Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy-a multicentre randomised controlled trial (LAVA trial).

OBJECTIVE: To investigate whether laparoscopic sacrohysteropexy (LSH) is non-inferior to vaginal sacrospinous hysteropexy (SSHP) in the surgical treatment of uterine prolapse. DESIGN: Multicentre randomised controlled, non-blinded non-inferiority trial. SETTING: Five non-university teaching hospitals in the Netherlands, one university hospital in Belgium. POPULATION: 126 women with uterine prolapse stage 2 or higher undergoing surgery without previous pelvic floor surgery. METHODS: Randomisation in a 1:1 ratio to LSH or SSHP, stratified per centre and severity of the uterine prolapse. The predefined inferiority margin was an increase in surgical failure rate of 10%. MAIN OUTCOME MEASURES: Primary outcome was surgical failure, defined as recurrence of uterine prolapse (POP-Q ≥ 2) with bothersome bulging/protrusion symptoms and/or repeat surgery or pessary at 12 months postoperatively. Secondary outcomes were anatomical recurrence (any compartment), functional outcome and quality of life. RESULTS: Laparoscopic sacrohysteropexy was non-inferior for surgical failure (n = 1, 1.6%) compared with SSHP (n = 2, 3.3%, difference -1.7%, 95% CI: -7.1 to 3.7) 12 months postoperatively. Overall, anatomical recurrences and quality of life did not differ. More bothersome symptoms of overactive bladder (OAB) and faecal incontinence were reported after LSH. Dyspareunia was more frequently reported after SSHP. CONCLUSION: Laparoscopic sacrohysteropexy was non-inferior to SSHP for surgical failure of the apical compartment at 12 months' follow up. Following LSH, bothersome OAB and faecal incontinence were more frequent, but dyspareunia was less frequent. TWEETABLE ABSTRACT: Laparoscopic sacrohysteropexy and vaginal sacrospinous hysteropexy have equally good short-term outcomes.

Renal failure caused by severe pelvic organ prolapse.

Pelvic organ prolapse (POP), the transvaginal descent of pelvic organs, can cause mild hydronephrosis but rarely leads to a deterioration in kidney function. We present a case of severe uterovaginal prolapse that caused bilateral ureteral obstruction and led to renal failure and urinary tract infection. During outpatient follow-up, kidney function had already been deteriorating, but POP was not recognised as a causal factor. A longer duration of ureteral obstruction can lead to irreversible kidney damage, and therefore, timely recognition and intervention is of essence. Even in complex cases with various causative factors for kidney injury, the presence of severe POP and kidney injury should prompt the clinician to exclude this cause.

Expressions of homeobox, collagen and estrogen genes in women with uterine prolapse.

OBJECTIVE: Genetic contribution is thought to be involved in the pathophysiology of pelvic organ prolapse (POP). We aimed to study the gene expression profiles of the genes HomeoboxA11 (HOXA11), HomeoboxA13 (HOXA13), Collagen Type I (COL1A), Collagen Type III (COL3A), estrogen receptor genes (ESR1 and ESR2) of round (RL) and uterosacral ligaments (USL) in postmenopausal women with uterine prolapse. STUDY DESIGN: Gene expressions of 32 postmenopausal women with prolapse were analysed according to gene expressions of 8 postmenopausal women without prolapse. Quantitative real-time PCR (qRT-PCR) method was used for the detection of expression levels of the genes. Student's t-Test and Mann-Whitney U test were used for statistical analysis. RESULTS: In the USL specimens of all women with uterine prolapse HOXA13 and ESR1 gene expressions were decreased compared to controls (0.5 fold, p = 0.04 and 0.82 fold, p = 0.04, respectively). In the RL specimens, ESR2 gene expression was decreased 0.7 fold in women with prolapse when compared to controls (p = 0.04). In the USL specimens of women with advanced stages of prolapse (stage ≥3), HOXA13 and COL3A gene expressions were decreased compared to controls (0.44 fold, p = 0.043 and 0.39 fold, p = 0.045, respectively). In the RL specimens, ESR2 gene expression was decreased 0.65 fold in women with prolapse when compared to controls (p = 0.052). CONCLUSION: The significant decrease in the expression of the genes HOXA13, COL3A in the USL and ESR2 in the RL especially in advanced stages of prolapse, implicate that these gene expressions may play a role in the development of uterine prolapse.

