Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse.

STUDY OBJECTIVE: To assess the feasibility and results of laparoscopic sacrocolpopexy (LSC) with two separate meshes along the anterior and posterior vaginal walls in correcting multicompartment pelvic organ prolapse (POP). DESIGN: Prospective study (Canadian Task Force classification I). SETTING: Tertiary care university-affiliated teaching hospital. PATIENTS: Forty-six consecutive women with radiologic diagnosis of multicompartment POP with or without genuine stress urinary incontinence and no history of surgery for either disorder. INTERVENTION: LSC with or without laparoscopic Burch colposuspension or tension-free vaginal tape procedure. MEASUREMENTS AND MAIN RESULTS: LSC was performed in 89% of patients. Mean operating and hospitalization times were 171 +/- 37 minutes and 4.0 +/- 2.1 days, respectively. Intraoperative complications were 7% of bladder injuries successfully treated by laparoscopic suture. The success rate for POP was 83%. The main recurrence was rectocele (12%), which occurred only among women undergoing LSC plus laparoscopic Burch colposuspension (P = 0.036). The LSC was effective in treating symptoms in 95% of women. Because of excessive mesh tension, one patient (2%) developed obstructed defecation, and two (5%) had de novo urinary incontinence. In no patient did occlusion or mesh infection and/or erosion in adjacent organs occur. CONCLUSION: LSC appears to be feasible and effective in treatment of multicompartment POP. Performing concomitant Burch colposuspension significantly enhances the risk of rectocele recurrence or development.

[Treatment of stress urinary incontinence with tension-free vaginal tape (TVT). Mid-term results of a prospective study of 124 cases]. / Traitement de l'incontinence urinaire d'effort pure par bandelette sous-urétrale sans tension (TVT). Résultats à moyen terme d'une étude prospective sur 124 cas.

OBJECTIVES: The role of urethral support in continence has been stressed since 1994, resulting in a new technique for repair of stress urinary incontinence: Tension-free Vaginal Tape (TVT). This technique has been performed in France since 1996 and we analyse the results of this technique in 124 consecutive patients treated for stress urinary incontinence. MATERIAL AND METHOD: The 124 patients did not present any prolapse requiring surgical repair and presented clinical urine leaks on effort after filling the bladder with 250 ml of physiological saline (stress test). 29 patients had already been operated for a disorder of pelvic tone, combined with an urological procedure in 22 cases; all patients completed an urodynamic assessment. 54 patients presented clinical signs of urgency in addition to stress urinary incontinence and 6 of them had cystomanometric signs of urgency. The mean maximum urethral closure pressure was 47 cm H2O (range: 12-120). All patients were operated under local anaesthesia (0.25% Xylocaine with adrenaline) according to the same standardized protocol. The mean follow-up was 35.2 months (range: 19-54). The operative and postoperative morbidity, the results demonstrated by stress test, the subjective result assessed by a patient satisfaction questionnaire and long-term complications were analysed. RESULTS: 110 patients (98.7%) were totally continent, 10 (8%) were improved and 4 (3.3%) were failures. 117 patients (94.3%) were satisfied. Signs of urgency resolved in 38 out of 54 patients (63%). The result was not influenced by closure pressure. Complications consisted of 11 bladder perforations (8.9%) and 3 haematomas, none of which required reoperation. Micturition was easily resumed in 122 patients, while acute retention was observed in 2 cases, on D2 and D3. In 76 patients (61.3%), the first residual urine was less than 100 ml. Long-term follow-up did not reveal any cases of rejection of the TVT, but 3 vaginal erosions were treated by simple plasty. CONCLUSION: With a follow-up of three years and an experience of 5 years, this series demonstrates the value of the TVT technique for treatment of female stress urinary incontinence based on the good results (objective: 89%; subjective: 95%), reproducibility, simplicity and low morbidity.