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BACKGROUND: Laparoscopic pectopexy is an alternative to sacrocolpopexy that was first reported in 2010. This procedure has been performed at our hospital since 2019 in patients with contraindications to sacrocolpopexy. OBJECTIVE: This study aimed to compare the outcomes of 50 cases of pectopexy with historical outcomes data for sacrocolpopexy. STUDY DESIGN: This was a retrospective review of 50 laparoscopic pectopexies performed from July 2020 to July 2022 at an academic tertiary referral center; this was the second reported use of this technique in North America. The outcomes from laparoscopic pectopexy were compared with laparoscopic sacrocolpopexy performed at the same institution by the same surgeons (n=207). The primary outcomes were complication rate, rate of recurrent prolapse (stage II or greater), and reoperation. RESULTS: Overall complication rates were 6.0% for pectopexy and 16.5% for sacrocolpopexy (relative risk, 0.79; P=.65). Recurrent prolapse was seen among 2.0% of patients who underwent pectopexy and 6.3% of patients who underwent sacrocolpopexy at most recent follow-up (relative risk, 1.27; P=.66). The rates of reoperation were 2.0% for pectopexy and 3.9% for sacrocolpopexy (relative risk, 1.04; P=.96). The average operative times were 138 minutes for pectopexy and 158 minutes for sacrocolpopexy. The average lengths of follow-up were 88.1 days for pectopexy and 325.5 for sacrocolpopexy. CONCLUSION: Although pectopexy was typically employed in patients with extensive pelvic adhesions or other conditions that placed them at higher risk of complications, both the success rate and the adverse event rate were similar to those in the historical cohort who underwent sacrocolpopexy. Although sacrocolpopexy remains the gold standard operation for apical prolapse, our data suggest that pectopexy can be employed to offer similar outcomes in many patients with contraindications to sacral fixation. These data give us increasing confidence that we can counsel our patients that this operation is likely to produce an outcome similar to a sacrocolpopexy.
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Laparoscopic pectopexy is an alternative to sacrocolpopexy utilizing fixation points in the anterior pelvis for vaginal vault suspension; it was originally developed for an obese population. This is a retrospective case series of 7 women who underwent laparoscopic pectopexy at one academic Institution between October 2019 and December 2020. The patients had preoperative vaginal vault prolapse (pelvic organ prolapse quantification system [POP-Q], stage 2 and 3). Pectopexy was performed because of relative contraindications to sacrocolpopexy, including use of antiplatelet therapy, extensive adhesions, and chronic back pain with lumbo-spinal fusion. No intraoperative complications were documented in this cohort. Average blood loss was 32.9 mL. All the patients were discharged home within 24 hours. One patient experienced urinary retention that required release of the retropubic midurethral sling placed at the time of pectopexy. The most recent follow-up examination occurred at an average of 127 days after the procedure. All 7 patients had a resolution of their prolapse (POP-Q ≤1). This case series highlights the application of pectopexy for patients with extensive adhesions, use of antiplatelet therapy and lumbar or sacral spinal surgical history. The complication rates and operative results are comparable with sacrocolpopexy at intermediate-term follow-up in this small case series, indicating that pectopexy may be a promising alternative for patients with relative contraindications to sacrocolpopexy. This is the first report of the application of the technique in North America.
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OBJECTIVES: The aim of this study was to investigate the association between urinary phytoestrogen levels with symptoms of pelvic organ prolapse (POP) and fecal incontinence (FI) in postmenopausal women. METHODS: This is a cross-sectional study using the National Health and Nutrition Examination Survey database from 2005 to 2010 including postmenopausal women 40 years or older who either had both ovaries removed and/or had no period in the past year due to hysterectomy and/or menopause. Urinary concentrations of 6 phytoestrogens were measured. Pelvic organ prolapse symptoms were defined as a positive response to the question, "Do you see or feel a bulge in the vaginal area?" Fecal incontinence was defined as leakage of mucus, liquid, or solid stool occurring at least monthly. Using appropriate sample weights, prevalence estimates and 95% confidence intervals were calculated. Logistic regression was performed assessing associations between pelvic floor symptoms and log-transformed phytoestrogen levels adjusting for appropriate covariates. RESULTS: Participants included 1341 postmenopausal women with phytoestrogen data; 1213 with or without POP symptoms and 1221 with or without FI symptoms. Multivariable analysis revealed no association of urinary phytoestrogen levels with POP symptoms. Higher urinary O-desmethylangolensin level was associated with decreased odds of FI symptoms in postmenopausal women (adjusted odds ratio, 0.92; 95% confidence interval, 0.86-0.99). CONCLUSIONS: Increased urinary O-desmethylangolensin level was associated with lower odds of FI. Future research may be warranted to further investigate the potential of specific phytoestrogens as mediators of FI, as well as the role of phytoestrogens on POP symptoms.
