Academic cosmetic gynecology and energy-based therapies: ambiguities, explorations, and FDA advisories”

Comments on Letter to the Editor: prolapse reduction deteriorates the urethral closure mechanism

Commentary on ‘Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations’

Prolapse reduction deteriorates the urethral closure mechanism

What if you could not do a mid-urethral sling?

Labial adhesions in postmenopausal women: presentation and management Abstract Labial adhesion is defined as complete or partial fusion of the labia minora in the midline through flimsy or dense adhesions. It may be congenital or acquired. Acquired cases are mainly seen in oestrogen deficiency states in prepubertal girls and postmenopausal women. Aggravating factors include chronic inflammation due to poor hygiene, eczema, lichen planus or sclerosus, seborrhic dermatitis, eczema, local trauma and recurrent urinary tract infections. Patients may be asymptomatic or present with urinary or vulval symptoms. Management in mild cases includes the application of topical oestrogen with or without topical steroids. If there is no response to topical therapy, surgical separation under anaesthesia should be performed. Herein, we report six cases of complete labial fusion in postmenopausal women who presented to our clinic with various urinary and vulval complaints. The mean age of these patients was 76 (range 61–85) years.

Levels of pelvic floor support: what do they look like on magnetic resonance imaging?

Twelve years’ experience with fascia lata autograft to replace complicated anterior vaginal mesh Abstract Objectives To report 12-year experience with replacing transvaginal mesh (TVM) with fascia lata autograft. Methods This was a chart review of TVM removal and replacement with a fascia lata autograft placement by a single surgeon between 2005 and 2017. The Pelvic Organ Prolapse Quantification (POP-Q) system before and 1 year following the procedure, patient-reported recurrence of symptoms, changes in the POP-Q examination and complication rates are analyzed. Results Twenty-four patients were included. Mean age was 57.2 (95% CI 53.2–61.2) years. Mean number of days to Foley catheter removal was 3.2 days (95% CI 1.6–4.9) and mean number of days to drain removal was 10.9 days (95% CI 9.9–12.0). Following the surgery, no leg seroma, infection or numbness was reported. UTI occurred in four (16.7%) of the participants postoperatively. At 3-month follow-up, mild urinary symptoms were reported in five participants (20.8%). At 1-year follow-up, one participant was symptomatic of pelvic organ prolapse. Paired t-test analysis revealed statistically significant retraction of Aa and Ba vaginal points (p < 0.001). C, GH and PB points were also statistically significantly retracted. Conclusion Fascia lata autograft for anterior compartment reconstruction due to TVM complications is associated with high safety and efficacy rates.

Urinary incontinence among women—which personal and professional relations are involved? A population-based study Abstract Introduction and hypothesis Urinary incontinence (UI) is frequent among women worldwide, but embarrassment and shame can prevent them from discussing symptoms with others. This study aimed to identify personal and professional relations involved by Danish women with UI. It further aimed to investigate whether age, persistence of symptoms, number of symptoms, influence on daily activities and concern about the symptoms are associated with involving personal and professional relations. Methods A sample of 51,090 Danish women, aged ≥ 20 years, were invited to participate in a web-based cross-sectional survey in 2012. We identified individuals with self-reported symptoms of stress incontinence, urge incontinence and UI without stress/urge and explored the involvement of personal and professional relations. Descriptive statistics and multivariate logistic regression were used for analyses. Results In total, 26,466 women completed the questionnaire. Of the 5861 (22.1%) women who had experienced a minimum of one UI symptom within the preceding 4 weeks, 71.4% did not involve any professional relations and 45.0% did not involve any personal relations. Further, 38.8% involved neither personal nor professional relations. Personal relations were most often involved, mainly those with the spouse/partner, friends and children. Involving a personal relation was associated with three to five times increased odds of involving health care professionals for all UI types. Conclusions UI is highly prevalent, but the condition is infrequently discussed in personal and professional relations. Future research should address the quality of the contacts made and barriers to involving other people.

Mesh-related complications of laparoscopic sacrocolpopexy Abstract Introduction and hypothesis Apical vaginal support for post-hysterectomy vault prolapse can be provided by vaginal, abdominal, or laparoscopic routes. Sacrocolpopexy is associated with higher satisfaction rates and a lower re-operation rate than vaginal sacrospinous fixation. The laparoscopic approach can reduce hospital stay and blood loss. There are concerns about the use of mesh in urogynaecological procedures, but limited data indicate a low mesh complication rate with sacrocolpopexy (0–5%). This study was aimed at establishing the incidence of complications following laparoscopic sacrocolpopexy. Methods We carried out a retrospective cohort study of patients who underwent laparoscopic sacrocolpopexy at a large tertiary hospital. Cases were identified from coding data, theatre logs and the national urogynaecology procedure database. Data were gathered from theatre records, patient notes and the national database. Demographic data, concomitant procedures performed, duration of surgery, intra-operative complications, change in pelvic organ prolapse quantification point C, duration of stay, late complications and further urogynaecological surgery were assessed. Results A total of 660 patients underwent laparoscopic sacrocolpopexy between 2005 and 2017 (median time from surgery 4 years 3 months). Five cases (0.7%) developed vaginal mesh exposure. Two were successfully managed conservatively with topical oestrogen. Three required surgical excision of the mesh. Four patients (0.6%) presented with erosion of non-absorbable vaginal sutures. Two were successfully managed conservatively with topical oestrogen and oral antibiotics. Two were managed with vaginal suture excision. Conclusions This large series suggests that laparoscopic sacrocolpopexy might confer a low risk of mesh exposure. Together with good anatomical and patient-reported outcomes, laparoscopic sacrocolpopexy is a safe option for patients presenting with post-hysterectomy vault prolapse.