Complications and patient satisfaction after transobturator anterior and/or posterior tension-free vaginal polypropylene mesh for pelvic organ prolapse

Complications and satisfaction with anterior and/or posterior prolapse repair using a transobturator polypropylene mesh (Prolift) in a single center prospective cohort was assessed. Among 30 women six mesh erosions were noted, five (17%) after anterior and one (3%) with combined anterior and posterior procedures. The patients' impression after six months was 'better' to 'much better' in 25 (84%), no change in four (13%) and one was worse (3%). At six months one patient had suffered re-appearance of an anterior prolapse and one had relapse of both an anterior and posterior prolapse. Concomitant procedures were not significantly related to risk of erosion, but the erosion group was younger (mean age 58 vs. 67 years, p<0.0001). After polypropylene transobturator mesh for pelvic organ prolapse relapses do occur. Safety may be hampered by a high rate of mesh erosions.     

The preliminary evaluation of surgical treatment of pelvic organ prolapse with polypropylene mesh by double transobturator approch technique (double TOT)

OBJECTIVES: The aim of this study was to evaluate preliminary results of a new, simple surgical technique with the use of polypropylene mesh (double TOT) used for the treatment of cystocele associated / not associated with urinary incontinence in females. MATERIAL AND METHODS: 19 women, aged 49-76, BMI 24-40, with cystocele associated or not with urinary incontinence, were operated on at the 1st Department of Obstetrics and Gynaecology in Warsaw, using double TOT technique. In this technique, described by Theobald, the trapezoidal polypropylene four-arm vaginal mesh is inserted through the obturator foramens from the outside to the inside and is positioned without tension under the urethra. RESULTS: 9 patients qualified for the operation were grade III in POPQA, 5--grade IV, 4--grade II and one patient grade I. 16 women had additional operations performed beside double TOT. The duration of operations varied from 30 to 135 minutes. No intra-operative complications were observed. There were no complications in short 6 weeks follow-up. CONCLUSIONS: Double Transobturator technique is simple, easy to learn, safe and, at the same time, efficient surgical procedure for the treatment of pelvic organ prolapse and female urinary stress incontinence. The results of longer follow-up on a larger group of operated patients will be more accurate.     

Comparing the midterm outcome of single incision vaginal mesh and transobturator vaginal mesh in treating severe pelvic organ prolapse

Objective

The aim of this study is to compare perioperative parameters and midterm clinical outcomes using two different mesh kits: transobturator vaginal mesh (TVM) (both Perigee and Apogee), versus single incision vaginal mesh (SIM) (combined Elevate anterior/apical system and Elevate posterior/apical system) in treating severe pelvic organ prolapse (POP).

Medium-term effects of a monofilament polypropylene mesh for pelvic organ prolapse and sexual function symptoms

This report is aimed at describing the effects and complications of a polypropylene mesh in standard gynaecological practice. This is single centre prospective cohort observational study performed at a University affiliated hospital in the UK. It involved the prospective symptom assessment of 41 consecutive patients in 2007 who underwent anterior and/or posterior Avaulta Plus? or Avaulta? Biosynthetic Support System (BARD). The validated International Consultation on Incontinence Modular Questionnaire - Vaginal Symptoms (ICIQ-VS) was completed in the clinic preoperatively. Postal questionnaires were sent to the patients up to 3 years postoperatively. Preoperatively the mean overall Quality of life (QoL) was 19.78 (SD 9.052) and at follow-up was 1.67 (SD 1.0) with p相似文献   

Vaginal mesh for pelvic organ prolapse repair

The use of mesh for pelvic organ prolapse repair through the vaginal route has increased within the last decade. The main objective is to improve anatomical results (based on the superiority of sacropexy with meshes when compared to vaginal traditional surgery), with the advantages of the vaginal route. An increasing number of cohort series and randomized control trials have been published. There is level-1 evidence that the use of mesh for the treatment of cystocele through the vaginal route improves anatomical results when compared to traditional surgery. The rates of complications between these two techniques seem equivalent, even for de novo dyspareunia.     