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Incontinencia Fecal/epidemiología , Incontinencia Fecal/orina , Isoflavonas/orina , Prolapso de Órgano Pélvico/epidemiología , Prolapso de Órgano Pélvico/orina , Fitoestrógenos/orina , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Encuestas Nutricionales , Posmenopausia , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Urinary incontinence, pelvic organ prolapse, and fecal incontinence are pelvic floor disorders (PFDs) disproportionately experienced by postmenopausal women. Limited data exist suggesting that phytoestrogens may have an impact on the pathophysiology and symptom of PFDs. PURPOSE OF REVIEW: The aim of the study was to review the current literature addressing the role of phytoestrogens on PFDs, including the pathophysiology, symptom, treatment, and possible prevention. FINDINGS: Qualifying literature spans from 2003 to 2017 and included 14 studies ranging from in vitro, animal, and observational studies to randomized clinical trials. SUMMARY: Although the literature is limited, most studies on phytoestrogens and PFDs support associations with pathophysiologic mechanisms, symptoms, and treatment for urinary incontinence and pelvic organ prolapse, but not fecal incontinence. Less is known regarding the prevention of PFDs with phytoestrogen intake over time. Overall, the potential influence of phytoestrogens on PFDs is not well understood, and more research is needed.
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Trastornos del Suelo Pélvico/tratamiento farmacológico , Fitoestrógenos/uso terapéutico , Animales , Femenino , Humanos , Diafragma Pélvico/fisiopatología , Trastornos del Suelo Pélvico/etiología , Trastornos del Suelo Pélvico/prevención & control , Fitoestrógenos/efectos adversosRESUMEN
OBJECTIVE: The aim of this study was to evaluate the associations between type and route of hormone use and urinary incontinence (UI) and pelvic organ prolapse (POP) in premenopausal and postmenopausal women. METHODS: The authors used the National Health and Nutritional Examination Survey database for data from 2005-2006, 2007-2008, 2009-2010, and 2011-2012. Seven thousand sixty-six of the women included were premenopausal, and 5387 were postmenopausal. Premenopausal women were younger than 51 years and reported menstrual periods in the last 12 months. Postmenopausal women reported being in natural or surgical menopause. Urinary incontinence was defined as experiencing urinary leakage "less than once a month" or more. Pelvic organ prolapse was defined as an affirmative response to "experience bulging in the vaginal area." Hormone route and use were stratified in years. Pearson χ and Pearson correlations were used, with P < 0.05 considered significant. RESULTS: In premenopausal women, birth control pills, estrogen/progestin pills, and estrogen-only patch use are associated with UI (P < 0.05). Birth control pills are associated with both UI and POP in premenopausal women (P < 0.05 for UI and POP). In postmenopausal women, estrogen-only pills, and estrogen/progestin pill use are associated with UI (P < 0.05). Birth control pill use is associated with POP in postmenopausal women (P = 0.029). Neither estrogen patch nor estrogen/progestin patch is associated with UI or POP in postmenopausal women. CONCLUSIONS: Type and route of hormone use have varied associations with UI and POP in premenopausal and postmenopausal women. Prospective studies are needed to further evaluate the effect of hormone type and route on UI and POP in premenopausal and postmenopausal women.
