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Comparison of midurethral sling outcomes with and without concomitant prolapse repair.

Han EJ, Kim SR, Kim SK, Bai SW - Obstet Gynecol Sci (2014)

Bottom Line: Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181).In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970).In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair.

Methods: We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis.

Results: We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970).

Conclusion: The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

No MeSH data available.


Related in: MedlinePlus

Preoperative pelvic organ prolapsed (POP)-Q staging of the midurethral sling with concomitant repair group. a)POP-Q stage. 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3 cm, and point C is between the total vaginal length (TVL) and TVL -2 cm. I: The most distal portion of the prolapse is >1 cm above the level of the hymen. II: The most distal portion of the prolapse is <1 cm proximal or distal to the plane of the hymen. III: The most distal portion of the prolapse is <1 cm below the plane of the hymen but no further than 2 cm less than the TVL. IV: Complete to nearly complete eversion of the vagina. The most distal portion of the prolapsed protrudes to more than (TVL-2) cm. Aa: Anterior wall 3 cm from the hymen, -3 cm to +3 cm. Ba: Most part of the rest of the anterior wall, -3 cm to +TVL. C: Cervix or vaginal cuff ±TVL. D: Posterior fornix (if no prior total hysterectomy) ±TVL. Ap: Posterior wall 3cm from the hymen, -3 cm to +3 cm. Bp: Most part of the rest of the posterior wall, -3 cm to +TVL.
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Figure 1: Preoperative pelvic organ prolapsed (POP)-Q staging of the midurethral sling with concomitant repair group. a)POP-Q stage. 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3 cm, and point C is between the total vaginal length (TVL) and TVL -2 cm. I: The most distal portion of the prolapse is >1 cm above the level of the hymen. II: The most distal portion of the prolapse is <1 cm proximal or distal to the plane of the hymen. III: The most distal portion of the prolapse is <1 cm below the plane of the hymen but no further than 2 cm less than the TVL. IV: Complete to nearly complete eversion of the vagina. The most distal portion of the prolapsed protrudes to more than (TVL-2) cm. Aa: Anterior wall 3 cm from the hymen, -3 cm to +3 cm. Ba: Most part of the rest of the anterior wall, -3 cm to +TVL. C: Cervix or vaginal cuff ±TVL. D: Posterior fornix (if no prior total hysterectomy) ±TVL. Ap: Posterior wall 3cm from the hymen, -3 cm to +3 cm. Bp: Most part of the rest of the posterior wall, -3 cm to +TVL.

Mentions: In total, 203 of the 212 (95%) women who underwent MUS between January 2009 and April 2012 completed the follow-up survey and were included in the study. Of these women, 114 (56%) underwent MUS only and 98 (48%) underwent MUS with concomitant pelvic floor repair. The women in the concomitant repair group were significantly older than those in the MUS only group (median age, 61 vs. 54 years, respectively; P < 0.001). Moreover, the women in the concomitant repair group showed increased parity (4.5 vs. 3.8, P = 0.017), diabetes mellitus (11.2 vs. 3.5, P = 0.029), hypertension (48.0 vs. 23.7, P < 0.001), mixed UI (20 vs. 5, P < 0.001), requirement of anti-cholinergic medication (21 vs. 9, P = 0.009), and incidence of having home delivery or difficult labor (39 vs. 19, P < 0.001) as compared to those in the MUS procedure only group, respectively. The groups did not significantly differ in terms of body mass index, body weight or prior pelvic surgery (Table 1). In the concomitant repair group, the most common type of POP-Q staging was IIIBa (39 women, 41%). The second-most common type of POP-Q staging was IVC (18 women, 14%) (Fig. 1). In addition, the women underwent concomitant repair had a significantly longer duration of hospital stay (6.7 ± 2.4 vs. 3.1 ± 0.6, P < 0.001), and increased blood loss (<50 mL; 81 vs. 114, P < 0.001), and operative time (120.9 ± 55.9 vs. 33.9 ± 10.5, P < 0.001) compared to the MUS only group, respectively.