Simplified laparoscopic sacropexy avoiding deep vaginal dissection.

OBJECTIVE: To evaluate the safety and efficacy of a "simplified" laparoscopic sacropexy approach. METHODS: Data were retrospectively assessed from women with apical prolapse of stage 2 or higher who underwent "simplified" laparoscopic sacropexy between October 1, 2010, and May 31, 2017 at the St Anna Hospital, City of Health and Science, Torino, Italy. Patients were treated with the "simplified" laparoscopic sacropexy, where meshes were anchored solely to the vaginal apex, even in the presence of advanced multi-compartment vaginal prolapse. Data on prolapse stage and urogenital functions collected through clinical examinations, and questionnaires at baseline, 6 months, 12 months, and annually thereafter were examined. RESULTS: Overall, 121 women were included in the analysis; the mean follow-up was 33.2 months. Mean operative time was 135.1 minutes; there were no intraoperative visceral or vascular injuries. There was 1 (0.8%) patient who experienced recurrence, and 2 (1.7%) who experienced vaginal erosion. Both urogenital symptom scores (all P<0.05) and quality of life scores (all P<0.05) improved significantly. CONCLUSION: Adequate re-suspension of only the apex was sufficient to correct other vaginal compartments, even for women with preoperative multi-compartment prolapse higher than POP-Q stage 2. The "simplified" laparoscopic sacropexy was an efficacious intraoperative time-saving technique; it could reduce adverse events caused by deep vaginal dissection up to puborectal muscles and the bladder trigone.

Advanced uterovaginal prolapse: is vaginal hysterectomy with McCall culdoplasty as effective as in lesser degrees of prolapse?

INTRODUCTION AND HYPOTHESIS: There is a paucity of data on the success of vaginal surgery for severe prolapse. The authors hypothesized that the success rates of total vaginal hysterectomy (TVH) with McCall culdoplasty in women with advanced pelvic organ prolapse (POP) and in women with less severe POP are similar. METHODS: This was a retrospective review of women undergoing TVH with McCall culdoplasty from 2005 to 2014. Advanced POP was defined as exteriorized uterovaginal prolapse with Pelvic Organ Prolapse Quantification (POP-Q) point C, Ba or Bp ≥50% of the total vaginal length. The primary aim was to compare surgical success of TVH with McCall culdoplasty for the repair of advanced POP and less severe POP at ≥1 year. RESULTS: A total of 311 women were included, 38 with advanced POP and 273 with less severe POP. Women with advanced POP were older (71.6 vs. 61.8 years, respectively; p < 0.0001), but there were no significant differences in the length of follow-up (102.5 vs. 117 weeks, p = 0.2378), success rates (76.3% vs. 68.5%, p = 0.3553) or reoperation rates (2.6% vs. 4%, p > 0.9999) between women with advanced POP and less severe POP, respectively. There was a higher failure rate in the anterior compartment in those with advanced POP (18.4% vs. 6.2%, p = 0.0168), but not in the apical or posterior compartment. CONCLUSIONS: TVH with McCall culdoplasty is equally effective for the treatment of advanced uterovaginal prolapse as for the treatment of less severe POP. Surgeons should consider this traditional surgery for their patients even if they have high-stage uterovaginal prolapse.

The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: a matched historical cohort study.

INTRODUCTION AND HYPOTHESIS: This study compares vaginal hysterectomy with uterosacral ligament suspension (VH) with the Manchester-Fothergill procedure (MP) for treating pelvic organ prolapse (POP) in the apical compartment. METHODS: Our matched historical cohort study is based on data from four Danish databases and the corresponding electronic medical records. Patients with POP surgically treated with VH (n = 295) or the MP (n = 295) in between 2010 and 2014 were matched for age and preoperative POP stage in the apical compartment. The main outcome was recurrent or de novo POP in any compartment. Secondary outcomes were recurrent or de novo POP in each compartment and complications. RESULTS: The risk of recurrent or de novo POP in any compartment was higher after VH (18.3%) compared with the MP (7.8%) (Hazard ratio, HR = 2.5, 95% confidence interval (CI): 1.3-4.8). Recurrence in the apical compartment occurred in 5.1% after VH vs. 0.3% after the MP (hazard ratio (HR) = 10.0, 95% confidence interval (CI) 1.3-78.1). In the anterior compartment, rates of recurrent or de novo POP were 11.2% after VH vs. 4.1% after the MP (HR = 3.5, 95% CI 1.4-8.7) and in the posterior compartment 12.9% vs. 4.7% (HR = 2.6, 95% CI 1.3-5.4), respectively. There were more perioperative complications (2.7 vs. 0%, p = 0.007) and postoperative intra-abdominal bleeding (2 vs. 0%, p = 0.03) after VH. CONCLUSIONS: This study shows that the MP is superior to VH; if there is no other indication for hysterectomy, the MP should be preferred to VH for surgical treatment of POP in the apical compartment.

Laparoscopic sacrohysteropexy versus vaginal hysterectomy for uterovaginal prolapse using validated questionnaires: 2-year prospective study.

INTRODUCTION: Surgical options for uterovaginal prolapse can be categorized into uterus conservation-e.g., laparoscopic sacrohysteropexy (LSHP) or vaginal hysterectomy (VH). There is insufficient reliable information on long-term comparative outcomes of these procedures. The primary aim of this study was to compare subjective and objective outcomes of LSHP and VH. The secondary aim was to record adverse events, recurrent prolapse, and new-onset stress urinary incontinence (SUI) up to 2 years. METHODS: Women with symptomatic uterovaginal prolapse who opted for either LSHP or VH were included. Subjective outcomes were compared at 1 and 2 years from baseline using the validated questionnaires. Objective/anatomical outcomes using the Pelvic Organ Prolapse Quantification (POP-Q) system were assessed before and at 3 months after surgery. Adverse events, recurrent prolapse, and new-onset SUI was recorded up to 2 years. RESULTS: The study assessed 226 women with uterovaginal prolapse; 125 opted for surgery (44 LSHP, 81 VH). There was no statistically significant difference in symptom domains between groups at baseline and 1 and 2 years. At 3 months POP-Q, greater improvement was seen in points Ba and Ap in the LSHP group compared to VH group and smaller genital hiatus was seen in the VH group. Adverse events, recurrent prolapse, or new-onset SUI were not significantly different in the two groups. CONCLUSIONS: Both LSHP and VH are effective surgical options for uterovaginal prolapse. At 2 years, both procedures had similar improvement in symptom domains, overall scores, adverse events, recurrent prolapse, and new-onset SUI. Long-term randomized studies are needed.

Posterior colporrhaphy does not affect the urethral closure mechanism.

INTRODUCTION AND HYPOTHESIS: Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. METHODS: This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300 ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher's exact test, where appropriate; p values <0.05 were considered statistically significant. RESULTS: Eighteen women with posterior vaginal wall prolapse ≥stage II were recruited. One woman did not undergo surgery. There were no changes in urethral pressure at rest (p = 0.4), during squeezing (p = 0.2) or straining (p = 0.2), before and after surgery. The results of the stress tests and ICIQ-UI short forms were the same after surgery. CONCLUSIONS: The urethral closure mechanism is not affected by posterior colporrhaphy. Our study does not support the theory that the posterior vaginal wall prolapse compresses the urethra and masks SUI.

The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine.

