Effects of pelvic organ prolapse repair on urinary symptoms: A comparative study between the laparoscopic and vaginal approach

Authors

  • Rajeev Ramanah,

    1. Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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  • Marcos Ballester,

    1. Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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  • Elisabeth Chereau,

    1. Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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  • Roman Rouzier,

    1. Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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  • Emile Daraï

    Corresponding author
    1. Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
    • Service de Gynécologie-Obstétrique, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
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  • Conflict of interest: none.

  • Linda Brubaker led the review process.

Abstract

Objective

To compare changes in urinary symptoms before and after pelvic organ prolapse (POP) surgery, using either laparoscopic sacrocolpopexy (LSC) or transvaginal porcine dermis hammock placement with sacrospinous ligament suspension (VS).

Materials and Methods

Data were prospectively collected from all women undergoing POP surgery between May 2001 and October 2009. Pre- and postoperative urinary symptoms, Urinary Distress Inventory (UDI), and Urinary Impact Questionnaires (UIQ) scores were compared within and between groups. A generalized linear model was used for multivariate analysis.

Results

Out of the 151 patients included, 87 patients underwent LSC, and 64 VS. Overall, after a median follow-up of 32.4 months, POP surgery improved urinary frequency (P = 0.006), voiding difficulty (P = 0.001), stress urinary incontinence (SUI) (P = 0.001), but not urgency (P = 0.29). VS was more effective in treating SUI (P < 0.001 vs. 0.52) while LSC more effective on voiding difficulty (P = 0.01 vs. 0.08). Postoperative de novo symptoms were observed in 35.8% of patients with no difference between the groups (P = 0.06). UDI (P = 0.04) and UIQ (P = 0.01) scores were significantly lower after surgery. However, LSC significantly improved UDI (P = 0.03) with no effect on UIQ (P = 0.29) scores while VS significantly improved both scores (P = 0.02 and 0.001, respectively). Upon multivariate analysis, only the improvement in the impact of urinary symptoms on daily living was independently associated to VS (OR = 5.45 [95% confidence interval 2.20–13.44], P = 0.01).

Conclusion

Most preoperative urinary symptoms decreased after POP surgery with equivalent proportion of de novo symptoms after vaginal and laparoscopic approaches. Neurourol. Urodynam. 31:126–131, 2012. © 2011 Wiley Periodicals, Inc.

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