Follow-up of patients after colpectomy or Le Fort colpocleisis: Single center experience.

OBJECTIVE: As the population ages, obliterative procedures (OP) are expected to become an increasingly important treatment option. The primary aim of this study was to evaluate vaginal and urinary symptoms 3 months after OP and peri- and postoperative complications. The secondary aim was to investigate long-term outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA. STUDY DESIGN: Retrospective study of 43 women who underwent OP during a 10-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 3 months postoperatively and at long-term follow-up. Records were reviewed for complications, use of anesthetics, recurrences, patient satisfaction and regret. RESULTS: A Le Fort colpocleisis was performed in 31 (72 %) and a colpectomy in 12 (28 %) patients. At 3 months` follow-up, patients had a statistically significant improvement in vaginal symptoms. Twelve patients (46 %) became continent, compared with 14 (54 %) with remaining urinary incontinence (UI). There were no patients with de novo UI 3 months' after surgery. Total complication rate was 4,6% (2/43). A symptomatic recurrent prolapse occurred in 4 patients (9.3 %). The satisfaction rate was 86 %. No patients reported regret choosing to have vaginal closure surgery. Twenty one (49 %) of the procedures were performed under local anesthesia with intravenous sedation. CONCLUSION: Obliterative procedures are good surgical options for elderly women with a positive impact on vaginal and urinary symptoms, low complication and recurrence rate. Patients report high satisfaction and no regret over loss of sexual ability at longterm follow-up. OP under LA with intravenous sedation is a feasible and safe option.

FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence.

The use of synthetic mesh implantation for the surgical management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) has grown in popularity since mesh was marketed for widespread use in the early 1990s. As mesh usage has expanded, patterns of previously unexpected complications have become apparent. In the United States and other countries, the increase in reported outcomes (both positive and negative) has led to the initiation of medico-legal actions by patients reporting negative effects of the implanted mesh. As a result, several national and professional societies have convened expert panels to publish summaries of reported outcomes and provide clinical recommendations regarding mesh use. Despite their recommendations and further dissemination of the potential complications reported after urogynecologic mesh use, the popularity of mesh use for POP and SUI has continued to expand, with apparent geographic and national patterns. As the largest global association focusing on women's health, FIGO, via its Urogynecology and Pelvic Floor Committee, has reviewed published national recommendations regarding the use of mesh, and has summarized them for the FIGO membership to help disseminate important recommendations to surgeons who may not be aware of the existence and content of these recommendations.

What happens to urinary incontinence after pelvic organ prolapse surgery?

INTRODUCTION AND HYPOTHESIS: The beneficial effect of pelvic organ prolapse (POP) surgery on urge urinary incontinence (UI) is well described in the literature, while effect on preoperative stress UI (SUI) is still unclear. The aim of this study was to investigate changes concerning UUI following POP surgery without concomitant anti-incontinence procedures and to identify possible factors influencing the changes. METHODS: We conducted a retrospective study of 678 women with prolapse surgery using native tissue repair during a 3-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) questionnaire and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who scored >0 on the ICIQ-UI SF before surgery were included in the study. RESULTS: A total of 379 patients (55.9%) with POP had concomitant UI. At 3 months' follow-up, 174 patients (46%) became continent compared with 205 patients (54%) with UI. Patients with remaining UI had statistically significant higher mean preoperative ICIQ-UI SF score than patients who became dry. The risk of remaining UI after POP surgery was greater in patients with previous anti-incontinence repair. UI type was not a risk factor for its persistance. CONCLUSION: Almost half of the patients with UI before POP surgery became completely dry after prolapse surgery alone. Severity of incontinence and previous anti-incontinence surgery were identified as risk factors for persisting UI after POP surgery. We found a reduction of incontinence after an operation in any of the three compartments.

Retrospective study on de novo postoperative urinary incontinence after pelvic organ prolapse surgery.

OBJECTIVE: Reported incidences of de novo urinary incontinence (UI) following pelvic organ prolapse (POP) surgery in preoperatively continent women vary between 2% and 43%. The aim of this study was to investigate the incidence and the types of de novo UI and differences between operations in different compartments. STUDY DESIGN: Retrospective study of 678 women with POP surgery using native tissue repair during a 3-year period. Patients completed three modified prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who were totally dry and scored 0 on ICIQ-UI SF before surgery were included in the study (N=299). The patients developing new onset UI on ICIQ-UI SF postoperatively were interviewed by telephone after median 30 months. RESULTS: A total of 33 patients (11%) developed subjective de novo UI at 3 months follow-up. The majority of patients (N=16) reported stress UI. The risk of developing de novo UI increased with parity (p=0.03). We found no difference between operations in different compartments. At long-term follow-up 12 patients became continent without incontinence surgery or medical treatment leaving only 21 patients (7%) incontinent. CONCLUSION: The risk of developing de novo UI after prolapse surgery with native tissue repair is low and improves over time. Parity is significantly associated with the risk of developing de novo UI. There is no difference in the incidence of de novo incontinence between operations in different compartments.

[Chlamydial infection with marked ascites that simulated ovarian cancer]. / Klamydiainfektion med stor mængde ascites simulerende ovariecancer.

We describe a case of genital chlamydial infection with marked ascites and an adnexal mass that simulated a malignant neoplasm. Laparotomy was performed. Multiple adhesions between visceral and peritoneum, enlarged retroperitoneal nodes were found. The right ovary contained a cystic mass. Examination of the peritoneal biopsies and ascites showed chronic lymphofollicular inflammation and chlamydial infection was suggested as the aetiology. The patient was treated with antibiotics and discharged from hospital in well-being. At follow-up examination four weeks later the patient had no symptoms.