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To analyse the results of the long-term prospective follow-up study of vaginal prolapse reconstructed using a Prolift Posterior.Prospective, cohort study.Institute for the Care of Mother and Child, Prague.Over a 5-year period (I/2006 - XII/2011) we prospectively followed a cohort of patients with posterior vaginal wall defect who underwent surgical reconstruction using a monofilament polypropylene implant Prolift Posterior (Gynecare, Ethicon, Inc., Piscataway, NJ, USA). Patients were invited for review at six weeks, three months, six months, 12 months and then yearly up to five years. Postoperative follow-up included the clinical examination and subjective evaluation using VAS, PISQ 12 and ICIQ SF.One hundred twenty-four women were included in the study, of which 14 (11.3%) had no prolapse surgery in their health history. There were no concomitant vaginal procedures such as hysterectomy or another implant surgery. The average operation time and blood loss were 64.25 min (min. 10, max. 205 min) and 115 ml (min. 10 ml, max. 1000 ml), respectively. Only one patient had a blood loss 1000 ml. There were no injuries of the urinary bladder or intestines during the needle insertion of the mesh. In the five-year period, the recurrence of posterior vaginal wall defect was observed in 4 cases (3.3%). The average time to the posterior vaginal wall recurrence prolapse was 19.5 months (min. 6, max. 36). De novo prolapse in the anterior compartment was observed in 25 patients (20.5%).In this prospective single centre study, we observed anatomical improvement in the implanted compartment with low recurrence rate. During five years follow-up period there was de novo anterior vaginal wall defect observed in 20.5% cases. The question of implant employment in urogynecology remain to be answered, however, our results show that implants have their position in reconstructive surgery.

The aim of the study is to compare the results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation.A single-center prospective, cohort study, in patients with defect grade II and more by POP-Q.The Institute for the Care of Mather and Child; 3rd Medical Faculty Charles university, Prague.Comparison of the preoperative state and the five years after the operation according POP Q, ICIQ-SF, PISQ 12, VAS. Comparison of intraoperative and postoperative complications.The study was attended by 142 patients; 75 patients underwent surgery Prolift Total and 67 patients sacrospinous fixation by Amreich Richter. On clinical examination at 5-year follow-up, we observed 15 (20.0%) case of anatomical failure in the Prolift group and 30 (44.8%) in the SSF group. Anatomic failure was defined clinically as Ba, C or Bp at the hymen or below. In assessing the overall condition before and five years after surgery using a VAS occurred in patients in the cohort Prolift Total decrease to 2.9 (± 1.9) from the original 7.8 (± 1.8). VAS in SSF group decreased after 5 years to 4.2 (± 2.7) of the original 7.8 (± 1.4). Values ICIQ-SF, analyzing the state of voiding PT group showed a decline from the original 6.7 (± 6.9) to 5.5 (± 5.3). A similar trend was evident even after the SSF. Parameters questionnaire PISQ-12 showed a positive increase from the original 28.6 (± 9.5) to 31.8 (± 7.9) points. PISQ-12 was improved from 28.7 (± 9.8) to 32.2 (± 7.5).Recurrences were observed more frequently in patients after sacrospinous fixation, while the quality of life questionnaires yielded comparable postoperative results. Quantity of intraoperative complications is low and both groups do not differ.

To describe first two cases of robotic sacrocolpopexy in the Czech Republic.Two case reports with literature overview.Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc.Robotic sacrocolpopexy was performed in two patients of the age 36 and 59 at the department of obstetrics and gynecology in Olomouc in 2009. We describe vaginal prolapse treatment in one case, and supracervical hysterectomy with cervicosacropexy in the other. These two cases are compared with literature overview, including long-term follow-up.Robotic sacrocolpopexy encompasses all advantages of minimally invasive surgery. Our results, as well as published data show very good long term results of vaginal prolapse treatment using this approach.

Levator ani avulsion injury is one of the main factors associated with vaginal prolapse of all compartments. Levator avulsion is the main link between vaginal delivery and subsequent vaginal prolapse - cause and sequel. The risk for prolapse is doubled in women with levator injury (RR = 1,9). The risk for prolapse is mainly expressed for anterior and central compartment. In retrospective analysis of women after vaginal repair without use of implants the recurrence rate was 29%. In subanalysis of only of women with recurrence the avulsion injury was detected in 85%. The risk of recurrence of prolapse after native tissue repair is four times higher if the avulsion is present to those where not. Levator avulsion injury is main etiological and risk factor associated with uterine and vaginal prolapse as the sequel of delivery trauma. This injury also increases significantly the risk of prolapse recurrence after native tissue vaginal repair.

