Evaluating the efficacy of the single-incision uphold system for pelvic organ prolapse repair

Objective

The aim of this study was to assess the efficacy and clinical outcomes of pelvic floor reconstruction with transvaginal mesh of the Uphold? Vaginal Support System (Boston Scientific Corporation).

Mesh-related complications in single-incision transvaginal mesh (TVM) and laparoscopic abdominal sacrocolpopexy (LASC)

ObjectiveFew studies have investigated the long-term impact of synthetic mesh reconstructive surgery for pelvic organ prolapse (POP) on patient outcomes. This study aimed to examine the incidence and risk factors of mesh exposure and the subsequent requirement for surgical interventions due to mesh-related complications.Materials and methodsThis retrospective study was conducted from November 2010 to April 2018. We recruited women with Pelvic Organ Prolapse Quantification (POP-Q) stage 3 or 4 who underwent mesh reconstructive surgery for POP, and enrolled 487 women who received transvaginal mesh (TVM) and 110 women who received laparoscopic abdominal sacrocolpopexy (LASC). Assessments included mesh exposure rate and mesh-related complications requiring surgical interventions in both groups.ResultsIn the LASC group, the overall mesh-related complication rate was 8.18% over a mean follow-up period of 18 months. Concomitant laparoscopic-assisted vaginal hysterectomy was associated with mesh exposure (OR = 9.240; 95% CI = 1.752–48.728). No patients in the concurrent supracervical hysterectomy group were exposed to mesh. In the single-incision TVM group, the overall rate of mesh-related complications was 3.29% over a mean follow-up period of 19 months. Concomitant total vaginal hysterectomy was also a risk factor for mesh exposure (OR = 4.799; 95% CI = 1.313–17.359).ConclusionPreserving the cervix or uterus decreased the rate of mesh exposure in those undergoing TVM and LASC surgery. The overall rate of mesh-related complications was low after up to 8 years of follow-up.     

High success rate and considerable adverse events of pelvic prolapse surgery with Prolift: A single center experience

ObjectivesThe aim of this study was to analyze short-term outcomes of pelvic prolapse surgery using Prolift transvaginal mesh in a teaching hospital.Materials and MethodsThirty-four patients who received prolapse surgery with Prolift were followed up for 7–26 months. Assessment included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage, and Urogenital Distress Inventory (UDI)-6, and Incontinence Impact Questionnaire (IIQ)-7 scores. Surgical characteristics and adverse events during follow-up were also recorded.ResultsObjective and subjective data were available for 29 patients. The overall anatomical success rate was 96.5 % (28/29) after a mean of 18 ± 6.3 months follow-up. The POP-Q, UDI, and IIQ all improved significantly after surgery. Uterine sparing prolapsed surgery with Prolift unexpectedly yielded a cure rate of 100%. Ten adverse events occurred during and after prolapse surgery with dyspareunia (3/34) as the most common, followed by bladder injury (2/34).ConclusionsProlapse surgery with Prolift yielded a good anatomical outcome and satisfactory symptom improvement at different periods of follow-up, especially in uterus-sparing prolapse surgery. However, adverse events were not uncommon, and patients should be fully informed of all possible adverse events prior to surgery.     

Assessment of Collagen-Coated Anterior Mesh Through Morphology and Clinical Outcomes in Pelvic Reconstructive Surgery for Pelvic Organ Prolapse

Study ObjectiveTo assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse.DesignEvidence obtained from several timed series with intervention (Canadian Task Force classification II-3).SettingChang Gung Memorial Hospital, Taoyuan, Taiwan, China.PatientsBetween April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System).InterventionAnterior armed transobturator collagen-coated mesh.Measurement and Main Results: Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01).ConclusionsUltrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.     

