Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques.
This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor.
This was a prospective, observational cohort study.
The study was conducted in a tertiary care setting.
All sexually active patients undergoing robot-assisted sacrocolporectopexy at our institution between 2012 and 2014 were included.
Robot-assisted sacrocolporectopexy was the study intervention.
Preoperative and postoperative (12 months) questionnaires using the Urinary Distress Inventory, Pescatori Incontinence Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and Pelvic Floor Impact Questionnaire were completed. In addition Wexner and Vaizey incontinence scores and the Wexner constipation score were recorded postoperatively.
Fifty-one patients underwent robot-assisted sacrocolporectopexy (median follow-up, 12.5 months). The simplified Pelvic Organ Prolapse Quantification improved significantly (p < 0.0005) for all 4 of the anatomic landmarks. Both median fecal (preoperative and postoperative Pescatori 4 vs 3, p = 0.002) and urinary incontinence scores (Urinary Distress Inventory, 27.8 vs 22.2; p < 0.0005) improved significantly at 12 months. Postoperatively median Wexner (3) and Vaizey incontinence (6) and Wexner Constipation (7) scores were noted. A positive effect on sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score 31.8 vs 35.9; p = 0.002) and quality of life for each compartment (p < 0.0005) was observed. One patient (2%) developed mesh erosion. No multicompartment recurrences were detected.
This was a observational study with a limited follow-up, no control group, and no preoperatively validated constipation score.
Robot-assisted sacrocolporectopexy is a safe and effective technique for multicompartment prolapse in terms of functional outcome, quality of life, and sexual function.
Diseases of the colon and rectum. 2016 Oct [Epub]
Jan J van Iersel, Chris J de Witte, Paul M Verheijen, Ivo A M J Broeders, Egbert Lenters, Esther C J Consten, Steven E Schraffordt Koops
1 Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands 2 Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands 3 Department of Gynecology, Meander Medical Center, Amersfoort, the Netherlands.