SGS Annual Meeting

CHARLESTON, S.C. – Cure rates and patient satisfaction following vaginal prolapse repair were high at 3-year follow-up regardless of whether vaginal mesh or native tissue was used for the repair, according to findings from a prospective randomized trial.

The findings raise questions about the long-term value of vaginal mesh repairs because subjects treated with mesh had more complications without experiencing benefit beyond that observed in the native tissue repair patients, Dr. Robert E. Gutman reported at the annual meeting of the Society of Gynecologic Surgeons.

Of 65 women who were enrolled in the trial before enrollment was halted because of a 15.6% mesh exposure rate, 51 – including 25 in the mesh group and 26 in the no mesh group – had quality of life data available for the planned 3-year final analysis, and 41 had 2- or 3-year pelvic organ prolapse quantification (POP-Q) examination information available.

No differences were noted between the groups with respect to POP-Q stage or individual POP-Q points at 3 years, and the majority in both the mesh and no mesh groups (90% and 86%, respectively) improved in stage from baseline, said Dr. Gutman of MedStar Washington Hospital Center and of the department of obstetrics and gynecology and urology at Georgetown University, both in Washington.

Furthermore, no differences were seen between the groups with respect to symptomatic improvement as assessed by the Pelvic Floor Distress Inventory (PFDI), the Pelvic Floor Impact Questionnaire (PFIQ), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ), including subscale scores. Also, cure rates – using a variety of definitions for cure – did not differ between the groups.

For example, based on a POP-Q stage of 1 or less as a definition of cure, 45% and 43% of those in the mesh and no mesh groups, respectively, were cured. When no prolapse beyond the hymen was used as a definition, 85% and 71% were cured When absence of bulge symptoms (a "no" answer to item 3 on the PFDI) was used as a definition, 92% and 81% were cured. The differences between the groups for these and other definitions – including a rating of very much better or much better on the Patient Global Impression of Improvement Index (PGI-I), having no prolapse reoperation, and composite outcomes using various combinations of these definitions – were not statistically significant, Dr. Gutman said.

Of note, no new mesh exposures occurred between the previously reported 1-year analysis (three cases required surgical excision before 1 year) and the 3-year analysis. The only prolapse reoperation after 1 year was in a woman who also had a reoperation prior to the 1-year analysis, he said at the meeting, which was jointly sponsored by the American College of Surgeons.

Also of note, the anatomic cure rate was lowest for the anterior compartment, and this did not differ between the mesh and no mesh groups.

Patients included in the study were women with stage 2-4 prolapse who were randomized to the mesh or no mesh group at baseline. Three-month and 1-year outcomes were previously reported.

Although the study is underpowered because of the early halting of enrollment, and is limited by the substantial number of patients lost to follow-up, it also has several strengths, including the long-term follow-up, multicenter design, and robust definitions of cure.

Therefore, the findings of a similar cure rate in the mesh and no mesh groups, excellent quality of life improvements in both groups, a mesh exposure rate of 15.6%, and a finding of only one new mesh exposure between 1- and 3-year follow-up, suggest that a "balanced approach is really required for vaginal mesh repairs, including a thorough patient consent," Dr. Gutman concluded.

He reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Cure rates and patient satisfaction following vaginal prolapse repair were high at 3-year follow-up regardless of whether vaginal mesh or native tissue was used for the repair, according to findings from a prospective randomized trial.

The findings raise questions about the long-term value of vaginal mesh repairs because subjects treated with mesh had more complications without experiencing benefit beyond that observed in the native tissue repair patients, Dr. Robert E. Gutman reported at the annual meeting of the Society of Gynecologic Surgeons.

Of 65 women who were enrolled in the trial before enrollment was halted because of a 15.6% mesh exposure rate, 51 – including 25 in the mesh group and 26 in the no mesh group – had quality of life data available for the planned 3-year final analysis, and 41 had 2- or 3-year pelvic organ prolapse quantification (POP-Q) examination information available.

No differences were noted between the groups with respect to POP-Q stage or individual POP-Q points at 3 years, and the majority in both the mesh and no mesh groups (90% and 86%, respectively) improved in stage from baseline, said Dr. Gutman of MedStar Washington Hospital Center and of the department of obstetrics and gynecology and urology at Georgetown University, both in Washington.

Furthermore, no differences were seen between the groups with respect to symptomatic improvement as assessed by the Pelvic Floor Distress Inventory (PFDI), the Pelvic Floor Impact Questionnaire (PFIQ), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ), including subscale scores. Also, cure rates – using a variety of definitions for cure – did not differ between the groups.

For example, based on a POP-Q stage of 1 or less as a definition of cure, 45% and 43% of those in the mesh and no mesh groups, respectively, were cured. When no prolapse beyond the hymen was used as a definition, 85% and 71% were cured When absence of bulge symptoms (a "no" answer to item 3 on the PFDI) was used as a definition, 92% and 81% were cured. The differences between the groups for these and other definitions – including a rating of very much better or much better on the Patient Global Impression of Improvement Index (PGI-I), having no prolapse reoperation, and composite outcomes using various combinations of these definitions – were not statistically significant, Dr. Gutman said.

Of note, no new mesh exposures occurred between the previously reported 1-year analysis (three cases required surgical excision before 1 year) and the 3-year analysis. The only prolapse reoperation after 1 year was in a woman who also had a reoperation prior to the 1-year analysis, he said at the meeting, which was jointly sponsored by the American College of Surgeons.

Also of note, the anatomic cure rate was lowest for the anterior compartment, and this did not differ between the mesh and no mesh groups.

Patients included in the study were women with stage 2-4 prolapse who were randomized to the mesh or no mesh group at baseline. Three-month and 1-year outcomes were previously reported.

Although the study is underpowered because of the early halting of enrollment, and is limited by the substantial number of patients lost to follow-up, it also has several strengths, including the long-term follow-up, multicenter design, and robust definitions of cure.

Therefore, the findings of a similar cure rate in the mesh and no mesh groups, excellent quality of life improvements in both groups, a mesh exposure rate of 15.6%, and a finding of only one new mesh exposure between 1- and 3-year follow-up, suggest that a "balanced approach is really required for vaginal mesh repairs, including a thorough patient consent," Dr. Gutman concluded.

He reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Cure rates and patient satisfaction following vaginal prolapse repair were high at 3-year follow-up regardless of whether vaginal mesh or native tissue was used for the repair, according to findings from a prospective randomized trial.

The findings raise questions about the long-term value of vaginal mesh repairs because subjects treated with mesh had more complications without experiencing benefit beyond that observed in the native tissue repair patients, Dr. Robert E. Gutman reported at the annual meeting of the Society of Gynecologic Surgeons.

Of 65 women who were enrolled in the trial before enrollment was halted because of a 15.6% mesh exposure rate, 51 – including 25 in the mesh group and 26 in the no mesh group – had quality of life data available for the planned 3-year final analysis, and 41 had 2- or 3-year pelvic organ prolapse quantification (POP-Q) examination information available.

No differences were noted between the groups with respect to POP-Q stage or individual POP-Q points at 3 years, and the majority in both the mesh and no mesh groups (90% and 86%, respectively) improved in stage from baseline, said Dr. Gutman of MedStar Washington Hospital Center and of the department of obstetrics and gynecology and urology at Georgetown University, both in Washington.

Furthermore, no differences were seen between the groups with respect to symptomatic improvement as assessed by the Pelvic Floor Distress Inventory (PFDI), the Pelvic Floor Impact Questionnaire (PFIQ), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ), including subscale scores. Also, cure rates – using a variety of definitions for cure – did not differ between the groups.

For example, based on a POP-Q stage of 1 or less as a definition of cure, 45% and 43% of those in the mesh and no mesh groups, respectively, were cured. When no prolapse beyond the hymen was used as a definition, 85% and 71% were cured When absence of bulge symptoms (a "no" answer to item 3 on the PFDI) was used as a definition, 92% and 81% were cured. The differences between the groups for these and other definitions – including a rating of very much better or much better on the Patient Global Impression of Improvement Index (PGI-I), having no prolapse reoperation, and composite outcomes using various combinations of these definitions – were not statistically significant, Dr. Gutman said.

Of note, no new mesh exposures occurred between the previously reported 1-year analysis (three cases required surgical excision before 1 year) and the 3-year analysis. The only prolapse reoperation after 1 year was in a woman who also had a reoperation prior to the 1-year analysis, he said at the meeting, which was jointly sponsored by the American College of Surgeons.

Also of note, the anatomic cure rate was lowest for the anterior compartment, and this did not differ between the mesh and no mesh groups.

Patients included in the study were women with stage 2-4 prolapse who were randomized to the mesh or no mesh group at baseline. Three-month and 1-year outcomes were previously reported.

