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Use of preoperative prolapse reduction stress testing and the risk of a second surgery for urinary symptoms following laparoscopic sacral colpoperineopexy

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Abstract

Introduction and hypothesis

The aim of this study was to determine the reoperation rate for sling placement or revision in patients who had primary continence procedures based on prolapse reduction stress testing (RST) prior to laparoscopic sacral colpoperineopexy (LSCP).

Methods

This was a retrospective cohort study of women who had RST prior to LSCP for symptomatic pelvic organ prolapse. Patients with positive test (Pos RST) had a concomitant midurethral sling procedure and those with negative test (Neg RST) did not. Variables were compared with either Student’s t test or Fisher’s exact test.

Results

In Neg RST group (n = 70), the rate of surgery for de novo urodynamic stress incontinence was 18.6%. In Pos RST group (n = 82), the rate of sling revision for bladder outlet obstruction was 7.3%. Overall, 88% of patients did not require a second surgery.

Conclusions

The use of RST to recommend concomitant continence procedures during LSCP results in a single surgery for the majority of our patients.

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Notes

  1. Details of the LSCP can be found in the appendix.

Abbreviations

LSCP:

Laparoscopic sacral colpoperineopexy

RST:

Reduction stress test

Pos RST:

Positive reduction stress test

Neg RST:

Negative reduction stress test

USI:

Urodynamic stress incontinence

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Conflicts of interest

Dr. Richard Bump is a full time employee of Lilly Research Laboratories (Indianapolis, IN, USA); Dr. Patrick Woodman is a speaker for Pfizer (New York, NY, USA) and Astellas/GlaxoSmithKline (Deerfield, IL, USA) and has a research grant from Women’s Health and Urology/Ethicon (Somerville, NJ, USA); Dr. Douglass S. Hale is a consultant and part of the speaker’s bureau for Women’s Health and Urology/Ethicon (Somerville, NJ, USA), is an investigator for Allergan (Irvine, CA, USA), and has previously received honoraria from American Medical Systems (Minnetonka, MN, USA). Dr. Colleen McDermott, Mr. Colin Terry, and Dr. Jean Park do not have any conflicts of interest. None of the authors have stock or stock options in any company whose product is discussed in the article.

Author information

Author notes

  1. Jean Park

    Present address: , 9985 Sierra Ave, Fontana, CA, 92335, USA

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN, USA

    Jean Park, Patrick J. Woodman & Douglass S. Hale

  2. Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Colleen D. McDermott

  3. Methodist Research Institute, Indiana University Health Methodist Hospital, Indiana University Health, Indianapolis, IN, USA

    Colin L. Terry

  4. Lilly Research Laboratories, Indianapolis, IN, USA

    Richard C. Bump

Authors
  1. Jean Park
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  2. Colleen D. McDermott
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  3. Colin L. Terry
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  4. Richard C. Bump
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  5. Patrick J. Woodman
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  6. Douglass S. Hale
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Corresponding author

Correspondence to Jean Park.

Additional information

This paper was presented at the American Urogynecologic Society 31st Annual Scientific Meeting held Sept 29–Oct 2 2010, Long Beach, California (previous title: “Effect of Urodynamic Testing before Laparoscopic Sacral Colpopexy on Urinary Outcomes: Retrospective Cohort Study”—ID#117).

Appendix

Appendix

The technique for the LSCP involved both a vaginal and abdominal approach. The posterior graft was fashioned out of a 6 × 15-cm piece of polypropylene mesh attached to a 4 × 12-cm acellular porcine dermis (Pelvicol, C.R. Bard, Inc, Murray Hill, NJ, USA). The polypropylene mesh and the porcine dermis mesh were sutured together using 10–13 sutures of 2-0 polyglycolic acid where they overlapped for 8 cm and the distal 2–4 cm was only the porcine dermis. The posterior graft was placed vaginally where the distal aspect of the polypropylene mesh was attached to the iliococcygeal fascia bilaterally with two sutures of 2-CV Gore-Tex (W.L. Gore & Associates, Inc., Flagstaff, AZ, USA). Then the porcine dermis was sutured to the levator ani fascia using 2-0 polydioxanone or Gore-Tex sutures to reinforce the rectovaginal septum. Lastly, the porcine dermis graft was trimmed to fit the patient’s anatomy and attached to the perineal body using 2-0 polydioxanone sutures.

Laparoscopically, the posterior mesh was sutured to the posterior vaginal wall using four to six sutures of 2-0 polyethylene terephthalate spreading the graft as widely using 2-cm vertical increments. The bladder was dissected off the anterior vaginal wall, deep in the vesicovaginal space, to the level of the trigone. A second piece of polypropylene mesh was attached to the anterior vaginal wall with two sutures of 2-0 polydioxanone distally, then four to five sutures of 2-0 polyethylene terephthalate proximally spreading the mesh as widely as possible using 2-cm vertical increments. Graft tension was adjusted prior to sacral fixation. Then the two pieces of mesh were sutured to the anterior longitudinal ligament, between S2–S4, using three sutures of 2-0 polyethylene terephthalate.

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Park, J., McDermott, C.D., Terry, C.L. et al. Use of preoperative prolapse reduction stress testing and the risk of a second surgery for urinary symptoms following laparoscopic sacral colpoperineopexy. Int Urogynecol J 23, 857–864 (2012). https://doi.org/10.1007/s00192-011-1648-0

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  • DOI: https://doi.org/10.1007/s00192-011-1648-0

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