis, Serbia
Introduction Pelvic organ prolapse (POP) is a frequent disorder in postmenopausal women and causes a lifetime need for surgery in up to 20% of patients [1]. Advanced POP is frequently associated with the urinary incontinence and bowel symptoms. Uterus preservation in the era of patient-oriented medicine is the preferred type of treatment compared to hysterectomy because o
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