Transvaginal cystocele repair with polypropylene mesh using a tension-free technique

This study describes an original surgical technique for the correction of medium/high-degree cystocele using a tension-free way to apply a polypropylene mesh: the “tension-free cystocele repair” (TCR). About 218 patients were available with a mean follow-up of 38 months. This technique showed an elevated rate of anatomic correction (75.7%), a statistically significant correction of storage symptoms (48.6 vs 32.5%, p < 0.05), voiding symptoms (40.3 vs 8.3%, p < 0.05), and symptoms associated with pelvic organ prolapse (POP; 55.9 vs 11.4%, p < 0.0001), with no negative impact on ano-rectal function and, in particular, on constipation. The percentage of erosions was 12.3%, but in the group where hysterectomy was not performed, we had erosions in only 2.5%. With the exception of the Personal Relationship domain, all of the categories examined by the Prolapse Quality of Life Questionnaire showed a statistically significant improvement, which confirms the positive impact of this surgery as perceived by patients.     

A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh

This study reports the 2-year results of an original technique for rectocele repair by the vaginal route, using a combined sacrospinous suspension and a polypropylene mesh. Twenty-six women were successively operated between October 2000 and February 2003. Mean age was 63.7 years [range 35–92]. 19 women had had previous pelvic surgery for prolapse and/or urinary incontinence (73.1%), but none had had a previous rectocele repair. Patients underwent physical examination staging of prolapse in the international pelvic organ prolapse staging system. Eleven women had stage 2 posterior vaginal wall prolapse (42.3%), seven had stage 3 (26.9%) and eight had stage 4 (30.8%). The procedure included a bilateral sacrospinous suspension and a polypropylene mesh (GyneMesh, Gynecare, Ethicon France) attached from the sacrospinous ligaments to the perineal body. We did not perform any associated posterior fascial repair, nor myorraphy. Patients were followed up for 10–44 months, with a median follow-up (±SD) of 22.7±9.2 months. Functional results and sexual function were evaluated using the PFDI, the PFIQ and the PISQ-12 self-questionnaires. Twenty-five women returned for follow-up (96.2%). At follow-up, 24 women were cured (92.3%) and one had asymptomatic stage 2 rectocele. All the patients but one had symptoms and impact on quality of life improved. No postoperative infection of the mesh or rectovaginal fistula was found, but there were three vaginal erosions (12%) and one out of 13 had de novo dyspareunia (7.7%).     

Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh

To evaluate whether symptom resolution and sexual function is better after reinforcement with polypropylene mesh than with traditional anterior repair. Ninety-seven patients were randomized to anterior colporrhaphy and 105 to an operation with mesh. Participants were evaluated up to 24 months by physical examination, standard questions, and questionnaire. The overall symptom rate did not differ between the groups, but a sensation of vaginal bulge was reported less frequently in the mesh group, the figures being 17 versus 5 (p = 0.003). The recurrence rate for the no-mesh group was 41% and for the mesh group 11% (p < 0.001). The dyspareunia score was statistically significantly lower in the mesh group (p = 0.015). The mesh exposure rate was 8%. Sensation of vaginal bulge was relieved more efficiently by the mesh technique without causing dyspareunia. Clinical trial registration available at , identifier NCT00420225.     

Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study

The aim of this study was to evaluate the anatomical and functional results of a low-weight polypropylene mesh coated with an absorbable film in prolapse surgery by vaginal route. We have conducted a prospective multicentre study in 13 gynaecological and urological units. There were 230 patients requiring repair for anterior or posterior vaginal prolapse included. The present report is based on the analysis of the first 143 patients evaluated after at least 10 months follow-up. All patients were operated by the vaginal route using a specially designed mesh (Ugytex, Sofradim, France). Prolapse severity were evaluated using the Pelvic Organ Prolapse staging system. Symptoms and quality of life were evaluated preoperatively and during follow-up using the validated Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) self-questionnaires. Mean age was 63 years (37–91). Anterior, posterior and anterior–posterior repair with the mesh were performed in 67 (46.9%), 11 (7.7%) and 65 (45.4%) patients, respectively. With a mean follow-up of 13 months (10–19), 132 patients were considered anatomically cured (92.3%) with a recurrence rate of 9 of 132 for cystocele (6.8%) and 2 of 76 for rectocele (2.6%). Nine vaginal erosions occurred (6.3%), six of them necessitated another procedure by simple excision. The rate of de novo dyspareunia was 12.8%. At follow-up, improvement of PFDI and PFIQ scores were highly significant (p<0.0001). The use of low-weight polypropylene mesh coated with a hydrophilic absorbable film for vaginal repair of genital prolapse seems to decrease local morbidity while maintaining low recurrence rates.     

Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors

Prosthetic reinforcement in the surgical repair of pelvic prolapse by the vaginal approach is not devoid of tolerability-related problems such as vaginal erosion. The purposes of our study are to define the risk factors for exposure of the mesh material, to describe advances and to recommend a therapeutic strategy. Two hundred and seventy-seven patients undergoing surgery due to pelvic prolapse with transvaginal mesh technique were included in a continuous, retrospective study between January 2002 and December 2003. Thirty-four cases of mesh exposure were observed within the 2 months following surgery, which represents an incidence of 12.27%. All the patients were medically treated, nine of whom were found to have completely healed during the check-up performed at 2 months. In contrast, 25 patients required partial mesh exeresis. Risk factors of erosion were concomitant hysterectomy [OR=5.17 (p=10⁻³)] and inverted T colpotomy [OR=6.06 (p=10⁻²)]. Two technical guidelines can be defined from this study as regards the surgical procedure required in order to limit mesh exposure via the vaginal route. The uterus must be preserved, and the number and extent of colpotomies needed to insert the mesh must be limited.     

Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study

The objective of this study was to compare mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft mesh. We retrospectively analyzed 138 consecutive cases of transvaginal repair of cystocele using synthetic mesh. The study endpoint was the pathological evidence of vaginal erosion. Multiple logistic regression was used to determine independent predictors of vaginal erosion. One hundred and thirty eight women (ages 30-83 years) with cystocele between October 1999 and October 2004, from a French University Hospital, participated in this study. Cystocele repair was performed in all patients according to the technique of tension-free polypropylene mesh. The median follow-up was 32.1 months (range 7.5-59.9) in the Gynemesh group and 7.1 months (range 1-21.9) in the Gynemesh-Soft group. Vaginal erosion was reported in 27 (20%) of the patients. Anatomically, the success rate was 95% (131/138). There was no statistically significant difference between the Gynemesh and the Gynemesh-Soft meshes [the rate of vaginal erosion of the mesh was 16% (15/89) vs 24% (12/49), respectively, p=0.39]. Univariate analysis only identified age class as factor significantly associated with the probability of vaginal erosion. Multivariate analysis revealed that age class is an independent predictive factor of vaginal erosion (age > 70 years, odds ratio (OR) 3.6, 95% confidence interval (CI) 1.3-9.7, p=0.010). Furthermore cystocele stage > 2 (Baden and Walker classification) is a protective factor against vaginal erosion (OR 0.3, 95% CI 0.1-0.8, p=0.016). Thirteen symptomatic patients (13/27, 48%) necessitated a partial excision of the mesh, associated with a vaginal mucosal closure. Two patients (2/27, 7%) underwent a complete excision of the mesh. The incidence of de novo dyspareunia was 9% in patients with vaginal erosion and 11% in patient without mesh erosion (p=0.85). There was no occurrence of bladder or urethral erosion and no vaginal or pelvic infection. Isolated vaginal erosion of the mesh did not prove to be problematic. Gynemesh-Soft mesh does not decrease the incidence of vaginal erosion. Age > 70 years is an independent predictive factor of vaginal erosion. We recommend that mesh placement by vaginal route should be avoided by women with moderate cystocele. Where possible, total hysterectomy and vertical incision should also be avoided. Management of vaginal erosion is simple and is associated with a low rate of morbidity. However, patients should be informed that vaginal erosion of the mesh can occur. A multivariate analysis reveals that the incidence of vaginal erosion is not significantly different between Gynemesh and Gynemesh-Soft meshes. Other factors of erosion are analyzed.     

