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Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women

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Abstract

Introduction and hypothesis

The aim of this study is to compare the outcomes of patients who underwent surgical repair of advanced pelvic organ prolapse amongst with normal-weight, overweight and obese Asian women.

Methods

Vaginal sacrospinous ligament fixation with anterior mesh repair as primary surgery was performed on 200 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was based on POPDI-6 (questions 2 and 3). Patients completed the UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and post-surgery. Outcome measures were observed in three categories of Asian BMI (normal weight 18.5 to 23.0 kg/m2, overweight >23.0 to 27.5 kg/m2, and obese ≥27.5 kg/m2).

Results

Postoperative data were available for 195 patients. Objective cure for the normal-weight, overweight, and obese were 93.0%, 92.5% and 90.6% respectively with an overall mean follow-up of 35.69 ± 18.97 months. The subjective cure was no different. All categories improved significantly with regard to anatomical outcome, UDI-6, IIQ-7, POPDI-6, PISQ-12 after primary surgery (p < 0.05) and none had recurrence requiring further surgery. However, obese patients have significantly less improvement in POPDI-6 (p <0.037) and PISQ-12 (p <0.005) compared with normal weight. There were no differences with regard to perioperative complications and the vaginal mesh exposure rate was 4.1%.

Conclusions

There was no difference in the objective outcome of sacrospinous ligament fixation with anterior mesh repair surgery among the three Asian BMI categories; however, obese patients showed less improvement in POP symptoms and sexual function.

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References

  1. Low S, Chin MC, Deurenberg-Yap M (2009) Review on epidemic of obesity. Ann Acad Med Singap 38(1):57–59

    PubMed  Google Scholar 

  2. Greer WJ, Richter HE, Bartolucci AA, Burgio KL (2008) Obesity and pelvic floor disorders: a systematic review. Obstet Gynecol 112(2 Pt 1):341–349. doi:10.1097/AOG.0b013e31817cfdde

    Article  PubMed  Google Scholar 

  3. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s health initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166

    Article  PubMed  Google Scholar 

  4. Kudish BI, Iglesia CB, Sokol RJ, Cochrane B, Richter HE, Larson J, Hendrix SL, Howard BV (2009) Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol 113(1):81–88. doi:10.1097/AOG.0b013e318190a0dd

    PubMed  Google Scholar 

  5. Petri E, Ashok K (2011) Sacrospinous vaginal fixation—current status. Acta Obstet Gynecol Scand 90(5):429–436. doi:10.1111/j.1600-0412.2011.01084.x

    Article  PubMed  Google Scholar 

  6. Fialkow MF, Newton KM, Weiss NS (2008) Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 19(11):1483–1487. doi:10.1007/s00192-008-0678-8

    Article  PubMed  Google Scholar 

  7. Morgan DM, Rogers MA, Huebner M, Wei JT, Delancey JO (2007) Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse: a systematic review. Obstet Gynecol 109(6):1424–1433. doi:10.1097/01.AOG.0000264066.89094.21

    Article  PubMed  Google Scholar 

  8. Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev (4):CD004014. doi:10.1002/14651858.CD004014.pub4

  9. Diez-Itza I, Aizpitarte I, Becerro A (2007) Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct 18(11):1317–1324. doi:10.1007/s00192-007-0321-0

    Article  PubMed  CAS  Google Scholar 

  10. Clark AL, Gregory T, Smith VJ, Edwards R (2003) Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 189(5):1261–1267

    Article  PubMed  Google Scholar 

  11. Chen CC, Collins SA, Rodgers AK, Paraiso MF, Walters MD, Barber MD (2007) Perioperative complications in obese women vs normal-weight women who undergo vaginal surgery. Am J Obstet Gynecol 98(1):197. doi:10.1016/j.ajog.2007.03.055, e91–98

    Google Scholar 

  12. Lo TS, Ashok K (2011) Combined anterior trans-obturator mesh and sacrospinous ligament fixation in women with severe prolapse–a case series of 30 months follow-up. Int Urogynecol J 22(3):299–306. doi:10.1007/s00192-010-1266-2

    Article  PubMed  Google Scholar 

  13. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  PubMed  CAS  Google Scholar 

  14. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn 14(2):131–139

    Article  PubMed  CAS  Google Scholar 

  15. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Continence Program in Women (CPW) Research Group. Qual Life Res Int J Qual Life Asp Treat Care Rehab 3(5):291–306