Although the study is underpowered because of the early halting of enrollment, and is limited by the substantial number of patients lost to follow-up, it also has several strengths, including the long-term follow-up, multicenter design, and robust definitions of cure.

Therefore, the findings of a similar cure rate in the mesh and no mesh groups, excellent quality of life improvements in both groups, a mesh exposure rate of 15.6%, and a finding of only one new mesh exposure between 1- and 3-year follow-up, suggest that a "balanced approach is really required for vaginal mesh repairs, including a thorough patient consent," Dr. Gutman concluded.

He reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Single-incision mini-slings for the treatment of stress urinary incontinence are associated with higher failure and reoperation rates than are retropubic midurethral slings, according to findings from a survey and review of medical records of more than 200 patients.

At a mean follow-up of 21 months, 71 of 93 (76%) women who underwent a single-incision mini-sling procedure reported treatment failure, defined as overall incontinence, compared with 70 of 109 (64%) women who underwent a retropubic midurethral sling procedure, Dr. Annetta M. Madsen reported at the annual meeting of the Society of Gynecologic Surgeons.

After adjustment for body mass index and follow-up time, which differed between the groups, the odds ratio for treatment failure in the mini-sling vs. retropubic midurethral sling group was 1.84, which trended toward statistical significance, said Dr. Madsen of the Mayo Clinic, Rochester, Minn.

The secondary outcomes of postoperative stress-specific incontinence occurred in 47% and 29% of the mini-sling and retropubic midurethral sling groups, respectively. This difference did reach statistical significance (adjusted odds ratio, 2.4). There was no significant difference between the groups with respect to de novo urge.

As for other secondary endpoints, the mini-sling group had significantly reduced odds of reporting global improvement and patient satisfaction, and significantly increased odds of surgery for recurrent or persistent stress urinary incontinence (SUI), compared with the retropubic midurethral sling group, but the retropubic midurethral sling group had a higher reoperation rate for mesh erosion, Dr. Madsen said.

There was no difference in urethrolysis between the groups.

Study participants were women with a mean age of 60 years with SUI or stress-predominant mixed urinary incontinence, who underwent a sling procedure between January, 2008, and December, 2009. Treatment failure was defined by a score of greater than 0 on the International Consultation on Incontinence Questionnaire, an affirmative response to questions about stress incontinence on the questionnaire, or a need for a repeat anti-incontinence procedure.

The mini-sling and retropubic midurethral sling groups were similar with respect to most demographics – with the exception of BMI and duration of follow-up, and also were similar with respect to baseline urodynamics, Dr. Madsen noted.

Although retropubic and transobturator midurethral slings have been shown to have similar efficacy, it has remained unknown how single-incision mini-slings compare with these types of slings, she said.

These findings suggest that the retropubic midurethral sling is associated with higher risk of mesh exposure and reoperation for mesh complications, but with lower rates of stress-specific incontinence, higher global impression of improvement and patient satisfaction, and similar rates of overall urethrolysis and reoperation rates for any indication, Dr. Madsen concluded.

She reported having no disclosures. The meeting was jointly sponsored by the American College of Surgeons.

CHARLESTON, S.C. – Single-incision mini-slings for the treatment of stress urinary incontinence are associated with higher failure and reoperation rates than are retropubic midurethral slings, according to findings from a survey and review of medical records of more than 200 patients.

At a mean follow-up of 21 months, 71 of 93 (76%) women who underwent a single-incision mini-sling procedure reported treatment failure, defined as overall incontinence, compared with 70 of 109 (64%) women who underwent a retropubic midurethral sling procedure, Dr. Annetta M. Madsen reported at the annual meeting of the Society of Gynecologic Surgeons.

After adjustment for body mass index and follow-up time, which differed between the groups, the odds ratio for treatment failure in the mini-sling vs. retropubic midurethral sling group was 1.84, which trended toward statistical significance, said Dr. Madsen of the Mayo Clinic, Rochester, Minn.

The secondary outcomes of postoperative stress-specific incontinence occurred in 47% and 29% of the mini-sling and retropubic midurethral sling groups, respectively. This difference did reach statistical significance (adjusted odds ratio, 2.4). There was no significant difference between the groups with respect to de novo urge.

As for other secondary endpoints, the mini-sling group had significantly reduced odds of reporting global improvement and patient satisfaction, and significantly increased odds of surgery for recurrent or persistent stress urinary incontinence (SUI), compared with the retropubic midurethral sling group, but the retropubic midurethral sling group had a higher reoperation rate for mesh erosion, Dr. Madsen said.

There was no difference in urethrolysis between the groups.

Study participants were women with a mean age of 60 years with SUI or stress-predominant mixed urinary incontinence, who underwent a sling procedure between January, 2008, and December, 2009. Treatment failure was defined by a score of greater than 0 on the International Consultation on Incontinence Questionnaire, an affirmative response to questions about stress incontinence on the questionnaire, or a need for a repeat anti-incontinence procedure.

The mini-sling and retropubic midurethral sling groups were similar with respect to most demographics – with the exception of BMI and duration of follow-up, and also were similar with respect to baseline urodynamics, Dr. Madsen noted.

Although retropubic and transobturator midurethral slings have been shown to have similar efficacy, it has remained unknown how single-incision mini-slings compare with these types of slings, she said.

These findings suggest that the retropubic midurethral sling is associated with higher risk of mesh exposure and reoperation for mesh complications, but with lower rates of stress-specific incontinence, higher global impression of improvement and patient satisfaction, and similar rates of overall urethrolysis and reoperation rates for any indication, Dr. Madsen concluded.

She reported having no disclosures. The meeting was jointly sponsored by the American College of Surgeons.

CHARLESTON, S.C. – Single-incision mini-slings for the treatment of stress urinary incontinence are associated with higher failure and reoperation rates than are retropubic midurethral slings, according to findings from a survey and review of medical records of more than 200 patients.

At a mean follow-up of 21 months, 71 of 93 (76%) women who underwent a single-incision mini-sling procedure reported treatment failure, defined as overall incontinence, compared with 70 of 109 (64%) women who underwent a retropubic midurethral sling procedure, Dr. Annetta M. Madsen reported at the annual meeting of the Society of Gynecologic Surgeons.

After adjustment for body mass index and follow-up time, which differed between the groups, the odds ratio for treatment failure in the mini-sling vs. retropubic midurethral sling group was 1.84, which trended toward statistical significance, said Dr. Madsen of the Mayo Clinic, Rochester, Minn.

The secondary outcomes of postoperative stress-specific incontinence occurred in 47% and 29% of the mini-sling and retropubic midurethral sling groups, respectively. This difference did reach statistical significance (adjusted odds ratio, 2.4). There was no significant difference between the groups with respect to de novo urge.

As for other secondary endpoints, the mini-sling group had significantly reduced odds of reporting global improvement and patient satisfaction, and significantly increased odds of surgery for recurrent or persistent stress urinary incontinence (SUI), compared with the retropubic midurethral sling group, but the retropubic midurethral sling group had a higher reoperation rate for mesh erosion, Dr. Madsen said.

There was no difference in urethrolysis between the groups.

Study participants were women with a mean age of 60 years with SUI or stress-predominant mixed urinary incontinence, who underwent a sling procedure between January, 2008, and December, 2009. Treatment failure was defined by a score of greater than 0 on the International Consultation on Incontinence Questionnaire, an affirmative response to questions about stress incontinence on the questionnaire, or a need for a repeat anti-incontinence procedure.

The mini-sling and retropubic midurethral sling groups were similar with respect to most demographics – with the exception of BMI and duration of follow-up, and also were similar with respect to baseline urodynamics, Dr. Madsen noted.

Although retropubic and transobturator midurethral slings have been shown to have similar efficacy, it has remained unknown how single-incision mini-slings compare with these types of slings, she said.

These findings suggest that the retropubic midurethral sling is associated with higher risk of mesh exposure and reoperation for mesh complications, but with lower rates of stress-specific incontinence, higher global impression of improvement and patient satisfaction, and similar rates of overall urethrolysis and reoperation rates for any indication, Dr. Madsen concluded.

She reported having no disclosures. The meeting was jointly sponsored by the American College of Surgeons.

CHARLESTON, S.C. – Mechanical bowel preparation prior to vaginal pelvic organ prolapse surgery offers no advantage over lack of any bowel preparation, with respect to surgeons’ assessment of acceptability, according to findings from a single-blind randomized trial involving 150 women.

Furthermore, the use of mechanical bowel preparation prior to surgery was associated with decreased patient satisfaction, Dr. Alicia C. Ballard reported at the annual meeting of the Society of Gynecologic Surgeons.

Surgeons’ acceptability, based on a rating of excellent or good in terms of bowel cleansing, was similar at 81.3% and 88% for 75 patients who underwent mechanical bowel preparation and 75 control subjects who received no bowel preparation. There also were no significant differences between the groups in intraoperative visualization, stooling, or difficulty in bowel handling, said Dr. Ballard of the University of Alabama at Birmingham.

Patient satisfaction was 61.3% in the bowel preparation group, compared with 89.3% in the control group. Patients in the bowel preparation group also were more likely to be willing to try a different form of bowel preparation (84.3% vs. 64.4%), she noted.

Study subjects were adult women scheduled to undergo vaginal prolapse surgery – with a planned apical suspension and posterior colporrhaphy – at a single center between January 2011 and August 2012. Those randomized to the intervention group were placed on a clear-liquid diet and administered saline enemas at 4 p.m. and 6 p.m. on the day prior to surgery. Those assigned to the control group continued on their regular diet. Both groups were instructed to take nothing by mouth after 12 a.m. on the day of the surgery.

The four participating surgeons were blinded as to patient allocation, and rated their acceptability of the bowel preparation using a 4-point Likert scale.

"Overall, surgeons assessed the bowel to be acceptably cleansed [excellent or good rating], with no differences noted between the intervention and control groups," Dr. Ballard said at the meeting, which was jointly sponsored by the American College of Surgeons.

In fact, bowel cleansing was assessed as "fair" or "poor" in more patients in the intervention group than the control group (14.7% vs. 9.3%), although this difference was not statistically significant.

Also, intraoperative assessment of the rectal vault showed no differences between the groups in the presence of gas or stool.

The findings are important given that 5 million women underwent prolapse procedures in the United States between 1976 and 2006, and that mechanical bowel preparation is commonly applied preoperatively - despite a lack of clear evidence that it is necessary or beneficial, Dr. Ballard said.

Although limited by the single-site design, this study has several strengths, including a robust sample size, randomization, and a well-defined surgical cohort that included patients undergoing concomitant apical suspension and posterior repair. It is also strengthened by the inclusion of both surgeon and patient assessments.

Therefore, the findings challenge the role of mechanical bowel preparation for vaginal prolapse surgery.

"Routine use of mechanical bowel preparation should be reconsidered," Dr. Ballard concluded.

She reported having no relevant financial disclosures.

CHARLESTON, S.C. – Mechanical bowel preparation prior to vaginal pelvic organ prolapse surgery offers no advantage over lack of any bowel preparation, with respect to surgeons’ assessment of acceptability, according to findings from a single-blind randomized trial involving 150 women.

Furthermore, the use of mechanical bowel preparation prior to surgery was associated with decreased patient satisfaction, Dr. Alicia C. Ballard reported at the annual meeting of the Society of Gynecologic Surgeons.

Surgeons’ acceptability, based on a rating of excellent or good in terms of bowel cleansing, was similar at 81.3% and 88% for 75 patients who underwent mechanical bowel preparation and 75 control subjects who received no bowel preparation. There also were no significant differences between the groups in intraoperative visualization, stooling, or difficulty in bowel handling, said Dr. Ballard of the University of Alabama at Birmingham.

Patient satisfaction was 61.3% in the bowel preparation group, compared with 89.3% in the control group. Patients in the bowel preparation group also were more likely to be willing to try a different form of bowel preparation (84.3% vs. 64.4%), she noted.

Study subjects were adult women scheduled to undergo vaginal prolapse surgery – with a planned apical suspension and posterior colporrhaphy – at a single center between January 2011 and August 2012. Those randomized to the intervention group were placed on a clear-liquid diet and administered saline enemas at 4 p.m. and 6 p.m. on the day prior to surgery. Those assigned to the control group continued on their regular diet. Both groups were instructed to take nothing by mouth after 12 a.m. on the day of the surgery.

The four participating surgeons were blinded as to patient allocation, and rated their acceptability of the bowel preparation using a 4-point Likert scale.

"Overall, surgeons assessed the bowel to be acceptably cleansed [excellent or good rating], with no differences noted between the intervention and control groups," Dr. Ballard said at the meeting, which was jointly sponsored by the American College of Surgeons.

In fact, bowel cleansing was assessed as "fair" or "poor" in more patients in the intervention group than the control group (14.7% vs. 9.3%), although this difference was not statistically significant.

Also, intraoperative assessment of the rectal vault showed no differences between the groups in the presence of gas or stool.

The findings are important given that 5 million women underwent prolapse procedures in the United States between 1976 and 2006, and that mechanical bowel preparation is commonly applied preoperatively - despite a lack of clear evidence that it is necessary or beneficial, Dr. Ballard said.

Although limited by the single-site design, this study has several strengths, including a robust sample size, randomization, and a well-defined surgical cohort that included patients undergoing concomitant apical suspension and posterior repair. It is also strengthened by the inclusion of both surgeon and patient assessments.

Therefore, the findings challenge the role of mechanical bowel preparation for vaginal prolapse surgery.

"Routine use of mechanical bowel preparation should be reconsidered," Dr. Ballard concluded.

She reported having no relevant financial disclosures.

CHARLESTON, S.C. – Mechanical bowel preparation prior to vaginal pelvic organ prolapse surgery offers no advantage over lack of any bowel preparation, with respect to surgeons’ assessment of acceptability, according to findings from a single-blind randomized trial involving 150 women.

Furthermore, the use of mechanical bowel preparation prior to surgery was associated with decreased patient satisfaction, Dr. Alicia C. Ballard reported at the annual meeting of the Society of Gynecologic Surgeons.

Surgeons’ acceptability, based on a rating of excellent or good in terms of bowel cleansing, was similar at 81.3% and 88% for 75 patients who underwent mechanical bowel preparation and 75 control subjects who received no bowel preparation. There also were no significant differences between the groups in intraoperative visualization, stooling, or difficulty in bowel handling, said Dr. Ballard of the University of Alabama at Birmingham.

Patient satisfaction was 61.3% in the bowel preparation group, compared with 89.3% in the control group. Patients in the bowel preparation group also were more likely to be willing to try a different form of bowel preparation (84.3% vs. 64.4%), she noted.

Study subjects were adult women scheduled to undergo vaginal prolapse surgery – with a planned apical suspension and posterior colporrhaphy – at a single center between January 2011 and August 2012. Those randomized to the intervention group were placed on a clear-liquid diet and administered saline enemas at 4 p.m. and 6 p.m. on the day prior to surgery. Those assigned to the control group continued on their regular diet. Both groups were instructed to take nothing by mouth after 12 a.m. on the day of the surgery.

The four participating surgeons were blinded as to patient allocation, and rated their acceptability of the bowel preparation using a 4-point Likert scale.

"Overall, surgeons assessed the bowel to be acceptably cleansed [excellent or good rating], with no differences noted between the intervention and control groups," Dr. Ballard said at the meeting, which was jointly sponsored by the American College of Surgeons.

In fact, bowel cleansing was assessed as "fair" or "poor" in more patients in the intervention group than the control group (14.7% vs. 9.3%), although this difference was not statistically significant.

Also, intraoperative assessment of the rectal vault showed no differences between the groups in the presence of gas or stool.

The findings are important given that 5 million women underwent prolapse procedures in the United States between 1976 and 2006, and that mechanical bowel preparation is commonly applied preoperatively - despite a lack of clear evidence that it is necessary or beneficial, Dr. Ballard said.

Although limited by the single-site design, this study has several strengths, including a robust sample size, randomization, and a well-defined surgical cohort that included patients undergoing concomitant apical suspension and posterior repair. It is also strengthened by the inclusion of both surgeon and patient assessments.

Therefore, the findings challenge the role of mechanical bowel preparation for vaginal prolapse surgery.

"Routine use of mechanical bowel preparation should be reconsidered," Dr. Ballard concluded.

She reported having no relevant financial disclosures.

CHARLESTON, S.C. – Obese women are at greater risk of complications from hysterectomy than are nonobese women, but the difference is primarily related to minor complications, according to findings from a large retrospective cohort study.

Of 907 women who underwent hysterectomy at a single center between July 2006 and January 2009, 267 (29%) were obese. Overall, 154 of the patients had at least one complication. After the investigators adjusted for race, prior cesarean section, malignancy, concomitant procedures, and previous surgeries, the obese women were found to be significantly more likely than the nonobese women to experience any complication (adjusted odds ratio, 1.62), Dr. Kristen A. Matteson reported at the annual meeting of the Society of Gynecologic Surgeons.

However, this was secondary to an increased odds of minor complications (adjusted OR, 1.69), not major complications (adjusted OR, 1.06), according to Dr. Matteson of the Women and Infants Hospital of Rhode Island and Brown University, both in Providence, R.I.

