To date sacrocolpopexy is regarded as the gold standard treatment for primarily apical compartment prolapse and multi-compartment prolapse. Most bladder and bowel dysfunction improves post-operatively after sacrocolpopexy, however de-novo bowel or de-novo bladder dysfunction can occur. The inferior hypogastric nerve is commonly known amongst pelvic surgeons. However the inferior hypogastric nerve and its fine fibers are difficult to identify, iatrogenic lesion is commonly tolerated although this can lead to bladder, bowel and sexual dysfunction. This study was performed to assess the functional outcome after nerve-sparing sacrocolpopexy MATERIAL AND METHODS: From 2014 to 2016 all women undergoing a laparoscopic sacrocolpopexy for apical or multi-compartment prolapse stage >2 were included in this prospective study. Laparoscopic sacrocolpopexy was performed utilizing the nerve-sparing approach. Objective outcome was assessed by pre-and post-operative POP-Q changes. De-novo bladder and de-novo bowel dysfunction were subjectively and objectively evaluated RESULTS: 137 women were included. Significant objective improvement for point Aa and C (p<0.0001) pre- to post-operatively was seen. The posterior compartment remained unchanged with point Ba -2. De-novo overactive bladder and de-novo bladder outlet obstruction with elevated post-residual volume was seen for both in 0.7% (1/137). De novo stress urinary incontinence was seen in 0.7% (5/137). De-novo constipation was seen in 5%, bowel incontinence in 0% and resolution of pre-existing obstipation in 14.5%. De novo laxative use (9%) in the first 12 weeks was the most common post-operative problem CONCLUSION: We could demonstrate that when nerve-sparing technique is applied for sacrocolpopexy low de-novo bladder (18%) and de-novo bowel dysfunction can be seen. This article is protected by copyright. All rights reserved.
Acta obstetricia et gynecologica Scandinavica. 2018 Mar 01 [Epub ahead of print]
Corina Christmann-Schmid, Isabell Koerting, Esther Ruess, Ivo Faehnle, Jörg Krebs
Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.