经阴道网片盆底重建术治疗盆底脏器脱垂患者临床疗效

目的探讨经阴道网片盆底重建术治疗盆底脏器脱垂（pelvic organ prolapse,POP）患者的临床效果观察及安全性疗效。 方法选取2016年1月至2017年12月,河北省邯郸市中心医院118例POP患者的临床资料,按照术式不同分为2组,每组患者59例。对照组采用传统的手术方式进行治疗,试验组采用经阴道网片盆底重建术进行治疗。 结果试验组手术时间、术后首次下床活动及住院时间均短于对照组,差异有统计学意义（P<0.05）。试验组术中出血量与对照组比较比较,差异无统计学意义（P>0.05）。试验组术后有效率明显高于对照组,差异有统计学意义（P<0.05）。 结论经阴道网片盆底重建术是治疗POP患者有效、安全的术式,可显著改善患者的临床症状,但需严格按照手术适应症进行。     

Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse

The aim of the study was to assess sexual function in women before and after surgery with transvaginal mesh for pelvic organ prolapse. Women were invited to complete a sexual function questionnaire including the Lemack and the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaires (PISQ-12) before undergoing surgery and 1 year after surgery. Eighty-three complete pre and postoperative questionnaires were analyzed. Mean age was 65.1 years. Forty-six were sexually inactive and 37 were sexually active women. Two sexually active women completed the preoperative PISQ-12 questionnaire retrospectively after surgery. There were no significant differences after surgery in the answers to the Lemack questionnaire and PISQ-12 scores. These results suggest that nonabsorbable transvaginal mesh repair of genital prolapse does not impair sexual function 1 year after surgery. Nevertheless, patients should not necessarily expect a significant improvement in sexual function outcome following transvaginal mesh repair for genital prolapse.     

Synthetic mesh in the surgical repair of pelvic organ prolapse: current status and future directions

In light of the recent Food and Drug Administration public health notification regarding complications associated with transvaginally placed mesh for pelvic organ prolapse (POP) repair, we review recent literature to evaluate current outcomes and complication data, analyze the clinical need for mesh on the basis of genetic and biochemical etiologies of POP, and investigate trends of mesh use via an American Urological Association member survey. Mesh-based techniques show better anatomic results than traditional repair of anterior POP, but subjective outcomes are equivalent. Further research and Level I evidence are required before mesh-based repair of POP can be standardized. Adequate surgical training and patient selection should decrease complication rates.     

Efficacy and safety of skeletonized mesh implants for advanced pelvic organ prolapse: 12-month follow-up

Objective

To evaluate the efficacy and safety of skeletonized mesh implants for advanced pelvic organ prolapse (POP).

Methods

Women with advances POP underwent repair of stage III or greater anterior or posterior and apical compartment prolapse using skeletonized mesh implants (Seratom PA MR MN^® system—SERAG-WIESSNER, Naila, Germany). Anatomical outcomes were assessed using pelvic organ prolapse quantification staging and functional outcomes were self-reported by the patients at 6 weeks, 6 and 12 months. Anatomical and functional cure rates, post-operative pain and dyspareunia as well as intra and post-operative complications were reported. Success was defined as a composite of no bulge symptoms and no prolapse beyond the hymenal ring.

Results

At 12 months, data were available for 103 of the 105 patients originally recruited. Intra-operative complications included 2 (2 %) cases of cystotomy that were corrected vaginally. The immediate post-operative complications included 1 patient (1 %) with UTI, 4 (3.9 %) cases of self-resolved hematomas, and 6 (5.8 %) cases of bladder outlet obstruction. At 12 months, a high success rate and low complication rate was noted. Recurrence of prolapse was reported by 7 (6.6 %) patients. However, only 4 (3.8 %) underwent a repeat procedure. Two patient developed de novo SUI, and 6 (5.7 %) developed dyspareunia. No cases of mesh erosion/extrusion were noted.

Conclusion

The present study showed excellent anatomical and quality of life results in patients with advanced POP treated with a skeletonized and reduced mesh system. No mesh exposure was recorded within the first year after surgery.

     

Guidelines for providing privileges and credentials to physicians for transvaginal placement of surgical mesh for pelvic organ prolapse

The adoption of new technology or procedures into a clinician's surgical armamentarium is driven by multiple factors. Patient safety and anticipated long-term improvement in outcomes should be the primary objective that guides a surgeon's decision to deliver care involving new procedures. Surgically complex procedures require a balance of knowledge, surgical skill, and experience, with appropriate ongoing surgical volume and monitoring of outcomes and adverse events. Transvaginal placement of surgical mesh for pelvic organ prolapse has the potential to improve quality of life and anatomic outcomes (especially in the anterior compartment), but also has potential serious adverse events as outlined by the FDA's July 2011 Safety Communication. This document provides Guidelines for privileging and credentialing of physicians planning to implement or continue using this new technology in clinical practice.     

Incidence and risk factors for mesh erosion after laparoscopic repair of pelvic organ prolapse by lateral suspension with mesh

Introduction and hypothesis

The objective of our study was to estimate the incidence and identify the risk factors for mesh erosion after laparoscopic repair of pelvic organ prolapse (POP) by lateral suspension with mesh.

Methods

We conducted a nested case–control study among 480 women who underwent POP repair by laparoscopic lateral suspension with mesh from January 2004 to October 2012. Cases (n?=?18) were women who showed mesh erosion following the first intervention through December 2014. Controls (n?=?133) were women randomly selected from the same cohort who did not have any erosion.

Results

The risk of mesh erosion was 3.8 % with a mean follow-up of 82.3 months (range 28.2 – 130.6 months). The main risk factor was the use of a type 3 mesh (macroporous with either multifilamentous or microporous components) rather than a type 1 mesh (macroporous and monofilamentous; adjusted OR 13.0, 95 % CI 1.5 – 110.6; P?=?0.02). Risk factors included smoking (adjusted OR 10.4, 95 % CI 2.3 – 46.5; P?<?0.01) and posterior mesh placement (adjusted OR 5.1, 95 % CI 1.2 – 21.8 P?=?0.03).

Conclusions

The risk of mesh erosion is low and may be further reduced by using the appropriate mesh material, and by identifying specific patient characteristics such as tobacco use. As conventional vaginal surgery is effective for the treatment of the posterior compartment, the use of posterior mesh during laparoscopic pelvic floor repair needs to be questioned.

     

Predictors of improved overactive bladder symptoms after transvaginal mesh repair for the treatment of pelvic organ prolapse

Introduction and hypothesis  

The aim of this study was to identify the predictors of improved overactive bladder (OAB) symptoms after transvaginal mesh repair.     

Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse

Necrotising fasciitis is a severe form of soft tissue infection. Herein, we present an unreported complication of the transvaginal repair of a pelvic organ prolapse (POP) with trocar-guided polypropylene mesh and a concomitant hysterectomy. A 61-year-old Caucasian female who had been using an intrauterine device (IUD) for 30 years presented with a stage 3 pelvic organ prolapse. A genital ultrasound examination confirmed the presence of an IUD, but found no endometrial abnormalities. The surgical management was limited to a transvaginal hysterectomy and simultaneous anterior vaginal wall repair augmented with trocar-guided mesh. A morphological examination of the removed uterus confirmed the presence of the intrauterine device and additionally found endometrial cancer (T1N0M0), which was not revealed during the preoperative ultrasound. Within 6 days of the surgery, she developed anaerobic bilateral necrotising fasciitis on both thighs. Non-clostridial streptococci were identified in the wound. After 18 days of intensive care, the patient died of fatal coagulopathy.     

Combined Burch urethropexy and anterior rectopexy in pelvic organ prolapse: skip the mesh

Purpose

Pelvic organ prolapse (POP) is a common accompaniment of advancing age. Current repair techniques incorporate transvaginal and transabdominal approaches with or without prosthetic mesh insertion. In this paper, we present the short- and medium-term results of a unit policy directed at patients with POP of combined abdominal rectopexy and Burch retropubic urethropexy without the use of prosthetic mesh assessing its safety profile in selected cases.

Methods

Between January 2009 and January 2011, 16 women with tri-compartmental prolapse who had all undergone prior hysterectomy underwent combined surgical pelvic floor repair. Preoperative symptom assessment by validated questionnaires and clinical examination were pre- and postoperatively recorded. Cures were defined as either optimal or satisfactory outcomes based on combined clinical, radiological examinations and reported patient satisfaction.

Results

The mean age of the 16 patients was 57.2?years, and their mean BMI was 28.6 (±5 SD). Pelvic examination revealed a POP-Q stage III prolapse in 12 patients and stage IV in 4 patients. The mean operating time was 57.5?min (range 40–85), with a mean length of hospital stay of 4.5?days. Cystocele and enterocele resolution was noted in every case on dynamic magnetic resonance imaging (MRI).

