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Kim-Fine S, Antosh DD, Balk EM, Meriwether KV, Kanter G, Dieter AA, Mamik MM, Good M, Singh R, Alas A, Foda M, Rahn DD, Rogers RG. Relationship of postoperative vaginal anatomy and sexual function: a systematic review with meta-analysis. Int Urogynecol J 2021; 32:2125-2134. [PMID: 33988785 DOI: 10.1007/s00192-021-04829-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This was a planned secondary analysis of a systematic review that described sexual function outcomes following pelvic organ prolapse (POP) surgery. We aimed to describe the relationship of pre- and postoperative vaginal anatomic measures with sexual function outcomes. Data Sources included the Medline, Embase, and clinicaltrials.gov databases from inception to April 2018. METHODS The original systematic review included prospective, comparative studies that reported sexual function outcomes before and following POP surgery. Studies were extracted for population characteristics, sexual function outcomes, and vaginal anatomy, including total vaginal length (TVL) and genital hiatus. By meta-regression, we analyzed associations across studies between vaginal anatomic measurements and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) and dyspareunia outcomes. RESULTS We screened 3124 abstracts and identified 74 papers representing 67 original studies. Among these, 14 studies reported TVL and PISQ-12 outcomes. Nine studies reported TVL and dyspareunia outcomes, eight studies reported GH and PISQ-12 outcomes, and seven studies reported GH and dyspareunia outcomes. We found no associations between anatomic measures and PISQ-12 or dyspareunia, although, we found a statistically significant association found between preoperative TVL and change in PISQ-12. CONCLUSION Across studies, the evidence does not support an association between vaginal anatomy and either validated, condition-specific sexual function questionnaires or dyspareunia. However, no study has directly analyzed these associations in the setting of pelvic floor reconstructive surgery.
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Affiliation(s)
- Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Kate V Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Gregg Kanter
- Department of Obstetrics and Gynecology, Salinas Valley Memorial Healthcare System, Salinas, CA, USA
| | - Alexis A Dieter
- Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington, Hospital Center/Georgetown University School of Medicine, Washington, DC, USA
| | - Mamta M Mamik
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meadow Good
- Obstetrics and Gynecology, University of Florida, Jacksonville, FL, USA
| | - Ruchira Singh
- Obstetrics and Gynecology, University of Florida, Jacksonville, FL, USA
| | - Alexandriah Alas
- Department of Obstetrics and Gynecology, UT Health, San Antonio, TX, USA
| | - Mohamed Foda
- Department of Obstetrics and Gynecology, HCA/UCF Consortium, Gainesville, FL, USA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca G Rogers
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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Kikuchi JY, Muñiz KS, Handa VL. Surgical Repair of the Genital Hiatus: A Narrative Review. Int Urogynecol J 2021; 32:2111-2117. [PMID: 33606054 DOI: 10.1007/s00192-021-04680-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An enlarged genital hiatus (GH) is associated with the development of prolapse and may be associated with prolapse recurrence following surgery; however, there is insufficient evidence to support surgical reduction of the GH as prophylaxis against future prolapse. The objective of this review is (1) to review the association between GH size and pelvic organ prolapse and (2) to discuss the existing literature on surgical procedures that narrow the GH. METHODS A literature search was performed in the PubMed search engine, using the keyword "genital hiatus." Articles were included if they addressed any of the following topics: (1) normative GH values; (2) associations between the GH and prolapse development or recurrence; (3) surgical alteration of the GH; (4) indications, risks or benefits of surgical alteration of the GH. RESULTS An enlarging GH has been observed prior to the development of prolapse. Multiple studies show that an enlarged pre- and/or postoperative GH is associated with an increased risk of recurrent prolapse following prolapse repair surgery. There are limited data on the specific risks of GH alteration related to bowel and sexual function. CONCLUSIONS GH size and prolapse appear to be strongly associated. Because GH size appears to be a risk factor for pelvic organ prolapse, the GH size should be carefully considered at the time of surgery. Surgeons should discuss with their patients the risks and potential benefits of additional procedures designed to reduce GH size.
