Are there the differences in urodynamic findings and functional outcomes between laparoscopic sacrocolpopexy and trocarless transvaginal mesh system for symptomatic pelvic organ prolapse?

Illiano E1, Natale F2, Marchesi A1, Costantini E1

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 824
Non Discussion Abstract
Scientific Non Discussion Abstract Session 37
Prolapse Symptoms Pelvic Organ Prolapse Urodynamics Techniques Surgery Prospective Study
1.Andrology and Urogynecological Clinic,Santa Maria Hospital,Terni,University of Perugia, 2.Urogynecological Clinic,San Carlo of Nancy ,Rome
Links

Abstract

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.
Results
In this study were included 91 women (47 in LSC group and 44 in TTMs group). The median follow- up of the study was 21 months (range 8-46 months). After surgery all urodynamic parameters improved in both groups without significant difference between the 2 approaches, except for the Qmax and the maximum cystometric capacity (Table I). Detrusor overactivity and BOO disappeared in 82% and in 92% of patients after LSC , and in 82.1% and 89.5% of patients in TTMs respectively without difference between the 2 groups.The DU persisted in 22% and of 50% women in LSC and TTMs group respectivley. The success rate of stress urinary incontinence (SUI) after LSC was higher then TTMs (72.3% vs 43% p=0.005). The most common pre-operative symptoms were voiding symptoms in both groups, they resolved in 93.6% and 86.3% of patients in LSC and TTMs respectively. The OAB disappeared in 72% and 87% of women in LSC and TTMs. The UDI-6 showed an improvement without differences between two groups (p=0.08). Apical prolapse was corrected to stage 0-I in 100% of cases by LSC, and in 92.4% by TTMs.
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
Concluding message
The urodynamic finding showed that both the LSC and TTMs in women with advanced apical POP provide good functional outcomes,with higher success rate of SUI in LSC approach
Figure 1 Table 1
Disclosures
<span class="text-strong">Funding</span> none <span class="text-strong">Clinical Trial</span> Yes <span class="text-strong">Public Registry</span> No <span class="text-strong">RCT</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> CEAS Umbria <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes