Comparison between the Outcomes of Short Term Versus Long Term Catheterisation after Anterior Colporraphy with or without Other Vaginal Procedures: A Hospital based Prospective, Comparative, Randomised Study

Introduction: Defects in the pelvic supporting structuresresult in a variety of clinically evident pelvic relaxationabnormalities. The present study was aimed to assess whetherremoval of an in-dwelling catheter 24 hours after surgery affectthe rate of re-catheterization, symptomatic or asymptomaticurinary tract infections and hospital stay in comparison to 72hours of catheterization.Material and methods: Interventional, Prospective, hospitalbased study was done in Department of Obstetrics andGynaecology of R.G. Kar Medical College and Hospitalduring July 2016- June 2017. All women under gone anteriorcolporrhaphy with or without other vaginal procedure wereincluded and divided into two groups randomly. Group Aincluded 195 patients with Foley catheter kept in situ for 24hours following surgery and Group B included 195 patientswith Foley catheter placed in situ for 72 hours followingcompletion of surgery.Results: Mean duration of catheter removal to voidingduration in group A (2.3077±1.2301 hours) and in groupB (2.2308±1.1090 hours) was statistically insignificant(p=0.5170). Difference between post-void residual urine ineach group was insignificant (p=0.1021). Need and attempts ofre-catheterisation in either group was statistically insignificant(p=0.1184). Presence of UTI and Asymptomatic Bacteriuriawere statistically significant (p=0.0002 for UTI and p=0.0115for asymptomatic bacteriuria) in two groups and found less ingroup A compared to group B. Mean hospital stay in group A(2.533±0.8572 days) was less than Group B (3.7487±1.0762days) and was statistically significant (p<0.0001).Conclusion: Early removal of catheter is associated with lesshospital-stay, less complication like UTI or asymptomaticbacteriuria but has no effect on post void residual volume,voiding duration, attempts and need of re-catheterisation.

Clinical Effects of Surgical Repair with or Without Biological Mesh on Uterine Prolapse / 中国微创外科杂志

Objective To analyze the different clinical effects of colpohysterectomy combined with anterior and posterior wall colporrhaphy with or without biological mesh for uterine prolapse.Methods From January 2010 to May 2015, colpohysterectomy combined with anterior and posterior wall colporrhaphy was performed in 106 cases of uterine prolapse, including 75 cases receiving biological mesh repair (experimental group) and 31 cases of non-biological mesh (control group).Clinical and surgical information of all patients was collected, and satistial analysis was done between the two groups.Results All the operations were accomplished successfully.There were no statistical differences in bleeding amount during operation [(34.5±7.3) ml vs.(32.1±4.9) ml, t=1.973, P=0.051], time to first flatus [(29.2±4.8) d vs.(30.2±5.3) d, t=-0.907, P=0.366], postoperative hospital stay [(6.1±1.5) d vs.(6.0±1.4) d, t=0.328, P=0.744], as well as the operative time [(91.4±3.4) min vs.(95.1±10.2) min, t=-1.970, P=0.051].At one year after surgery, in the experimental group there were 74 patients cured, 1 patient improved, and no invalid or recurrence case, while in the control group there were 27 patients cured, 1 patient improved, 3 cases of recurrence and no invalid case.The treatment effect of the experimental group was significant better than that of the control group (Z=-2.571, P=0.010).Conclusions Colpohysterectomy with anterior and posterior wall colporrhaphy with biological mesh can be selected for uterine prolapse patients without contraindications.The results of surgery are better with biological mesh, with low recurrence rate.

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis / Cirurgia com tela para correção de prolapso de parede anterior: metanálise

Abstract Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6- 8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used,with or without the use of vaginalmeshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.

Resumo Introdução Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comumo anterior. Para tratamento são utilizadas cirurgias, comou semtelas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): "Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)". Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p 1 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado.

Comparison of Pre-Operative and Post-Operative Post Void Residual Urine Volume in Urogenital Prolapse.

Background: Post Void Residual Urine (PVR) is a key marker for the evaluation of the efficacy of bladder emptying particularly in women with pelvic organ prolapse and lower urinary tract dysfunction. Objectives of the present study were to compare pre and postoperative post void residual urine volume and to know the relation of PVR to urinary symptoms and prolapse. Methods: 65 patients admitted with urogenital prolapse. Detailed history, general physical examination was done as per predesigned and pretested proforma. Grading for prolapse was done by POP-Q, Baden walker halfway. PVR was measured before and after operation Results: Age has shown significant relation with the raised PVR > 50 ml (p=0.007). Out of 65 cases, 11 had second, 48 had third degree and 6 had procedentia according to Baden Walker system. Urge and stress incontinence were complained by 43% and 26% of patients respectively and increased frequency and nocturia was complained by 68% and 65% of patients. Storage symptoms were not significantly associated with degree of prolapse or raised PVR. Straining to void, incomplete emptying and has to reduce to void were present in 42, 46 and 47 patients respectively and showed significant association with degree of prolapse. Except incomplete emptying other two were associated with raised PVR. Conclusion: Vaginal hysterectomy with anterior colporrhaphy was effective procedure in reducing elevated PVR in prolapse patients.