Comparison of midurethral sling outcomes with and without concomitant prolapse repair.

Han EJ, Kim SR, Kim SK, Bai SW - Obstet Gynecol Sci (2014)

Preoperative pelvic organ prolapsed (POP)-Q staging of the midurethral sling with concomitant repair group. a)POP-Q stage. 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3 cm, and point C is between the total vaginal length (TVL) and TVL -2 cm. I: The most distal portion of the prolapse is >1 cm above the level of the hymen. II: The most distal portion of the prolapse is <1 cm proximal or distal to the plane of the hymen. III: The most distal portion of the prolapse is <1 cm below the plane of the hymen but no further than 2 cm less than the TVL. IV: Complete to nearly complete eversion of the vagina. The most distal portion of the prolapsed protrudes to more than (TVL-2) cm. Aa: Anterior wall 3 cm from the hymen, -3 cm to +3 cm. Ba: Most part of the rest of the anterior wall, -3 cm to +TVL. C: Cervix or vaginal cuff ±TVL. D: Posterior fornix (if no prior total hysterectomy) ±TVL. Ap: Posterior wall 3cm from the hymen, -3 cm to +3 cm. Bp: Most part of the rest of the posterior wall, -3 cm to +TVL.
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Related In: Results  -  Collection

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Figure 1: Preoperative pelvic organ prolapsed (POP)-Q staging of the midurethral sling with concomitant repair group. a)POP-Q stage. 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3 cm, and point C is between the total vaginal length (TVL) and TVL -2 cm. I: The most distal portion of the prolapse is >1 cm above the level of the hymen. II: The most distal portion of the prolapse is <1 cm proximal or distal to the plane of the hymen. III: The most distal portion of the prolapse is <1 cm below the plane of the hymen but no further than 2 cm less than the TVL. IV: Complete to nearly complete eversion of the vagina. The most distal portion of the prolapsed protrudes to more than (TVL-2) cm. Aa: Anterior wall 3 cm from the hymen, -3 cm to +3 cm. Ba: Most part of the rest of the anterior wall, -3 cm to +TVL. C: Cervix or vaginal cuff ±TVL. D: Posterior fornix (if no prior total hysterectomy) ±TVL. Ap: Posterior wall 3cm from the hymen, -3 cm to +3 cm. Bp: Most part of the rest of the posterior wall, -3 cm to +TVL.
Mentions: In total, 203 of the 212 (95%) women who underwent MUS between January 2009 and April 2012 completed the follow-up survey and were included in the study. Of these women, 114 (56%) underwent MUS only and 98 (48%) underwent MUS with concomitant pelvic floor repair. The women in the concomitant repair group were significantly older than those in the MUS only group (median age, 61 vs. 54 years, respectively; P < 0.001). Moreover, the women in the concomitant repair group showed increased parity (4.5 vs. 3.8, P = 0.017), diabetes mellitus (11.2 vs. 3.5, P = 0.029), hypertension (48.0 vs. 23.7, P < 0.001), mixed UI (20 vs. 5, P < 0.001), requirement of anti-cholinergic medication (21 vs. 9, P = 0.009), and incidence of having home delivery or difficult labor (39 vs. 19, P < 0.001) as compared to those in the MUS procedure only group, respectively. The groups did not significantly differ in terms of body mass index, body weight or prior pelvic surgery (Table 1). In the concomitant repair group, the most common type of POP-Q staging was IIIBa (39 women, 41%). The second-most common type of POP-Q staging was IVC (18 women, 14%) (Fig. 1). In addition, the women underwent concomitant repair had a significantly longer duration of hospital stay (6.7 ± 2.4 vs. 3.1 ± 0.6, P < 0.001), and increased blood loss (<50 mL; 81 vs. 114, P < 0.001), and operative time (120.9 ± 55.9 vs. 33.9 ± 10.5, P < 0.001) compared to the MUS only group, respectively.

Bottom Line: Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181).In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970).In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair.

Methods: We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis.

Results: We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970).

Conclusion: The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

No MeSH data available.


Related in: MedlinePlus