title: Genital prolapse repair using porcine skin implant and bilateral sacrospinous fixation: midterm functional outcome and quality-of-life assessment.
abstract: OBJECTIVE
  To evaluate the midterm anatomic and functional outcome of genital prolapse repair by the vaginal route using a porcine skin implant (Pelvicol) and bilateral sacrospinous fixation.
  
  
  METHODS
  From May 2001 to June 2006, 101 patients with Stage III-IV genital prolapse were treated using a porcine skin collagen implant and bilateral sacrospinous fixation. The functional results were evaluated using the Pelvic Floor Distress Inventory short form, Pelvic Organ Prolapse Distress Inventory-6, Colorectal Anal Distress Inventory-8, Urogenital Distress Inventory-6, Pelvic Floor Impact Questionnaire-7 (including Urinary Impact Questionnaire-7, Pelvic Organ Prolapse Impact Questionnaire-7, and Colo-Rectal-Anal Impact Questionnaire-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire.
  
  
  RESULTS
  Of the 101 patients, 89 (88%) completed all the questionnaires. The mean follow-up was 38 +/- 18 months. An improvement was noted in the Pelvic Organ Prolapse Distress Inventory-6 (P < .0001), Urogenital Distress Inventory-6 (P = .001), and Pelvic Floor Distress Inventory scores (P < .0001) but not in the Colorectal Anal Distress Inventory-8 scores. An improvement was noted in the Urinary Impact Questionnaire-7 (P < .0001), Pelvic Organ Prolapse Impact Questionnaire-7 (P < .0001), and Pelvic Floor Impact Questionnaire Short Form 7 (p < 0.0001) scores but not in the Colo-Rectal-Anal Impact Questionnaire-7 scores. The quartile distribution showed that women with a preoperative Pelvic Floor Distress Inventory-short form score >133 had a 45% chance of postoperative improvement and those with a preoperative Pelvic Floor Impact Questionnaire Short Form 7 score >195 had an 81% chance of postoperative improvement. Using multivariate regression analysis, the preoperative Pelvic Floor Distress Inventory score was negatively predictive of satisfaction (t = -2.03, P = .05) and the preoperative Pelvic Floor Impact Questionnaire Short Form 7 score was positively predictive of satisfaction (t = 2.40, P = .02). No differences in the pre- and postoperative Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores were noted.
  
  
  CONCLUSIONS
  The results of our study have shown that biologic implantation and bilateral sacrospinous fixation are effective in high-grade genital prolapse repair. Validated questionnaires are potentially useful tools to predict the postoperative outcome.
authors.affiliation: Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France. emile.darai@tnn.aphp.fr
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.forename: Emmanuel
authors.initials: E
authors.lastname: David-Montefiore
authors.forename: Deborah
authors.initials: D
authors.lastname: Apfelbaum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011788:Quality of Life; D016038:Skin Transplantation; D011795:Surveys and Questionnaires; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*