经阴道前入路悬吊修补术治疗膀胱膨出（附19例报告）

目的探讨Avaulta网片经阴道前入路悬吊修补术治疗老年女性膀胱膨出的适应症、安全性和有效性。 方法回顾性研究2013年1月至2016年10月中山大学附属第三医院岭南医院收治的老年女性膀胱膨出患者（POP-Q III-IV期）行Avaulta网片经阴道前入路悬吊修补术病例资料。记录患者一般临床资料和围手术期手术资料,出院后电话和门诊定期随访,测量患者POP-Q各指示点位置,评价治愈率和手术并发症发生情况。 结果19例老年女性膀胱膨出患者纳入研究,手术均顺利完成,围手术期均无腹腔脏器损伤、大出血等严重并发症发生。平均手术时间55 min（45～70 min）,其中1例膀胱膨出患者术前尿动力学诊断合并隐匿压力性尿失禁,单纯行膀胱膨出悬吊修补术后咳嗽、大笑时仍有明显尿失禁发生,二期行TVT治愈。平均随访时间6.5个月（1～24个月）,所有膀胱膨出患者均完全修复,无膀胱膨出复发、网片侵蚀和尿潴留等严重并发症发生。 结论Avaulta网片经阴道前入路悬吊修补术治疗老年女性中重度膀胱膨出患者安全有效,远期疗效尚需长期大样本临床随机对照研究资料进一步循证。     

Mechanical properties of polypropylene mesh used in pelvic floor repair

The aim of this study was the comparison of the stiffness of different meshes under two types of mechanical tests. Five different mesh types were mechanically tested. The methods used consisted on uniaxial tension test (tensile stiffness) and tape ring tests, experimental continuous compression of the mesh loops (flexural stiffness). The most significant difference of tensile stiffness behaviour appears between Aris™ and TVTO™. From the analysis of the experimental data, we divided the flexural stiffness, in two main groups. The first group includes Auto Suture™ and Aris™ meshes. The two meshes seem to have a similar flexural behaviour. The second group includes TVTO™, Uretex™ and Avaulta™. The difference between these two groups is clearly evident comparing TVTO™ and Aris™. This study shows that there are significant differences on the mechanical properties between urogynecology meshes. An erratum to this article can be found at     

Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse

Synthetic mesh augmentations for pelvic floor reconstructive surgeries are increasing in usage and popularity. Many studies are focusing on the anatomical success rates of transvaginal anterior compartment repairs with synthetic mesh, with minimal attention on its postoperative complications. We present a case report on a 59-year-old postmenopausal woman who underwent an anterior repair with 6×4-cm polypropylene mesh. Postoperatively, she developed severe dyspareunia and debilitating chronic pelvic pain. The patient failed conservative medical therapy and now requests complete removal of the synthetic mesh. No financial support or corporate sponsorship was obtained for this project.     

改良前入路腹膜前平片修补腹股沟疝的临床应用

目的探讨前入路腹膜前置人平面补片修补腹股沟疝的临床应用和改良技术要点。方法回顾性分析总结从2007年1月至2010年8月,采用平面补片,做腹股沟疝（斜疝、直疝、复发疝）的特定修补术式428例临床资料,对患者术前合并症、手术时间、手术方式、术后并发症、住院天数等进行综合分析。结果手术时间40—90min（平均50min）,术后12～24h下床活动（平均20h）,术后3～5d恢复日常行走活动,术后切口轻微疼痛,无需止痛剂使用,3d后白细胞、体温均恢复正常,术后5～7d出院。随访8～51个月,局部硬物感0．7％（3／428）,疼痛发生率0．47％（2／428）,尤复发。结论改良前入路腹膜前平片无张力疝修补术的临床应用是全腹股沟区修补,适合修复各型腹股沟疝,尤其适用于腹横筋膜缺损大的患者,操作简便、安全、经济,易于推广。     

Long-term foreign-body reaction to preperitoneal polypropylene mesh in the pig

Summary The aim of the study is to establish the long-term foreign-body reaction to a polypropylene mesh used for inguinal hernia repair in a pig model. Twenty-two Surpipro^® meshes were implanted in 22 preperitoneal inguinal areas in 11 female 10-week-old Yorkshire and Dutch landway swine. The prosthetic mesh was implanted using a laparoscopic transperitoneal technique. At 1, 2, 3, 4, 6, 12 and 26 weeks, the animals were sacreificed and the number of foreign-body giant-cells at the mesh-tissue interface was counted. The mean numbers of giant-cells (SD) after 1, 2, 3, 4, 6, 12 and 26 weeks were: 0.9 (2.4), 7.3 (5.4), 19 (8.2), 15.2 (7.9), 15.9 (6.9), 14.1 (5.6), and 8.2 (4.7). The mean number of giant-cells at 12 weeks was significantly lower than at 3 weeks. The mean number of giant-cells at 26 weeks was significantly lower than at 3, 4, 6, and 12 weeks. We conclude that the foreign-body giant-cell reaction to polypropylene mesh increases until the third week after implantation. Thereafter, it gradually decreases, and at six months it persists at half the maximal level at 3 weeks.     

Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair

Introduction and hypothesis  This study aimed to document intraoperative and postoperative complications associated with the use of transvaginal polypropylene mesh in the repair of pelvic organ prolapse (POP). Methods  This is a retrospective review of 127 cases of transvaginal repair of POP using synthetic mesh. Results  Mean postoperative value (±SD) for pelvic organ prolapse quantification (POPQ) measurements Aa, Ap, and C were: −2.4 ± 1.1 (cm), −2.4 ± 0.9 (cm), and −7.7 ± 1.2 (cm), respectively. The difference between preoperative and postoperative values of these points was significant (p < 0.0001). Mesh erosion rate was 13/127 (10.2%) with significant correlation between mesh erosion and concurrent vaginal hysterectomy (p = 0.008). Combined anterior and posterior vaginal mesh surgery increased the risk of intraoperative bleeding and blood transfusion (p < 0.05). Conclusions  Concurrent vaginal hysterectomy is associated with increased risk of vaginal mesh erosion. Combined anterior and posterior vaginal mesh repair is an increased risk factor for intraoperative bleeding and blood transfusion.     

应用聚丙烯单丝网片纠正轻、中度乳房下垂

目的：介绍一种适用于轻、中度乳房下垂的矫正术。方法：采用乳晕周围环状切口，用聚丙烯单丝网片制成内置式乳罩，行乳腺组织的上提、塑形和固定，并为21例乳房下垂者行矫正术。结果：21例均达到较为理想的上提效果，随访2－16个月，无下垂复发和切口瘢痕增生，未发生异物排斥反应。结论：聚丙烯单丝网片用作乳房塑形的支持材料安全可靠，减少了切口的瘢痕增生，避免了下垂复发。     

轻量聚丙烯补片与自固定补片在Lichtenstein疝修补术的研究

目的对比研究轻量大网孔聚丙烯补片与自固定补片在Lichtenstein疝修补术中的应用。 方法选择2021年1-3月在吉林大学第二医院60例单侧男性腹股沟疝患者行前瞻性随机对照研究,随机分为轻量大网孔聚丙烯补片组和自固定补片组各30例,分别应用轻量大网孔聚丙烯补片和自固定补片进行Lichtenstein疝修补术;对比2组一般资料、手术相关指标、术后平均住院时间、血清肿、补片感染、术后疼痛、复发、异物感以及治疗费用等相关情况进而评价两种补片的治疗效果。 结果2组患者一般资料、手术麻醉方式、术后住院时间比较差异无统计学意义（P>0.05）,2组的平均手术时间和治疗费用差异有统计学意义（P<0.05）;术后血清肿、术后短期（7 d及1个月）疼痛和慢性疼痛、补片感染、局部不适或异物感、复发等并发症差异均无统计学意义。 结论自固定补片可明显缩短手术时间,但医疗费用明显高于轻量大网孔聚丙烯补片,在术后复发和慢性疼痛等并发症方面差异不显著。     

Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift™ technique)—a case series multicentric study

Our goal was to report the preliminary results of a transvaginal mesh repair of genital prolapse using the Prolift™ system. This retrospective multicentric study includes 110 patients. All patients had a stage 3 (at the hymen) or stage 4 (beyond the hymen) prolapse. Total mesh was used in 59 patients (53.6%), an isolated anterior mesh in 22 patients (20%) and an isolated posterior mesh in 29 patients (26.4%). We report one bladder injury sutured at surgery and two haematomas requiring secondary surgical management. At 3 months, 106 patients were available for follow-up. Mesh exposure occurred in five patients (4.7%), two of them requiring a surgical management. Granuloma without exposure occurred in three patients (2.8%). Failure rate (recurrent prolapse even asymptomatic or low grade symptomatic prolapse) was 4.7%. According to the perioperative and immediate post-operative results, Prolift™ repair seems to be a safe technique to correct pelvic organ prolapse. Anatomical and functional results must be assessed with a long-term follow-up to confirm the effectiveness and safety of the procedure.     

A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele

The aim of this study was to compare the efficiency of polypropylene mesh surgery with the site-specific repair surgeries in the treatment of cystocoeles. We randomized 90 patients into two groups according to a computer-based program. After a 12-month (mean) follow up, we noticed that the polypropylene mesh surgery yielded good anatomical results. Acceptable anatomical cure rates were 91 and 72% in the mesh surgery group and site-specific surgery group, respectively. There were three cases (6.9%) of mesh erosion. One case of urinary retention and two cases of de novo dyspareunia were seen in the mesh surgery group. De novo stress urinary incontinence developed in three patients in the site-specific surgery group. We concluded that surgery with light polypropylene mesh (Sofradim®, Parietene) is superior to the site-specific surgery in the treatment of cystocoeles.     

猪小肠黏膜下层脱细胞基质补片与轻量聚丙烯补片在腹股沟疝Lichtenstein修补术中的对比研究

目的探讨猪小肠黏膜下层脱细胞基质（porcine small intestine submucosa,SIS）补片对比轻量聚丙烯（polypropylene mesh,PP）补片在腹股沟疝Lichtenstein修补术中应用的安全性和短期疗效。 方法回顾性分析2012年1月至2015年8月,中山大学附属第一医院使用SIS补片和轻量PP补片做单侧腹股沟疝Lichtenstein修补术的连续男性病例资料,SIS组和PP组分别纳入64例,比较2组患者手术安全性和短期疗效。 结果SIS组与PP组在术后24 h疼痛评分、发热、伤口脂肪液化、血清肿、尿潴留、睾丸并发症发生率比较,差异无统计学意义（P均>0.05）。2组均无手术部位感染和血肿发生病例。2组均无复发病例。SIS组在术后慢性疼痛（14.1%比15.6%,χ²=0.062,P=0.804）,术后腹股沟区不适感（12.5%比17.2%,χ²=0.556,P=0.456）,异物感（3.1%比4.7%,P=1.000）均低于PP组,但2组差异无统计学意义（P均>0.05）。2组在术后均无明显射精疼痛或障碍,无睾丸萎缩。PP组有2例（3.1%）患者出现手术侧睾丸肿大。 结论SIS补片对比轻量PP补片在腹股沟疝Lichtenstein修补术中应用的安全性和短期疗效是相当的,其长期疗效仍有待进一步观察。     

