An alternative technique in surgical correction of anterior compartment prolapse; Iliococcygeal fixation of the pubocervical fascia by native tissue repair.

AIM: To present 'bilateral iliococcygeal fixation of the pubocervical fascia' as an alternative vaginal surgical technique for anterior compartment repair with native tissue and the surgical outcomes of 30 cases. MATERIALS-METHODS: The consecutive 30 cases who admitted to urogynecology clinic with anterior vaginal prolapse/cystocele and underwent anterior compartment repair by bilateral iliococcgeal fixation of the pubocervical fascia by native tissue were included to the study. All cases attended to the postoperative follow-up visits at the sixth and the twelfth months. RESULTS: There were no major or minor intraoperative complications. Overall, in 28 (93.3 %) patients surgical success was achieved at the postoperative 12th month when it was defined as the maximum descent of the anterior segment was proximal to the hymen. During the study period, none of the patients requested or admitted for re-treatment for anterior compartment prolapse. Subjective cure that was assessed by the absence of bulge symptoms was achieved in 29 cases (96.7 %) at first year follow-up. Lower urinary tract symptoms (LUTS) were found to be significantly lower at the first-year postoperative visit compared to pre-operative evaluation. A clinically significant improvement in the quality of life parameters were also noted (mean PFIQ-7 scores = 8.5, 5.6 and 50.8, respectively). CONCLUSION: Bilateral iliococcygeal fixation of the pubocervical fascia seems to be effective in surgical correction of anterior vaginal prolapse according to our post-operative follow-up results. It is an easy to learn procedure with low complication rates and associated with high patient satisfaction.

Efficacy analysis of the laparoscopic CY Liu non-mesh pelvic floor repair surgery in treatment of the pelvic organ prolapse / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effectiveness and safety of laparoscopic CY Liu non-mesh pelvic floor repair surgery in treatment of pelvic organ prolapse(POP).METHODS: From February 2016 to September 2017,a total of 83 patients with POP were treated in Zhejiang Province People's Hospital,and they were included in this retrospective study.The clinical data were retrospectively analyzed;the POP-Q scores were used as the objective evaluation indicators for POP.Analyze the changes of POP-Q indicator points after surgery,and observe surgery related data and complications.Evaluate the postoperative symptom improvement and subjective satisfaction rate of the patients using pelvic floor impact questionnaire short form(PFIQ-7).RESULTS: All surgeries of the included 83 patients were successfully finished laparoscopically.The average follow-up time was(18.88±3.82)months,but there were 8 cases of loss of follow-up.During the follow-up,the total anatomical success rate of laparoscopic CY Liu non-mesh pelvic floor repair surgery was 97.33%(73/75).The differences in POP-Q scores and PFIQ-7 scores were statistically significant before and after the surgery(P<0.05).Subjective satisfaction rate was 96.00%(72/75)after surgery.CONCLUSION: Laparoscopic CY Liu non-mesh pelvic floor repair surgery is effective in the management of Ⅱ-Ⅳ pelvic organ prolapse.There's no need for mesh,and the recurrence rate is low in short-term follow-up,which is worth paying attention to.

Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers.

The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.

Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers / 대한해부학회지

The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.