In the 142 obese women in the study who underwent hysterectomy for benign indications, but had no concomitant procedures, the minor complication rate was greatest with abdominal hysterectomy (23.3%), followed by laparoscopic hysterectomy (12.6%). No complications occurred in those who underwent vaginal hysterectomy, but the differences between the groups with respect to minor complications were not statistically significant.

"No difference was seen in major complication rates in this subgroup," Dr. Matteson said at the meeting, which was jointly sponsored by the American College of Surgeons.

Patients included in the study were all those who underwent laparoscopic hysterectomy at the Women and Infants Hospital during the study period, as well as a random subset of women who underwent abdominal and vaginal hysterectomies, who were selected as comparators. Obesity was determined based on body mass index and according to World Health Organization guidelines.

Minor complications included conversion to laparotomy, wound cellulitis, need for transfusion, prolonged surgery, and length of hospitalization above the 90th percentile. Major complications included bowel injury, blood vessel injury, trocar site hernia, pelvic hematoma, vaginal nonhealing, need for reoperation, pelvic infection, urinary tract infection, sepsis, and thromboembolic event.

The findings are important given that approximately 600,000 hysterectomies are performed in the United States each year, according to the Centers for Disease Control and Prevention, and given that the prevalence of obesity is skyrocketing, Dr. Matteson said, explaining that a better understanding of the complications associated with hysterectomy in obese women could facilitate patient counseling about the risks.

Dr. Matteson reported having no relevant financial disclosures.

CHARLESTON, S.C. – Obese women are at greater risk of complications from hysterectomy than are nonobese women, but the difference is primarily related to minor complications, according to findings from a large retrospective cohort study.

Of 907 women who underwent hysterectomy at a single center between July 2006 and January 2009, 267 (29%) were obese. Overall, 154 of the patients had at least one complication. After the investigators adjusted for race, prior cesarean section, malignancy, concomitant procedures, and previous surgeries, the obese women were found to be significantly more likely than the nonobese women to experience any complication (adjusted odds ratio, 1.62), Dr. Kristen A. Matteson reported at the annual meeting of the Society of Gynecologic Surgeons.

However, this was secondary to an increased odds of minor complications (adjusted OR, 1.69), not major complications (adjusted OR, 1.06), according to Dr. Matteson of the Women and Infants Hospital of Rhode Island and Brown University, both in Providence, R.I.

In the 142 obese women in the study who underwent hysterectomy for benign indications, but had no concomitant procedures, the minor complication rate was greatest with abdominal hysterectomy (23.3%), followed by laparoscopic hysterectomy (12.6%). No complications occurred in those who underwent vaginal hysterectomy, but the differences between the groups with respect to minor complications were not statistically significant.

"No difference was seen in major complication rates in this subgroup," Dr. Matteson said at the meeting, which was jointly sponsored by the American College of Surgeons.

Patients included in the study were all those who underwent laparoscopic hysterectomy at the Women and Infants Hospital during the study period, as well as a random subset of women who underwent abdominal and vaginal hysterectomies, who were selected as comparators. Obesity was determined based on body mass index and according to World Health Organization guidelines.

Minor complications included conversion to laparotomy, wound cellulitis, need for transfusion, prolonged surgery, and length of hospitalization above the 90th percentile. Major complications included bowel injury, blood vessel injury, trocar site hernia, pelvic hematoma, vaginal nonhealing, need for reoperation, pelvic infection, urinary tract infection, sepsis, and thromboembolic event.

The findings are important given that approximately 600,000 hysterectomies are performed in the United States each year, according to the Centers for Disease Control and Prevention, and given that the prevalence of obesity is skyrocketing, Dr. Matteson said, explaining that a better understanding of the complications associated with hysterectomy in obese women could facilitate patient counseling about the risks.

Dr. Matteson reported having no relevant financial disclosures.

CHARLESTON, S.C. – Obese women are at greater risk of complications from hysterectomy than are nonobese women, but the difference is primarily related to minor complications, according to findings from a large retrospective cohort study.

Of 907 women who underwent hysterectomy at a single center between July 2006 and January 2009, 267 (29%) were obese. Overall, 154 of the patients had at least one complication. After the investigators adjusted for race, prior cesarean section, malignancy, concomitant procedures, and previous surgeries, the obese women were found to be significantly more likely than the nonobese women to experience any complication (adjusted odds ratio, 1.62), Dr. Kristen A. Matteson reported at the annual meeting of the Society of Gynecologic Surgeons.

However, this was secondary to an increased odds of minor complications (adjusted OR, 1.69), not major complications (adjusted OR, 1.06), according to Dr. Matteson of the Women and Infants Hospital of Rhode Island and Brown University, both in Providence, R.I.

In the 142 obese women in the study who underwent hysterectomy for benign indications, but had no concomitant procedures, the minor complication rate was greatest with abdominal hysterectomy (23.3%), followed by laparoscopic hysterectomy (12.6%). No complications occurred in those who underwent vaginal hysterectomy, but the differences between the groups with respect to minor complications were not statistically significant.

"No difference was seen in major complication rates in this subgroup," Dr. Matteson said at the meeting, which was jointly sponsored by the American College of Surgeons.

Patients included in the study were all those who underwent laparoscopic hysterectomy at the Women and Infants Hospital during the study period, as well as a random subset of women who underwent abdominal and vaginal hysterectomies, who were selected as comparators. Obesity was determined based on body mass index and according to World Health Organization guidelines.

Minor complications included conversion to laparotomy, wound cellulitis, need for transfusion, prolonged surgery, and length of hospitalization above the 90th percentile. Major complications included bowel injury, blood vessel injury, trocar site hernia, pelvic hematoma, vaginal nonhealing, need for reoperation, pelvic infection, urinary tract infection, sepsis, and thromboembolic event.

The findings are important given that approximately 600,000 hysterectomies are performed in the United States each year, according to the Centers for Disease Control and Prevention, and given that the prevalence of obesity is skyrocketing, Dr. Matteson said, explaining that a better understanding of the complications associated with hysterectomy in obese women could facilitate patient counseling about the risks.

Dr. Matteson reported having no relevant financial disclosures.

CHARLESTON, S.C. – Most women who undergo an isolated midurethral sling procedure pass active bladder testing on the first attempt, but the likelihood of being discharged with an indwelling catheter increases as bladder capacity increases, maximum flow rate decreases, or detrusor overactivity occurs, findings from a retrospective cross-sectional study have shown.

Of 112 patients who underwent an isolated midurethral sling procedure at a single site, 90 (80.4%) passed active bladder testing (ABT) on the first attempt prior to discharge home, and 22 (19.6%) failed, Dr. Meadow M. Good reported at the annual meeting of the Society of Gynecologic Surgeons.

Bladder testing involved filling the bladder with sterile fluid to 300 mL or to patient discomfort, whichever came first. Passing the test required that two-thirds of the instilled volume was voided.

Average bladder capacity among those who failed ABT was 415 cc, compared with 381 cc in those who passed; average maximum flow rate in those who failed ABT was 15.6 cc/second, compared with 21.6 cc/second in those who passed; and detrusor overactivity was observed in 41% of those who failed ABT, compared with 20% of those who passed, said Dr. Good of the University of Texas Southwestern Medical Center, Dallas.

Furthermore, the capacity-to-infused volume ratio was 1:5 for those who failed ABT and 1:3 for those who passed. Most (81.8%) of those who failed had bladder capacity greater than the infused amount, but no significant difference in the capacity-to-infused volume ratios was seen in the group who passed ABT.

On multivariate analysis, every 50-cc increase in bladder capacity significantly increased the odds of failing ABT (odds ratio, 1.25); every unit increase in the maximum flow rate significantly decreased the odds of ABT failure (OR, 0.91); and the presence of detrusor overactivity was associated with a fivefold increase in the odds of failure (OR, 5.0).

Age, race, body mass index, maximum urethral closure pressure, and maximum detrusor pressure during pressure-flow studies were not found to be associated with ABT outcomes.

Patients included in this study were all those who underwent an isolated midurethral sling procedure at the medical center between January 2011 and August 2012, excluding those who had intraoperative complications requiring discharge with a Foley catheter.

The findings are important because the rates of postoperative urinary retention following midurethral sling procedures are highly variable, and the identification of factors associated with ABT failure could help improve outcomes.

"Patients with postoperative retention are generally discharged home with an indwelling catheter or intermittent self-catheterization; catheter-associated bacteria lead to increased urinary tract infections and health care costs, and to decreased quality of life," Dr. Good said, adding that reducing the rates of postoperative catheter use should be a priority.

"While further research is needed, filling patients to cystometric capacity may improve the success of postoperative bladder testing," she said.

