Pelvic Organ Prolapse
The objective of this study was the implementation of open bilateral cervicosacropexy (CESA) and vaginosacropexy (VASA) surgical techniques into a laparoscopic approach.
It should be observed, if changes of the methods may influence clinical outcome (in regard to apical restoration and urinary incontinence).
We performed a retrospective observational study on 107 women with pelvic organ prolapse with urinary incontinence who underwent laparoscopic bilateral cervicosacropexy (CESA) and vaginosacropexy (VASA) between March 2013 and December 2016, in a primary care Hospital in Germany. Outcome was obtained 4 months after surgery. Urinary incontinence symptoms were documented according to validated questionnaires. Prolapse was assessed using the Pelvic Organ Prolapse Quantification System (POP-Q).
107 women were included. Median operating time was 92 minutes (37-194min). At 4 months, 70 patients (65%) with urinary incontinence (mixed and urgency urinary incontinence) before surgery reported continence. Subdivided according to the POP-Q stages, 34 Patients (60%) with POP-Q stage 1 before surgery and 36 patients (71%) with POP-Q stage 2 - 4 were continent. 103 (96%) patients had POP-Q stage 0 regarding the apical vaginal (the first 4 patients had relapse of prolapse due to fast-absorbable sutures). No mesh erosion appeared.
The CESA and VASA surgical techniques can also be performed laparoscopically. Beside the effect of apical fixation, nearly identical percentages of urinary continence were achieved in patients with advanced and less advanced POP-Q stages.
The CESA and VASA surgical techniques are techniques to restore apical vaginal prolapse and urinary incontinence as already described. The laparoscopic approach of these bilateral USLs replacement with fixation at physiological landmarks with a minimum of material (PVDF ligament-replacement structure) contributes to the established surgical treatment option for genital prolapse and urinary incontinence.