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Nederlands Tijdschrift Voor Geneeskunde 2011To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. (Review)
Review
OBJECTIVE
To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse.
DESIGN
Systematic review.
METHOD
We searched in Pubmed, Embase, the Cochrane Library and the reference lists of relevant publications for articles comparing uterus preserving procedures with vaginal hysterectomy. The following outcome measures were studied: anatomical result, subjective outcome regarding prolapse symptoms, micturition, defecation and sexual function, quality of life, duration of surgery, duration of hospital stay, amount of blood loss, complications and postoperative recovery.
RESULTS
We found one systematic review, one randomised trial and five cohort studies, from which eight comparative studies were selected for review. There was no difference in subjective outcome after sacrospinous fixation, Manchester Fothergill procedure, abdominal hysteropexy and intravaginal slingplasty on comparison with vaginal hysterectomy. All procedures, except for sacrospinous ligament fixation, had similar anatomical outcomes to vaginal hysterectomy. With the exception of Manchester Fothergill procedure hospital stay was shorter after uterus preservation. The quality of most of the studies was poor, with only small numbers of patients included and short-term follow up.
CONCLUSIONS
Although some uterus preserving procedures are associated with shorter operation time, shorter duration of hospital stay and less blood loss than vaginal hysterectomy, based on the current literature there is no clear preference for either uterus preserving surgery or hysterectomy in surgical treatment of uterine descent, since randomised trials of sufficient quality are lacking. Prospective clinical randomised trials with long term follow-up are needed to investigate the value of uterine preserving procedures.
Topics: Blood Loss, Surgical; Female; Gynecologic Surgical Procedures; Humans; Hysterectomy, Vaginal; Length of Stay; Postoperative Complications; Quality of Life; Treatment Outcome; Uterine Prolapse
PubMed: 22027462
DOI: No ID Found -
BMJ Clinical Evidence Mar 2007Prolapse of the uterus or vagina is usually the result of loss of pelvic muscle support, and causes mainly non-specific symptoms. It may affect over half of women aged... (Review)
Review
INTRODUCTION
Prolapse of the uterus or vagina is usually the result of loss of pelvic muscle support, and causes mainly non-specific symptoms. It may affect over half of women aged 50-59 years, but spontaneous regression may occur. Risks of genital prolapse increase with advancing parity and age, increasing weight of the largest baby delivered, and hysterectomy.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments in women with genital prolapse? What are the effects of surgical treatments in women with genital prolapse? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found four systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: abdominal Burch colposuspension, abdominal sacral colpopexy, abdominal sacrohysteropexy, anterior colporrhaphy with mesh reinforcement, laparoscopic surgery, mesh or synthetic grafts, native (autologous) tissue, open abdominal surgery, pelvic floor muscle exercises, posterior colporrhaphy (with or without mesh reinforcement), posterior intravaginal slingplasty (infracoccygeal sacropexy), sacrospinous colpopexy (vaginal sacral colpopexy), sutures, traditional anterior colporrhaphy, transanal repair, ultralateral anterior colporrhaphy alone or with cadaveric fascia patch, vaginal hysterectomy, vaginal oestrogen, vaginal pessaries, and vaginal sacrospinous colpopexy.
Topics: Cystocele; Female; Gynecologic Surgical Procedures; Humans; Hysterectomy, Vaginal; Laparoscopy; Pessaries; Prolapse; Surgical Mesh; Transplants; Uterine Prolapse; Vagina
PubMed: 19454058
DOI: No ID Found -
BJOG : An International Journal of... Jan 2010Trial of vaginal birth after Caesarean (VBAC) is considered acceptable after one caesarean section (CS), however, women wishing to have trial after two CS are generally... (Comparative Study)
Comparative Study Meta-Analysis Review
Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.
BACKGROUND
Trial of vaginal birth after Caesarean (VBAC) is considered acceptable after one caesarean section (CS), however, women wishing to have trial after two CS are generally not allowed or counselled appropriately of efficacy and complications.
OBJECTIVE
To perform a systematic review of literature on success rate of vaginal birth after two caesarean sections (VBAC-2) and associated adverse maternal and fetal outcomes; and compare with commonly accepted VBAC-1 and the alternative option of repeat third CS (RCS).
