Elsevier

Urology

Volume 73, Issue 2, February 2009, Pages 245-250
Urology

Female Urology
Genital Prolapse Repair Using Porcine Skin Implant and Bilateral Sacrospinous Fixation: Midterm Functional Outcome and Quality-of-Life Assessment

https://doi.org/10.1016/j.urology.2008.09.044Get rights and content

Objectives

To evaluate the midterm anatomic and functional outcome of genital prolapse repair by the vaginal route using a porcine skin implant (Pelvicol) and bilateral sacrospinous fixation.

Methods

From May 2001 to June 2006, 101 patients with Stage III-IV genital prolapse were treated using a porcine skin collagen implant and bilateral sacrospinous fixation. The functional results were evaluated using the Pelvic Floor Distress Inventory short form, Pelvic Organ Prolapse Distress Inventory-6, Colorectal Anal Distress Inventory-8, Urogenital Distress Inventory-6, Pelvic Floor Impact Questionnaire-7 (including Urinary Impact Questionnaire-7, Pelvic Organ Prolapse Impact Questionnaire-7, and Colo-Rectal-Anal Impact Questionnaire-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire.

Results

Of the 101 patients, 89 (88%) completed all the questionnaires. The mean follow-up was 38 ± 18 months. An improvement was noted in the Pelvic Organ Prolapse Distress Inventory-6 (P < .0001), Urogenital Distress Inventory-6 (P = .001), and Pelvic Floor Distress Inventory scores (P < .0001) but not in the Colorectal Anal Distress Inventory-8 scores. An improvement was noted in the Urinary Impact Questionnaire-7 (P < .0001), Pelvic Organ Prolapse Impact Questionnaire-7 (P < .0001), and Pelvic Floor Impact Questionnaire Short Form 7 (p < 0.0001) scores but not in the Colo-Rectal-Anal Impact Questionnaire-7 scores. The quartile distribution showed that women with a preoperative Pelvic Floor Distress Inventory-short form score >133 had a 45% chance of postoperative improvement and those with a preoperative Pelvic Floor Impact Questionnaire Short Form 7 score >195 had an 81% chance of postoperative improvement. Using multivariate regression analysis, the preoperative Pelvic Floor Distress Inventory score was negatively predictive of satisfaction (t = −2.03, P = .05) and the preoperative Pelvic Floor Impact Questionnaire Short Form 7 score was positively predictive of satisfaction (t = 2.40, P = .02). No differences in the pre- and postoperative Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores were noted.

Conclusions

The results of our study have shown that biologic implantation and bilateral sacrospinous fixation are effective in high-grade genital prolapse repair. Validated questionnaires are potentially useful tools to predict the postoperative outcome.

Section snippets

Material and Methods

From May 2001 to June 2006, all women with Stage III or IV genital prolapse referred to the Gynecology Department of Tenon Hospital for reconstructive pelvic surgery were included in this study, with the exception of patients who underwent laparoscopy. The study population consisted of 101 women. All the patients underwent augmentation of the genital prolapse with a total hammock of porcine skin collagen implant (Pelvicol).

All women underwent pelvic examination to evaluate the stage of genital

Epidemiology and Surgical Findings

The demographic and clinical characteristics of the 101 patients are listed in Table 1. Nearly two thirds of the patients had cardiovascular disorders requiring anticoagulant treatment. Surgery was feasible in every case and took a median of 112 minutes (range 40-310), including the operating time for hysterectomy and urinary incontinence treatment (transobturator tape).

The overall intraoperative complication rate was 4.9% (5/101). One vessel injury of the infundibulopelvic ligament occurred

Comment

The results of the present study have demonstrated that the preoperative scores of validated questionnaires are potential tools to predict the outcome after genital prolapse repair. Moreover, we found that the porcine skin collagen implant and bilateral sacrospinous fixation offer a high midterm success rate.

In addition to the anatomic results, the main goal of surgical management of genital prolapse is to improve patients' QOL. In the present study, a significant improvement in the POPDI-6,

Conclusions

The results of the present study support the use of a biologic implant with bilateral sacrospinous fixation for the effective treatment of high-grade genital prolapse with high objective and subjective success rates. Validated questionnaires appear to be not only relevant in evaluating the effect of surgery, but also a potential useful tool to predict the outcome after genital prolapse repair. However, these assertions require additional studies for confirmation.

References (24)

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