Sara B Papp, Alana L Christie, Dominic Lee, Philippe E Zimmern
{"title":"Abdominal Mesh Colpopexy Without Promontory Fixation: 10-Year Follow-up Results of the Peritoneocolpopexy Technique.","authors":"Sara B Papp, Alana L Christie, Dominic Lee, Philippe E Zimmern","doi":"10.1016/j.urology.2024.08.065","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To restore apical vaginal prolapse support when the access to the promontory is challenging, a modified method of colpopexy may be needed. We present our 10-year results on the peritoneocolpopexy (PCP) technique without promontory fixation relying on unidirectional barbed delayed absorbable sutures (V-Loc).</p><p><strong>Methods: </strong>Fourteen women who underwent PCP for vaginal vault prolapse between 2011 and 2014 participated in an IRB-approved prospective study (11 noninfected; 3 with infected mesh needing excision). Ten-year follow-up data including validated questionnaires (Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), QoL), pelvic organ prolapse quantifications (POP-Q), complications, reoperations, and secondary prolapses were collected. Paired statistical analyses compared various timepoints and mixed model analysis assessed questionnaire and POP-Q trends over time.</p><p><strong>Results: </strong>Median follow-up was 9.7years (interquartile range (IQR): 6.0-0.7) to last POP-Q and 10.4years (IQR: 9.6-11.5) to last contact. No patients were lost to follow-up. Mean baseline C point for all patients was -4.3 and -2.9; 1-year C point was -9.1 and -9.2 and -8.6 and -8.5, respectively at last visit. POP-Q findings improved between pre-PCP and 1-year post surgery and did not significantly change until the last visit. Trends in UDI-6, IIQ-7, QoL, and POP-Q findings showed no significant change in any category per year (95% confidence interval (CI), P=.2-.9). Secondary anterior compartment prolapse was noted in 3 patients with 1 requiring a repair.</p><p><strong>Conclusion: </strong>PCP provides durable vaginal apical support when access to the promontory is compromised. PCP can also be used to prevent secondary prolapse after an infected mesh removal.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urology.2024.08.065","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To restore apical vaginal prolapse support when the access to the promontory is challenging, a modified method of colpopexy may be needed. We present our 10-year results on the peritoneocolpopexy (PCP) technique without promontory fixation relying on unidirectional barbed delayed absorbable sutures (V-Loc).
Methods: Fourteen women who underwent PCP for vaginal vault prolapse between 2011 and 2014 participated in an IRB-approved prospective study (11 noninfected; 3 with infected mesh needing excision). Ten-year follow-up data including validated questionnaires (Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), QoL), pelvic organ prolapse quantifications (POP-Q), complications, reoperations, and secondary prolapses were collected. Paired statistical analyses compared various timepoints and mixed model analysis assessed questionnaire and POP-Q trends over time.
Results: Median follow-up was 9.7years (interquartile range (IQR): 6.0-0.7) to last POP-Q and 10.4years (IQR: 9.6-11.5) to last contact. No patients were lost to follow-up. Mean baseline C point for all patients was -4.3 and -2.9; 1-year C point was -9.1 and -9.2 and -8.6 and -8.5, respectively at last visit. POP-Q findings improved between pre-PCP and 1-year post surgery and did not significantly change until the last visit. Trends in UDI-6, IIQ-7, QoL, and POP-Q findings showed no significant change in any category per year (95% confidence interval (CI), P=.2-.9). Secondary anterior compartment prolapse was noted in 3 patients with 1 requiring a repair.
Conclusion: PCP provides durable vaginal apical support when access to the promontory is compromised. PCP can also be used to prevent secondary prolapse after an infected mesh removal.
期刊介绍:
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.