Long term outcomes of the vaginally assisted laparoscopic sacrocolpopexy (VALS)
IUGA Academy. Athanasiou S. Jun 30, 2018; 213021; 352 Topic: Pelvic Organ Prolapse
Stavros Athanasiou
Stavros Athanasiou

Access to Premium content is currently a membership benefit.


Click here to join IUGA or renew your membership.

Abstract
Discussion Forum (0)
Rate & Comment (0)

352

Long term outcomes of the vaginally assisted laparoscopic sacrocolpopexy (VALS)

Athanasiou, S1; Zacharakis, D1; Protopapas, A1; Chatzipapas, I1; Pitsouni, E1; Grigoriadis, T1

1: National and Kapodistrian University of Athens

Introduction: Surgical treatment of women with severe uterovaginal prolapse (UVP) remains a complex challenge of current urogynecology (1). Patients with severe UVP suffer from multicompartmental defects, which ideally should be addressed at primary surgery. The vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach for the treatment of women with severe UVP (2). During this procedure a vaginal hysterectomy is initially performed, followed by a transvaginal placement of a synthetic mesh, which is suspended laparoscopically on the sacral promontory. The VALS minimizes thus the need of extensive laparoscopic tissue dissections, manipulations and laparoscopic suturing in the deep pelvis and has been shown to be valid and safe with encouraging short-term anatomical and functional outcomes (2).

Objective: To evaluate the long-term anatomical and functional outcomes of the VALS and report the long-term complications. Secondary outcome measures were evaluation of symptoms using condition-specific POP instruments (ICIQ-FLUTS, PFDI-20, PFIQ-7)

Methods: This was a single center prospective study including women who underwent VALS between 09/2007 and 12/2014. The study was given local ethics committee approval and informed consent was obtained from all patients. Inclusion criteria were women with symptomatic stage III or IV vaginal prolapse, with at least 36 months of follow-up. Primary outcome was a “composite surgical success”, defined as: 1) no apical descent greater than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (anatomical success) 2) no vaginal bulge symptoms (POPDI-6 question No3) and 3) no re-treatment for prolapse recurrence.

Results: 94 patients were included in the study with a median follow-up of 7 years (range 3-10 years) (table 1). The composite surgical success rate was 95.7% (90/94). All POP-Q ICS points showed statistically significant improvement at 7 years apart from TVL, which remained unchanged (table 2). According to our criteria one anatomical recurrence was observed in the posterior compartment, which was surgically managed by posterior colporraphy (reoperation rate 1.1%). Moreover 3/94 (3.2%) women reported vaginal bulge symptoms without having anatomical recurrence. Two patients (2/94, 2.1%) were diagnosed with mesh extrusion at the level of the vaginal cuff. Both were successfully treated with surgical removal of the mesh and vaginal estrogens. A statistically significant improvement was observed in all condition specific questionnaires with the exception of the bowel symptoms (CRAIQ-7) and urge urinary incontinence symptoms (UUI) (tables 3 and 4).

Conclusions: The VALS procedure showed excellent rates of anatomical support, symptomatic relief and low vaginal mesh extrusion rates after a minimum follow-up of 36 months. The VALS appears to be a valid and safe surgical option for treating women severe UVP.

References

  1. Ultrasound Obstet Gynecol 2017;49:404-408.
  2. Int Urogynecol J 2013;24:839-845.

Table 1. Demographics

N (%)

Follow-up, median (range)

Age, median (range)

7 (3-10)

56 (41-73)

Parity

0

0 (0)

1-2

71 (75.5.)

>2

23 (24.54)

BMI, mean (SD)

24.8 (2.6)

Sexually active

70 (74.5)

Preoperative USI

37 (39.4)

Preoperative DO

14 (14.9)

Type of concomitant Surgery

TVT/ TVT-O

37 (39.4)

Anterior / posterior repair

64 (68.1)

Bilateral salpingoophorectomy

54 (57.4)

Table 2. Long term anatomical outcomes of VALS according to POP-Q system.

POP-Q (N=94)

Preoperatively

Median (range)

Postoperatively

median (range)

p-value

Aa

2,5 (-2 to 3)

-2,5 (-3 to -1)

<0.001

Ba

5,0 (-1 to 10)

-2,5 (-3 to -1)

<0.001

Ap

-0,5 (-2.5 to 3)

-3,0 (-3 to 0)

<0.001

Bp

0,0 (-2.5 to 10)

-3,0 (-3 to 0)

<0.001

C

6,0 (0.5 to 11)

-8,0 (-11 to -7)

<0.001

TVL

9,0 (6 to 12)

9,0 (7 to 12)

0.153

GH

4,5 (2 to 6)

3,0 (1.5 to 7)

<0.001

PB

3,0 (2 to 5)

3,0 (2 to 4)

0.004

Table 3. Impact of VALS on pelvic floor symptoms and health-related quality of life based on the median values of the PFDI-20 and PFIQ7 questionnaire.

Pre

Post

P

Median

Median

POPDI6

50,0

4,0

<0.001

CRADI8

12,0

6,0

0.044

UDI6

25,0

8,0

<0.001

PFDI-20

91

20,0

<0.001

UIQ7

9,0

0,0

<0.001

CRAIQ7

0,0

0,0

0.201

POPIQ7

38,0

0,0

<0.001

PFIQ7

52,0

2,0

<0.001

Table 4. Mean values on ICIQ-FLUTS questionnaire items before and after surgery regarding urinary incontinence symptoms.

Pre

Post

P*

Median

Median

Frequency (Fluts 2)

1

1

0.009

Urgency (Fluts 3)

1

0

<0.001

UUI (Fluts 9)

0

0

0.059

SUI (Fluts 11)

1

0

<0.001

Disclosure:

Work supported by industry: no.

Code of conduct/disclaimer available in General Terms & Conditions

By clicking “Accept Terms & all Cookies” or by continuing to browse, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies