The evolution of sacrocolpopexy and development of novel techniques via natural orifice transluminal endoscopic surgery

Prolapse of one or more pelvic organs through the vagina,such as the uterus,bladder,or rectum,is an increasingly common occurrence in the aging female population,with rates approaching 60%of parous women.1 Its associated symptoms of vaginal bulge or bladder,bowel,or sexual dysfunction can drastically affect a woman's quality of life.Multiple surgical options for the treatment pelvic organ prolapse exist and may involve autologous tissue repair or the use of biological or synthetic grafts.Abdominal sacrocolpopexy,first described in 1957 by Arthure and Savage,involves using the sacrum as a point of support for the vaginal apex.2 The technique was further refined by Huguier and Scali by the incorporation of a graft to improve tissue strength and to improve postoperative anatomical cure rates.3 For many surgeons,abdominal sacrocolpopexy is the preferred surgical technique as it has demonstrated superior outcomes with higher postoperative success rates through restoration of normal anatomy and lower rates of prolapse recurrence and postoperative dyspareunia.

Stone accumulation overlying vaginal mesh exposure:A case report

BACKGROUND Vaginal stones are rare with current literature limited to case reports.Vaginal stones are classified as primary or secondary stones.Primary stones form in the vagina when there is urinary stasis.Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts.Foreign bodies,such as surgical mesh,make vaginal stone formation more likely,particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.CASE SUMMARY A 71-year-old female with a history of sacrocolpopexy,hyperaldosteronism,and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure.The vaginal stones were initially removed to permit examination,but the stones reaccumulated at the site of the exposed mesh,later requiring definitive surgical management.CONCLUSION Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure,particularly if they have coexisting urinary incontinence.These individuals should be counseled about possible vaginal stone accumulation,and surgical management should be considered.

Nerve preserving vs standard laparoscopic sacropexy: Postoperative bowel function

AIM To compare our developed nerve preserving technique with the non-nerve preserving one in terms of de novo bowel symptoms.METHODS Patients affected by symptomatic apical prolapse, admitted to our department and treated by nerve preserving laparoscopic sacropexy(LSP) between October, 2010 and April, 2013(Group A or "interventional group") were compared to those treated with the standard LSP, between September, 2007 and December, 2009(Group B or "control group"). Functional and anatomical data were recorded prospectively at the first clinical review, at 1, 6 mo, and every postsurgical year. Questionnaires were filled in by the patients at each follow-up clinical evaluation.RESULTS Forty-three women were enrolled, 25/43 were treated by our nerve preserving technique and 18/43 by the standard one. The data from the interventional group were collected at a similar follow-up(> 18 mo) as those collected for the control group. No cases of de novo bowel dysfunction were observed in group A against 4 cases in group B(P = 0.02). Obstructed defecation syndrome(ODS) was highlighted by an increase in specific questionnaires scores and documented by the anorectal manometry. There were no cases of de novo constipation in the two groups. No major intraoperative complications were reported for our technique and it took no longer than the standard procedure. Apical recurrence and late complications were comparable in the two groups.CONCLUSION Our nerve preserving technique seems superior in terms of prevention of de novo bowel dysfunction compared to the standard one and had no major intraoperative complications.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse

Background:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time.The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse(POP)over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.Methods:A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1,2004 and September 30,2018 were included from 22 tertiary academic medical centers.The data were reported voluntarily and obtained from a database.We compared the proportion of each procedure in the 7 years before and 7 years after September 30,2011.The data were analyzed by performing Z test(one-sided).Results:The number of different procedures during October 1,2011-September 30,2018 was more than twice that during October 1,2004-September 30,2011.Regarding pelvic floor surgeries related to POP,the rate of synthetic mesh procedures increased from 38.1%(5298/13,906)during October 1,2004-September 30,2011 to 46.0%(14,107/30,688)during October 1,2011-September 30,2018,whereas the rate of non-mesh procedures decreased from 61.9%(8608/13,906)to 54.0%(16,581/30,688)(Z=15.53,P<0.001).Regarding synthetic mesh surgeries related to POP,the rates of transvaginal placement of surgical mesh(TVM)procedures decreased from 94.1%(4983/5298)to 82.2%(11,603/14,107)(Z=20.79,P<0.001),but the rate of laparoscopic sacrocolpopexy(LSC)procedures increased from 5.9%(315/5298)to 17.8%(2504/14,107).Conclusions:The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly.The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.Trial registration number:NCT03620565,https://register.clinicaltrials.gov.

Using a needle for sacrospinous ligament fixation for pelvic organ prolapse based on the Miyazaki technique

Background:Approximately 7%of all women will require surgery to correct pelvic organ prolapse during their lives.Of these,approximately 10%-13%will require another operation within 5 years due to recurrence of the disease.Increases in life expectancy and elderly individuals with estrogen deficiencies will mean higher rates of pelvic organ prolapse,significantly reducing the quality of life for millions of people.This study introduces technologies that can help treat pelvic prolapse while reducing the rate of recurrence.Methods:This paper outlines how to properly perform sacrospinous ligament fixation using the Miyazaki technique.Results:A needle was used to successfully perform a sacrospinous ligament fixation using Miyazaki's technique.Conclusions:Considering the Food and Drug Administration’s 2019 decision to permit surgeries with native tissue,this method can be used with sacrospinous ligament fixation as the primary treatment option for pelvic organ prolapse.