Izett, Matthew;
(2021)
The surgical management of uterine prolapse and the role of mesh.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Background Uterine prolapse is a common condition that impairs quality of life. Vaginal hysterectomy with apical suspension is the standard treatment, yet associated with a high risk of recurrent prolapse. Laparoscopic sacrohysteropexy offers an alternative approach, resuspending the uterus utilising non-absorbable mesh. However, supporting evidence is low quality and mesh use is controversial. Predicting postoperative bladder function remains challenging, and patients’ postoperative health concerns remains unexplored within academic literature. Aim Determine the safety and efficacy of laparoscopic sacrohysteropexy. Understand the role of urodynamic studies for bladder dysfunction. Explore women’s health concerns following the procedure. Methods Cross-sectional study to determine the incidence of mesh associated complications. Randomised controlled trial comparing vaginal hysterectomy to laparoscopic sacrohysteropexy. Retrospective cohort study to compare preoperative urodynamic diagnoses to postoperative bladder symptoms. Thematic analysis exploring health concerns in women following laparoscopic sacrohysteropexy. Results Following laparoscopic sacrohysteropexy, the incidence of reoperation for mesh associated complications is 0.4% of from a cohort of 1,121 women at an average four years postoperatively. The randomised controlled trial with 101 participants showed a non-significant trend towards a lower rate of apical reoperation following sacrohysteropexy as compared to vaginal hysterectomy (6.1% versus 17.2% p = 0.17 ) at seven years. Only a preoperative urodynamic diagnosis of voiding dysfunction is significantly associated with such symptoms postoperatively. The principal focus for women following the procedure are their pelvic floor symptoms and associated quality of life. Conclusion Laparoscopic sacrohysteropexy appears to be associated with a low risk of mesh associated complications requiring reoperation. It may confer anatomical and recurrent prolapse associated benefits as compared to vaginal hysterectomy. Preoperative urodynamic diagnoses appear to correlate poorly with postoperative bladder function, yet diagnosing stress incontinence may alter surgical management. Despite ongoing media coverage and debate about mesh, this is not the focus of women who have had mesh augmented surgery.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | The surgical management of uterine prolapse and the role of mesh |
| Event: | UCL |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10134005 |
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