Hypothesis / aims of study
The evaluation of functional outcomes after pelvic organ prolapse (POP) surgery is important, infact they have stronger associations to quality of life improvements. In literature few studies have objectified the functional outcomes of POP surgery by urodynamic parameters, comparing the vaginal and laparoscopic approaches. The aim of this study was to compare the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) and trocarless transvaginal mesh system (TTMs) in patients with advanced apical pelvic organ prolapse (POP).
Study design, materials and methods
This is a single-centre prospective study. The study was approved by the local ethics committee .We included women with symptomatic and POP stage II-IV, who underwent LSC and TTMs. All surgical procedures were performed by two senior surgeons. The preoperative evaluation included: history, clinical examination, urodynamic testing,translabial ultrasound.
Diagnosis of urinary symptoms was made my means of clinical history according to International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on terminology.
Women were followed up at 1,3,6,12 months after surgery and annually by history, examination. At 6 months after surgery we performed urodynamic testing .
Multichannel urodynamic evaluation was performed using the Mediwatch EBN system©, in accordance with ICS Good Urodynamic Practice 2002 and ICS-GUP2016 updates .A urodynamic report was completed according to ICS-GUP2016. Bladder Outlet Obstruction (BOO) was defined according to Blaivas- Groutz nomogram [Maximum flow (Qmax) ≤ 12 mL/s and detrusor pressure at Qmax (PdetQmax) ≥ 20 cm H2O in the pressure-flow study. Detrusor underactivity (DU) was defined according to Projected Isovolumetric Pressure (PIP) index, that it was calculated as Qmax + PdetQmax (normal range 30–75 cmH2O). Detrusor overactivity (DO) was defined according to current recommendations as involuntary detrusor contractions during filling cystometry, of variable duration and amplitude. All urodynamic tests were performed by an indipendend urologist. To evaluate the urinary symptoms we used Urogenital distress inventory short form (UDI-6) questionnaires before and 6 months after surgery. All calculations were performed using IBM-SPSS® version 22.0 (IBM Corp., Armonk, NY, USA, 2013). The categorical data are presented in the form of absolute numbers and their corresponding percentage values.The Satistical analysis: McNemar test, χ2 tests, the Wilcoxon signed ranks test, p < 0.05.
Interpretation of results
There were no differences on functional results between LSC and TTMs. The success rate was higher after LSC compared TTMs probably because the surgical technique was different. In laparoscopic colposacropexy we performed a dissection from the bladder down to the bladder neck, and this could explain a better action on urethral mobility. The strengths of our study are the use urodynamic evaluation to objectify clinical outcomes after a minimaly invasive procedure in women with severe POP and a relatively large sample compared to other studies in literature