Pelvic organ prolapse affect 50% of parous women over 50 years of age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 is 11.1%. Recurrence rates for classical prolapse surgery are as high as 30%. For this reason various graft materials have been proposed to improve the long-term surgical outcomes. The aim of our study was to investigate the safety and efficacy of posterior colporrhaphy incorporating Vypro II (polyglactin 910-polypropylene) mesh in the treatment of posterior vaginal wall prolapse.Retrospective study.Gynaecological and Obstetric Clinic, First Medical Faculty of Charles University and General University Hospital, Prague.Standard posterior colporrhaphy was performed with levator ani muscles plication. Vypro II (Ethicon, Somerville, NJ, USA) is a type III macroporous mixed fibre lightweight mesh composed of 50% absorbable multifilamentous polyglactin 910 and of 50% non-absorbable multifilamentous polypropylene fibres. This operation was performed in 28 women between March 2003 and November 2005. All patients underwent before surgery, urodynamics, ultrasound and physical examination. 22 women (78.5%) had a previous hysterectomy, 16 women (57%) had previous pelvic surgery for prolapse and/or urinary incontinence. Concomitant surgeries performed included vaginal hysterectomy 7% (n = 2), anterior colporrhaphy 50% (n = 14), anterior colporrhaphy with Vypro II mesh 21.4% (n = 6), TVT 7% (n = 2), TVT O 7% (n = 2), sacrospinous vaginal vault suspension 32% (n = 9). The pelvic organ prolapse was staged in ICS POP-Q system. All women had stage II-IV symptomatic prolapse of the posterior compartment (11 patients 39.2% with stage II, 14 patients 50% with stage III and 3 patients 10.7% with stage IV). All patients were examined always in case of complications and were invited to follow-up 2 months after surgery and once a year. The mean follow-up was 26.2 months (range 2-58), whereas 71% of patients had a follow up longer then 24 months.Patients mean age was 63.7 years (range 46-83), mean parity 2.1 (1-3) and mean BMI 30.34 kg/m2 (25-42). There were no operative or early postoperative complications like bowel erosion or rectovaginal fistula. The incidence of rectocele recurrence was 10.7%: 1 case of stage II rectocele and 2 cases of stage III rectocele. The incidence of mesh vaginal erosion was 10.7%. Two cases were resolved by repeated excision in office and by local estrogen and local antimicrobial therapy. The third case required reoperation and mesh exstirpation.Posterior colporrhaphy with levator ani muscles plication and incorporating a Vypro II mesh was associated with a higher incidence of post-operative complications even if cure rate was quite good.

Polypropylene mesh in the treatment of genital prolapse in women was introduced at the turn of the millennium with the rationale of decreasing surgical invasiveness, reinforcing weak tissues and to possibly complement insufficient surgical techniques. Prospective randomized studies comparing traditional and modern operations are lacking.Prospective multicentre randomized study.Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague.A prospective multicentre trial was approved by the Ministry of Health of the Czech Republic and registered with the FDA planning to recruit 500 patients with vaginal prolapse, 18 years of age and over, undergoing surgery at 5 major urogynaecologic centres. The patients were divided into three groups according to prolapse predominance. The surgical techniques used were: anterior and posterior prolift, and randomly allocated total prolift or sacrospinous fixation. The examination setup included lower urinary tract ultrasound, MRI, POP-Q assessment and QoL questionnaires before surgery and six and 24 month after the surgery.Preliminary analysis of partial data of 225 women showed an acceptable rate of complications and a better success rate in the mesh groups, whereas operation time and blood loss was lower in the classical operation group. Quality of life questionnaires documented that all the methods used have comparably good results. The surgical techniques used are acceptable methods for pelvic organ prolapse repair with low complication rates and excellent impact on the subjective perception of the patient's quality of life.

To evaluate and quantify early and late changes in mesh length after anterior vaginal repair with implants with ultrasound.Prospective interventional study.Ultrasound assessment of 35 patient randomized in two groups both with Gynemesh insertion. In one group with Gynemesh Prolift anterior kit and second group with individualized size of the Gynemesh. Ultrasound measurement of the mesh in sagittal plane was performed postoperative day 4 and after 3-4 month. Measured values were put in proportions, together with the original size of the mesh. Results are expressed as a percentage of shortening.In comparison of measurements from the late ultrasound scans with original size the shortening of the Prolift was 45% vs. 25% in Mesh group. When we compared the late and early ultrasound scans, there was no difference in the shrinking of the mesh in both group 16% vs 20%.Insufficient spreading and anchoring of the anterior Prolift has a major impact on the final length of the mesh. The tissue reaction expressed as shrinking of the mesh is only 16-20%.

