Non-absorbable versus absorbable sutures for anterior colporrhaphy: study protocol for a randomised controlled trial in South Korea

Introduction The anterior vaginal wall is the segment most commonly affected by prolapse. Traditionally, anterior vaginal wall prolapse is repaired via anterior colporrhaphy, which is known to have a high recurrence rate. Several factors might affect the outcome of anterior colporrhaphy, and the use of absorbable sutures might also be associated with the high recurrence rate because the sutures might not be able to retain adequate strength until the plicated pubocervical fascia remodels and regains maximum tensile strength. Nonetheless, no comparative data exist about the relative efficacy and safety of anterior colporrhaphy using non-absorbable versus absorbable sutures. The objective of this study is to compare the surgical outcomes of anterior colporrhaphy using non-absorbable sutures with those of anterior colporrhaphy using absorbable sutures. Methods and analysis This is a randomised, multicentre, superiority trial. Anterior colporrhaphy will be performed in a traditional manner with midline plication of the fibromuscular layer using either non-absorbable or absorbable sutures. The primary outcome is composite surgical success 1 year after surgery defined as the absence of all of the following: (1) anterior vaginal descent beyond the hymen, (2) the presence of vaginal bulge symptoms and (3) retreatment for recurrent anterior vaginal wall prolapse with either surgery or pessary. The secondary outcomes include the individual components of the composite primary end point, anatomical outcomes, condition-specific quality of life and adverse events related to anterior colporrhaphy. The planned number of participants is 192. Ethics and dissemination This study was approved by the Institutional Review Board of Seoul National University Hospital (H-1810-037-977). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.ope

Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation

PURPOSE: Descent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by "true cervical elongation," compared with vaginal hysterectomy (VH). MATERIALS AND METHODS: Medical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤-4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage. RESULTS: During the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08-2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01-0.75) were identified as significant risk factors for recurrence of POP. CONCLUSION: The Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.ope

Postoperative urinary symptoms after transobturator tape in normal-weight compared with overweight and obese woman

Objectives: To examine the clinical outcome of obesity in women who underwent the transobturator tape procedure for stress urinary incontinence and to compare postoperative urinary symptoms after transobturator tape surgery between normal-weight women and overweight and obese women. Methods: We performed a retrospective cohort study of the risk of postoperative urinary symptoms, including recurrence after transobturator tape surgery, in normal-weight women compared with overweight and obese women at our institution from January 2009 through October 2011. We compared the body mass index (BMI) among the four groups. The primary outcome was the occurrence of postoperative urinary symptoms. Results: Three hundred ten patients who underwent transobturator tape surgery were reviewed. At the 1-year follow-up, 281 women were analyzed: 89 (34%) normal-weight women, 78 (25%) overweight women, 101 (37%) obese 1 women, and 13 (3%) obese 2 women. There was a significant difference in the occurrence of postoperative urinary symptoms. They occurred in 3.4% (n=3) of normal-weight women, 5.1% (n=4) of overweight women, and 12.9% (n=13) of obese 1 women (P=0.038). The most common postoperative urinary symptom was frequent urination (n=14). There was a significant difference in leakage; it occurred in 1.1% (n=1) of normal-weight women, 3.9% (n=3) of overweight women, and 7.9% (n=8) of obese 1 women (P=0.139). Postoperative urinary symptoms were almost four times more likely to occur in obese 1 women than in normal-weight women. Conclusion: Transobturator tape surgery seems effective regardless of BMI, but obese women had a higher occurrence of postoperative urinary symptoms than did normal-weight women.ope

Clear Cell Carcinoma Arising from Endometriosis at the Cesarean Scar Site: A Case Report

The association of endometriosis with ovarian cancer has been a rare but well-documented phenomenon since 1925, when Sampson first described clear cell carcinoma arising from endometriosis. Here, we report the case of a woman who underwent staging laparotomy including total abdominal hysterectomy and bilateral salpingo-oophorectomy with the excision of an abdominal wall mass at the site of her cesarean section scar. Although the abdominal wall mass and lymph node was proven to be clear cell carcinoma, the patient’s ovaries were free of carcinoma. This case provides important etiological evidence because it is a clear example of endometriosis that has transitioned to clear cell carcinoma. We report this case for review.ope

Impact of Body Mass Index on Postoperative Urinary Symptoms after Miduretheral Sling Surgery in Female Patients

