Study on modified Prolift for pelvic floor reconstruction in the prevention of stress urinary incontinence

( views:143, downloads:0 )
MA Ning(Department of Obstetricsand Gynaecology, Fuzhou General Hospital, Fuzhou 350025, China)
WANG Feng-mei(Department of Obstetricsand Gynaecology, Fuzhou General Hospital, Fuzhou 350025, China)
HUANG Hui-juan(Department of Obstetricsand Gynaecology, Fuzhou General Hospital, Fuzhou 350025, China)
SONG Yan-feng(Department of Obstetricsand Gynaecology, Fuzhou General Hospital, Fuzhou 350025, China)
Journal Title:
Chinese Journal of Obstetrics and Gynecology
Volume 47, Issue 07, 2012
Key Word:
Pelvic organ prolapse; Urinary incontinence, stress; Gynecologic surgicalprocedures; Pelvic floor

Abstract: Objective To evaluate the safety and efficacy of modified Prolift pelvic floor reconstruction with improving the placement of Prolift-A in treatment of severe pelvic floor dysfunction and stress urinary incontinence (SUI).Methods From July 2008 to September 2010,170 cases with severe pelvic organ prolapse(POP) treated by modified Prolift pelvic floor reconstruction surgery in Fuzhou General Hospital were enrolled in this study.The Prolift-A was laid tension-free under the mid-urethra with the position of Prolift-A displaced from the neck of bladder to the mid-urethra.No concomitant tension-free urethra suspender via vagina was performed.Primary outcomes were assessed with POP quantitation ( POPQ) system to evaluate the postoperative anatomical replacement stage.Secondary outcome measure were:urogenital distress inventory 6 ( UDI-6),the incontinence impact questionnaire 7 ( IIQ-7 ) and the pelvic floor incontinence questionnaire 7 (PFIQ-7) to evaluate the impact on life quality at the follow-up of 1,6,12 months.Results At 6 and 12 months after surgery,168 cases and 163 cases were followed up.The anatomical cure rates were 98.8% (166/168) at 6 months and 97.5% (159/163) at 12 months,respectively.One case with bladder injury and 1 case with rectum injury were observed.Five cases with recurrence were observed,including 2 cases with anterior vagina prolapse,2 cases with uterine prolapse and 1 case with posterior vagina prolapse.Meanwhile,3 cases with hematoma and 7 cases with mesh erosion were observed.Quality of life of all patients were improved significantly by UDI-6,IIQ-7 and PFIQ-7 scoring system evaluation.Among 79 POP patients with SUI,the cure rate of SUI was 93.7% (74/79).Of 5 cases with symptomatic SUI,2 cases were needed surgical intervention.Twenty-three cases were found with minimal SUI symptoms and subjective satisfaction without objective influence on quality of life.Seven patients presented dysuria after surgery,5 cases recovered urination with 10 days,1 case recovered with 1 months,and 1 case with 6 months by bladder drainage.Eleven cases with discomfort urination and 3 cases with slow urination were found.Conclusions The modified Prolift pelvic reconstructive surgery was safe and efficacy intervention in treatment of POP and prevention of SUI.

  • [1]Olsen A,Smith V,Bergstrom JO,et al.Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997,89:501-506.
  • [2]Fatton B,Amblard J,Debodinance P,et al.Transvaginal repair of genital prolapse:preliminary results of a new tension-free vaginal mesh (Prolift technique):a case series multicentric study.Int Urogynecol J Pelvic Floor Dysfunct,2007,18:743-752.
  • [3]Bump RC,Mattiasson A,B(Φ) K,et al.The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol,1996,175:10-17.
  • [4]Zyczynski HM,Carey MP,Smith AR,et al.One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device.Am J Obstet Gynecol,2010,203:587.e1-8.
  • [5]卢丹,崔桂芬,张亚兰.子宫脱垂手术失败及复发13例.中 国实用妇科与产科杂志,2002,12:749-750.
  • [6]Bradley CS,Rovner ES,Morgan MA,et al.A new questionnaire for urinary incontinence diagnosis in woman:Development and testing.Am J Obstet Gynecol,2005,193:66-73.
  • [7]Sandvik H,Hunskaar S,Seim A,et al.Validation of a sevenity index in female urinary incontinence and its implementation in an epidemiological surgery.J Epidemiol Community Health,1993,47:497-499.
  • [8]DeLancey JO.Structural support of the urethra as it relates to stress urinary incontinence:the hammock hypothesis.Am J Obstet Gynecol,1994,170:1713-1720.
  • [9]Grody MH.Urinary incontinence and concomitant prolapse.Clin Obstet Gynecol,1998,41:777-785.
  • [10]Stanton SL,Hilton P,Norton C,et al.Clinical and urodynamic effects of anterior colporthaphy and vaginal hysterectomy for prolapse with and without incontinence.Br J Obstet Gynaecol,1982,89:459-463.
  • [11]Borstad E,Rud T.The risk of developing urinary stress incontinence after vaginal repair in continent women.A clinical and urodynamic follow-up study.Acta Obstet Gynecol Scand,1989,68:545-549.
  • [12]Kleeman S,Vassallo B,Segal J,et al.The ability of history and a negative cough stress test to detect occult stress incontinence in patients undergoing surgical repair of advanced pelvic organ prolapse.Int Urogynecol J Pelvic Floor Dysfunct,2006,17:27-29.
  • [13]Huang KH,Kung FT,Liang HM,et al.Concomitant pelvic organ prolapse surgery with TVT procedure.Int Urogynecol J Pelvic Floor Dysfunct,2006,17:60-65.
  • [14]Abou-Elela A,Salah E,Torky H,et al.Outcome of treatment of anterior vaginal wall prolapse and stress urinary incontinence with transobturator tension-free vaginal mesh (prolift) and concomitant tension-free vaginal tape-obturator.Adv Urol,2009,2009:341268-341274.
  • [15]Borstad E,Abdelnoor M,Staff AC,et al.Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence.Int Urogynecol J,2010,21:179-186.
  • [16]Reena C,Kekre AN,Kekre N.Occult stress incontinence in women with pelvic organ prolapse.Int J Gynaecol Obstet,2007,97:31-34.
  • [17]Casiano ER,Gebhart JB,McGree ME,et al.Does concomitant prolapse repair at the time of midurethral sling affect recurrent rates of incontinence?.Int Urogynecol J,2011,22:819-825.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615