Reoperation rate for traditional anterior vaginal repair: analysis of 207 cases with a median 4-year follow-up.

INTRODUCTION AND HYPOTHESIS: To determine the reoperation rate for symptomatic recurrence of cystoceles following traditional anterior colporrhaphy (without mesh). METHODS: Retrospective case note review of 207 cases of primary anterior colporrhaphy with/without other prolapse surgery. All patients received a 3-month clinic follow-up. Reoperation details for prolapse and/or urinary incontinence were obtained from patients general practitioners with a median follow-up of 50 months. RESULTS: The median age was 60 years (32-85), and median parity was 2. Twenty-nine of 207 (14%) patients had previous gynecological surgery. While the anatomical recurrence rate of cystoceles at 3 months postoperatively was 12%, the reoperation rate for recurrent cystocele by 50 months was 3.4%. Overall, 9.1% of the group underwent prolapse or incontinence surgery during this period. CONCLUSIONS: While the anatomical recurrence rates for cystocele following traditional anterior colporrhaphy might be high, the low reoperation rate at more than 4 years (3.4%) suggests that patient's symptoms might not be bothersome enough to require further surgery. Both subjective and anatomical outcomes are required to assess the outcome of both traditional and new prolapse procedures.

Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study.

This study assessed the effect of moderate weight loss in obese women with urodynamically proven urinary incontinence using the International Consultation on Incontinence recommended outcome measures. Sixty-four incontinent women were offered a weight reduction programme with a target loss of 5-10%. This included a low-calorie diet and exercise. An anti-obesity drug (Orlistat) was offered to those who failed to achieve their target. Forty-two (65%) achieved the target weight loss and had significant reduction in body mass index and girth. Weight loss was associated with significant reduction in pad test loss (median difference, 19 g; 95% confidence interval, 13-28 g; p < 0.001). There was also a clinical and statistically significant improvement in quality of life measures. These results suggest that weight reduction of 5% of initial body weight can improve urinary incontinence severity and its effects on quality of life in obese women.

The development of pelvic organ prolapse after colposuspension: a prospective, long-term follow-up study on the prevalence and predisposing factors.

The objectives of this prospective study were to determine the prevalence of pelvic organ prolapse (POP) after colposuspension and to investigate possible preoperative and operative risk factors. Seventy-seven women who underwent colposuspension between 1996 and 1997 were investigated. POP was assessed before colposuspension using the pelvic organ prolapse quantification system (POPQ). Women were reassessed at one and seven to eight years (or when referred with symptomatic POP). By seven to eight years, of the 77 women, 29 (38%) had developed symptomatic prolapse, 29 (38%) had asymptomatic prolapse, 7 (9%) had no symptoms and no prolapse, and 12 (15%) could not be assessed. POP at one year was significantly associated with the presence of posterior vaginal descent before colposuspension (odds ratio 3.07, 95% CI 1.10-8.60, p = 0.03). No variable reached statistical significance by eight years postcolposuspension. In conclusion, this is the first study to assess POP prospectively using a validated method before and after colposuspension. The results add support to the view that there is an association between colposuspension and the development of symptomatic POP (requiring surgery).

Vaginal evisceration, small bowel prolapse and acute obstruction as a late complication of sacrospinous fixation.

We describe the presentation, acute management and subsequent follow-up of a case of vaginal evisceration of small bowel in a woman who had complained of recurrent symptoms of prolapse following a vaginal hysterectomy and posterior repair and subsequent sacrospinous fixation for prolapse. The published incidence, risk factors, potential complications and described options of management are discussed.