Objectives: This study aims to examine the clinical outcomes of women who underwent a midurethral sling surgery for stress urinary incontinence and compare postoperative urinary symptoms among different body mass index (BMI) groups. Methods: A retrospective cohort study on results after midurethral sling surgery according to BMI was conducted at the institution of the current study from January 2010 to December 2019. The study population was classified into three groups according to patients' BMI (in kg/m²) during surgery: normal weight (BMI < 23.0 kg/m²), overweight (BMI, 23.0-24.9 kg/m²), and obese (BMI ≥ 25.0 kg/m²). The primary outcome was the recurrence of urinary symptoms after surgery. The secondary outcomes were operation time, estimated blood loss, length of hospital stay, and postoperative complications. Results: This study included 376 patients (normal weight, 148; overweight, 74; and obese women, 154) who underwent midurethral sling surgery. No significant difference was noted in urinary symptom recurrence after midurethral sling surgery. Of the patients, 6.8% (n = 10), 9.5% (n = 7), and 7.8% (n = 12) were normal weight, overweight, and obese women, respectively (P = 0.775). Moreover, operation time (P = 0.589), blood loss (P = 0.138), and complication rate (P = 0.865) showed no significant difference. Conclusions: Midurethral sling surgery is effective regardless of BMI. Even when midurethral sling surgery was performed as a concomitant surgery, no significant difference in urinary symptom recurrence, operation time, intraoperative blood loss, and complication rate was noted among different BMI groups.ope

Surgical treatments for vaginal apical prolapse

Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits.ope

Outcome of Midurethral Sling in Elderly Women over 75 Years Old with Female Stress Urinary Incontinence

Objective: Despite controversies, aging seems to be perceived as relevant to failure in Midurethral sling surgery for female stress urinary incontinence (SUI). However, few reports have addressed the effect of Midurethral sling surgery on elderly female patients. The aim of this study is to evaluate the outcome of Midurethral sling surgery among elderly female patients with age over 75 years. Methods: Patients with SUI underwent Midurethral sling surgery including TOT, TVT from 2005 to 2011. Among these patients, 30 patients were over 75 years old; 468 patients were under 75 years old. Medical records were reviewed retrospectively to clarify whether Midurethral sling surgery was effective in this age group. The primary end point is subjective symptom recurrence. “Cure” is defined as no urinary symptom at all in any circumstances. “No cure” is defined as any urinary symptom or post op complication. Results: The median age of the participating patients was 77.67 ± 2.23 among 30 patients over 75 years old, and 55.68 ± 9.66 among 468 patients under 75 years old. Frequency, Urethral hypermobility, cystoscope finding, trabeculation rate were distinguishable between the two groups. Cure and no cure rate were not (e.i. 89.53% were cure and 10.47% were no cure in patients over 75 years old; 90% were cure and 10% were no cure in patients under 75 years old). No statistically meaningful gap exists between the success rate of Midurethral sling surgery in elderly women over 75 years old and that of patient groups under 75 years old which had been studied in other articles. Conclusion: SUI may impair the quality of life by limiting lifestyle and putting a barrier to social life, as well as exacerbate female psychological morbidity. Midurethral sling surgery including TOT, TVT is an effective treatment even among elderly women. As the population of elderly women and women with SUI symptom is on a rise, the study about the elderly female group should be assessed and further study be needed.prohibitio

Impact of Age on Outcomes of Midurethral Sling Procedures in Women

Introduction and hypothesis: Trans-obturator tape (TOT) and tension-free vaginal tape (TVT) comprise minimally invasive surgical management for stress urinary incontinence (SUI). The aim of this retrospective cohort study was to investigate outcomes of TOT and TVT among different age groups of women. Methods: Medical records of patients who underwent TOT and TVT from January 2010 to December 2015 were reviewed. Patients were stratified into three groups according to age. All patients were interviewed routinely before and after surgery. The primary outcome was cure rate after surgery. Secondary outcomes included hospital stay, operative time, blood loss in surgery, and complication rate. A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. Results: A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. There were 81 patients in group 1 (≤ 50 years), 97 patients in group 2 (51-59 years), and 84 patients in group 3 (≥ 60 years). After surgery, there were no significant differences in cure rates among the three groups (96.3% vs. 94.8% vs. 97.6%, P = 0.623). There were also no significant differences in operation time, blood loss, hospital stay, and complication rate among the three groups. When analyzing the TOT group (217 patients) and TVT group (45 patients) separately, primary and secondary outcomes did not differ significantly according to age group. Conclusions: As surgical management for SUI, midurethral sling procedures, both TOT and TVT, were found to be safe and effective among different age groups.restrictio