Laparoscopic Uterosacral Ligament Hysteropexy vs Total Vaginal Hysterectomy with Uterosacral Ligament Suspension for Anterior and Apical Prolapse: Surgical Outcome and Patient Satisfaction

Study ObjectiveTo compare anatomic and clinical cure rates as well as patient satisfaction between uterine-preserving laparoscopic uterosacral ligament suspension and total vaginal hysterectomy with uterosacral ligament suspension in women with apical and anterior prolapse.DesignSingle-center clinical comparative retrospective cohort study.SettingA female pelvic medicine and reconstructive surgery service at a tertiary teaching hospital.PatientsWomen with pelvic organ prolapse who underwent surgical treatment for their condition between July 2010 and December 2015.InterventionsAll women underwent laparoscopic uterosacral ligament suspension or total vaginal hysterectomy with uterosacral ligament suspension for apical and anterior prolapse. Concomitant procedures included anterior and posterior repair, as well as a midurethral sling when indicated.Measurements and Main ResultsPreoperative and postoperative Pelvic Organ Prolapse Quantification (POP-Q) measurements were obtained. The primary outcome was clinical cure rate. Secondary outcomes included anatomic cure rate and outcomes of site-specific POP-Q points Ba, C, and Bp for the whole cohort. Patient satisfaction was measured using the Patient Global Impression of Improvement questionnaire. During the study period, 106 women underwent transvaginal hysterectomy with uterosacral ligament suspension, and 53 women had laparoscopic uterosacral ligament suspension. At a mean follow-up of 14.7 ± 13.23 months for the vaginal group and 17.5 ± 15.84 months for the laparoscopic group (p = .29), there were significant improvements of POP-Q points Ba, C, and Bp (p < .0001 for all comparisons in both groups). The clinical cure rate was 96% in the vaginal group and 98% in the laparoscopic group (p = .50). The anatomic cure rate was 85.4% in the vaginal group and 93.75% in the laparoscopic group (p = .11) Patient satisfaction was high in both groups.ConclusionIn appropriately selected patients, laparoscopic uterosacral ligament suspension is a valid uterus-preserving option for women with anterior and apical prolapse, associated with high anatomic and clinical cure rates and patient satisfaction.     

Anterior colporrhaphy versus repair with mesh for anterior vaginal wall prolapse: a comparative clinical study

Purpose

To compare the clinical effectiveness of anterior colporrhaphy versus mesh repair as surgical management of anterior vaginal prolapse.

Methods

Of 50 patients with ≥stage II anterior vaginal prolapse on Pelvic Organ Prolapse Quantification (POPQ) system who were initially approached, 44 consented and underwent surgery. They were randomly recruited into two groups. Group I (23 patients) received anterior colporrhaphy, while group II (21 patients) received soft polypropylene mesh (GYNEMESH*PS, Gynecare, Ethicon, France). Clinical assessment took place preoperatively and postoperatively at definite intervals. Functional and anatomical comparisons were based on comparison between preoperative and 24?months postoperative assessments of symptoms and POPQ stages, respectively. Four patients in total did not complete the follow-up assessments and were excluded.

Results

Both groups showed clinical improvement in their symptoms and POPQ staging at the end of the postoperative follow-up period. Improvement, however, was more significant in the repair with mesh group, as patients in this group reported better improvement of their prolapse symptoms, mainly vaginal bulge/pressure sensation (P?P?P?Conclusion Our data shows that repair with mesh is superior to anterior colporrhaphy with more satisfactory outcome to the patients. Due to the small size of our study and uncertainty of the long-term safety and resilience of the mesh, we recommend larger studies to confirm our preliminary results.     

Anatomic and functional outcomes with the prolift procedure in elderly women with advanced pelvic organ prolapse who desire uterine preservation

Study ObjectiveTo assess the clinical outcomes of total mesh repair with the Prolift technique as treatment of advanced pelvic organ prolapse in elderly patients who desire uterine preservation.DesignCase control series study (Canadian Task Force classification II-2).SettingMedical school–affiliated hospital.PatientsSixty-eight patients over the age of 70 years with advanced pelvic organ prolapse, Pelvic Organ Prolapse Quantification stage III (n = 59) or IV (n = 9), underwent a total Prolift procedure and were followed up for a minimum of 2 years.InterventionsTransvaginal pelvic floor repairs were performed with a total Prolift system. The concurrent pelvic surgery included midurethral sling operation with a TVT-O, if indicated. The assessment included intraoperative and postoperative complications, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores.Measurements and Main ResultsObjective and subjective data were available for 68 patients. The anatomic success rate was 97.1% after 2 years. Complications included bladder perforation in 1 patient (1.5%), de novo stress urinary incontinence in 20 patients (29.4%), dyspareunia in 4 patients (22.2%), and vaginal erosion in 1 patient (1.5%). The Pelvic Organ Prolapse Quantification stages, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores all improved significantly after surgery.ConclusionsThe total Prolift procedure is an alternative surgical option that uses a minimally invasive transvaginal approach to surgically treat elderly patients with advanced pelvic organ prolapse.     