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Affiliation(s)
- Jacqueline Y Kikuchi
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
| | - Keila S Muñiz
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA
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Immediate Postoperative Pelvic Organ Prolapse Quantification Measures and 2-Year Risk of Prolapse Recurrence. Obstet Gynecol 2020; 136:792-801. [PMID: 32925609 DOI: 10.1097/aog.0000000000004043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether resting genital hiatus, perineal body, and total vaginal length measured intraoperatively at the conclusion of surgery are associated with prolapse recurrence 2 years after native tissue pelvic organ prolapse reconstruction. METHODS This ancillary analysis of the OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) trial included women who had an immediate postoperative pelvic organ prolapse quantification (POP-Q) examination and 2-year follow-up. Primary outcome was bothersome bulge symptoms. Secondary outcomes were anatomic failure, surgical failure (either anatomic failure or bothersome bulge symptoms), and sexual function. Descriptive statistics assessed relationships between postprocedure POP-Q measures and these four outcomes. Multivariable models were fit to the data to control for baseline differences in bivariate comparisons. Receiver operating characteristic curves were generated to identify an optimal genital hiatus cut point associated with bothersome bulge, and this threshold was explored. RESULTS This analysis included 368 participants. Bivariate analyses identified age, body mass index, vaginal deliveries, baseline genital hiatus, perineal body, and advanced POP-Q stage (3 or higher vs 2) as clinically relevant variables to include in multivariable models. After adjusting for these variables, the association between immediate postoperative genital hiatus and bothersome bulge (adjusted odds ratio [aOR] 1.4; 95% CI 0.9-2.1) was not significant at the P<.05 level; however, immediate postoperative genital hiatus was associated with anatomic (aOR 1.6; 95% CI 1.1-2.3) and surgical failure (aOR 1.5; 95% CI 1.0-2.1). Immediate postoperative genital hiatus of 3.5 cm was the selected cutoff (area under the curve 0.58, 95% CI 0.50-0.66 from the bothersome bulge model). Women with genital hiatus 3.5 cm or greater were more likely to have anatomic and surgical failures at 2 years. No POP-Q measures were correlated with 2-year sexual function. CONCLUSION A larger immediate postoperative genital hiatus measurement of 3.5 cm or greater is not associated with bothersome bulge symptoms or sexual dysfunction but is associated with anatomic and surgical failures 2 years after native tissue vaginal reconstructive surgery.
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Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol 2020; 17:373-390. [DOI: 10.1038/s41585-020-0334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/09/2022]
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Polat M, Kahramanoglu I, Senol T, Senturk B, Ozkaya E, Karateke A. Comparison of the Effect of Laparoscopic and Abdominal Hysterectomy on Lower Urinary Tract Function, Vaginal Length, and Dyspareunia: A Randomized Clinical Trial. J Laparoendosc Adv Surg Tech A 2015; 26:116-21. [PMID: 26671303 DOI: 10.1089/lap.2015.0437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The effect of hysterectomy on vesicourethral and sexual functions remains controversial. The primary objective of this study was to compare the effects of a laparoscopic hysterectomy and a total abdominal hysterectomy on lower urinary tract function. The secondary aims were to compare the two surgeries in terms of postoperative vaginal length and dyspareunia. MATERIALS AND METHODS This was a prospective randomized clinical study in which 292 women were assigned to either the laparoscopic hysterectomy (n = 146) or total abdominal hysterectomy (n = 146) groups. The vaginal length and urodynamic measurements were taken, and the patients were asked to grade the presence and severity of dyspareunia using a visual analog scale 3 weeks before and 12 weeks after the surgery. The relationship between the postoperative vaginal length and the incidence of dyspareunia was evaluated. The urodynamic procedures used included uroflowmetry and voiding cystometry to record the maximum flow rate (Q-max) and to assess the bladder capacity. RESULTS The preoperative vaginal length was similar between the groups, whereas the postoperative vaginal length was significantly longer in the laparoscopic hysterectomy group. When the 15 patients who developed postoperative dyspareunia were evaluated, no differences in the postoperative vaginal length were seen, but a significant difference in the change in the length of the vagina was found when compared with the other patients. No significant difference was found with regard to pre- and postoperative Q-max, bladder capacity, and change in bladder capacity between the study groups. CONCLUSIONS The change in the length of the vagina was much more remarkable after total abdominal hysterectomy, compared with laparoscopic hysterectomy. It seems that the Q-max and the bladder capacity increase after hysterectomies, regardless of the surgical type. Further prospective randomized comparative studies are warranted to ascertain whether laparoscopic hysterectomies cause less damage to the pelvic floor, compared with abdominal hysterectomies.
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Affiliation(s)
- Mesut Polat
- 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey
| | - Ilker Kahramanoglu
- 2 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Istanbul University Cerrahpasa School of Medicine , Istanbul, Turkey
| | - Taylan Senol
- 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey
| | - Baki Senturk
- 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey
| | - Enis Ozkaya
- 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey
| | - Ates Karateke
- 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey
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Vaginal adhesions after transvaginal pelvic reconstructive surgeries: prevalence and clinical implications. Int Urogynecol J 2015; 27:141-5. [DOI: 10.1007/s00192-015-2807-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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Jiang SJ, Shi H, Swar G, Wang HX, Liu XJ, Wang YG. Trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife: A pilot animal study. World J Gastroenterol 2013; 19:6857-6862. [PMID: 24187461 PMCID: PMC3812485 DOI: 10.3748/wjg.v19.i40.6857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/27/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model.