OBJECTIVE: The aim of the study was to investigate the association between severity of anterior vaginal or apical prolapse and postvoid residual volume (PVR). METHODS: The charts of all women who presented to Urogynecology Clinic at Olive View-UCLA Medical Center for a 2-year period were reviewed. Demographic data, the degree of prolapse pelvic organ prolapse quantification points Aa, Ba, and C, and PVR were recorded. Patients with incomplete pelvic organ prolapse quantification assessment or improperly measured PVR were excluded. RESULTS: Three hundred fifty-two patients were included. Median age was 54 years (range, 26-80). Mean gravidity and parity were 4.4 and 3.7, respectively. Mean body mass index was 29.9 kg/m. One hundred forty-nine women had previous pelvic surgery. Median PVR was 25 mL, and 40 patients (11.4%) had a PVR of 100 mL or greater.Considering 15 potential PVR predictors, we found that the position of apex/cervix (point C) significantly correlated with an increase in PVR and also after controlling for the other significant covariates (rate of change b = 4.7% increase in PVR/cm, P = 0.0007). The other significant (P < 0.05) covariates were gravidity (5.7% per pregnancy), postmenopausal status (32.4%), and vaginal surgical history (61.4%). This was not true, however, for the anterior vaginal position (points Aa, Ba; P > 0.15). There was no difference in mean PVR in patients with versus without a hysterectomy (P = 0.236). CONCLUSIONS: Elevated PVR values have long been linked with prolapse of the anterior vaginal wall. We found that there is a linear association between PVR and the anatomic position of the apex. There was no association of PVR with the position of the anterior vaginal wall.

Robotic Single-Site Sacrocolpopexy Using Barbed Suture Anchoring and Peritoneal Tunneling Technique: Tips and Tricks.

STUDY OBJECTIVE: To demonstrate the tips and tricks of a simpler technique for single-site sacrocolpopexy using barbed suture anchoring and retroperitoneal tunneling to make the procedure more efficient and reproducible. DESIGN: Step-by-step description of surgical tutorial using a narrated video (Canadian Task Force classification III). SETTING: Academic tertiary care hospital. PATIENTS: Patient with Stage III uterine prolapse. INTERVENTIONS: Sacrocolpopexy is increasing utilized since the FDA warning about complications of vaginal mesh surgery. It is the gold standard for repair of apical prolapse. However, there is great variation in the sacrocolpopexy procedure techniques and they have not been standardized. Traditional single-site laparoscopic sacrocolpopexy is very challenging as the procedure time is long and suturing is difficult. The advantages of suturing with wristed needle drivers in robotic single-site surgery simplify this complex procedure. Furthermore, using barbed suture anchoring and peritoneal tunneling technique potentially decreases the surgeon's learning curve and makes the procedure reproducible. In this video, we demonstrate a supracervial hysterectomy with a stepwise explanation of the correct technique for performing a robotic single incision sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS: Sacrocolpopexy is increasing used since the US Food and Drug Administration warning about complications of vaginal mesh surgery. It is the gold standard for repair of apical prolapse. However, a great variation exists in the sacrocolpopexy procedure techniques that need to be standardized. Traditional single-site laparoscopic sacrocolpopexy is very challenging because the procedure time is long and suturing is difficult. The advantages of suturing with wristed needle drivers in robotic single-site surgery simplify this complex procedure. Furthermore, using the barbed suture anchoring and peritoneal tunneling technique potentially decreases the surgeon's learning curve and makes the procedure reproducible. In this video, we demonstrate a supracervical hysterectomy with a stepwise explaation of the correct technique for performing a robotic single-incision sacrocolpopexy. CONCLUSION: The possibility of using the barbed suture and peritoneal tunneling technique with wristed needle drivers in robotic single-site sacrocolpopexy offers the possibility of an effective, safe, reproducible, and cosmetic surgical option.

Cervical amputation versus vaginal hysterectomy: a population-based register study.