SEARCH STRATEGY
We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, Current Controlled Trials, HMIC Database, Grey Literature Databases (SIGLE, Biomed Central), using search terms Caesarean section, caesarian, C*rean, C*rian, and MeSH headings 'Vaginal birth after caesarean section', combined with second search string two, twice, second, multiple.
SELECTION CRITERIA
No randomised studies were available, case series or cohort studies were assessed for quality (STROBE), 20/23 available studies included.
DATA COLLECTION AND ANALYSIS
Two independent reviewers selected studies and abstracted and tabulated data and pooled estimates were obtained on success rate, uterine rupture and other adverse maternal and fetal outcomes. Meta-analyses were performed using RevMan-5 to compare VBAC-1 versus VBAC-2 and VBAC-2 versus RCS.
MAIN RESULTS
VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel).
CONCLUSIONS
Women requesting for a trial of vaginal delivery after two caesarean sections should be counselled appropriately considering available data of success rate 71.1%, uterine rupture rate 1.36% and of a comparative maternal morbidity with repeat CS option.
Topics: Asphyxia Neonatorum; Cesarean Section, Repeat; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Risk Factors; Trial of Labor; Vaginal Birth after Cesarean
PubMed: 19781046
DOI: 10.1111/j.1471-0528.2009.02351.x -
European Journal of Obstetrics,... Jan 2017To critically appraise studies comparing benefits and harms in women with benign disease without prolapse undergoing hysterectomy by natural orifice transluminal... (Comparative Study)
Comparative Study Meta-Analysis Review
Postoperative outcomes and quality of life following hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) compared to laparoscopy in women with a non-prolapsed uterus and benign gynaecological disease: a systematic review and meta-analysis.
OBJECTIVE
To critically appraise studies comparing benefits and harms in women with benign disease without prolapse undergoing hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) versus laparoscopy.
STUDY DESIGN
We followed the PRISMA guidelines. We searched MEDLINE, EMBASE and CENTRAL for randomised controlled trials (RCTs), controlled clinical trials (CCTs) and cohort studies comparing NOTES with laparoscopy assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH) in women bound to undergo removal of a non-prolapsed uterus for benign disease. Two authors searched and selected studies, extracted data and assessed the risk of bias independently. Any disagreement was resolved by discussion or arbitration.
RESULTS
We did not find RCTs but retrieved two retrospective cohort studies comparing NOTES with LAVH. The study quality as assessed by the Newcastle-Ottawa scale was acceptable. Both studies reported no conversions. The operative time in women treated by NOTES was shorter compared to LAVH: the mean difference (MD) was -22.04min (95% CI -28.00min to -16.08min; 342 women; 2 studies). There were no differences for complications in women treated by NOTES compared to LAVH: the risk ratio (RR) was 0.57 (95% CI 0.17-1.91; 342 women; 2 studies). The length of stay was shorter in women treated by NOTES versus LAVH: the MD was -0.42days (95% CI -0.59days to -0.25days; 342 women; 2 studies). There were no differences for the median VAS scores at 12h between women treated by NOTES (median 2, range 0-6) or by LAVH (median 2, range 0-6) (48 women, 1 study). There were no differences in the median additional analgesic dose request in women treated by NOTES (median 0, range 0-6) or by LAVH (median 1, range 0-5) (48 women, 1 study). The hospital charges for treatment by NOTES were higher compared to LAVH: the mean difference was 137.00 € (95% CI 88.95-185.05 €; 294 women; 1 study).
CONCLUSIONS
At the present NOTES should be considered as a technique under evaluation for use in gynaecological surgery. RCTs are needed to demonstrate its effectiveness.
