Pelvic organ prolapse (POP) may occur in up to 20% of parous women.
It may cause a variety of urinary, bowel and sexual symptoms and, as
reported, necessitates surgical correction in 11% of the female
population. Previously reported surgical modalities such as colporrhaphy,
plication of the uterosacral ligaments, sacrospineous and sacral
colpopexies are associated with an to up 58% recurrence rate in terms of
objective POPQ scoring and prolapse related subjective symptoms. For the
last decade, various surgical modalities for curing POP through
reconstruction of the pelvic floor have been advocated, mainly
modification of the colpo-sacral and colpo-sacro-spinal fixations, using
vaginal or abdominal approaches, via laparotomy or laparoscopy.
These operations where associated with well
documented complications such as mesh erosion, dyspareunia, buttock pain,
urinary and fecal incontinence, altered defecation and constipation,
bladder injuries, urinary retention and infections, cystocele and
rectocele formation and protrusion, and other disadvantages such as long
operative time, slow return to normal living activities and great costs.
Against this background, Petros was encouraged to develop the novel PIVS,
entailing minimal invasiveness via a vaginal approach together with
anatomical restoration of the uterosacral ligament suspension of the
vaginal apex, performed in a daycare setting. This operation permits the
restoration of the anatomical position of the vaginal apex, hence the
conservation of the prolapsed uterus. Preservation of the uterus was
lately shown to contribute positively to the patient's self-esteem, body
image, confidence and sexuality.
The overall operative result with the PIVS patients demonstrates the
safety and efficacy of the PIVS method for vaginal apex support.
Replacement of the broken uterosacral ligaments applying PIVS provides
adequate uterine re-suspension, hereby permitting uterine preservation
while treating advanced uterine prolapse. Amputation of an elongated
uterine cervix in order to prevent later bulging out might be appropriate.
The differences between the hysterectomy and non-hysterectomy groups are
insignificant except for the length of hospitalization. Bladder
overactivity symptoms such as urgency, frequency, urge incontinence and
nocturia, which had been troublesome for about three thirds of the
patients preoperatively, were postoperatively reduced to about 10% of the
patients in each group. The explanation for this major finding, the
improvement of unstable bladder symptoms is unclear, as such symptoms are
generally deemed to be incurable.
It has been previously explained with
reference to the Integral Theory, using the trampoline analogy, whereby
lax ligaments cannot support the bladder base stretch receptors, as a
result of which these fire off prematurely. The PIVS restores the
posterior ligamentous supports, hence contributing to the neural stability
of the bladder and avoiding bladder overactivity symptoms. The PIVS
therapeutic effectiveness does not appear to be inferior to previously
reported operative techniques and uterine conservation does affect neither
the cure nor the complication rates. This procedure seems easier and
faster to perform and might be less associated with intra and
post-operative procedure related morbidity than the above-reported
Previously reported tape exposure rate of 10%,
related to the mash nature, was successfully reduced since the tape is
lately consisted with macro-porous mono-filament material. The Prolift,
introduced by a 9 French surgeons group, is actually an improvement of the
PIVS both - in terms of the mesh quality and mesh dimensions. Being a
"type 1" mesh, manly macro porous and monofilament, is this mesh "bacteria
unfriendly", hence are the field infection and mesh exposure rate reduced.
Also is this a mesh rather then a tape, providing the possibility to
reinforce the whole prolapse pelvic floor compartment rather than
supporting the vaginal apex only. The long-term effectiveness of this type
of uterine suspension as yet has to be demonstrated.