INTRODUCTION AND HYPOTHESIS: Surgical management of uterine prolapse varies greatly and recently uterus-preserving techniques have been gaining popularity. The aim of this study was to compare patient-reported outcomes after cervical amputation versus vaginal hysterectomy, with or without concomitant anterior colporrhaphy, in women suffering from pelvic organ prolapse. METHOD: We carried out a population-based longitudinal cohort study with data from the Swedish National Quality Register for Gynecological Surgery. Between 2006 and 2013, a total of 3,174 patients with uterine prolapse were identified, who had undergone primary surgery with either cervical amputation or vaginal hysterectomy, with or without concomitant anterior colporrhaphy. Pre- and postoperative prolapse-related symptoms and patient satisfaction were assessed, in addition to complications and adverse events. Between-group comparisons were performed using univariate and multivariate logistic regression. RESULTS: There were no differences between the two groups in neither symptom relief nor patient satisfaction. In both groups a total of 81 % of the women reported the absence of vaginal bulging 1 year after surgery and a total of 89 % were satisfied with the result of the operation. The vaginal hysterectomy group had a higher rate of severe complications than the cervical amputation group, 1.9 % vs 0.2 % (p < 0.001). The vaginal hysterectomy group also had a longer duration of surgery and greater perioperative blood loss, in addition to longer hospitalization. CONCLUSIONS: Cervical amputation seems to perform equally well in comparison to vaginal hysterectomy in the treatment of uterine prolapse, but with less morbidity and a lower rate of severe complications.

Role of vaginal mesh hysteropexy for the management of advanced uterovaginal prolapse.

OBJECTIVE: To determine the role of vaginal mesh hysteropexy in the management of advanced genital organ prolapse as assessed by subjective and objective parameters. STUDY DESIGN: Retrospective case series of 77 women followed for at least 1 year after vaginal mesh hysteropexy performed for stage III or greater uterovaginal prolapse. The primary outcome was Pelvic Organ Prolapse Quantification (POP- Q) stage < II and no subjective bothersome bulge and no further interventions for prolapse. Secondary outcomes assessed were complications such as intraoperative bleeding, injuries, and postoperative complications such as mesh exposure, mesh retraction, dyspareunia, urinary incontinence, and voiding dysfunction. RESULTS: Mean follow-up was 13.7 +/- 4.1 months. Our composite success score was 85.7%. The anatomic (POP-Q) success score was 90.9%. Most failures (all but 1) were stage II with cervix as leading edge. Incidence of de novo dyspareunia was 3.7% and vaginal mesh erosion was 6.5%. Most patients 68/77 (88.3%) were discharged home voiding normally. CONCLUSION: Vaginal mesh hysteropexy offers good success; however, comparative studies are required to validate its true role.

Trends in inpatient prolapse procedures in the United States, 1979-2006.

OBJECTIVE: We sought to describe national trends for inpatient procedures for pelvic organ prolapse from 1979-2006. STUDY DESIGN: The National Hospital Discharge Survey was analyzed for patient and hospital demographics, as were International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedures codes from 1979-2006. Age-adjusted rates (AARs) per 1000 women were calculated using the 1990 US Census data. RESULTS: There was a significantly decreasing trend in the AARs for inpatient prolapse procedures, from 2.93-1.52 per 1000 women from 1979-2006. AARs for hysterectomy decreased from 8.39-4.55 per 1000 women from 1979-2006. Over the study period, AARs remained at about the 1979 level among the women>or=52 years old (2.73-2.86; P=.075). In women<52 years old, AARs declined to less than one-third of the 1979 rate (3.03-0.84; P<.001). CONCLUSION: AARs for inpatient procedures for prolapse in the United States remained stable for women aged>or=52 years from 1979-2006; rates declined by two-thirds for women aged<52 years.

A história da classificação do prolapso genital / The history of genital prolapse classification

A avaliação do prolapso genital constitui uma etapa importante do exame ginecológico, devendo, sempre que possível, ser classificados os graus de prolapso por meio de métodos padronizados. Embora a afecção não possa ser considerada fatal, ela pode determinar sequelas importantes para a saúde da mulher, comprometendo a sua qualidade de vida. Como o prolapso genital só se torna sintomático quando o segmento prolapsado ultrapassa o introito vaginal, torna-se necessário o diagnóstico precoce com o objetivo de prevenir o estágio final da doença. A história da classificação do prolapso genital nos mostra o esforço dos pesquisadores para adquirir uma linguagem comum que permita a comunicação mais precisa da posição anatômica dos órgãos pélvicos.