Dr. Good reported having no relevant financial disclosures.

CHARLESTON, S.C. – Most women who undergo an isolated midurethral sling procedure pass active bladder testing on the first attempt, but the likelihood of being discharged with an indwelling catheter increases as bladder capacity increases, maximum flow rate decreases, or detrusor overactivity occurs, findings from a retrospective cross-sectional study have shown.

Of 112 patients who underwent an isolated midurethral sling procedure at a single site, 90 (80.4%) passed active bladder testing (ABT) on the first attempt prior to discharge home, and 22 (19.6%) failed, Dr. Meadow M. Good reported at the annual meeting of the Society of Gynecologic Surgeons.

Bladder testing involved filling the bladder with sterile fluid to 300 mL or to patient discomfort, whichever came first. Passing the test required that two-thirds of the instilled volume was voided.

Average bladder capacity among those who failed ABT was 415 cc, compared with 381 cc in those who passed; average maximum flow rate in those who failed ABT was 15.6 cc/second, compared with 21.6 cc/second in those who passed; and detrusor overactivity was observed in 41% of those who failed ABT, compared with 20% of those who passed, said Dr. Good of the University of Texas Southwestern Medical Center, Dallas.

Furthermore, the capacity-to-infused volume ratio was 1:5 for those who failed ABT and 1:3 for those who passed. Most (81.8%) of those who failed had bladder capacity greater than the infused amount, but no significant difference in the capacity-to-infused volume ratios was seen in the group who passed ABT.

On multivariate analysis, every 50-cc increase in bladder capacity significantly increased the odds of failing ABT (odds ratio, 1.25); every unit increase in the maximum flow rate significantly decreased the odds of ABT failure (OR, 0.91); and the presence of detrusor overactivity was associated with a fivefold increase in the odds of failure (OR, 5.0).

Age, race, body mass index, maximum urethral closure pressure, and maximum detrusor pressure during pressure-flow studies were not found to be associated with ABT outcomes.

Patients included in this study were all those who underwent an isolated midurethral sling procedure at the medical center between January 2011 and August 2012, excluding those who had intraoperative complications requiring discharge with a Foley catheter.

The findings are important because the rates of postoperative urinary retention following midurethral sling procedures are highly variable, and the identification of factors associated with ABT failure could help improve outcomes.

"Patients with postoperative retention are generally discharged home with an indwelling catheter or intermittent self-catheterization; catheter-associated bacteria lead to increased urinary tract infections and health care costs, and to decreased quality of life," Dr. Good said, adding that reducing the rates of postoperative catheter use should be a priority.

"While further research is needed, filling patients to cystometric capacity may improve the success of postoperative bladder testing," she said.

Dr. Good reported having no relevant financial disclosures.

CHARLESTON, S.C. – Most women who undergo an isolated midurethral sling procedure pass active bladder testing on the first attempt, but the likelihood of being discharged with an indwelling catheter increases as bladder capacity increases, maximum flow rate decreases, or detrusor overactivity occurs, findings from a retrospective cross-sectional study have shown.

Of 112 patients who underwent an isolated midurethral sling procedure at a single site, 90 (80.4%) passed active bladder testing (ABT) on the first attempt prior to discharge home, and 22 (19.6%) failed, Dr. Meadow M. Good reported at the annual meeting of the Society of Gynecologic Surgeons.

Bladder testing involved filling the bladder with sterile fluid to 300 mL or to patient discomfort, whichever came first. Passing the test required that two-thirds of the instilled volume was voided.

Average bladder capacity among those who failed ABT was 415 cc, compared with 381 cc in those who passed; average maximum flow rate in those who failed ABT was 15.6 cc/second, compared with 21.6 cc/second in those who passed; and detrusor overactivity was observed in 41% of those who failed ABT, compared with 20% of those who passed, said Dr. Good of the University of Texas Southwestern Medical Center, Dallas.

Furthermore, the capacity-to-infused volume ratio was 1:5 for those who failed ABT and 1:3 for those who passed. Most (81.8%) of those who failed had bladder capacity greater than the infused amount, but no significant difference in the capacity-to-infused volume ratios was seen in the group who passed ABT.

On multivariate analysis, every 50-cc increase in bladder capacity significantly increased the odds of failing ABT (odds ratio, 1.25); every unit increase in the maximum flow rate significantly decreased the odds of ABT failure (OR, 0.91); and the presence of detrusor overactivity was associated with a fivefold increase in the odds of failure (OR, 5.0).

Age, race, body mass index, maximum urethral closure pressure, and maximum detrusor pressure during pressure-flow studies were not found to be associated with ABT outcomes.

Patients included in this study were all those who underwent an isolated midurethral sling procedure at the medical center between January 2011 and August 2012, excluding those who had intraoperative complications requiring discharge with a Foley catheter.

The findings are important because the rates of postoperative urinary retention following midurethral sling procedures are highly variable, and the identification of factors associated with ABT failure could help improve outcomes.

"Patients with postoperative retention are generally discharged home with an indwelling catheter or intermittent self-catheterization; catheter-associated bacteria lead to increased urinary tract infections and health care costs, and to decreased quality of life," Dr. Good said, adding that reducing the rates of postoperative catheter use should be a priority.

"While further research is needed, filling patients to cystometric capacity may improve the success of postoperative bladder testing," she said.

Dr. Good reported having no relevant financial disclosures.

CHARLESTON, S.C. – Women with pelvic organ prolapse symptoms are more likely to favor treatment that allows for uterine preservation than treatment involving hysterectomy, according to findings from a Fellow’s Pelvic Research Network study.

Of 213 women who participated in the multicenter cross-sectional study, 36% said they would prefer uterine preservation and 20% said they would prefer hysterectomy in a scenario in which outcomes were equal, Dr. Nicole. Korbly reported at the annual meeting of the Society of Gynecologic Surgeons.

The remaining 44% had no strong preference, said Dr. Korbly of the Women and Infants’ Hospital of Rhode Island and Brown University, both in Providence, R.I.

"In a scenario in which uterine preservation was superior, the proportion of women preferring uterine preservation increased from 36% to 44%; 11% preferred hysterectomy," she said.

In a scenario in which hysterectomy was superior, the proportion preferring hysterectomy increased from 20% to 36%. Of note, in this scenario, 21% of women still preferred uterine preservation, despite its inferior efficacy, she said.

Responses in some cases differed by geographic region. For example, in the scenarios in which outcomes would be equal and in which uterine preservation would be superior, those living in the West and Northeast regions of the United States were more likely than those in the South and Midwest regions to prefer uterine preservation. The responses did not differ significantly by region in the scenario in which hysterectomy was superior.

On logistic regression analysis, those living in the South had a lower odds of preferring uterine preservation compared with those living in the Northeast (odds ratio, 0.2), Dr. Korbly noted.

Also, women with at least some college education and those who said they considered the uterus important for a sense of self had increased odds of preferring uterine preservation (OR, 3.37 and 26.3, respectively). Age, race, and ethnicity, however, were not significant predictors.

Women included in the study were patients with a mean age of 59 years who presented with prolapse symptoms at one of nine participating centers between May 2011 and October 2012. They completed a 35-item questionnaire designed to assess uterine preservation and hysterectomy preference, as well as attitudes about the potential benefits and risks of uterine preservation and knowledge about pelvic organ prolapse.

The findings are timely, given a recent increased interest in prolapse treatment options that allow for uterine preservation, Dr. Korbly said, explaining that because long-term efficacy of these treatment methods remains unclear, patient preference remains a particularly important consideration when determining the best treatment approach.

Few studies have looked at patient preference regarding uterine preservation, she said at the meeting, jointly sponsored by the American College of Surgeons.

"Well-designed clinical trials comparing uterine-preserving versus hysterectomy-based techniques for prolapse are needed to improve the decision-making process and to balance patients’ values and preferences with evidence-based treatment outcomes data," she concluded.

Dr. Korbly reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Women with pelvic organ prolapse symptoms are more likely to favor treatment that allows for uterine preservation than treatment involving hysterectomy, according to findings from a Fellow’s Pelvic Research Network study.

Of 213 women who participated in the multicenter cross-sectional study, 36% said they would prefer uterine preservation and 20% said they would prefer hysterectomy in a scenario in which outcomes were equal, Dr. Nicole. Korbly reported at the annual meeting of the Society of Gynecologic Surgeons.

The remaining 44% had no strong preference, said Dr. Korbly of the Women and Infants’ Hospital of Rhode Island and Brown University, both in Providence, R.I.

"In a scenario in which uterine preservation was superior, the proportion of women preferring uterine preservation increased from 36% to 44%; 11% preferred hysterectomy," she said.