METHODS: Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endsocope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation.
RESULTS: Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure.
CONCLUSION: Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.
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Schmid C, O'Rourke P, Maher C. Vaginal invagination: definition, clinical presentation and surgical management. Int Urogynecol J 2012; 24:313-7. [PMID: 22711214 DOI: 10.1007/s00192-012-1838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/20/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this observational study is to define vaginal invagination identified at vaginal prolapse surgery and to report the prevalence and risk factors for its development. METHODS All women undergoing vaginal prolapse surgery between January and December 2010 were prospectively evaluated intraoperatively for invagination of the vagina. The preoperative details and characteristics of the invagination were recorded and the area of vaginal mucosa released was quantified in square centimetres. Vaginal topography was evaluated using the Pelvic Organ Prolapse Quantification system. RESULTS Intraoperative assessment demonstrated that vaginal invagination occurred in 8 % (25/295) and was characterized by a tight, fixed and tethered portion of vaginal mucosa at the vault which was bilateral in 14 (56 %) women. Prior gynaecological surgery with hysterectomy being the most common surgery and vaginal route the most frequent approach were identified as overall risk factors. The gain (mean ± SD) of vaginal mucosa after releasing entrapped tissue was 3.5 ± 0.63 cm(2). CONCLUSIONS Vaginal invagination is diagnosed intraoperatively as a fixed and tight area of vaginal mucosa at the vault. The identification and release of the invaginated vagina ensures a safer access to the pelvic sidewall and increases vaginal mucosal area.
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Affiliation(s)
- Corina Schmid
- Royal Brisbane & Women's Hospital, Urogynaecology, Butterfield Street, Herston, QLD 4029, Australia.
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Wehbe SA, Kellogg S, Whitmore K. Urogenital complaints and female sexual dysfunction. Part 2. J Sex Med 2011; 7:2304-17; quiz 2318-9. [PMID: 20653832 DOI: 10.1111/j.1743-6109.2010.01951.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity. AIM Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function. METHODS Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia. MAIN OUTCOME MEASURES Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function. RESULTS FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function. CONCLUSIONS Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.
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Affiliation(s)
- Salim A Wehbe
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P. Hybrid NOTES transgastric cholecystectomy with reliable gastric closure: an animal survival study. Surg Endosc 2010; 25:728-36. [PMID: 20721586 PMCID: PMC3044824 DOI: 10.1007/s00464-010-1242-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 02/27/2010] [Indexed: 12/21/2022]
Abstract
Background Secure transluminal closure remains the most fundamental barrier to safe translation of transgastric natural orifice transluminal endoscopic surgery (NOTES) procedures to humans. Obtaining optimal critical view of safety (CVS) is a prerequisite to performing cholecystectomy avoiding common bile duct injury. Objectives (1) To evaluate feasibility and safety of hybrid transgastric NOTES cholecystectomy. (2) To evaluate feasibility and reliability of gastrotomy closure using a novel Over-The-Scope-Clip (OTSC; Ovesco) in survival porcine experiments. Methods Laparoscopic access to the abdominal cavity was obtained by two 2-mm and one umbilical optical trocar(s). Gastric access was created by balloon dilatation of a needle knife puncture up to 18 mm. Exposure of CVS was obtained and evaluated by aid of a 2-mm device. Subsequently the cystic duct and artery were clipped endoscopically. After laparoscopic dissection the specimen was extracted via the stomach. The gastrotomy was closed endoscopically using the OTSC. Necropsy was performed after 10 days with inspection of gastrotomy and peritoneal cavity for complications. Experiments were planned in 3 acute and 16 survival pigs. Main outcome parameters were documented exposure of CVS, successful cholecystectomy and closure, uncomplicated survival and histology-confirmed full-thickness closure. Results In all 16 survival experiments CVS was obtained satisfactorily and hybrid cholecystectomy was successfully performed [100%; 95% confidence interval (CI): 81–100%]. Transgastric closure was endoscopically successful in all experiments in mean time of 7 min [standard deviation (SD) 3 min]. At necropsy 10 days after surgery there were no signs of (infectious) complications. Histology confirmed full-thickness healing with 100% success (95% CI: 81–100%). Conclusion Hybrid transgastric NOTES cholecystectomy is feasible, safe and results in optimal CVS. Use of OTSC for gastrotomy closure is feasible, reliable and results in histology-proven full-thickness closure in survival porcine experiments. Electronic supplementary material The online version of this article (doi:10.1007/s00464-010-1242-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rogier P. Voermans