经阴网片全盆重建术治疗重度盆腔器官脱垂中长期临床疗效评价

目的 探讨经阴网片全盆重建手术治疗盆腔器官脱垂的疗效及并发症,评估该手术的有效性和安全性。方法 回顾性分析2007年1月至2014年6月在广州医科大学附属第一医院因盆腔器官脱垂行经阴网片全盆重建术110例患者的临床资料,比较手术前后盆腔器官脱垂定量分期法(POP-Q)各指示点位置,评价总体客观治愈率及复发率。采用盆底功能障碍性疾病症状问卷简表(PFDI-20)等相关问卷评分评价主观治愈率以及术后尿失禁相关症状改善情况。结果 110例患者中失访12例（12/110, 10.91%）,其中1例因心血管疾病术后1年余死亡,随访98例（98/110, 89.09%）。随访时间6～90个月,中位随访时间：48个月。110例患者年龄(65.30±8.00)岁;绝经时间(14.01±9.08)年;采用POP-Q分期评价,术后15例（15/98,15.31%）出现复发,其中11例POP-Q分期Ⅱ期,无主观症状不需再次手术,4例阴道顶端复发（POP-Q Ⅲ期）,需再次手术治疗。术后主观治愈率95.92%(94/98）,客观治愈率84.69%(83/98）;网片挛缩4例（4/98, 4.08%）,网片外露11例（11/98,11.22%）。术后PFDI-20评分与术前比较,差异有统计学意义(P<0.05);术后性生活13例,其中性生活质量5例满意,6例患者较术前差,2例配偶出现性交疼痛;患者总体术后满意度评分满意率95.91%(94/98)。结论 经阴网片全盆重建术用于治疗重度盆腔器官脱垂主、客观治愈率高,不仅能达到较好的解剖学复位,对患者的盆腔器官脱垂相关症状有明显改善,术后满意度高且长期疗效稳定,但对性生活质量无明显改善。     

Transvaginal cystocele repair using tension-free polypropylene mesh at the time of sacrospinous colpopexy for advanced uterovaginal prolapse: a prospective randomised study

The management of an advanced multi-compartment prolapse requires a combination of techniques. The objective of this study was to report the anatomical outcomes of a prospective randomised trial comparing tension-free polypropylene mesh-reinforced anterior vaginal prolapse with anterior colporrhaphy at the time sacrospinous colpopexy and posterior fascial plication for the management of massive uterovaginal prolapse. A total of 116 patients with a stage III or IV (Pelvic Organ Prolapse Quantification System/International Continence Society) uterovaginal prolapse were randomised into two groups. The mesh group includes transvaginal cystocele repair using a tension-free polypropylene mesh, while the non-mesh group includes anterior colporrhaphy. All patients in the two groups underwent a sacrospinous colpopexy and posterior fascial plication. The primary outcome was objective success < stage 2 prolapse. The secondary outcomes were reoperation for recurrent prolapse, subjective success rates, patient satisfaction with the surgery and complications. The overall objective success rates (in all compartments) were 79 % (42/53) in the mesh group and 62 % (39/63) in the non-mesh group (p?=?0.043). The objective success rates in the anterior compartment were 85 % (45/53) in the mesh group and 62 % (39/63) in the non-mesh group (p?=?0.006). Three (6 %) patients in the mesh group and 12 (19 %) in the non-mesh group underwent repeat surgery for recurrent pelvic organ prolapse (p?=?0.03). The subjective success rates were 89 % (47/53) in the mesh group and 76 % (48/63) in the non-mesh group (p value?=?0.08). The mean patient satisfaction rates with the surgery were 84 % in the mesh group and 76 % in the non-mesh group (p?=?0.08). The development of a urinary tract infection, right-sided buttock pain (temporary sciatic neuralgia) and new-onset stress urinary incontinence were not significantly different between the two groups. The mesh exposure rate was 8 %. Transvaginal cystocele repair using tension-free polypropylene mesh at the time of sacrospinous colpopexy and posterior fascial plication offers lower anatomic recurrence and less need for further prolapse surgery to correct recurrent pelvic floor defects than anterior colporrhaphy, sacrospinous colpopexy and posterior fascial plication.     