Collagen-coated vs noncoated low-weight polypropylene meshes in a sheep model for vaginal surgery. A pilot study

The aims of this study were dual. First, to evaluate the feasibility of a sheep model as an animal model for vaginal surgery with meshes. Second, to compare host response to two low-weight polypropylene (PP) meshes, a noncoated (Soft Prolene™, Gynecare, Ethicon) and a coated mesh with an absorbable hydrophilic film (Ugytex™, Sofradim). Thirty-six 20×20 mm polypropylene meshes (18 coated and 18 noncoated) were surgically implanted by the vaginal route in 12 adult ewes. Meshes were implanted in the anterior (n=12) and the posterior vaginal compartments (n=24). Animals were killed 1 (n=6) and 12 (n=6) weeks after surgery. Postimplantation evaluation included macroscopical examination, histological and immunohistochemical analysis and histomorphometrical measures of the distance between the meshes and the vaginal epithelium. The experimental procedure was feasible in all cases. Vaginal erosions were observed twice as frequently with the noncoated-PP meshes (6/18, 33.3%) as with the coated-PP meshes (3/18, 16.7%), even if that difference was not significant (p=0.4). However, no differences were observed between the two meshes in terms of shrinkage, tissue ingrowth, inflammatory response, and position of the mesh in the vaginal wall. The mechanism involved in the reduction of vaginal erosion could be due to the lesser adhesion of the coated mesh on the vaginal wound during the early postoperative period.     

Hernioplasty with bilayer polypropylene mesh: a new tension-free technique

Different open-mesh techniques have been developed for inguinal hernia repair since the introduction of the tension-free technique. The present study reports a new self-designed tension-free technique for hernioplasty using a bilayer polypropylene mesh. Fifty-one patients with severe transverse fascia weakness were repaired by means of a self-designed, tension-free technique using bilayer polypropylene mesh. The postoperative complications, inpatient hospitalization time, and recurrence rate were studied. Patients were mobilized within 6 h after surgery and no complications were found. The length of hospital stay was 2–3 days. The follow-up period ranged from 3 months to 40 months, with a mean of 20.4 months, and no recurrence was found. Our own experience showed the self-designed, tension-free technique using bilayer polypropylene mesh to be a reliable approach for inguinal hernia repair with many advantages—such as a much lower expense, simplicity, rapid return to unrestricted activities, minor complications, and impressively no recurrence, a particularly superior option for those patients with severe transverse fascia weakness or large defect.     

Prosthetic repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh

The employment of synthetic mesh for incisional hernia repair in kidney-transplanted patients is rarely reported in the present literature. Many authors believe that mesh employment in such conditions is not safe due to fear of mesh related complications. From 1965 through 1999, a total of 1685 kidney transplants were performed at our Kidney Transplant Unit and 19 patients developed eventrations in the kidney transplant incision, an incidence of 1.1%. From September 1996 eight of these patients had prosthetic repair of the abdominal wall with onlay polypropylene mesh. All patients were under immunosuppressive therapy with prednisone, ciclosporine and azathioprine. Mean age was 48.8 years, mean body mass index was 22.5 and mean number of previous abdominal operations was 2.5. A large polypropylene mesh (Marlex^® mesh) was fixed over the aponeurosis after primary closure of the aponeurotic borders, as an onlay graft. There was neither morbidity nor mortality associated to the surgical procedure. No recurrences or long-term complications associated with mesh employment were verified after a follow-up ranging from one year to three years. We concluded that prosthetic repair of incisional hernia in transplanted patients can be performed routinely.