The assessment of genital prolapse is a major phase of the gynecological exam and, whenever is possible, the degree of prolapse should be identified by means of standard methods. Although the disease should is not considered fatal, it can bring significant sequelae to women's health and determine negative impacts on quality of life. As the genital prolapse only becomes symptomatic when the segment exceeds the vaginal introitus, it is necessary to perform the early diagnosis in order to prevent the final stage of the disease. The history of classification of genital prolapse shows us the effort of researchers to acquire a common language that allows more precise communication on the anatomical position of the pelvic organs.

The role of nurses in the management of women with pelvic organ prolapse.

Pelvic organ prolapse is a common female complaint, with 50% of women experiencing some degree of pelvic relaxation, although not all have any symptoms. Prolapse is found most commonly in the anterior vaginal walls. Posterior vaginal wall and apical prolapse are the other, less common, categories. There are a large number of potential risk factors, but increased age, parity and body mass index are most consistently reported. A variety of symptoms may be experienced, including a feeling of something coming down, pelvic heaviness, urinary, bowel and sexual dysfunction. Two main treatment options exist, conservative management (pessary or pelvic floor rehabilitation) or surgical repair, however the evidence-base for treatment is weak. The specialist nurse is well-placed to contribute to the initial assessment, management and ongoing support of women with prolapse.

[Mid-term results of the grade 3-4 genital prolapse cure by vaginal route using a total hammock of porcine skin implant associated with bilateral sacro-spinofixation]. / Résultats à moyen terme du traitement par voie vaginale du prolapsus génital de grade 3 et 4 par hamac total de derme porcin associé à une sacro-spinofixation bilatérale.

OBJECTIVE: To evaluate the feasibility, morbidity and mid-term results of genital prolapse cure by vaginal route using a total hammock of porcine skin implant (Pelvicol) and bilateral sacro-spinofixation. PATIENTS AND METHODS: From May 2001 to June 2006, 101 patients with grade 3-4 genital prolapse, using the POPQ classification, were treated by vaginal route. One patient refused the use of porcine skin implant for religious reasons. Anterior fixation of the total hammock was performed by transobturator route and the posterior fixation was done on sacrospinous ligaments associated with a bilateral Richter operation. Intra- and postoperative complications, anatomical results, as well as global satisfaction, have been evaluated. RESULTS: The technique was always feasible. With a mean follow-up of 29 months, anatomical results were optimal in 73.3% while 16.8% of recurrences were observed. Mean operating time was 112+/-39 min (range: 40-310). Intraoperative complication rate was 4.9% (three bladder injuries, one rectal injury, one unfundibulo pelvic ligament injury during hysterectomy). Postoperative complication rate was 11.9% (four cases of urinary retention, one urethral plication and five pararectal haematomas including two cases requiring a second surgery complicated by an urethrovaginal fistula in one case and one urinary infection). With a mean follow-up of 29+/-12 months (74-12), optimal anatomical results and recurrence rate were 73.3 and 16.8%, respectively. Global satisfaction rate was 87.7%. This rate decreased to 60% for patients with a 4- to 6-year follow-up. CONCLUSION: Our results confirmed the feasibility of genital prolapse cure using a total hammock of porcine skin and bilateral sacro-spinofixation with a similar rate of complications to vaginal surgery without implant. However, anatomical results at mid-term raise the issue on the permanence of biological meshes.

[Validity of the registration and reporting of vaginal prolapse surgery]. / Validitet af kodning og indberetning ved vaginal prolapskirurgi.