Combined Pelvic Reconstructive Surgery and Transobturator Tape (Monarc) in Women with Advanced Prolapse and Urodynamic Stress Incontinence: A Case Control Series

Study ObjectiveThe aim was to evaluate the safety and efficacy of transobturator tape (TOT) using Monarc with extensive vaginal reconstructive surgery in patients with urodynamic stress incontinence (USI) and advanced genital prolapse (stage ≥ III pelvic organ prolapse quantification system staging).DesignCase control study. Canadian Task Force classification II-2.SettingMedical school-affiliated hospital.PatientsA total of 57 women were surgically treated (28 stage III and 29 stage IV prolapse). Urodynamic stress incontinence was defined as demonstrable involuntary urine leakage with negative pressure transmission observed at stress urethral pressure profile. Severe USI was defined as leak on 1-hour pad test of more than 10 g.InterventionsThe indicated extensive pelvic reconstructive procedures including anterior colporrhaphies, posterior colporrhaphies, vaginal total hysterectomies, sacrospinous ligament fixations, and LeFort procedures were completed before the TOT procedure. The TOT procedure using Monarc device was performed through a separate small vaginal incision sparing vaginal reconstructive procedures.Measurements and Main ResultsThe mean follow-up period was 18.2 months. Objective data were available for 51 patients. In all, 44 (86.3%) were completely dry at 1 year postoperatively. Among the 7 failures, 5 had severe preoperative USI. No major surgical complications, including bladder injury, occurred. The mean blood loss was 154 mL; the mean operating time for complete procedure and TOT alone was 86 minutes and 18 minutes, respectively; and the mean postoperative hospital stay was 4.1 days. Six (10.5%) patients maintained intermittent catheterization for more than 72 hours. All were classified as having severe bladder outlet obstruction preoperatively. Two patients developed recurrent prolapse onto stage II (pelvic organ prolapse quantification system staging). Urodynamic parameters related to voiding dysfunction showed an improvement after the surgery. De nova detrusor instability was observed in 2 patients.ConclusionUsing separate incisions and sequencing the TOT as the last procedure, the combination surgery is safe and effective for USI and advanced pelvic prolapse. The bladder outlet obstructions caused by severe prolapse and preoperative severity of urinary incontinence seem to be a risk factor for prolonged postoperative catheterization and failure of antiincontinent procedure, respectively. Additional information on treatment of recurrent prolapse required a longer period of follow-up.     

Prospective study of transobturator mesh kit (Prolift™) in pelvic reconstructive surgery with vaginal hysterectomy after 3 years’ follow-up

Introduction and hypothesis

This study is to analyze prospectively the anatomical and functional outcomes of transvaginal pelvic reconstructive surgery using the Prolift? system for pelvic organ prolapse (POP) with hysterectomy.

Methods

A prospective, observational, noncomparative study was conducted in 80 patients with prolapse ≥2. Postoperative pelvic organ prolapse quantification stage was the main outcome measure. Anatomical cure was defined as vaginal vault stage 0 and improvement as stage 1. Secondary outcomes include pelvic floor distress inventory-20, incontinence impact questionnaire short form-7, and pelvic floor impact questionnaire short form-7.

Results

A total of 80 patients were recruited. The cure and improvement rates were 96.3 % (77/80) and 3.7 % (3/80) respectively at 1 year. At the follow-up of 3-years, the cure rates were 93.3 % (70/75). Among the five patients, three had stage 2 anterior wall prolapse, two had stage 2 posterior wall prolapse. Only one patient with intraoperative adverse event (rectal perforation) was encountered. Postoperative complications included prolonged catheterization in three patients (3.7 %), postoperative stress urinary incontinence in five patients (6.25 %) and asymptomatic mesh extrusions in five patients (6.25 %). All of them occurred within 1 year follow-up. Significant improvements in quality of life were detected at 1 and 3 years compared with baseline.

Conclusion

The total Prolift? system surgery represents a safe, simple and useful treatment for severe POP with satisfactory objective clinical outcomes.     

Sacral Colpopexy Versus Transvaginal Mesh Colpopexy in Obese Patients

ObjectivesObesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse.MethodsWe conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann?Whitney U, and Fisher exact tests, and by analysis of covariance.ResultsThe women in the SC group had significantly higher mean apical vaginal measurements (P < 0.05), and significantly fewer stage II recurrences than women in the transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05).ConclusionIn these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.     