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Hormonas Esteroides Gonadales/efectos adversos , Prolapso de Órgano Pélvico/inducido químicamente , Incontinencia Urinaria/inducido químicamente , Administración Cutánea , Adolescente , Adulto , Anciano , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Estrógenos/efectos adversos , Femenino , Terapia de Reemplazo de Hormonas , Humanos , Persona de Mediana Edad , Encuestas Nutricionales , Posmenopausia/fisiología , Premenopausia/fisiología , Progestinas/efectos adversos , Estudios Prospectivos , Parche Transdérmico , Adulto JovenRESUMEN
Context: The premenopausal circulating lipid profile may be linked to the hormonal profile and ovarian lipid metabolism. Objective: Assess how estradiol, progesterone, and ovarian lipid metabolism contributes to the premenopausal lipid profile; and evaluate the acute effects of a common hormonal oral contraceptive (OC) on circulating lipids. Design: Experimental crossover with repeated measures. Setting: Academic hospitals. Patients: Eight healthy, regularly menstruating women. Interventions: Participants underwent periodic serum sampling during a normal menstrual cycle; a standard 21-day, monophasic combined hormonal OC cycle (30 µg of ethinyl estradiol and 150 µg of levonorgestrel per day); menopause simulated by leuprolide acetate (22.5-mg depot); and an artificial menstrual cycle achieved via transdermal estradiol (50 to 300 µg/d) and vaginal micronized progesterone (100 to 300 mg/d). Main Outcome Measures: Primary outcomes included evaluation of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, triglycerides, and the total cholesterol to HDL cholesterol ratio. To estimate the effect of estradiol, progesterone, and ovarian lipid metabolism, all specimens except those from the OC cycle were analyzed. Subgroup analysis was conducted on the follicular and luteal phases. In a separate analysis, the effect of the OC was evaluated relative to the normal menstrual cycle. Results: Estradiol was significantly associated with increased levels of HDL cholesterol throughout the menstrual cycle and in the follicular phase. Ovarian effects were associated with reduced lipid levels, especially during the luteal phase. The OC was associated with an increased total cholesterol to HDL cholesterol ratio and triglycerides. Conclusion: Previously unappreciated factors including ovarian lipid metabolism may contribute to the premenopausal lipid profile.
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Anticonceptivos Hormonales Orales/administración & dosificación , Metabolismo de los Lípidos/fisiología , Ciclo Menstrual/sangre , Ovario/metabolismo , Premenopausia/sangre , Centros Médicos Académicos , Adulto , HDL-Colesterol/sangre , HDL-Colesterol/efectos de los fármacos , LDL-Colesterol/sangre , LDL-Colesterol/efectos de los fármacos , Intervalos de Confianza , Estudios Cruzados , Femenino , Voluntarios Sanos , Humanos , Metabolismo de los Lípidos/efectos de los fármacos , Investigación Cualitativa , Análisis de RegresiónRESUMEN
OBJECTIVE: This study was undertaken to examine the effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. STUDY DESIGN: Analysis of data from a multicenter, randomized, double-blind, placebo-controlled trial of a 0.014 mg/day transdermal estradiol patch in 417 women aged 60 to 80 years. Sexual function was assessed by self-administered questionnaires at baseline and 4, 12, and 24 months. A linear effects model was used to assess treatment effects using data from all on-study assessments. RESULTS: Women randomly assigned to estradiol had a 4.3 point greater improvement in the vaginal pain/dryness domain relative to placebo (95% CI = 0.3-8.4, P = .04). No significant differences in frequency of sexual activity or other sexual function domains (desire, satisfaction, problems, or orgasm) were observed between treatment groups (P > or = .10 for all). CONCLUSIONS: Ultralow-dose estradiol resulted in modest improvement in sexual function related to vaginal pain and dryness, but not in other domains of sexual function.
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Estradiol/administración & dosificación , Estradiol/farmacología , Estrógenos/administración & dosificación , Estrógenos/farmacología , Posmenopausia , Sexualidad/efectos de los fármacos , Sexualidad/fisiología , Administración Cutánea , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Ureteral injury during elective pregnancy termination is rare and has been reported only 8 times. Two of these cases involved avulsion, and 1 occurred during a second-trimester procedure. CASE: Ureteral avulsion and damage to the lower colon occurred during second-trimester pregnancy termination. Although the ureter was initially thought to be intact on direct visualization of the pelvic ureter and stent placement, pathologic evaluation of the curettage specimen revealed a segment of ureter. Subsequently, intravenous pyelography confirmed ureteral avulsion at the junction of the ureter with the kidney. CONCLUSION: Although damage to the ureter at the time of uterine evacuation is unusual, use of intraoperative intravenous pyelography may be advisable when injury is suspected but not obvious.
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Aborto Inducido/efectos adversos , Uréter/lesiones , Adulto , Asma/complicaciones , Colon/lesiones , Colon/cirugía , Femenino , Humanos , Nefrectomía , Embarazo , Complicaciones del Embarazo , Segundo Trimestre del Embarazo , Radiografía , Ultrasonografía Prenatal , Uréter/diagnóstico por imagenRESUMEN
OBJECTIVE: Data on the sexual activity of middle-aged and older women are scant and vary widely. This analysis estimates the prevalence and predictors of sexual activity and function in a diverse group of women aged 40-69 years. METHODS: The Reproductive Risk Factors for Incontinence Study at Kaiser (RRISK) was a population-based study of 2,109 women aged 40-69 years who were randomly selected from long-term Kaiser Permanente members. Women completed self-report questionnaires on sexual activity, comorbidities, and general quality of life. Logistic and linear regression and proportional odds models were used when appropriate to identify correlates of sexual activity, frequency, satisfaction, and dysfunction. RESULTS: Mean age was 55.9 (+/- 8) years and nearly three fourths of the women were sexually active. Of the sexually active women, 60% had sexual activity at least monthly, approximately two thirds were at least somewhat satisfied, and 33% reported a problem in one or more domains. Monthly or more frequent sexual activity was associated with younger age, higher income, being in a significant relationship, a history of moderate alcohol use, and lower body mass index (BMI) (all P < .05). Satisfaction with sexual activity was associated with African-American race, lower BMI, and higher mental health score (all P < .05). More sexual dysfunction was associated with having a college degree or greater, poor health, being in a significant relationship, and a low mental health score (all P < .05). CONCLUSION: Middle-aged and older women engage in satisfying sexual activity, and one third reported problems with sexual function. Demographic factors as well as some issues associated with aging can adversely affect sexual frequency, satisfaction, and function. LEVEL OF EVIDENCE: II-3.
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Calidad de Vida , Conducta Sexual/fisiología , Disfunciones Sexuales Fisiológicas/epidemiología , Disfunciones Sexuales Psicológicas/epidemiología , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Antropometría , California , Estudios de Cohortes , Escolaridad , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Lineales , Modelos Logísticos , Persona de Mediana Edad , Oportunidad Relativa , Satisfacción Personal , Prevalencia , Probabilidad , Medición de Riesgo , Disfunciones Sexuales Fisiológicas/diagnóstico , Disfunciones Sexuales Psicológicas/diagnóstico , Factores Socioeconómicos , Encuestas y Cuestionarios , Salud de la MujerRESUMEN
OBJECTIVE: To examine the prevalence and correlates of sexual activity and function in postmenopausal women with heart disease. METHODS: We included baseline self-reported measures of sexual activity and the sexual problem scale from the Medical Outcomes Study in the Heart and Estrogen/Progestin Replacement Study (HERS), a study of 2,763 postmenopausal women, average age 67 years, with coronary disease and intact uteri. We used multivariable linear and logistic regression to identify independent correlates of sexual activity and dysfunction. RESULTS: Approximately 39% of the women in HERS were sexually active, and 65% of these reported at least 1 of 5 sexual problems (lack of interest, inability to relax, difficulty in arousal or in orgasm, and discomfort with sex). In multivariable analysis, factors independently associated with being sexually active included younger age, fewer years since menopause, being married, better self-reported health, higher parity, moderate alcohol use, not smoking, lack of chest discomfort, and not being depressed. Among the 1,091 women who were sexually active, lower sexual problem scores were associated with being unmarried, being better educated, having better self-reported health, and having higher body mass index. CONCLUSION: Many women with heart disease continue to engage in sexual activity into their 70s, and two thirds of these report discomfort and other sexual function problems. Physicians should be aware that postmenopausal patients are sexually active and address the problems these women experience. LEVEL OF EVIDENCE: II-2.