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Urogynaecology
vaginal prolapse.
32–34
Rectocele recurrence appeared regardless of colpopexy for vaginal vault prolapse. For both procedures, the authors
polyglactin mesh augmentation.
35
In one randomised controlled trial, showed statistical improvements in quality of life after prolapse surgery
after one year the failure rate was higher in women who received a using disease-specific questionnaires.
16
However, the general health-
biologic graft-augmented repair with porcine small intestine related quality of life, as measured by the SF-36 questionnaire, turned
submucosa than in women who received site-specific repair or out to be improved in only a few domains (physical role for abdominal
posterior colporrhaphy only.
36
From literature research it can be surgery, physical role and bodily pain for the vaginal surgery).
16
One
concluded that native tissue repair remains more appropriate in questionnaire, the Urogenital Distress Inventory (UDI), was used by
posterior vaginal wall repair than biologic or absorbable synthetic Roovers et al.
39
to compare abdominal sacrocolpopexy with uterus
grafts. There are no comparative studies to suggest a preservation versus vaginal hysterectomy with anterior and posterior
recommendation for the use of non-absorbable synthetic mesh in colporrhaphy in patients with uterine prolapse stages II–IV. In both arms,
posterior vaginal wall repair compared with native tissue repair. all UDI domain scores were reduced after surgery, but for all domains
the vaginal group provided better results.
The introduction of synthetic and biologic prostheses has been
proposed to reduce recurrence rates while maintaining vaginal The gynaecological surgeon is regularly confronted with new
capacity and coital function. The role of synthetic prostheses is well procedures and new materials with the implication that new is better.
established for continence surgery in the form of midurethral slings Although this may often be the case, most new products and
and for abdominal sacrocolpopexy to correct vault prolapse. procedures lack clinical outcome and safety data over a clinically
However, post-operative morbidity – specifically the risk of mesh relevant period. Graft augmentation that bypasses the use of native
erosion – has limited their use for vaginal prolapse surgery. Biologic tissue support is gaining rapid acceptance, especially since the advent
prostheses have been introduced as an alternative. While these of trocar-placed grafts. If the future of pelvic reconstructive surgery is
grafts largely avoid the problem of erosion, there are concerns the passage of trocars and needles through blind spaces, it is of utmost
regarding longevity, and only short-term outcome data are currently importance for the surgeon to have a clear 3D understanding of pelvic
available. The use of prosthetics in pelvic floor surgery is an evolving floor anatomy.
and controversial method. Current and future research should be
directed at evaluating the safety and efficacy of specific products When a surgeon is considering procedures for prolapse treatment, it is
and comparing subjective and objective outcome parameters in essential to know about the available options, to have the technical
order to standardise surgical techniques for pelvic organ prolapse. expertise to use the materials and to have the ability to recognise and
deal with potential complications associated with the surgery. ■
Some proposed criteria for graft use are: when previous reconstructive
surgery has failed, when intraoperative dissection reveals inadequate
Christl Reisenauer is an Associate Professor and Head
tissue and when patients suffer from congenital collagen deficiency.
37
of the Urogynaecological Division of the Department of
Relative contraindications for the use of grafts include: a history of Obstetrics and Gynaecology at University Hospital
previous irradiation, severe urogenital atrophy, immunosupression,
Tübingen. She is a member of several national and
international organisations, including the International
active pelvic or vaginal infection, systemic steroid use and conditions
Continence Society (ICS) and the International
that impair healing such as obesity, poorly controlled diabetes and Urogynaecological Association (IUGA). Her research
heavy smoking.
38
To date, only a few trials have used validated
activities are macroscopical anatomy of the pelvic floor,
histomorphology of the uterosacral ligament, the
questionnaires for pelvic organ prolapse. Specifically, Maher et al.
16
used
conservative and surgical treatment of urinary incontinence and pelvic organ prolapse
the Short Urogenital Distress Inventory (SUDI), the Incontinence Impact and fistulas. She has published numerous articles in scientific journals and has
Questionnaire and the Short Form-36 (SF-36) Health Survey to compare
received several awards for her research activities.
the outcome of abdominal sacral colpopexy and vaginal sacrospinous
1. Beck RP, McCormick S, Nordstrom L, Obstet Gynecol, 15. Welgoss JA, Vogt VY, McClellan EJ, et al., Int Urogynecol J, 27. FitzGerald MP, Richter HE, Siddique S, et al., Int Urogynecol J,
1991;78:1011–18. 1999;10:11–14. 2006;17:261–71.
