BERKELEY, CA (UroToday.com) - Pelvic organ prolapse (POP) occurs in up to 50% of parous women and the lifetime risk of requiring surgery for POP is more than 10%.
The goal of surgical repair for POP is to return the pelvic organs to their original anatomical positions. Laparoscopic surgery allows a good view of the anterior and posterior compartments so that an overall approach for the prolapse is possible by the same surgical route.
Recently, Bacle, et al. assessed the long-term outcomes of laparoscopic promontofixation (LP) for the treatment of POP, in a series of 501 consecutive patients. The mean age of the patients was 63.2 years and 38.9% had a history of abdominal surgery. All the patients underwent a Bonney test and urodynamic study. If anti-incontinence treatment was indicated, the patients underwent the insertion of a tension-free vaginal tape (TVT) simultaneously with the LP. Recurrence of POP was assessed as grade ≥2 at follow-up visits scheduled at 6, 12, 24, 36, 48 and 60 months. In order to assess the long-term anatomical and functional results of LP, a prolapse quality of life questionnaire was sent by mail to all patients. The mean time taken by the operation was 97.4 min and the mean hospitalization time was 3.7 days. In 1% of the cases the laparoscopic operation was converted to an open one because of intra-operative complications.
The mean follow-up time was 20.74 months. There was one case of a pelvic abscess and one other case of a vesicovaginal fistula, treated surgically after the first month. All but one of the cases of constipation (5.5%) were managed with long-term laxatives, while in the remaining patient surgical revision with a posterior section of the mesh was needed based on the findings of the colonoscopy. In multivariate analysis, only the use of the polypropylene mesh (used until 2007) was a statistically significant risk factor for vaginal erosion in comparison with the polyester mesh (P <0.0001). At the end of follow-up, 11.5% recurrences were recorded (7.2% grade ≥3). Risk factors for recurrence were: use of the initial polypropylene mesh in comparison with the polyester mesh (P <0.0001), intra-operative hysterectomy (P = 0.02), and bleeding (P = 0.049). Collectively, 86.4% of the patients reported a successful assessment for LP and 94.8% would prefer LP if there was an option to choose an operation for the treatment of POP again.
In conclusion, the present study supports the use of laparoscopy for the treatment of POP. LP appears to be safe with a low complication rate and it does not represent a steep learning curve in surgeons who already practice laparoscopy. However, longer term studies are needed to confirm these findings.
Athanasios Papatsoris MD, MSc, PhD, FEBU, FES as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.