Menahem NEUMAN and Yuval LAVY, Israel and Walter ARTIBANI, Italy
Objectives: To evaluate the
preliminary data of a Prolift patients' series, for curing pelvic
organ prolapse with intact uterus or after hysterectomy.
Methods: Patients with pelvic
organ prolapse grater than +2 for A,B,C or D points of the ICS
standardised POP-Q method had
ProLift operations. Peri-operative data was prospectively collected.
Results: 232 ProLift operations
were performed. Ninety three (40.1%) patients elected conservation
of prolapsed uterus. Forty nine patients (21.1%) had concomitant
urodynamic urinary stress incontinence and had An additive TVTO .
Anterior (149) and posterior (83) Prolift operations (52 patients
had both) were performed under general (66.4%) or regional (33.6%)
anesthesia. Intra and immediate post operative recorded
complications included 3 patients with para-vesical and one patient
with para-rectal self resumed pelvic hematomas, not affecting the
Hematocrit level. Three patients had bladder perforations that were
immediately vaginaly corrected, one patient needed laparotomy for
bladder tear repair with no morbid sequela. All these complications,
except for one bladder wall injury, occurred with the first 50
Forty seven patients were eligible for
12 months evaluation including physical evaluation and subjective
report on QoL, bladder, bowel and sexual functions with validated
questioners (UDI6 and IIQ7). Two patients (4.3%) with vaginal pain
due to mesh retraction needed surgical mesh release and three
patients (6.4%) had tape protrusion that was removed successfully at
the outpatient clinic. Hospitalization period was 24 to 48 hours.
All patients but 4 (91.5%) reported high satisfaction (>80%) with
the overall therapeutic consequences, on the twelve month follow up
appointment. This refers to the improvement with general QoL,
bladder, sexual and bowel functions and the genital prolapse.
Clinical evaluation of the anatomical surgical correction of the
pelvic organ prolapse revealed two patients with minor recurrent
cystocele and three patients with recurrent minor rectocele,
reporting high satisfaction, and two patients (4.3%) with recurrent
vaginal vault prolapse. One had a further abdominal sacral fixation
while the other had a repeated Prolift.
The Prolift operations dose not requires laparotomy, yet they involve rather large para-vesical and/or para-rectal
dissections. Hence, previous familiarisation with deep pelvic anatomy and ability to deal with potential complications
are mandatory. This series results shows early efficacy, safety and short rehabilitation period of this procedure. Longterm
data is required for drawing solid conclusion concerning the benefits of on of the discussed operative technique.
Source: European Urology Association,
Annual meeting, 2008, Milan, Italy of P-864