In a scenario in which hysterectomy was superior, the proportion preferring hysterectomy increased from 20% to 36%. Of note, in this scenario, 21% of women still preferred uterine preservation, despite its inferior efficacy, she said.

Responses in some cases differed by geographic region. For example, in the scenarios in which outcomes would be equal and in which uterine preservation would be superior, those living in the West and Northeast regions of the United States were more likely than those in the South and Midwest regions to prefer uterine preservation. The responses did not differ significantly by region in the scenario in which hysterectomy was superior.

On logistic regression analysis, those living in the South had a lower odds of preferring uterine preservation compared with those living in the Northeast (odds ratio, 0.2), Dr. Korbly noted.

Also, women with at least some college education and those who said they considered the uterus important for a sense of self had increased odds of preferring uterine preservation (OR, 3.37 and 26.3, respectively). Age, race, and ethnicity, however, were not significant predictors.

Women included in the study were patients with a mean age of 59 years who presented with prolapse symptoms at one of nine participating centers between May 2011 and October 2012. They completed a 35-item questionnaire designed to assess uterine preservation and hysterectomy preference, as well as attitudes about the potential benefits and risks of uterine preservation and knowledge about pelvic organ prolapse.

The findings are timely, given a recent increased interest in prolapse treatment options that allow for uterine preservation, Dr. Korbly said, explaining that because long-term efficacy of these treatment methods remains unclear, patient preference remains a particularly important consideration when determining the best treatment approach.

Few studies have looked at patient preference regarding uterine preservation, she said at the meeting, jointly sponsored by the American College of Surgeons.

"Well-designed clinical trials comparing uterine-preserving versus hysterectomy-based techniques for prolapse are needed to improve the decision-making process and to balance patients’ values and preferences with evidence-based treatment outcomes data," she concluded.

Dr. Korbly reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Women with pelvic organ prolapse symptoms are more likely to favor treatment that allows for uterine preservation than treatment involving hysterectomy, according to findings from a Fellow’s Pelvic Research Network study.

Of 213 women who participated in the multicenter cross-sectional study, 36% said they would prefer uterine preservation and 20% said they would prefer hysterectomy in a scenario in which outcomes were equal, Dr. Nicole. Korbly reported at the annual meeting of the Society of Gynecologic Surgeons.

The remaining 44% had no strong preference, said Dr. Korbly of the Women and Infants’ Hospital of Rhode Island and Brown University, both in Providence, R.I.

"In a scenario in which uterine preservation was superior, the proportion of women preferring uterine preservation increased from 36% to 44%; 11% preferred hysterectomy," she said.

In a scenario in which hysterectomy was superior, the proportion preferring hysterectomy increased from 20% to 36%. Of note, in this scenario, 21% of women still preferred uterine preservation, despite its inferior efficacy, she said.

Responses in some cases differed by geographic region. For example, in the scenarios in which outcomes would be equal and in which uterine preservation would be superior, those living in the West and Northeast regions of the United States were more likely than those in the South and Midwest regions to prefer uterine preservation. The responses did not differ significantly by region in the scenario in which hysterectomy was superior.

On logistic regression analysis, those living in the South had a lower odds of preferring uterine preservation compared with those living in the Northeast (odds ratio, 0.2), Dr. Korbly noted.

Also, women with at least some college education and those who said they considered the uterus important for a sense of self had increased odds of preferring uterine preservation (OR, 3.37 and 26.3, respectively). Age, race, and ethnicity, however, were not significant predictors.

Women included in the study were patients with a mean age of 59 years who presented with prolapse symptoms at one of nine participating centers between May 2011 and October 2012. They completed a 35-item questionnaire designed to assess uterine preservation and hysterectomy preference, as well as attitudes about the potential benefits and risks of uterine preservation and knowledge about pelvic organ prolapse.

The findings are timely, given a recent increased interest in prolapse treatment options that allow for uterine preservation, Dr. Korbly said, explaining that because long-term efficacy of these treatment methods remains unclear, patient preference remains a particularly important consideration when determining the best treatment approach.

Few studies have looked at patient preference regarding uterine preservation, she said at the meeting, jointly sponsored by the American College of Surgeons.

"Well-designed clinical trials comparing uterine-preserving versus hysterectomy-based techniques for prolapse are needed to improve the decision-making process and to balance patients’ values and preferences with evidence-based treatment outcomes data," she concluded.

Dr. Korbly reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Native tissue, vaginal mesh, and abdominal mesh repairs may all be viable treatment options for repeat surgery after failed pelvic organ prolapse repair when used in appropriately selected patients, findings from a retrospective study of 63 cases has shown.

Of 20 patients with a failed initial vaginal mesh procedure, 1 underwent repeat vaginal mesh placement in a different compartment, 10 underwent sacrocolpopexy, and 9 had a native tissue procedure for their repeat surgery. Of 43 patients with a failed initial native tissue procedure, 2 underwent a vaginal mesh repair; 33, sacrocolpopexy; and 8, a repeat native tissue procedure for their repeat surgery, Dr. Lee A. Richter reported at the annual meeting of the Society of Gynecologic Surgeons.

All patients achieved objective success. Mean Pelvic Organ Prolapse Quantification (POP-Q) scores were significantly improved for all patients following their repeat surgery, regardless of the type of initial repair and the type of repeat surgery, and none of the patients required additional surgery or pessary use during follow-up, said Dr. Richter, a fourth-year urology resident at Medstar Washington (D.C.) Hospital Center.

At 1-year follow-up, mean POP-Q measurements at anterior point B improved by 2.18 and 2.25 points in the patients treated initially with native tissue and vaginal mesh, respectively (despite significantly worse preoperative anterior prolapse in the native tissue group). Measurements at posterior point B improved by 2.63 and 2.35 points in the groups, respectively; and measurements at the cervix or vaginal cuff were improved by 8.10 and 7.65 points in the groups.

No major perioperative or postoperative complications occurred.

Of note, the time to repeat surgery was 123 months for those who initially underwent native tissue repair, compared with 30 months for those who initially underwent vaginal mesh repair, Dr. Richter noted at the meeting, jointly sponsored by the American College of Surgeons.

Patients included in the study were treated between 2008 and 2011 for failed initial vaginal native tissue or vaginal mesh repair. Most (63%) were referred from outside institutions for the repeat surgery.

The findings are important because regardless of whether mesh or native tissue is used, surgery for pelvic organ prolapse is not always successful, Dr. Richter said, noting that 13% of patients require reoperation within 5 years, and 29% require reoperation at some point during their lifetime.

In this study, native tissue repair was associated with more anterior failures than vaginal mesh, but total reoperation rates were highest for vaginal mesh.

Although the majority of patients with failed initial procedures were treated with sacrocolpopexy, native tissue and vaginal mesh repairs were equally successful for reoperation.

Dr. Richter reported having no relevant financial disclosures.

CHARLESTON, S.C. – Native tissue, vaginal mesh, and abdominal mesh repairs may all be viable treatment options for repeat surgery after failed pelvic organ prolapse repair when used in appropriately selected patients, findings from a retrospective study of 63 cases has shown.

Of 20 patients with a failed initial vaginal mesh procedure, 1 underwent repeat vaginal mesh placement in a different compartment, 10 underwent sacrocolpopexy, and 9 had a native tissue procedure for their repeat surgery. Of 43 patients with a failed initial native tissue procedure, 2 underwent a vaginal mesh repair; 33, sacrocolpopexy; and 8, a repeat native tissue procedure for their repeat surgery, Dr. Lee A. Richter reported at the annual meeting of the Society of Gynecologic Surgeons.

All patients achieved objective success. Mean Pelvic Organ Prolapse Quantification (POP-Q) scores were significantly improved for all patients following their repeat surgery, regardless of the type of initial repair and the type of repeat surgery, and none of the patients required additional surgery or pessary use during follow-up, said Dr. Richter, a fourth-year urology resident at Medstar Washington (D.C.) Hospital Center.

At 1-year follow-up, mean POP-Q measurements at anterior point B improved by 2.18 and 2.25 points in the patients treated initially with native tissue and vaginal mesh, respectively (despite significantly worse preoperative anterior prolapse in the native tissue group). Measurements at posterior point B improved by 2.63 and 2.35 points in the groups, respectively; and measurements at the cervix or vaginal cuff were improved by 8.10 and 7.65 points in the groups.

No major perioperative or postoperative complications occurred.

Of note, the time to repeat surgery was 123 months for those who initially underwent native tissue repair, compared with 30 months for those who initially underwent vaginal mesh repair, Dr. Richter noted at the meeting, jointly sponsored by the American College of Surgeons.

