Technique of anterior colporrhaphy: a Dutch evaluation

Contains fulltext : 96395.pdf (publisher's version ) (Closed access)INTRODUCTION AND HYPOTHESIS: To evaluate the variation in techniques of anterior colporrhaphy among members of the Dutch Urogynecologic Society. METHODS: A questionnaire evaluating the technique of anterior colporrhaphy, preoperative and postoperative care, and use of the POP-Q score was sent out by e-mail. RESULTS: One hundred thirty-three completed questionnaires were received. The response rate was 65%. There are large variations in incisions, use of hydrodissection, method of plication, and excision of redundant vaginal epithelium. The urinary catheter was generally removed on day 2 after surgery and the vaginal pack on day 1. Less than half of the respondents used the POP-Q score routinely. CONCLUSIONS: Dutch gynecologists use a variety of surgical techniques to operate on a cystocele. This suggests that there is no widely accepted opinion on the best surgical approach. The lack of differentiation between central and lateral defects is striking and in contrast with the, mostly, American literature

A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System.

Contains fulltext : 51080.pdf (publisher's version ) (Closed access)OBJECTIVE: To compare the pre- and intraoperative situation using the POP-Q system during optimally standardized conditions of both examinations. STUDY DESIGN: In a prospective observational study, 108 women were compared. The POP-Q in the outpatient department (preoperative) was compared with the situation just prior to surgery after full anesthesia was reached (intraoperative). During the intraoperative measurement, traction with 0.5 kg force was applied on all relevant places. RESULTS: The pre- and intraoperative measurements were all significant correlated with the R-values between 0.43 and 0.85. All six points, which are measured during the POP-Q, were more prolapsed in the intra- as compared with the preoperative situation. The points Bp, C, and D were significantly more prolapsed, but for the points Aa, Ba, and Ap this was not significant. Fifteen patients were upstaged by the intraoperative measurements and five patients were downstaged in the overall POP-Q grading system. CONCLUSIONS: Intraoperative evaluation of the prolapse can reveal significant changes as compared with the preoperative situation. In general, the prolapse is more pronounced especially in the middle and posterior compartment

Does vaginal reconstructive surgery with or without vaginal hysterectomy or trachelectomy improve sexual well being? A prospective follow-up study.

Contains fulltext : 51305.pdf (publisher's version ) (Closed access)OBJECTIVE: To compare sexual well being in women with pelvic organ prolapse before and after vaginal reconstructive surgery. METHODS: Sixty-seven women, mean age 61 (36-85) years, who underwent vaginal reconstructive surgery, were asked to complete detailed questionnaires before and after surgery. In addition, they underwent a physical examination using the Pelvic Organ Prolapse Quantification (POPQ), before surgery and at follow-up. RESULTS: Mean duration of follow-up was 14.4 months (6.6-27.6 months). The overall satisfaction with the operation was high with a mean of 7.5 on a visual analogue scale from 0 to 10. There was a significant improvement of dyspareunia after vaginal reconstructive surgery. The ability to have intercourse, the satisfaction with intercourse as well as the frequency of intercourse also improved although not significantly. Urine loss during intercourse improved significantly. CONCLUSION: Vaginal reconstructive surgery for pelvic organ prolapse has a positive effect on the sexual well being of the afflicted women