2. Kontogeorgos L, Vassillopoulos P, Tentes A, Br J Urol, 16. Maher C, Qatawneh AM, Dwyer PL, et al., Am J Obstet 28. Kahn MA, Stanton SL, Kumar D, et al., Neurourol Urodyn,
1985;57:360–61. Gynecol, 2004;190:20–26. 1999;18:329–30.
3. Olsen A, Smith V, Bergstrom J, et al., Obstet Gynaecol, 17. Lo TS, Wang AC, J Gynecol Surg, 1998;14:59–64. 29. Nieminen K, Hiltunen K, Laitinen J, et al., Dis Colon Rectum,
1997;89:501–6. 18. Culligan PJ, Blackwell L, Goldsmith IJ, et al., Obstet Gynecol, 2004;47:1636–42.
4. Karram MM, Urol Int, 2001;67:12–13. 2005;106:29–37. 30. Kahn MA, Stanton SL, Br J Obstet Gynaecol, 1997;104:82–6.
5. Maglinte DDT, Kelvin FM, Fitzgerald K, et al., AJR, 19. Meschia M, Gattei U, Pifarotti P, et al., Proceedings of the 31. Richardson CA, Clin Obstet Gynecol, 1993;36:976–83.
1999;172:439–44. International Continence Society (34th Annual Meeting) 32. Cundiff GW, Weidner AC, Visco AG, et al., Am J Obstet
6. Murphy M, Obstet Gynecol, 2008;112:1123–30. and the International UroGynecological Association, 2004; Gynecol, 1998;179(6):1451–7.
7. Ng CC, Chong CY, Ann Acad Med Singapore, 2006;35:875–81. abstract 614. 33. Porter WE, Steele A, Walsh P, et al., Am J OLbstet Gynecol,
8. Deffieux X, de Tayrac R, Huel C, et al., Int Urogynecol J, 20. Hilger WS, Poulson M, Norton PA, Am J Obstet Gynecol, 1999;181:1353–9.
2007;18:73–9. 2003;189:1606–10. 34. Kenton K, Shott S, Brubaker L, Am J Obstet Gynecol,
9. Maher C, Baessler K, Glazener CM, et al., Neurourol Urodyn, 21. Culligan PJ, Murphy M, Blackwell L, et al., Am J Obstet 1999;180:1360–64.
2008;27:3–12. Gynecol, 2002;187:1473–80. 35. Scand PK, Koduri S, Lobel RW, et al., Obstet Gynecol,
10. Benson JT, Lucente V, McClellan E, Am J Obstet Gynecol, 22. Diwan A, Rardin CR, Kohli N, Int Urogynecol J, 2001;184:1357–64.
1996;175:1418–22. 2004;15:286–92. 36. Paraiso M, Barber M, Muir T, et al., Am J Obstet Gynecol,
11. Benson JT, McClellan E, Obstet Gynecol, 1993;82:387–9. 23. Kovac SR, Cruikshank SH, Am J Obstet Gynecol, 1993;168: 2006;195:1762–71.
12. Borirakchanyavat S, Aboseif SR, Carroll PR, et al., J Urol, 1778–83. 37. Kohli N, Goldberg R, Maccarone J, OBG Manage, 2006;1–8.
1997;158:822–6. 24. Mant J, Painter R, Vessey M, Br J Obstet Gynaecol, 38. Davila GW, Drutz H, Deprest J, Int Urogynecol, 2006;17:51–5.
13. Zivkovic F, Tamussino KI, Ralph G, et al., Obstet Gynecol, 1997;104:579–85. 39. Roovers JPWR, van der Vaart CH, van der Bom JG, et al., Br
1996;87:257–60. 25. Swift SE, Am J Obstet Gynecol, 2000;183:277–85. J Obstet Gynaecol, 2004;11:50–56.
14. Ball TP Jr, Teichmann MH, Sharkey FE, et al., J Urol, 26. Blandon RE, Bharucha AE, Melton LJ 3rd, et al., Am J Obstet
1997;158:827–9. Gynecol, 2007;197(664):e1–7.
74 EUROPEAN OBSTETRICS & GYNAECOLOGY
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