Patients included in the study were treated between 2008 and 2011 for failed initial vaginal native tissue or vaginal mesh repair. Most (63%) were referred from outside institutions for the repeat surgery.

The findings are important because regardless of whether mesh or native tissue is used, surgery for pelvic organ prolapse is not always successful, Dr. Richter said, noting that 13% of patients require reoperation within 5 years, and 29% require reoperation at some point during their lifetime.

In this study, native tissue repair was associated with more anterior failures than vaginal mesh, but total reoperation rates were highest for vaginal mesh.

Although the majority of patients with failed initial procedures were treated with sacrocolpopexy, native tissue and vaginal mesh repairs were equally successful for reoperation.

Dr. Richter reported having no relevant financial disclosures.

CHARLESTON, S.C. – Native tissue, vaginal mesh, and abdominal mesh repairs may all be viable treatment options for repeat surgery after failed pelvic organ prolapse repair when used in appropriately selected patients, findings from a retrospective study of 63 cases has shown.

Of 20 patients with a failed initial vaginal mesh procedure, 1 underwent repeat vaginal mesh placement in a different compartment, 10 underwent sacrocolpopexy, and 9 had a native tissue procedure for their repeat surgery. Of 43 patients with a failed initial native tissue procedure, 2 underwent a vaginal mesh repair; 33, sacrocolpopexy; and 8, a repeat native tissue procedure for their repeat surgery, Dr. Lee A. Richter reported at the annual meeting of the Society of Gynecologic Surgeons.

All patients achieved objective success. Mean Pelvic Organ Prolapse Quantification (POP-Q) scores were significantly improved for all patients following their repeat surgery, regardless of the type of initial repair and the type of repeat surgery, and none of the patients required additional surgery or pessary use during follow-up, said Dr. Richter, a fourth-year urology resident at Medstar Washington (D.C.) Hospital Center.

At 1-year follow-up, mean POP-Q measurements at anterior point B improved by 2.18 and 2.25 points in the patients treated initially with native tissue and vaginal mesh, respectively (despite significantly worse preoperative anterior prolapse in the native tissue group). Measurements at posterior point B improved by 2.63 and 2.35 points in the groups, respectively; and measurements at the cervix or vaginal cuff were improved by 8.10 and 7.65 points in the groups.

No major perioperative or postoperative complications occurred.

Of note, the time to repeat surgery was 123 months for those who initially underwent native tissue repair, compared with 30 months for those who initially underwent vaginal mesh repair, Dr. Richter noted at the meeting, jointly sponsored by the American College of Surgeons.

Patients included in the study were treated between 2008 and 2011 for failed initial vaginal native tissue or vaginal mesh repair. Most (63%) were referred from outside institutions for the repeat surgery.

The findings are important because regardless of whether mesh or native tissue is used, surgery for pelvic organ prolapse is not always successful, Dr. Richter said, noting that 13% of patients require reoperation within 5 years, and 29% require reoperation at some point during their lifetime.

In this study, native tissue repair was associated with more anterior failures than vaginal mesh, but total reoperation rates were highest for vaginal mesh.

Although the majority of patients with failed initial procedures were treated with sacrocolpopexy, native tissue and vaginal mesh repairs were equally successful for reoperation.

Dr. Richter reported having no relevant financial disclosures.

CHARLESTON, S.C. – Women who desire pregnancy after undergoing robotic-assisted myomectomy – including those with known infertility prior to the procedure – may have a good chance of conceiving following the procedure, findings from a retrospective case series have shown.

Of 198 women who underwent robotic myomectomy between 2006 and 2011 and who were followed for between 1 and 6.5 years, 52% attempted pregnancy, and 71% of those had a total of 81 pregnancies. A subset of 39% of the participants had known infertility prior to myomectomy, and of those, 62% achieved a total of 52 pregnancies, Dr. Lauren Rascoff reported at the annual meeting of the Society of Gynecologic Surgeons.

Of the 81 pregnancies, 38 (47%) occurred spontaneously, including 14 in the group with preoperative infertility, and 43 (53%) were achieved using assisted reproductive technology, including 39 in the infertility group, said Dr. Rascoff of Mount Sinai Medical Center, New York.

Of 40 deliveries that had occurred by the time of Dr. Rascoff’s presentation, 31 (78%) were done at term, including 19 in the infertility group, and 9 (22%) were preterm, including 8 in the infertility group. Most (37, or 92.5%) of the women were delivered by cesarean section, including 26 in the infertility group, and 3 (7.5%) involved a normal spontaneous vaginal delivery, including 1 in the infertility group.

One pregnancy was complicated by cesarean hysterectomy secondary to a placenta accreta, but no cases of uterine rupture occurred.

Eighteen pregnancies were ongoing, and 18 resulted in spontaneous abortion, including 14 in the infertility group. The rest, except for one molar pregnancy, ended as a result of elective termination or intrauterine fetal demise.

Participants were interviewed by phone using a 27-item survey about pregnancy attempts and outcomes before and after myomectomy, and about preoperative and postoperative infertility treatments. They had a mean age of 37 years, had a mean body mass index of 24.75 kg/m², and were ethnically diverse. Parity ranged from 0 to 4.

On average, 3.3 fibroids with a mean weight of 332 g each were removed during the procedures. The mean operative time was 152 minutes.

The findings are important because the prevalence of fibroids in an unselected female population ranges from 5% to 25%, and fibroids account for 27% of uterine abnormalities in women attempting to become pregnant. The presence of fibroids is known to have adverse effects on implantation and pregnancy continuation, Dr. Rascoff said.

Although several studies have demonstrated the benefit of fibroid removal on fertility, few address pregnancy outcomes after robotic-assisted myomectomy, she noted.

The current findings are comparable to those of other series reported in the literature, she said.

Dr. Rascoff reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Women who desire pregnancy after undergoing robotic-assisted myomectomy – including those with known infertility prior to the procedure – may have a good chance of conceiving following the procedure, findings from a retrospective case series have shown.

Of 198 women who underwent robotic myomectomy between 2006 and 2011 and who were followed for between 1 and 6.5 years, 52% attempted pregnancy, and 71% of those had a total of 81 pregnancies. A subset of 39% of the participants had known infertility prior to myomectomy, and of those, 62% achieved a total of 52 pregnancies, Dr. Lauren Rascoff reported at the annual meeting of the Society of Gynecologic Surgeons.

Of the 81 pregnancies, 38 (47%) occurred spontaneously, including 14 in the group with preoperative infertility, and 43 (53%) were achieved using assisted reproductive technology, including 39 in the infertility group, said Dr. Rascoff of Mount Sinai Medical Center, New York.

Of 40 deliveries that had occurred by the time of Dr. Rascoff’s presentation, 31 (78%) were done at term, including 19 in the infertility group, and 9 (22%) were preterm, including 8 in the infertility group. Most (37, or 92.5%) of the women were delivered by cesarean section, including 26 in the infertility group, and 3 (7.5%) involved a normal spontaneous vaginal delivery, including 1 in the infertility group.

One pregnancy was complicated by cesarean hysterectomy secondary to a placenta accreta, but no cases of uterine rupture occurred.

Eighteen pregnancies were ongoing, and 18 resulted in spontaneous abortion, including 14 in the infertility group. The rest, except for one molar pregnancy, ended as a result of elective termination or intrauterine fetal demise.

Participants were interviewed by phone using a 27-item survey about pregnancy attempts and outcomes before and after myomectomy, and about preoperative and postoperative infertility treatments. They had a mean age of 37 years, had a mean body mass index of 24.75 kg/m², and were ethnically diverse. Parity ranged from 0 to 4.

On average, 3.3 fibroids with a mean weight of 332 g each were removed during the procedures. The mean operative time was 152 minutes.

The findings are important because the prevalence of fibroids in an unselected female population ranges from 5% to 25%, and fibroids account for 27% of uterine abnormalities in women attempting to become pregnant. The presence of fibroids is known to have adverse effects on implantation and pregnancy continuation, Dr. Rascoff said.

Although several studies have demonstrated the benefit of fibroid removal on fertility, few address pregnancy outcomes after robotic-assisted myomectomy, she noted.

The current findings are comparable to those of other series reported in the literature, she said.

Dr. Rascoff reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Women who desire pregnancy after undergoing robotic-assisted myomectomy – including those with known infertility prior to the procedure – may have a good chance of conceiving following the procedure, findings from a retrospective case series have shown.

Of 198 women who underwent robotic myomectomy between 2006 and 2011 and who were followed for between 1 and 6.5 years, 52% attempted pregnancy, and 71% of those had a total of 81 pregnancies. A subset of 39% of the participants had known infertility prior to myomectomy, and of those, 62% achieved a total of 52 pregnancies, Dr. Lauren Rascoff reported at the annual meeting of the Society of Gynecologic Surgeons.

