UROLOGICAL SURVEY
Elliott DS, Krambeck AE, Chow GK.
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
J Urol. 2006; 176: 655-9
PURPOSE: Transabdominal sacrocolpopexy is a definitive treatment option for vaginal vault prolapse with durable success rates. However, it is associated with increased morbidity compared with vaginal repairs. We describe a minimally invasive technique of vaginal vault prolapse repair and present our experience with a minimum of 1 year followup.
MATERIALS AND METHODS: The surgical technique involves 5 laparoscopic ports: 3 for the da Vinci robot and 2 for the assistant. A polypropylene mesh is attached to the sacral promontory and vaginal apex using polytetrafluoroethylene sutures. The mesh material is then covered by peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction and morbidity with a minimum of 12 months followup.
RESULTS: A total of 30 patients with post-hysterectomy vaginal vault prolapse underwent robotic assisted laparoscopic sacrocolpopexy at our institution and 21 have a minimum of 12 months followup. Mean followup was 24 months (range 12 to 36) and mean age was 67 years (range 47 to 83). Mean operative time was 3.1 hours (range 2.15 to 4.75). All but 1 patient were discharged home on postoperative day 1 and the 1 patient left on postoperative day 2. Recurrent grade 3 rectocele developed in 1 patient, 1 had recurrent vault prolapse and 2 had vaginal extrusion of mesh. All patients were satisfied with outcome.
CONCLUSIONS: The robotic assisted laparoscopic sacrocolpopexy is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the decreased morbidity of laparoscopy. We found a decreased hospital stay, low complication rates and high patient satisfaction with a minimum of 1 year followup.
Editorial Comment
This article discusses the use of robotic assisted laparoscopic sacrocolpopexy for female vaginal vault prolapse. The authors review their findings in thirty patients treated with this technique with a minimum of 12 month follow-up and found excellent results at the end of the study period.
These surgeons should be congratulated for this and their previous report on the use of robotic technology in urologic and pelvic floor reconstruction (1). Currently, the vast majority of discussion of the use of the robot has been with prostatic surgery when it appears, as presently reported, that it has great potential applicability to pelvic floor reconstruction. Praise should be extended for the author's frank discussion of their management of short and long term complications and in describing the evolution of their surgical technique to address and minimize same. Their dedication to the principles and tenets of pelvic floor reconstruction should be noted. I hope that in the future, the readership of this journal will have the opportunity to review the 3 and 5 year durability rates of this studied patient population.
Reference
1. DiMarco DS, Chow GC, Gettman MT, Elliott DS: Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology. 2004; 63: 373-6.
Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke's Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
Dorsal Graft Urethroplasty for Female Urethral Stricture
Tsivian A, Sidi AA
Department of Urologic Surgery, Wolfson Medical Center, Holon, Tel Aviv University, Israel
J Urol. 2006; 176: 611-3
PURPOSE: Urethral strictures in females are uncommon, and treatment options and outcome are not well-defined with scanty reports. We describe a new method of urethroplasty for the repair of female urethral stricture.
MATERIALS AND METHODS: Three 60-year-old females, each with a history of recurrent urinary tract infections and obstructive voiding symptoms due to urethral stricture, underwent urethroplasty with a dorsal vaginal or buccal mucosal graft. The dorsal aspect of the distal urethra was dissected from the surrounding tissue through a suprameatal incision and the urethral wall was incised through the stricture at the 12 o'clock position. A 1.5 cm wide free graft was harvested from the vaginal wall or buccal mucosa in 1 case, and the mucosal surface was placed upon the urethral lumen and sutured with a running 5-zero polyglactin suture to the open urethra. Indwelling 18Fr urethral and 16Fr suprapubic catheters were left in place for 2 and 3 weeks, respectively.
RESULTS: No additional treatment was required during the 1, 8 and 27 months of followup. All patients had normal micturition following catheter removal.
CONCLUSIONS: Dorsal graft urethroplasty is feasible and effective for the correction of persistent female urethral stricture.
Editorial Comment
The authors describe a method of addressing female urethral stricture through a suprameatal approach. The technique utilized both vaginal wall graft as well buccal mucosa with excellent results.
These surgeons used the same incision as that used for the suprameatal transvaginal urethrolysis (1). Of note is though significant strictures were addressed, there was no incidence of stress urinary incontinence postoperatively. As discussed with the use of the suprameatal transvaginal urethrolysis, patients should be warned of potential sexual dysfunction utilizing this approach secondary to its proximity to the clitoris1. Though the authors suffered no stress urinary incontinence in their patient population, they do make the excellent point that the area of potential addressment with a suburethral sling is not surgically altered through their urethroplasty approach.
Reference
1. Petrou SP, Brown JA, Blaivas JG: Suprameatal transvaginal urethrolysis. J Urol. 1999; 161: 1268-71.
Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke's Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
Neurourology & female urology
Publication Dates
-
Publication in this collection
23 Oct 2006 -
Date of issue
Aug 2006