A Comparative Study Between Mesh and Traditional Colporrhaphy for Pelvic Organ Prolapse：a Meta-analysis / 中国微创外科杂志

Objective To review systemically the effectiveness and safety of mesh versus traditional colporrhaphy for pelvic organ prolapse . Methods The literature were retrieved from the PubMed ( 1980 -2013 ) , Cochrane ( 1995 -2013 ) , Google Scholar (1980-2013), CNKI (1980-2013), and SinoMed (1980-2013).The randomized controlled trials (RCT) were collected and compared, and the data were analyzed by using the RevMan 5.0 software. Results There were totally 10 randomized controlled trials collected .Meta-analysis showed that:the operation time was significantly longer in the mesh group than that in the colporrhaphy group [WMD:16.57 min, 95%CI:14.06-19.08 min, P<0.00001]; the intraoperative blood loss was significantly more in the mesh group than that in the colporrhaphy group [ WMD: 24.98 ml, 95%CI:7.13 -42.84 ml, P=0.006]; the mesh group was superior to colporrhaphy group in the increase of objective cure rate [OR:4.16, 95%CI:3.10-5.58,P<0.00001] and subjective cure rate [OR:2.13, 95%CI:1.55-2.91, P<0.00001]; as compared with all various relating operations , the incidence rate of dyspareunia was statistically significant (P=0.04), whereas there were no statistical differences in postoperative recurrence of urinary incontinence and re-operation (P=0.13, P=0.06). Conclusion Apllication of mesh for pelvic organ prolapse can improve the objective and subjective cure rates .Mesh may be usefully applied to the treatment of pelvic organ prolapse , and further high-quality prospective studies are needed .

The Effect of Posterior Colporrhaphy Performed Concurrently with Midurethral Sling Surgery on the Sexual Function of Women with Stress Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: Some women choose to undergo posterior colporrhaphy (PC) concurrently with procedures for SUI to regain sexual confidence and improve sexual function. We determine the effect of PC on sexual function in women requiring a midurethral sling for SUI. MATERIALS AND METHODS: A total of 119 women were retrospectively reviewed 81 women had the midurethral sling alone (Group A), and 38 women voluntarily had PC concurrently with the midurethral sling (Group B). Sexual function was evaluated using the FSFI before and after surgery. RESULTS: The postoperative composite scores were significantly increased in both groups (Group A: p=0.02; Group B: p=0.04), and significant increases were observed in 'desire,' 'arousal' and 'satisfaction'. However, there were no significant differences in the composite score or six domainscores between the two groups. CONCLUSION: PC performed concurrently with midurethral sling for treatment of SUI does not provide any additional benefits towards improving the sexual function.

Comparison of Rectoanal Physiologic Changes and Treatment Results between Transanal Repair and Transanal Repair with Posterior Colporrhaphy in Patients with Rectocele

PURPOSE: Rectoceles are often associated with anorectal symptoms. Various surgical techniques have been described to repair rectoceles, but the surgical results vary. The aim of this study was to compare transanal repair (TAR) and transanal repair with posterior colporrhaphy (TAR+PC). METHODS: The records of 58 patients operated on during a 56-month period were reviewed. Of those 26 patients had a TAR, and 32 patients had a TAR+PC. Interviews and anorectal physiologic studies were performed preoperatively and postoperatively. RESULTS: The recurrence rate after a TAR+PC was lower than the recurrence rate after a TAR (TAR 19.2% vs. TAR+PC 3.1%). The rectal sensation (sensory threshold: TAR 64.8+/-18.9 ml vs. TAR+PC 56.1+/-23.67 ml; earliest defecation urge: TAR 116.4+/-29.5 ml vs. TAR+PC 104.8+/-31.2 ml) was more improved after a TAR+PC. CONCLUSIONS: A TAR+PC for treatment of a rectocele is safe and effectively corrects obstructed defecation. The improvement probably relates, at least in part, to rectal sensational factors other than the dimensions of the rectocele.