Topics: Adult; Blood Loss, Surgical; Evidence-Based Medicine; Female; Genital Diseases, Female; Hospital Charges; Humans; Hysterectomy; Laparoscopy; Length of Stay; Natural Orifice Endoscopic Surgery; Postoperative Complications; Postoperative Hemorrhage; Quality of Life; Uterine Diseases
PubMed: 27880893
DOI: 10.1016/j.ejogrb.2016.10.044 -
BMJ Clinical Evidence May 2007Between 5-77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, infertility, or... (Review)
Review
INTRODUCTION
Between 5-77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, infertility, or recurrent pregnancy loss. Risk factors for fibroids include obesity, having no children, and no long-term use of the oral contraceptive pill. Fibroids tend to shrink or fibrose after the menopause.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: medical treatment alone; preoperative medical treatments for women scheduled for surgery; and surgical treatments in women with fibroids? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 41 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: gonadorelin analogues (with progestogen, raloxifene, tibolone, or combined oestrogen-progestogen); hysterectomy (plus oophorectomy); hysteroscopic resonance-focused ultrasound; laparoscopic myomectomy; laparoscopically assisted vaginal hysterectomy; rollerball endometrial ablation; thermal balloon ablation; thermal myolysis with laser; total abdominal hysterectomy; total abdominal myomectomy; total laparoscopic hysterectomy; total vaginal hysterectomy.
Topics: Humans; Hysterectomy; Hysterectomy, Vaginal; Leiomyoma; Uterine Neoplasms
PubMed: 19454074
DOI: No ID Found -
PloS One 2013Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this... (Review)
Review
BACKGROUND
Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding.
OBJECTIVES
We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy.
SEARCH STRATEGY
A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers.
RESULTS
Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy). Six patients were initially treated by silver nitrate application without success.
CONCLUSIONS
This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment.
Topics: Abdominal Pain; Dyspareunia; Fallopian Tube Diseases; Fallopian Tubes; Female; Humans; Hysterectomy; Postoperative Complications; Prolapse
PubMed: 24116117
DOI: 10.1371/journal.pone.0076543 -
Journal of Minimally Invasive Gynecology 2014We conducted a meta-analysis comparing the efficacy of laparoscopic suturing with or without barbed suture for myomectomy or hysterectomy. We used a systematic... (Meta-Analysis)
Meta-Analysis
We conducted a meta-analysis comparing the efficacy of laparoscopic suturing with or without barbed suture for myomectomy or hysterectomy. We used a systematic electronic search strategy of published literature using the following databases: Cochrane Database of Systematic Reviews, MEDLINE, Embase, and OVID MEDLINE In-Process & Other Non-Indexed Citations databases. The following medical subject heading terms, key words, and their combinations were used: laparoscopy, myomectomy, hysterectomy, and barbed suture. Studies in which women undergoing laparoscopic myomectomy or hysterectomy using barbed suture or conventional suture were selected. The main outcome measures chosen for the current meta-analysis were operative time, suturing time, estimated blood loss or change in hemoglobin level, and degree of suturing difficulty. The results of the meta-analysis studies were expressed as the standardized mean difference (SMD) with 95% confidence intervals (CIs). Compared with the use of conventional suture, the total operative time of laparoscopic myomectomy (SMD = -0.58; 95% CI, -0.88 to -0.28) and the suturing time to close the uterine incision (SMD = -1.38; 95% CI, -1.86 to -0.90) were significantly reduced with the use of barbed suture. Meta-analysis on laparoscopic hysterectomy shows that the time to suture the vaginal vault, the total operative time, and the estimated blood loss were comparable with or without the use of barbed suture. The degree of suturing difficulty was reported in 2 randomized trials. Compared with the use of conventional suture, the degree of suturing difficulty was lower with the use of barbed suture (SMD = -1.39; 95% CI, -1.83 to -0.95). The use of barbed suture facilitates laparoscopic suturing of myomectomy incision and closure of the vaginal vault. Its use is associated with a reduced operative time of laparoscopic myomectomy.
Topics: Adult; Blood Loss, Surgical; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Operative Time; Randomized Controlled Trials as Topic; Sutures; Uterine Myomectomy; Vagina
PubMed: 24126257
DOI: 10.1016/j.jmig.2013.09.014 -
The Cochrane Database of Systematic... Oct 2013Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management... (Comparative Study)
Comparative Study Review
BACKGROUND
Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management for selected early-stage cervical cancer is radical hysterectomy. Traditionally, radical hysterectomy has been carried out via the abdominal route and this remains the gold standard surgical management of early cervical cancer. In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery.