INTRODUCTION: To validate the coding and local registration of vaginal prolapse surgery in 1996-1998, and reporting of such data to the Danish National Patient registry (LPR). MATERIAL AND METHODS: Comparison of different sets of data from the local data base (GS) and LPR, and retrospective study of 296 patient files. RESULTS: The concordance between two GS-data sets was 96.4%, and 0-100% between different LPR-data sets. The validity of reporting of data from GS to LPR was 96.2% on the level of patient ID (cpr), and 99.3% concerning length of hospital stay. If a procedure was registered as a vaginal prolapse procedure the validity of this being true was 93.6%. 18 non-prolapse procedures were registered as vaginal procedures. The registration was incomplete in 12.5% due to typing or hearing errors or missing codes. The coding was misleading in 11.8%, due to lack of consensus on coding. 86.6% of errors were passed through from the patient file to GS and LPR. Through simple guidelines misleading use of combination of codes was reduced from 7% to 0.5%. CONCLUSION: The validity of the two sets of GS data, and the reporting from GS to LPR of vaginal surgical procedures is satisfactory on the cpr-level. However, the validity of such register data is affected by the risk of errors when drawing such data, and by coding errors. The main problems are lack of consensus on which codes to use, and that codes for very different procedures are very much alike. To improve the quality and usefulness of register data in monitoring vaginal prolapse procedures consensus on coding is desirable. Different methods to increase the quality of coding are discussed.

[Transvaginal repair of genital prolapse with Prolift: evaluation of safety and learning curve]. / Cure de prolapsus par voie vaginale selon la technique du Prolift: évaluation du caractère minimal invasif et de sa courbe d'apprentissage.

AIMS: Evaluation of the mini invasiveness and the learning curve of the Prolift technique. MATERIALS AND METHODS: Prospective study. All patients were operated on by the same surgeon. The mini-invasiveness of the procedure was estimated through the evaluation of the intraoperative and immediate postoperative complications. The learning curve was evaluated through the analysis of the operative time. RESULTS: Between January and December 2007. Forty-seven patients were included in the study. Mean follow-up was: 11,8 months. Two cases of bladder injury and two cases of intraoperative bleeding (>500 ml) were reported. One case of vaginal erosion and one case of recurrence of the prolapse occurred during the follow-up. The mean operative time was 62+/-18 min. The mean operative time of the posterior step of the Prolift was 24+/-min and remained stable after the 18th procedure. DISCUSSION: The learning cure of the posterior of the procedure is longer because of the passage of the needles through the ischiorectal foramens. The technique is mini-invasive considered the low rate of intra and immediate postoperative complication and the learning curve short. CONCLUSIONS: Longer follow-up is needed to evaluate the efficacy of the procedure in the long term.

Uso del sistema POPQ para la clasificación de los prolapsos: Hospital Parroquial de San Bernardo / Use of the POPQ system for prolapses classification: Hospital Parroquial de San Bernardo

El sistema de Pelvic Organ Prolapse Quantification (POPQ) ha demostrado ser útil, fácil de aprender, rápido de realizar y con una buena confiabilidad intra e interobservador. Quisimos comenzar a aplicar este tipo de clasificación y compararla con la clasificación clásica de Baden y Walker descrita en la ficha clínica. Para esto se realizó un estudio observacional de 41 pacientes en que se comparó el sistema tradicional consignado en la ficha, con la medición de nueve puntos que utiliza el sistema POPQ. En 17 por ciento de los casos ambos sistemas coincidieron en el diagnóstico del descenso de todos los elementos del prolapso: pared anterior, posterior y cuello uterino. El sistema POPQ permite un diagnóstico acabado del estado y magnitud del descenso de los órganos pelvianos.

The Pelvic Organ Prolapse Quantification (POPQ) System has proved to be a good method for describing and quantifying pelvic organ prolapse. The objective of this observational study was to compare the classification consigned in the clinical records (Baden and Walker classification) with the new POPQ system. In the first 41 cases we proceed to evaluate our patients by mean of the POPQ system. In only 17 percent of the cases the two systems agreed in the diagnosis of the anterior, posterior and cervix descents. POPQ system allows an acute diagnosis of the state and magnitude of the descent of pelvic organs.