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Willem A. Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Braun V. Female Genital Cosmetic Surgery: A Critical Review of Current Knowledge and Contemporary Debates. J Womens Health (Larchmt) 2010; 19:1393-407. [DOI: 10.1089/jwh.2009.1728] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virginia Braun
- Department of Psychology, The University of Auckland, Auckland, New Zealand
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12
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Fine needle vaginoplasty: a simplified novel approach for correction of vaginal aplasia. Fertil Steril 2010; 94:309-12. [DOI: 10.1016/j.fertnstert.2009.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 02/04/2009] [Accepted: 02/04/2009] [Indexed: 11/19/2022]
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Bouchet P, Crenn D, Deleflie M, Hocké C. Retentissement de la chirurgie du prolapsus génital sur la sexualité des patientes. ACTA ACUST UNITED AC 2010; 38:373-9. [DOI: 10.1016/j.gyobfe.2010.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 02/26/2010] [Indexed: 12/21/2022]
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Fatton B. [Sexual outcome after pelvic organ prolapse surgery]. Prog Urol 2009; 19:1037-59. [PMID: 19969276 DOI: 10.1016/j.purol.2009.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 10/01/2009] [Indexed: 11/28/2022]
Abstract
Sexual well-being is an important parameter of women's health and quality of live. Sexual disorders may occur in women with pelvic organ prolapse and/or stress urinary incontinence and also after pelvic reconstructive surgery. Sexual dysfunction after POP or SUI surgery has been poorly documented but new condition specific questionnaires have been developed to help us to better evaluate such consequences. This paper reports updated data and highlights more specifically consequences of surgery with mesh reinforcement which is, currently, an important issue particularly when performing by vaginal approach.
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Affiliation(s)
- B Fatton
- Département de Gynécologie-Obstétrique, Unité de Maternité, Hôpital Hôtel-Dieu, CHU de Clermont-Ferrand, Boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 1, France.
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Pathophysiology of sexual dysfunction as related to pelvic floor disorders. Int Urogynecol J 2009; 20 Suppl 1:S19-25. [DOI: 10.1007/s00192-009-0831-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fatton B, Savary D, Velemir L, Amblard J, Accoceberry M, Jacquetin B. [Sexual outcome after pelvic reconstructive surgery]. ACTA ACUST UNITED AC 2009; 37:140-59. [PMID: 19233704 DOI: 10.1016/j.gyobfe.2008.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 10/22/2008] [Indexed: 12/26/2022]
Abstract
Sexual well-being is an important parameter of women's health and quality of live. Sexual disorders may occur in women with pelvic organ prolapse and/or stress urinary incontinence and also after pelvic reconstructive surgery. Sexual dysfunction after POP or SUI surgery has been poorly documented but new condition specific questionnaires have been developed to help us to better evaluate such consequences. This paper reports available data and highlights more specifically consequences of surgery with mesh reinforcement which is, currently, an important issue particularly when performing by vaginal approach.
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Affiliation(s)
- B Fatton
- Département de gynécologie-obstétrique, maternité Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 1, France.
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Florido Navío J, García García MJ. Dispareunia. Rev Int Androl 2007. [DOI: 10.1016/s1698-031x(07)74067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abramov Y, Webb AR, Miller JJR, Alshahrour A, Botros SM, Goldberg RP, Ameer GA, Sand PK. Biomechanical characterization of vaginal versus abdominal surgical wound healing in the rabbit. Am J Obstet Gynecol 2006; 194:1472-7. [PMID: 16647930 DOI: 10.1016/j.ajog.2006.01.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Revised: 10/17/2005] [Accepted: 01/13/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study was to compare biomechanical properties of vaginal versus abdominal surgical wound healing in the rabbit. STUDY DESIGN Bilateral 6-mm full-thickness circular segments were excised from the vagina and abdominal skin in 38 New Zealand White female rabbits. Animals were killed 0, 4, 7, 10, 14, 21, 28, and 35 days after wounding, and the wounds were assessed for surface area and tensile properties. RESULTS Wound closure and scar contraction were significantly faster in the vagina than the abdomen (P = .001). Baseline tensile strength (P = .05), modulus (P = .001), and tensile energy to break (P = .18) were higher in the abdomen, whereas maximal tissue elongation was higher in the vagina (P = .13). After wounding, a drop in tensile strength, modulus, and tensile energy to break was observed in both tissues through postwounding day 4, followed by a progressive recovery of these properties. A progressive loss of elasticity was noted in both tissues after wounding. CONCLUSION The surgical wound closes and contracts faster in the rabbit vagina than in its abdomen. Although these tissues have different biomechanical properties at baseline, they regenerate their tensile strength and lose their elasticity at a similar rate.
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Affiliation(s)
- Yoram Abramov
- Division of Urogynecology, Evanston Continence Center, Evanston, IL 60201, USA.
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