OBJECTIVES
To compare the effectiveness and safety of laparoscopically assisted radical vaginal hysterectomy (LARVH) and radical abdominal hysterectomy (RAH) in women with early-stage (1 to 2A) cervical cancer.
SEARCH METHODS
We searched the Cochrane Gynaecological Cancer Group Trials Register, and Cochrane Register of Controlled Trials (CENTRAL) Issue 7, 2013, MEDLINE, and EMBASE up to July 2013. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that compared laparoscopically assisted radical hysterectomy and radical abdominal hysterectomy, in adult women diagnosed with early (stage 1 to 2A) cervical cancer.
DATA COLLECTION AND ANALYSIS
Two review authors independently abstracted data and assessed risk of bias.
MAIN RESULTS
We found one RCT, which included 13 women, that met our inclusion criteria and this trial reported data on LARVH versus RAH.Women who underwent LARVH for treatment of early-stage cervical cancer appeared to have less blood loss compared with those who underwent RAH. The trial reported a borderline significant difference between the two types of surgery (median blood loss 400 mL (interquartile range (IQR): 325 to 1050) and 1000 mL (IQR: 800 to 1025) for LARVH and RAH, respectively, P value = 0.05). RAH was associated with significantly shorter operation time compared with LARVH (median: 180 minutes with LARVH versus 138 minutes with RAH, P value = 0.05).There was no statistically significant difference in the risk of perioperative complications in women who underwent LARVH and RAH. The trial reported two (29%) and four (57%) cases of intraoperative and postoperative complications, respectively, in the LARVH group and no (0%) reported cases of intraoperative complications and five (83%) cases of postoperative complications in the RAH group. There were no reported cases of severe perioperative complications.Bladder and bowel dysfunction of either a transient or chronic nature remain major morbidities after radical hysterectomy, and the one included study showed that there may be significantly less after LARVH.
AUTHORS' CONCLUSIONS
The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore, the absence of reliable evidence, regarding the effectiveness and safety of the two surgical techniques for the management of early-stage cervical cancer, precludes any definitive guidance or recommendations for clinical practice. The trial did not report data on long-term outcomes, but was at moderate risk of bias due to very low numbers of included women.
Topics: Adult; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Neoplasm Staging; Randomized Controlled Trials as Topic; Uterine Cervical Neoplasms
PubMed: 24085528
DOI: 10.1002/14651858.CD006651.pub3 -
American Journal of Obstetrics &... Oct 2023Previous cesarean delivery is a risk factor for developing placenta accreta spectrum in a subsequent pregnancy and patients with antenatally suspected placenta accreta...
BACKGROUND
Previous cesarean delivery is a risk factor for developing placenta accreta spectrum in a subsequent pregnancy and patients with antenatally suspected placenta accreta spectrum frequently undergo planned cesarean hysterectomy. There is a paucity of data regarding unsuspected placenta accreta spectrum among patients undergoing trial of labor after cesarean delivery for attempted vaginal birth after cesarean delivery.
OBJECTIVE
This study aimed to investigate the incidence, characteristics, and delivery outcomes of patients with placenta accreta spectrum diagnosed at the time of vaginal birth after cesarean delivery.
STUDY DESIGN
The Healthcare Cost and Utilization Project's National Inpatient Sample was retrospectively queried to examine 184,415 patients with a history of low transverse cesarean delivery who had vaginal delivery in the current index hospital admission between 2017 and 2020. Those with placenta previa, previous vertical cesarean delivery, other uterine scars, and uterine rupture were excluded. This study identified placenta accreta spectrum cases using the World Health Organization International Classification of Disease, Tenth Revision, codes of O43.2. Coprimary outcomes were (1) the incidence rate of placenta accreta spectrum at vaginal birth after cesarean delivery; (2) clinical and pregnancy characteristics related to placenta accreta spectrum, assessed with multivariable binary logistic regression model; and (3) delivery outcomes associated with placenta accreta spectrum by fitting propensity score adjustment. The secondary outcome was to conduct a systematic literature review using 3 public search engines (PubMed, Cochrane, and Scopus). Data on incidence rate and maternal morbidity related to placenta accreta spectrum at vaginal birth after cesarean delivery were evaluated.