To present a case of huge submucous leiomyoma prolaps to the vagina with severe haemorrhage and its management and to analyse current articles with this rare complication.A case report, review article.Department of Gynecology and Obstetrics Trinec Hospital.A case report of huge submucous leiomyoma prolaps in 49-year-old woman. The patient presented at our department with sudden onset of profuse vaginal bleeding. The vaginal and utrasound examination was performed with diagnosis of huge submucous leiomyoma obturating upper third of the vagina. The cervix was not palpable, rised up. While manipulating with the leiomyoma the bleeding exceeded. The patient agreed with abdominal hysterectomy without adnexectomy. Then the patinent colapsed and the operation was performed immediately, taking care of changed anatomy--the line between the vaginal wall and the uterus was almost invisible caused by "non-existing cervix" and the uterus was partialy inverted into the vagina. The haemoglobin level failed from 124 g/l to 95 g/l with no need of tranfusion. The patient quickly recovered and was dimised the sixth day after the operation.Uterine myomas in their submucous localisation may protrude through the cervix into the vagina and cause rare but very serious complications--profuse vaginal bleeding and non-puerperal inversion of the uterus, and thus need very urgent management.

This study eims to evaluate risk factors for postsurgical uroinfection (UTI) in gynecology.Clinical retrospective trial.Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.All of 290 women who underwent hysterectomy and/or anterior vaginal repair (with or without anti-incontinence operation) in our hospital during the year 2005 were studied. The following data were noted: age, weight, anamnestic UTI, diabetes, other serious morbidity, moving disorders, estrogene deficiency, the type of surgery, the type of catheter and the duration of its indweling, intra/postoperative complications, urologic symptoms and urine analysis including bacteriology on the 6th postoperative day. There were excluded cases with antibiotic therapy (due to non-urological indications) from the study. The risk factors were assessed on the rest of 262 women, in two subgroups according to the catheter type (Foley/minicatheter), as there were remarcable differences in the indwelling time and other characteristics. "Mini-catheter" (a thin transurethral catheter) enables spontaneous voiding as well as measuring the postmiction residuum. It was used in case of anterior vaginal repair or Burch operation and extracted as soon as the voiding function had been restored, mostly on the 2nd-3rd day. The Foley was used in the others, mostly for one day. The unidimensional (Fisher and Mann-Whitney test) and multidimensional (logit model, Walds statistic) analyses were performed. The influence of the type of catheter itself was analysed within an indwelling time period (20-32 hours) in which women of both subgroups were present.The Foley group (115 women, indwelling time 16-32 hours) had 3.5% UTI, none of studied factors was estimated as significant. In the mini-catheter group (147 women, catheterisation for 20-234 hours) was 35.4% UTI, with two risk factors: the time of catheterisation (p = 0.000029) and complications (p = 0.021515). The statistic model we have used (logit analysis) predicts UTI with sensitivity 61.5 and specificity 89.5. There was no difference in the risk of UTI between the two types of used catheters in case of equal time of their insertion.Postsurgical UTI was connected significantly with the duration of catheterisation and intra/postoperative complications. In case of short time catheterisation (up to 32 hours), however, the percentage of UTI was low and no risk factor was assessed as significant.

To evaluate the effectiveness and complications of abdominal sacrocolpopexy in the treatment of vaginal vault prolapse.Review article.Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague.Review from biomedical database Medline from 1960 till 2006. The articles were found under the key words: vaginal vault prolaps, abdominal sacrocolpopexy, effectiveness, complications, urinary incontinence, female sexual dysfunctions.The effectiveness of surgery is getting near to 100 percent in the smaller groups between 11 and 21 women. The larger groups are presenting greater success rate variability from 85 to 97 percent. The studies with up to 2 years of follow up are giving representative results of the effectiveness of surgery. Prolapse recurrence and cystocele, rectocele, enterocele and stress urinary incontinence occurrance belong among the characteristic failure signs. Studies evaluating abdominal sacrocolpopexy argue low incidence of complications. Complications connected with surgery can be divided to intraoperative and early and late postoperative. Bleeding from injured medial sacral artery, cystotomy, enterotomy and ureterotomy are the most common intraoperative complications. Wound infection, ileus and urinary tract infection are the most often early postoperative complications. Stress urinary incontinence, anterior or posterior vaginal wall descent, recurrence of vaginal vault prolapse and mesh erosion through vaginal wall are characteristic late postoperative complications.Abdominal sacrocolpopexy can be a method of choice in the treatment of vaginal vault prolapse, mainly because of the low morbidity and high success rate. Polypropylene mesh is the prefered suspension structure but the accurate surgical technique is the most important for the abdominal sacrocolpopexy success and safety.