改良盆底重建术与传统手术治疗盆腔器官脱垂的随访评价

目的:评价经阴道全子宫切除术加改良盆底重建术和经阴道全子宫切除术加阴道前后壁修补术治疗盆腔脏器脱垂的治疗效果。方法:对2007年4月至2011年4月盆腔脏器脱垂Ⅱ～Ⅳ度102例患者进行术后3个月、6个月、12个月、36个月随访,其中经阴道子宫切除术加改良盆底重建术(重建组)65例,经阴道子宫切除术加阴道前后壁修补术(传统组)37例。采用POP-Q分度法,Ⅱ度及Ⅱ度以上判定为复发。结果:重建组2例(3.08%)复发,传统组6例(16.21%)复发,两组复发率差异有统计学意义(P<0.05);重建组复发患者均合并网片侵蚀、外露,剪除外露网片并局部雌激素治疗后放置子宫托,目前疗效满意;传统组复发患者分别行子宫托治疗、改良盆底重建术、Prolift盆底重建术、阴道封闭术,目前疗效满意;重建组35例术后恢复性生活,传统组25例术后恢复性生活,性功能问卷评分均较术前下降(P<0.05),但两组术后性功能评分无显著差异(P>0.05)。结论:改良盆底重建术作为一种新术式,能更好地修补缺陷、实现结构重建和组织替代,其复发率低,尤其是对于Ⅲ～Ⅳ度脱垂患者较传统手术更具优势。术后复发患者首选子宫托治疗,传统组可行网片再次手术治疗,阴道封闭术为最后的选择方法。     

盆底重建手术保留子宫效果的初步评价

目的:初步评价保留子宫的盆底重建手术的效果。方法:2007年2月至9月我科开展了以网片添加为主的盆底重建手术,盆腔脏器脱垂按POP-Q分期为Ⅲ~Ⅳ期,除外阴道穹隆脱垂者。术前行盆腔检查、B超及TCT排除子宫附件器质性病变。切除子宫组(CH组)11例,保留子宫组(UC组)13例。术后定期复查。结果:两组患者的一般临床资料无统计学差异。CH组平均年龄64.82±8.29岁,UC组为70.92±6.89岁,P=0.057。CH组和UC组术前Aa、Ba、C、D、Ap、Bp各点POP-Q数值无统计学差异。UC组手术时间95.77±35.05min,显著短于CH组的151.36±29.42min(P=0.000),UC组术中出血为110.77±112.21ml,明显少于CH组的241.82±234.34ml,但差异无统计学意义(P=0.087)。平均住院日、术后体温、应用抗生素时间两组间差异无统计学意义(P>0.05)。手术后,POP-Q各组数值与术前相比,差异均有统计学意义(P<0.05),手术治疗盆腔脏器脱垂近期效果显著。术后复查上述各点均值两组差异无统计学意义(P>0.05),两种术式改善患者盆腔脏器脱垂效果相似。随访2~9月,平均4.2个月,随访率100%。CH组术后近期主观治愈率100%,客观治愈率90.9%,复发率9.1%(1/11)。UC组主客观治愈率均为92.31%,复发率7.69%(1/13)。无感染和网片暴露及侵蚀发生。结论:盆底重建手术时保留子宫对维持盆底结构稳定具有一定的意义,近期效果与切除子宫组相似,手术时间短,有利于降低高龄妇女围手术期的风险。但需要观察长期疗效、远期并发症以及对性生活的影响。     

Self-perceived quality of life after pelvic organ prolapse reconstructive mesh surgery: prospective study

Objective

To assess the self-perceived quality of life in women with advanced pelvic organ prolapse before and after mesh surgery.

Study design

Women with symptomatic pelvic organ prolapse (stage III–IV according to pelvic organ prolapse quantification (POP-Q)) were invited to participate in the study. All enrolled patients underwent prolapse surgery using the transvaginal mesh technique. Success was defined as ICS POP-Q stage 0 and I. The SF36v2 questionnaire was used as a subjective outcome measure.

Results

113 patients were available for follow-up at 6–8 weeks and 16–18 months. Overall anatomic success rates were 87.6%. Statistically significant improvements in the self-perceived quality-of-life were found in 3 individual domains (general health (GH), vitality (V) and mental health (MH)) and in one summary domain (MCS) at 6–8 weeks post-op. In one individual and one summary domain (role – physical (RP) and physical component summary (PCS)) the scores were significantly lower. At the end of the study statistically significant improvement was observed in four out of eight individual domains (vitality (V), menthal health (MH), physical functioning (PF), social functioning (SF)) as well as in both summary scores (PCS and MCS).

