Laparoscopic promontofixation: Where to stop the anterior dissection?

Background: Laparoscopic promontofixation is the gold standard to treat apical defects but the dissection of the anterior compartment is variable since based on surgical judgment only. We therefore evaluate the placement of the anterior mesh using an ultrasonographic measurement after promontofixation. Design: A prospective cohort study (Canadian Task Force Classification II-1) was conducted between January 2015 and September 2015. 63 women that underwent a promontofixation for prolapse were included. Pelvic floor descent was evaluated with POP-Q. The distance between the bladder neck, and the anterior mesh was measured by ultrasound at the end of surgery. The placement of the mesh was subsequently correlated to the anatomical repair 1 month after surgery, and the occurrence of de novo symptoms as stress urinary incontinence. Results: Ultrasound permitted to measure the distance between bladder neck and Mesh (BMD = Bladder neck-Mesh Distance) in all patients with variation between repeated measurements ranging for 0.6 to 1.2 mm. The BMD was highly variable from 0 to 13 mm (mean ± SD; 5.3 ± 3.1 mm). The BMD inversely correlated with the difference between C (P = 0.01) and Bp (P = 0.04) after and before surgery respectively, with the complication rate (P = 0.01) but not with the difference of Ba. A BMD of more than 6 mm predicted the absence of postoperative de novo symptoms. De novo“ stress urinary incontinence occurred in 23.8%. Conclusion: BMD can be accurately measured by ultrasound. BMD predicts the apical repair but not the anterior repair. A short BMD predicted postoperative de novo stress urinary incontinence.