The aim of this article is to review the incidence and prevalence of complications after prosthetic surgery for POP (pelvic organ prolaps) and USI (urodynamic stress incontinence) and to introduce diagnostic and therapeutic advice into clinical practice.Review article.Gynecological and Obstetric Clinic, 1st LF UK and VFN, Prague.Summary of complications, recent findings, opinions and specific diagnostic and therapeutic recommendations with special focus to vaginal erosion, post-operative voiding difficulties, persisting leakage of urine and de novo urgency.In the last decade the surgical treatment of female USI by prosthetic slings procedures has been shown to be effective with high cure rate and low morbidity. Similary, prosthetic reconstruction of pelvic organ prolapse through the different compartments has been introduced into clinical practice with good anatomical and promising functional results. The article is structured to the different sections, describing the epidemiology and management of complications after prosthetic slings procedures and after vaginal prosthetic treatment of pelvic organ prolapse. The effect of various operations of pelvic floor and USI using synthetic implants may differ, depending on the material of the implant used. Current recommendation for the implants material: a light-weight, flexible polypropylene; Amid's classification: type 1, i.e macro-porous, monofilament material. The advantage of surgical treatment of pelvic floor defect using implants comprises a low percentage of recurrence of the descensus.

A case review of laparoscopic management of the uterovaginal descent and rectal prolaps in one step in a young female following her complicated pelvic fracture.

To present an overview of current procedures used in female pelvic floor reconstructive surgery.Review article.Teaching Hospital Bulovka, 1st Faculty of Medicine, Charles University, Prague.Pelvic organ prolapse (POP) in women including associated disorders belong to the top problems in current urogynecology. During the last decade a substantial progress in elucidation of detail morphology and function of each pelvic floor compartments had been made. These new findings could be rapidly implemented into clinical medicine, mainly as application of new mesh implants. The results of reconstructive operations are variable, one of the reason is the existence of many operation techniques. This review article represents a short overview of those methods.Wide range of current operation procedures must be re-evaluated respecting the existence of new techniques based on recent anatomical studies.

Find out the features of descending posterior vaginal wall using ultrasonography and set the objective diagnostic criteria.Prospective comparative study.Department of Obstetrics and Gynaecology, Teaching Hospital Bulovka, First Medical Faculty, Charles University in Prague.We included 39 attendants, 19 with clinicaly proven descent of posterior vaginal wall; 20 as a negative control group. We observed the ultrasonographical features of descending posterior vaginal wall according to the horisontal line crossing the inferior margin of pubic bone (PM) and central anorectal angle (PARA) at rest and during Valsalva manoevre with and without intrarectal application of sonographic yelly. Student's t-Test was used for statistical evaluation.We proved the statisticaly significant increase in the distances PM and PM' in the group of females suffering from the descent compared to the group of healthy women. Values of PARA were also signifinatly hightened in the group of patients with the descent compared to healthy females.The ultrasonographical evaluation of descending posterior vaginal wall appears to be promising chance in diagnostics of female's pelvic floor pathology.

To determine the main etiopathogenic factors which may participate in the development of vaginal prolapse after hysterectomy.A retrospective study.Department of Obstetrics and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc.The analysis of relevant factors which can participate in the origin and development of vaginal prolapse was carried out on the group of 51 patients treated for vaginal prolapse after hysterectomy performed in the years 2002 to 2005. The data were retrieved retrospectively from medical documentation and appended by the information obtained from questionnaires send to the patients.Factors participating in the development of vaginal prolapse can be divided into 3 groups: 1. Mistakes in surgical technique and complications in the post-operative period, 2. inherited qualities of patients, and 3. impact of adverse external factors.Several factors are involved in the etiopathogenesis of vaginal prolapse, the most important of which are the inherited qualities of patients, incorrect surgical technique and adverse outcome in the post-operative period.

