| Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation. | |
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MedLine Citation:
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PMID: 12752079 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To identify risk factors in recurrence and to evaluate anatomic and functional results of vaginal sacrospinous ligament fixation and pelvic floor reconstruction for genital prolapse. METHODS: One hundred and thirty-eight women underwent surgery for uterovaginal or vault prolapse. Follow-up data were available for 122 cases; 83% were examined and others were interviewed by telephone. The median (range) follow-up was 24 (1-141) months. Cox regression was used to identify risk factors associated with recurrence; uni- and multivariate regression was used to identify risk factors underlying postoperative infections because infections were found to be a risk factor of recurrence. Recurrence-free survival was estimated using the Kaplan-Meier method. RESULTS: Seven (5%) patients suffered severe cardiopulmonary complications including one postoperative death due to a pulmonary embolism. Twenty-six (21%) patients suffered a recurrence, 14 with cystocele. Ten patients with recurrence were symptomatic and six underwent a re-operation. The Cox regression model showed that vaginal cuff infection raised the odds ratio (OR) for recurrence to 6.13 [confidence interval (CI) 1.80-20.83] and urinary tract infection to 3.65 (CI 1.40-9.47). In both uni- and multivariate analysis, lack of intravenous antibiotic prophylaxis, age less than 73 years and vaginal ulcerations were statistically significant risk factors for postoperative infection. Eleven (33%) out of 33 sexually active women reported improvement and three (9%) complained of dyspareunia. CONCLUSIONS: Transvaginal sacrospinous ligament fixation with pelvic floor repair is an effective means of correcting both vault prolapse and uterine procidentia. Women who wish to preserve coital function will also benefit from this operation. Postoperative infection is an independent and most important individual risk factor underlying recurrence. Prophylactic antibiotics seem to be effective in reducing the rate of postoperative infections. |
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Authors:
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Kari Nieminen; Heini Huhtala; Pentti K Heinonen |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Acta obstetricia et gynecologica Scandinavica Volume: 82 ISSN: 0001-6349 ISO Abbreviation: Acta Obstet Gynecol Scand Publication Date: 2003 May |
Date Detail:
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Created Date: 2003-05-19 Completed Date: 2003-07-08 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370343 Medline TA: Acta Obstet Gynecol Scand Country: Unknown |
Other Details:
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Languages: eng Pagination: 471-8 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School and School of Public Health, University of Tampere, Tampere, Finland. kn37975@uta.fi |
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| MeSH Terms | |
Descriptor/Qualifier:
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Activities of Daily Living Aged Aged, 80 and over Antibiotic Prophylaxis Broad Ligament / surgery* Female Finland Gynecologic Surgical Procedures / adverse effects, methods Humans Middle Aged Multivariate Analysis Pelvic Floor / surgery Proportional Hazards Models Pulmonary Embolism / etiology Quality of Life Recurrence Retrospective Studies Risk Factors Sacrococcygeal Region / physiopathology, surgery* Time Factors Urinary Tract Infections / etiology Uterine Prolapse / physiopathology, surgery* Vagina / surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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