Of the 81 pregnancies, 38 (47%) occurred spontaneously, including 14 in the group with preoperative infertility, and 43 (53%) were achieved using assisted reproductive technology, including 39 in the infertility group, said Dr. Rascoff of Mount Sinai Medical Center, New York.

Of 40 deliveries that had occurred by the time of Dr. Rascoff’s presentation, 31 (78%) were done at term, including 19 in the infertility group, and 9 (22%) were preterm, including 8 in the infertility group. Most (37, or 92.5%) of the women were delivered by cesarean section, including 26 in the infertility group, and 3 (7.5%) involved a normal spontaneous vaginal delivery, including 1 in the infertility group.

One pregnancy was complicated by cesarean hysterectomy secondary to a placenta accreta, but no cases of uterine rupture occurred.

Eighteen pregnancies were ongoing, and 18 resulted in spontaneous abortion, including 14 in the infertility group. The rest, except for one molar pregnancy, ended as a result of elective termination or intrauterine fetal demise.

Participants were interviewed by phone using a 27-item survey about pregnancy attempts and outcomes before and after myomectomy, and about preoperative and postoperative infertility treatments. They had a mean age of 37 years, had a mean body mass index of 24.75 kg/m², and were ethnically diverse. Parity ranged from 0 to 4.

On average, 3.3 fibroids with a mean weight of 332 g each were removed during the procedures. The mean operative time was 152 minutes.

The findings are important because the prevalence of fibroids in an unselected female population ranges from 5% to 25%, and fibroids account for 27% of uterine abnormalities in women attempting to become pregnant. The presence of fibroids is known to have adverse effects on implantation and pregnancy continuation, Dr. Rascoff said.

Although several studies have demonstrated the benefit of fibroid removal on fertility, few address pregnancy outcomes after robotic-assisted myomectomy, she noted.

The current findings are comparable to those of other series reported in the literature, she said.

Dr. Rascoff reported having no relevant financial disclosures.

[email protected]

CHARLESTON, S.C. – Most simple vesicovaginal fistulae are initially managed by surgery, which is successful in the majority of cases, according to a multicenter review from the Fellows’ Pelvic Research Network.

Conversely, most of those initially managed conservatively by catheter drainage fail to resolve.

Of 226 patients with vesicovaginal fistulae (VVF) included in the review, 166 were managed surgically at the outset, and 77.5% of these resolved with one surgery. Of 37 who did not resolve after initial surgery, 32 underwent a second surgery; 56% of these resolved, Dr. Susan H. Oakley reported at the annual meeting of the Society of Gynecologic Surgeons.

Of the 60 patients who were managed conservatively, only 12% resolved during a median duration of catheterization of 35 days. The 53 who did not resolve went on to have surgery; the majority of these patients resolved. The overall success rate in the study was 83% in the 219 who underwent surgery, said Dr. Oakley of Good Samaritan Hospital, Cincinnati.

The patients (mean age, 49.5 years) were treated for VVF at 1 of 12 participating academic medical centers between July 2006 and June 2011. Most patients were postmenopausal (53%), nonsmokers (59.5%) and white (71%).

Of those initially managed surgically, 41% underwent vaginal repair, 23% underwent abdominal repair, and the remaining patients underwent other types of repair such as electrocautery. Of those initially managed conservatively who underwent subsequent surgery, 41% underwent vaginal repair, 53% underwent abdominal repair, and the remaining patients underwent other types of repair.

"VVF are the most common acquired fistulae of the urinary tract, and in the United States, gynecologic surgery is often the cause. Regardless of the etiology, the physical and emotional effects on patients are profound," Dr. Oakley said, adding that because a standardized algorithm for the management of VVS is lacking, the purpose of this study was to describe practice patterns and treatment outcomes for VVF.

While conservative management is often suggested as first-line therapy, it has been unclear how often this strategy is successful, she said at the meeting, jointly sponsored by the American College of Surgeons.

Although limited by its retrospective nature and by missing data that prevented complete analysis of all of the variables of interest, the study does have several strengths, including the multicenter design and a large number of cases. The findings thus support a recommendation that early surgical management should be considered as the preferred approach to treating simple VVF, Dr. Oakley concluded.

She reported having no relevant financial disclosures.

CHARLESTON, S.C. – Most simple vesicovaginal fistulae are initially managed by surgery, which is successful in the majority of cases, according to a multicenter review from the Fellows’ Pelvic Research Network.

Conversely, most of those initially managed conservatively by catheter drainage fail to resolve.

Of 226 patients with vesicovaginal fistulae (VVF) included in the review, 166 were managed surgically at the outset, and 77.5% of these resolved with one surgery. Of 37 who did not resolve after initial surgery, 32 underwent a second surgery; 56% of these resolved, Dr. Susan H. Oakley reported at the annual meeting of the Society of Gynecologic Surgeons.

Of the 60 patients who were managed conservatively, only 12% resolved during a median duration of catheterization of 35 days. The 53 who did not resolve went on to have surgery; the majority of these patients resolved. The overall success rate in the study was 83% in the 219 who underwent surgery, said Dr. Oakley of Good Samaritan Hospital, Cincinnati.

The patients (mean age, 49.5 years) were treated for VVF at 1 of 12 participating academic medical centers between July 2006 and June 2011. Most patients were postmenopausal (53%), nonsmokers (59.5%) and white (71%).

Of those initially managed surgically, 41% underwent vaginal repair, 23% underwent abdominal repair, and the remaining patients underwent other types of repair such as electrocautery. Of those initially managed conservatively who underwent subsequent surgery, 41% underwent vaginal repair, 53% underwent abdominal repair, and the remaining patients underwent other types of repair.

"VVF are the most common acquired fistulae of the urinary tract, and in the United States, gynecologic surgery is often the cause. Regardless of the etiology, the physical and emotional effects on patients are profound," Dr. Oakley said, adding that because a standardized algorithm for the management of VVS is lacking, the purpose of this study was to describe practice patterns and treatment outcomes for VVF.

While conservative management is often suggested as first-line therapy, it has been unclear how often this strategy is successful, she said at the meeting, jointly sponsored by the American College of Surgeons.

Although limited by its retrospective nature and by missing data that prevented complete analysis of all of the variables of interest, the study does have several strengths, including the multicenter design and a large number of cases. The findings thus support a recommendation that early surgical management should be considered as the preferred approach to treating simple VVF, Dr. Oakley concluded.

She reported having no relevant financial disclosures.

CHARLESTON, S.C. – Most simple vesicovaginal fistulae are initially managed by surgery, which is successful in the majority of cases, according to a multicenter review from the Fellows’ Pelvic Research Network.

Conversely, most of those initially managed conservatively by catheter drainage fail to resolve.

Of 226 patients with vesicovaginal fistulae (VVF) included in the review, 166 were managed surgically at the outset, and 77.5% of these resolved with one surgery. Of 37 who did not resolve after initial surgery, 32 underwent a second surgery; 56% of these resolved, Dr. Susan H. Oakley reported at the annual meeting of the Society of Gynecologic Surgeons.

Of the 60 patients who were managed conservatively, only 12% resolved during a median duration of catheterization of 35 days. The 53 who did not resolve went on to have surgery; the majority of these patients resolved. The overall success rate in the study was 83% in the 219 who underwent surgery, said Dr. Oakley of Good Samaritan Hospital, Cincinnati.

The patients (mean age, 49.5 years) were treated for VVF at 1 of 12 participating academic medical centers between July 2006 and June 2011. Most patients were postmenopausal (53%), nonsmokers (59.5%) and white (71%).

Of those initially managed surgically, 41% underwent vaginal repair, 23% underwent abdominal repair, and the remaining patients underwent other types of repair such as electrocautery. Of those initially managed conservatively who underwent subsequent surgery, 41% underwent vaginal repair, 53% underwent abdominal repair, and the remaining patients underwent other types of repair.

"VVF are the most common acquired fistulae of the urinary tract, and in the United States, gynecologic surgery is often the cause. Regardless of the etiology, the physical and emotional effects on patients are profound," Dr. Oakley said, adding that because a standardized algorithm for the management of VVS is lacking, the purpose of this study was to describe practice patterns and treatment outcomes for VVF.

While conservative management is often suggested as first-line therapy, it has been unclear how often this strategy is successful, she said at the meeting, jointly sponsored by the American College of Surgeons.

Although limited by its retrospective nature and by missing data that prevented complete analysis of all of the variables of interest, the study does have several strengths, including the multicenter design and a large number of cases. The findings thus support a recommendation that early surgical management should be considered as the preferred approach to treating simple VVF, Dr. Oakley concluded.

She reported having no relevant financial disclosures.