Assessment of the effects of a new surgical method for complex resolution of pelvic floor defects.Case study.Department of Obstetrics and Gynaecology, Bata Hospital, Zlín.We evaluated the procedures and results of the new TVM (transvaginal mesh) surgical method which we used in a group of 12 patients. Ten patients had vaginal prolapse following vaginal hysterectomy and in two cases there was uterine prolapse and vaginal prolapse. Only in one case there was a small protrusion in the range of 0.5 cm which we resolved by removal of the penetrated section. The resulting anatomic effect was very good in all the cases.

Implementation of a new surgical method for treatment of vaginal prolapse after hysterectomy.The description of a new surgical method. The results in the first 16 patients.Department of Obstetric and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc.The description of a new surgical method, pointing out the advantages and possibilities of the use in clinical practice. Presentation of the results in the group of 16 patients treated.Sacrospinous fixation of vaginal prolapse after hysterectomy sec. Miyazaki is a modification of sacrospinous fixation sec. Amreich-Richter. Contrary to the classical procedure this new method has several advantages. It makes easier the exact placement of the stitches to the sacrospinous ligament which decreases the danger of bleeding often substantially complicating the classical procedure. The procedure requires a special instrument, namely the so called Miyazaki hook. The results in the first 16 patients operated on by this method are presented.

To evaluate the safety and efficacy of the abdominal sacral colpopexy in the treatment of posthysterectomy vault prolapse.Retrospective clinical trial.Obstetric and Gynecologic Department, The Charles University 2nd Medical School and Faculty Hospital Motol, Prague.A group of 18 patients with vaginal vault prolapse after hysterectomy who underwent abdominal sacral colpopexy between July 2001 and June 2003 was studied. Ten women had undergone previous abdominal and 8 previous vaginal hysterectomy. All patients were operated on by one surgeon. Preoperative evaluation consisted of physical examination, age, parity, body mass index, history of previous pelvic surgery and hormonal status. The cure rate and complications were evaluated in follow-up.The mean age was 59.5 (41-72) years, the median parity was 2.05 (1-5). Seven (38.9%) patients were slightly overweight (BMI 25-30 kg/m2), one (5.6%) patient was obese (BMI 33.4 kg/m2) and 10 (55.5%) had normal weight (20-25 kg/m2). The average period of follow-up was 14.9 months (6-24). The cure rate was 94.4% (17 of 18 patients). No serious intraoperative complications occurred. Postoperative complications occurred in 2 (11.2%) cases (one urgent and one stress urinary incontinence). The complications were resolved and the patients were free of negative postoperative symptoms in the time of the last follow-up visit.Vaginal vault prolapse is an infrequent complication after both vaginal and abdominal hysterectomy. The study shows that abdominal sacral colpopexy is an effective and safe surgical procedure in the treatment of posthysterectomy vault prolapse. The operative technique is simple but the surgery should be performed by experienced pelvic surgeons able to resolve intraoperative complications.

To present personal experience in the fixation of the vaginal stump to the sacrotuberal ligament.Description of the surgery including modified surgical instruments.32 surgical procedures were performed during a 4-year period. Two relapses were recorded.Various surgical procedures including abdominal approach to the fixation are mentioned, complications and prevention of relapses are discussed.The method is appropriate for sexually active patients. It preserves the length, axis and volume of the vagina.

The uterine and vaginal descent create multidisciplinary issue. Its consequences interfere in gynaecology, urology, geriatrics, general medicine and psychiatry. Collateral symptomatology, pathology of the anatomy, diagnostics, both conservative therapy and surgery are discussed. The author mentions the abdominal and vaginal approach, being most experienced with the latter. Prevention is seen shortening of the labour stress, reduction of chronic elevation of the intraabdominal pressure and use of hormonal replacement therapy in the menopause.

Preliminary experience with vaginal vault prolapse treatment with sacrospinous fixation (Amreich II-Richter) is described. Anatomical considerations having taking into account the method used by author are presented. From 1986 at the 1st Dept. of Obstetrics and Gynaecology 38 patients (20 of them after abdominal, 18 after vaginal hysterectomy) with this rare condition were treated by the discussed operation. Similar to other authors a high success rate, 97.4%, was achieved and no major bleeding or injury of adjacent nerves occurred. One injury of the bladder, one of the rectum was solved during the operation and an infection of supravaginal haematoma was treated. This operation provides excellent results and a good vaginal support.