Conclusions

Our results in a small patient cohort employing a simple ‘all-in-one’ repair approach combining a retropubic colposuspension with an anterior rectopexy appear to be satisfactory. Further larger randomized studies are required, incorporating a laparoscopic arm in order to determine the longer-term effectiveness of this approach.     

Sexual function in women following transvaginal mesh procedures for the treatment of pelvic organ prolapse

Introduction and hypothesis

Synthetic mesh kits recently adopted in pelvic reconstructive surgeries have achieved great surgical efficacy, but the effects of transvaginal synthetic mesh procedures on women’s sexual function are still controversial. This study was conducted to demonstrate sexual function in women before and after surgery with transvaginal mesh (TVM) repair for pelvic organ prolapse (POP).

Methods

A total of 93 sexually active women scheduled for correcting POP with synthetic mesh kits were recruited. In addition to urogynecological history, pelvic examination by the Pelvic Organ Prolapse Quantification system, and urodynamic testing, consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function before and after surgery.

Results

At the 3-month urodynamic studies, among the 25 patients with coexistent urodynamic stress incontinence (USI) who had undergone a concomitant transobturator suburethral tape procedure (TOT), 1 (4 %) had persistent USI; 8 of 68 (11.8 %) patients with a negative pessary test developed postoperative USI. Six-month prolapse recurrence rates following TVM alone and TVM with concomitant TOT were 9 and 12 %, respectively. The total PISQ-12 score after surgery showed worse results in the TVM alone group but not in the TVM with concomitant TOT group. The individual scores of PISQ-12 after surgery demonstrated prolapse-related items improved in both TVM groups; sexual function worsened in dyspareunia and behavior domains.

Conclusions

Our data revealed that transvaginal synthetic mesh procedures for the treatment of POP generated favorable clinical outcomes, but situations might worsen in dyspareunia and behavior domains, thereby invoking a negative emotional reaction during intercourse after surgery.     

改良腹腔镜阴道骶前固定术治疗重度盆腔器官膨出及其并发症的处理和预防

1962年,Lane报道了经腹骶骨阴道固定术（Abdominal Sacrocolpopexy）治疗阴道穹窿膨出,之后这种术式就在临床逐渐应用起来。其后逐渐发展出保留子宫的骶骨固定术。被认为是治疗重度盆腔器官脱垂的经典金标准。随着人类寿命的延长和对生活质量要求的提高,腹腔镜手术已应用于该手术,因手术区域受限和诸多的镜下缝合延长了手术时间,增加了腔镜下手术的难度。     

Body image in women before and after reconstructive surgery for pelvic organ prolapse

Introduction and hypothesis  

This study seeks to determine the impact of prolapse surgery on body image in women with pelvic organ prolapse.     

Mid-term results of pelvic organ prolapse repair using a transvaginal mesh: the experience in Sherbooke,Quebec

Objective:

The objective was to report our experience on the implantation of the Prolift system since 2005.

Methods:

Fifty-six patients were operated on between July 2005 and August 2008 by 1 surgeon. The patients were implanted with the transvaginal mesh, the Prolift system, for the treatment of recurrent or high-grade (Baden-Walker stage III or IV) multiple compartment pelvic organ prolapse (POP) associated with symptoms. A concomitant anti-incontinence surgery was performed in 38 patients (68%).

Results:

The population had a mean age of 68 (range 46–88), a body mass index of 27 (range 21–40) and a parity average of 3 (range 1–16). Previous POP repair had been performed in 17 patients (30%) and a hysterectomy in 43 (77%). The operating room time was on average 98 minutes (range 70–135), blood loss 81 mL (range 50–300) and hospital stay 3 days (range 1–10). With a median follow-up of 21 months, we found that the cure rate for POP was 91% (48/53) and the reoperation rate was 8% (4/53). Perioperative complications included 1 rectal laceration and 1 prolonged bleeding. Short-term postoperative complications included 10 episodes of transient urinary retention that required immediate tape release in 4 patients. Long-term complications included 5 POP recurrences, 2 low grade and 3 high grade.

Conclusion:

The Prolift system appears to be a relatively safe and effective alternative to conventional surgeries for the treatment of recurrent or high-grade multiple compartment POP, because of a high mid-term cure rate and a satisfactory complication profile. However, long-term follow-up is still needed to confirm these results.