RESULTS
The incidence rate of placenta accreta spectrum at vaginal birth after cesarean delivery was 8.1 per 10,000 deliveries. Most placenta accreta spectrum cases were placenta accreta (83.3%). In a multivariable analysis, older maternal age, tobacco use, preeclampsia, multifetal pregnancy, fetal anomaly, preterm premature rupture of membrane, chorioamnionitis, low-lying placenta, and preterm delivery were associated with an increased risk of placenta accreta spectrum (all, P<.05). Of these factors, low-lying placenta had the largest odds for placenta accreta spectrum (526.3 vs 7.3 per 10,000 deliveries; adjusted odds ratio, 35.02; 95% confidence interval, 18.19-67.42). Patients in the placenta accreta spectrum group were more likely to have postpartum hemorrhage (80.0% vs 5.5%), blood product transfusion (23.3% vs 1.0%), shock or coagulopathy (20.0% vs 0.2%), and hysterectomy (43.3% vs <0.1%) than those without placenta accreta spectrum (all, P<.001). In a systematic literature review, a total of 212 studies were screened, and none of these studies examined the incidence and morbidity of placenta accreta spectrum at vaginal birth after cesarean delivery.
CONCLUSION
This nationwide assessment suggests that although placenta accreta spectrum with vaginal birth after cesarean delivery is uncommon (1 of 1229 cases), the diagnosis of placenta accreta spectrum at vaginal birth after cesarean delivery is associated with significant maternal morbidity. In addition, the data suggest that low-lying placenta in the setting of previous low transverse cesarean delivery warrants careful evaluation for possible placenta accreta spectrum before a trial of labor.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Placenta Accreta; Vaginal Birth after Cesarean; Retrospective Studies; Cesarean Section; Delivery, Obstetric; Premature Birth
PubMed: 37543142
DOI: 10.1016/j.ajogmf.2023.101115 -
Obstetrical & Gynecological Survey Mar 2017Pelvic organ prolapse is a common condition, the prevalence of which is likely to increase with the aging of our population. Also changing are parameters by which... (Review)
Review
IMPORTANCE
Pelvic organ prolapse is a common condition, the prevalence of which is likely to increase with the aging of our population. Also changing are parameters by which outcomes are assessed, shifting toward patient-centered care.
OBJECTIVE
To review vaginal obliterative procedures for surgical treatment of advanced pelvic organ prolapse historically and to discuss evidence on indications for colpocleisis, outcomes, and complications, as well as review pros and cons for concomitant vaginal hysterectomy and anti-incontinence procedures.
EVIDENCE ACQUISITION
Review predominantly of the English language literature on issues associated with obliterative vaginal surgery for advanced pelvic organ prolapse from LeFort's and Neugebauer's original description in the late 1800s to now.
RESULTS
LeFort and total colpocleisis are effective procedures for surgical treatment of advanced pelvic organ prolapse with relatively low complication rates. Patient satisfaction is high. Loss of coital function is rarely a reason for regret. Hysterectomy is not required in most patients with procidentia. Anti-incontinence procedures can be performed at time of colpocleisis for patients with coexisting stress incontinence. Evidence is conflicting with regard to occult stress urinary incontinence.
CONCLUSIONS AND RELEVANCE
Colpocleisis are valuable procedures for women with severe pelvic organ prolapse who do not wish to retain coital function. Results are maintained in women with recurrent prolapse after prior failed reconstructive surgery. Considering a patient's goals for surgery and comprehensive presurgical counseling are important determinants of patient satisfaction.
TARGET AUDIENCE
Obstetricians and gynecologists, family physicians.
LEARNING OBJECTIVES
After completing this activity, the learner should be better able to list indications and contraindications for vaginal obliterative procedures, discuss risks and benefits of sling placement at time of colpocleisis, list perioperative complications, and discuss perioperative workup for LeFort colpocleisis.
Topics: Female; Gynecologic Surgical Procedures; Humans; Hysterectomy; Patient Satisfaction; Pelvic Organ Prolapse; Postoperative Complications; Sexual Behavior; Suburethral Slings; Treatment Outcome; Urinary Incontinence, Stress; Vagina
PubMed: 28304415
DOI: 10.1097/OGX.0000000000000406