    Article  CAS  Google Scholar 

  16. Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113. doi:10.1016/j.ajog.2004.12.025

    Article  PubMed  CAS  Google Scholar 

  17. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14(3):164–168. doi:10.1007/s00192-003-1063-2; discussion 168

    Article  PubMed  Google Scholar 

  18. Su TH, Lau HH (2010) Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire. The J of Sex Med 7(12):3940–3945. doi:10.1111/j.1743-6109.2010.01891.x

    Article  PubMed  Google Scholar 

  19. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies (2004) Lancet 363(9403):157–163. doi:10.1016/S0140-6736(03)15268-3

    Article  Google Scholar 

  20. Rane A, Kannan K, Barry C, Balakrishnan S, Lim Y, Corstiaans A (2008) Prospective study of the perigee system for the management of cystocoeles–medium-term follow up. Aust N Z J Obstet Gynaecol 48(4):427–432. doi:10.1111/j.1479-828X.2008.00858.x

    Article  PubMed  Google Scholar 

  21. Miyazaki FS (1987) Miya hook ligature carrier for sacrospinous ligament suspension. Obstet Gynecol 70(2):286–288

    PubMed  CAS  Google Scholar 

  22. Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, Swift S, Whitmore K, Ghoniem G, de Ridder D (2012) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J 23(5):527–535. doi:10.1007/s00192-012-1726-y

    Article  PubMed  Google Scholar 

  23. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26. doi:10.1007/s00192-009-0976-9

    Article  PubMed  Google Scholar 

  24. Bradley CS, Kenton KS, Richter HE, Gao X, Zyczynski HM, Weber AM, Nygaard IE (2008) Obesity and outcomes after sacrocolpopexy. Am J Obstet Gynecol 199(6):690. doi:10.1016/j.ajog.2008.07.030, e691–698

    Article  PubMed  Google Scholar 

  25. Kapoor DS, Davila GW, Rosenthal RJ, Ghoniem GM (2004) Pelvic floor dysfunction in morbidly obese women: pilot study. Obes Res 12(7):1104–1107. doi:10.1038/oby.2004.138

    Article  PubMed  Google Scholar 

  26. Washington BB, Erekson EA, Kassis NC, Myers DL (2010) The association between obesity and stage II or greater prolapse. Am J Obstet Gynecol 202((5):503. doi:10.1016/j.ajog.2010.01.016, e501–504

    PubMed  Google Scholar 

  27. Uustal Fornell E, Wingren G, Kjolhede P (2004) Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand 83(4):383–389

    Article  PubMed  Google Scholar 

  28. Bradley CS, Zimmerman MB, Wang Q, Nygaard IE (2008) Vaginal descent and pelvic floor symptoms in postmenopausal women: a longitudinal study. Obstet Gynecol 111(5):1148–1153. doi:10.1097/AOG.0b013e31816a3b96

    Article  PubMed  Google Scholar 

  29. Tsai KK, Marques F, Myers DL, Sung VW (2010) Association between obesity, sexual activity and sexual function in women with pelvic floor disorders. Female Pelvic Med Reconstr Surg16(6):331–335. doi:10.1097/SPV.0b013e3181f526c8

    Article  PubMed  Google Scholar 

  30. Jain P, Parsons M (2011) The effects of obesity on the pelvic floor. Obstet Gynaecol 13(3):133–142. doi:10.1576/toag.13.3.133.27664

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, 5, Fu-Hsin Street, Kwei-shan, Taoyuan, 333, Taiwan, Republic of China

    Tsia-Shu Lo, Yiap Loong Tan, Siwatchaya Khanuengkitkong & Anil Krishna Dass

  2. Department of Obstetrics & Gynecology, Sarawak General Hospital, Kuching, Sarawak, Malaysia

    Yiap Loong Tan

  3. Department of Obstetrics & Gynecology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand

    Siwatchaya Khanuengkitkong

  4. Urogynecology Unit, Department of Obstetrics &Gynecology, Penang Hospital, Penang, Malaysia

    Anil Krishna Dass

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  1. Tsia-Shu Lo
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  2. Yiap Loong Tan
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Correspondence to Tsia-Shu Lo.

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Lo, TS., Tan, Y.L., Khanuengkitkong, S. et al. Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women. Int Urogynecol J 24, 809–816 (2013). https://doi.org/10.1007/s00192-012-1940-7

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  • DOI: https://doi.org/10.1007/s00192-012-1940-7

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