Conclusions

Reconstructive mesh surgery improved significantly various self-perceived quality of life dimensions. Therefore, women should expect significant improvement in their general quality of life after this type of operation. The assessment of urogenital well-being should be a routine attitude when counseling menopausal women.     

Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse

OBJECTIVE: To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). STUDY DESIGN: A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using polypropylene mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The polypropylene mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. RESULTS: Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the mesh (8.3%); 4 necessitated a second procedure for partial excision of the mesh. CONCLUSION: Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.     

盆底重建术治疗盆腔器官脱垂短期主客观疗效分析

目的探讨应用网片的全盆底重建术治疗盆腔器官脱垂的疗效。方法应用主观及客观评分法对中国医科大学附属盛京医院2007年7月至2009年7月收治的盆腔器官脱垂、需要手术治疗的78例患者进行评分。研究组58例采用应用网片的全盆底重建术;对照组20例应用阴式全子宫切除及阴道前后壁修补。结果 (1)术后3～6个月门诊复查,研究组未见术后复发,POP评分法测定各指示点均在正常位置,客观治愈率达100%。主观症状评分改善24.59±2.28,6例患者术后仍有轻度尿频症状及轻度压力性尿失禁(SUI)症状,主观治愈率89.7%。对照组术后复发Ⅱ度4例,客观治愈率80%。主观症状评分改善18.30±3.68,主观症状复发9例,包括盆腔、肠道及膀胱症状,主观治愈率55%。两组治愈率比较差异有统计学意义(P<0.05)。(2)对于同时合并SUI患者,研究组通过应用经闭孔尿道中段悬吊术(TVT-O)或前路网片提升等办法,使其均得治愈,对照组中未行TVT-O手术者症状无明显改善,1例出现隐匿性SUI症状,主观症状评分改善较小。结论应用替代材料的全盆底重建术对于恢复女性盆底器官解剖结构及改善盆底功能障碍症状方面的疗效肯定。     

Assessment of the Psychometric Properties of the Short‐Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) following Surgical Placement of Prolift+M: A Transvaginal Partially Absorbable Mesh System for the Treatment of Pelvic Organ Prolapse

IntroductionImpairment of sexual function is a significant problem among women suffering from pelvic organ prolapse (POP). Because anatomical measures of POP do not always correspond with patients' subjective reports of their condition, patient‐reported outcome measures may provide additional valuable information regarding the experiences of women who have undergone surgery. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) is a validated, widely used condition‐specific questionnaire focused on sexual function among patients with POP or urinary incontinence.AimThis study aims to report sexual function outcomes as measured by PISQ‐12 and to evaluate the psychometric characteristics of the questionnaire following surgical mesh implant for the treatment of POP.Main Outcome MeasuresThe PISQ‐12 was used to measure sexual function, while a set of other measures, namely, Pelvic Organ Prolapse Quantification, Patient Global Impression of Change, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Surgical Satisfaction Questionnaire, was used for validation.MethodsData for the study were collected from a prospective multicenter, single‐arm study of surgical POP repair via the transvaginal placement of a partially absorbable mesh system. For baseline, month 3, and month 12 following POP surgery, several psychometric properties of the PISQ‐12 were evaluated, including internal consistency (Cronbach's alpha), concurrent validity, discriminant validity, and responsiveness.ResultsAs measured by the PISQ‐12 questionnaire, statistically significant improvements were observed in the composite summary score as well as all three subscale scores at 1 year. The PISQ‐12 generally demonstrated good psychometric properties including internal consistency reliability, validity, and responsiveness. The PISQ‐12 items had good distributional properties at baseline, with substantial ceiling effects at follow‐up visits reflecting improvements experienced by the patients.ConclusionThe PISQ‐12 is a valid measure of sexual function in studies involving patients with POP. Roy S, Mohandas A, Coyne K, Gelhorn H, Gauld J, Sikirica V, and Milani AL. Assessment of the psychometric properties of the short‐form prolapse/urinary incontinence sexual questionnaire (PISQ‐12) following surgical placement of prolift+M: A transvaginal partially absorbable mesh system for the treatment of pelvic organ prolapse. J Sex Med 12;9:1190–1199.