采用聚丙烯网片的阴道前壁修补术治疗阴道前壁脱垂临床效果的荟萃分析

目的:比较聚丙烯网片和传统的前壁修补术对阴道前壁脱垂患者的临床效果及并发症。方法:通过Pubmed数据库、Cochrane图书馆数据库、荷兰医学文摘(EMBASE)、OVID数据库,收集国外已发表的1990年至2013年符合要求的英文随机对照实验,按纳入和排除标准进行筛选和质量评估,采用RevMan 5.2对手术失败率、术后新增压力性尿失禁、新增的性交困难、术后尿储留进行meta分析。结果:经筛选,共纳入10篇符合要求的随机对照文献,共1288例受试者。与传统的前壁修补术比较,使用聚丙烯网片能明显降低手术的失败率(P0.01,RR=0.37,95%CI为0.31~0.45),术后新增的压力性尿失禁和性交困难则无显著差异(P=0.10,RR=1.52,95%CI为0.93~2.48;P=0.16,RR=1.99,95%CI为0.97~4.08),术后尿储留网片发生率较高(P0.05,RR=2.31,95%CI为1.10~4.83)。结论:使用聚丙烯网片能显著降低手术的失败率和术后复发率,但在术后并发症上无特殊优势,并且术后尿储留的发生率略高。     

A modified anterior compartment reconstruction and Prolift-a for the treatment of anterior pelvic organ prolapse: a non-inferiority study

Objective

To evaluate, in terms of efficacy and safety, a modified anterior compartment reconstruction procedure for anterior pelvic organ prolapse (POP).

Methods

The patients were assigned to two groups according to their individual willingness and economical condition, of whom 68 were treated with the modified procedure and 37 with the ‘Prolift-a’ procedure. The objective cure rate was defined by 0 or I according to POP-Q, which was detected by non-inferiority test between the two groups.

Results

The cure rates were found to be 94.1% (64/68) in the modified group and 97.3% (36/37) in the Prolift-a group, respectively. No significant difference was found between these two groups in the cure rate by non-inferiority test (u?=?2.252, P?=?0.012). The blood loss and hospitalization costs were significantly lower in the modified group than the Prolift-a group (P?P?>?0.05).

Conclusion

Both the modified total pelvic reconstruction and Prolift-a operations are safe, efficacious and minimally invasive surgical treatments, while the modified procedure is relatively inexpensive, which has great perspective of clinical application in developing countries.     

硅胶子宫托用于女性盆腔器官脱垂的疗效分析

目的探讨硅胶子宫托治疗女性盆腔器官脱垂的临床效果及生活质量改善情况。方法对2009年9月至2012年5月硅胶子宫托保守治疗POP-QⅢ~Ⅳ期盆腔器官脱垂72例患者进行随访,填写盆底功能障碍问卷简表（PFDI-20）和盆底功能影响问卷简表（PFIQ-7）,评价子宫托治疗的疗效。结果 72例盆腔器官脱垂患者中,1例为全盆腔重建术后复发。随访时间24~50个月,平均随访时间（30.71±5.49）个月。13例失访,59例完成随访,随访率为81.94%。59例患者中,35例（59.32%）效果显著,持续佩戴,取放间隔时间为1~4周;24例（40.68%）在3个月内放弃使用子宫托,其中取放困难11例（45.83%）,长期佩戴有不适感8例（33.33%）,易脱落4例（16.67%）,1例83岁患者因偏瘫长期卧床放弃使用。35例患者治疗前PFDI-20和PFIQ-7评分分别为（46.94±36.10）分和（98.23±48.01）分,治疗后6个月分别下降至（6.07±15.63）分和（14.56±11.14）分,治疗后2年分别下降为（3.72±12.76）分和（5.3±4.87）分,与治疗前比较,差异均有统计学意义（P均〈0.05）。结论子宫托可以有效改善盆腔器官脱垂患者的症状,提高生活质量,适合门诊广泛开展应用。     

Vaginal surgery for pelvic organ prolapse using mesh and a vaginal support device

Objectives  To describe a new surgical procedure for pelvic organ prolapse using mesh and a vaginal support device (VSD) and to report the results of surgery.
Design  A prospective observational study.
Setting  Two tertiary referral Urogynaecology practices.
Population  Ninety-five women with International Continence Society pelvic organ prolapse quantification stage 2 or more pelvic organ prolapse who underwent vaginal surgery using mesh augmentation and a VSD.
Methods  Surgery involved a vaginal approach with mesh reinforcement and placement of a VSD for 4 weeks. At 6 and 12 months, women were examined for prolapse recurrence, and visual analogue scales for satisfaction were completed. Women completed quality-of-life (QOL) questionnaires preoperatively and at 6 and 12 months.
Main outcome measures  Objective success of surgery at 6 and 12 months following surgery. Secondary outcomes were subjective success, complications, QOL outcomes and patients' satisfaction.
Results  Objective success rate was 92 and 85% at 6 and 12 months, respectively. Subjective success rate was 91 and 87% at 6 and 12 months, respectively. New prolapse in nonrepaired compartments accounted for 7 of 12 (58%) failures at 12 months. Two of 4 mesh exposures required surgery. Sexual dysfunction was reported by 58% of sexually active women preoperatively and 23% at 12 months. QOL scores significantly improved at 12 months compared with baseline ( P < 0.0001).
Conclusion  Vaginal surgery using mesh and a VSD is an effective procedure for pelvic organ prolapse. However, further studies are required to establish the role of the surgery described in this study.     

Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh

PURPOSE OF REVIEW: Innumerable techniques have been described for vaginal vault prolapse and enterocele repair including abdominal (open, laparoscopic, and robotic) and vaginal techniques. Recently, the use of surgical mesh in pelvic floor surgery has become increasingly popular due to the high incidence of recurrence with primary repairs and no surrogate material. The increasing variety of available materials and techniques, combined with a lack of well conducted clinical trials, make the choice of repair to use difficult. RECENT FINDINGS: This article provides an update review on the different procedures available to the urogynecologist and female urologist for repair of vault prolapse. We will also discuss a new surgical technique for the repair of vault prolapse, which recreates the sacrouterine-cardinal ligament complex and reconstructs the pelvic floor with mesh. SUMMARY: The best approach to vaginal vault prolapse remains unknown. Surgeon comfort and preference as well as proper patient selection remain critical. The use of graft materials in pelvic floor reconstruction should have limited use in a carefully selected patient population. There is a need for well powered, controlled, long-term, randomized studies with patient generated quality-of-life questionnaires comparing the short and long-term outcomes of these techniques.     

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。     

硅胶子宫托治疗盆腔脏器脱垂临床观察

目的探讨应用硅胶子宫托治疗盆腔脏器脱垂。方法 2005年11月至2009年3月北京大学第三医院,对硅胶子宫托治疗有症状的POP-Q分期Ⅲ～IV期盆腔脏器脱垂患者52例,进行使用方法、使用时间有无合并症的随访,并填写生活质量调查问卷(PFDI-20短表)。采用配对资料秩和检验统计分析。结果 2005年11月至2009年3月有52例患者试戴硅胶子宫托,33例(63.46%)患者试戴成功。随访31/33例(93.94%),其中23/31例(74.2%)自行取放子宫托;取放间隔时间约1d至6月,28/31例(90.32%)<1月。除1例网片添加盆底重建术术后复发后配戴子宫托患者出现网片侵蚀和阴道壁脓肿外,无严重合并症发生。随访中8/31例(25.81%)放弃使用子宫托,其中7/8在1年内放弃。放弃的主要原因为子宫托大小不合适、取放麻烦或困难。持续使用者随访时间为(10.04±2.57)个月(3～17个月)。27例(含5例放弃者)完成生活质量调查问卷。PFDI-20上托前中位评分为36.16分,上托后为25.98分,差异有统计学意义(P<0.05)。结论硅胶子宫托治疗重度盆腔脏器脱垂安全、有效,可以显著改善患者的生存质...     

Use of vaginal mesh for pelvic organ prolapse repair: a literature review

The use of mesh for pelvic organ prolapse repair through the vaginal route has increased during this last decade. The objective is to improve anatomical results (sacropexy with mesh seeming better than traditional surgery) and keep still the advantage of vaginal route. Numbers of cohort series and randomized control trials have been recently published. These works increase our knowledge of advantages and risks of mesh. It has been shown that the use of mesh to treat cystocoele through vaginal route improves anatomical results when compared to traditional surgery. The rate of complications, especially de novo dyspareunia, remains equivalent between the two techniques.     

Risk factors of surgical failure following transvaginal mesh repair for the treatment of pelvic organ prolapse

Objective

To identify the factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair.

Study design

One hundred and thirteen women with symptomatic POP stage II to IV were scheduled for TVM procedures. All subjects underwent urinalyses and pelvic examination using the POP quantification (POP-Q) staging system before and after surgery.

Results

Seven (6.2%) of 113 women reported POP recurrence after a mean follow-up time of 30 months. We performed a univariate analysis of patients’ characteristics to identify the predictors of surgical failure after TVM. There was no difference between two groups as to body mass index, POP stage, mesh type, and preoperative urinary symptoms and urodynamic parameters (P > 0.05). However, we found that uterine prolapse (P = 0.016) and surgical experience (P = 0.043) were two significant predictors of surgical failure. Multivariate logistic regression showed similar results.

Conclusion

Advanced uterine prolapse and lack of surgical experience were two significant predictors of failure following TVM. POP recurrence after mesh repair appears to be unlikely beyond the learning curve.     

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.     

Vaginal mesh colpopexy for the treatment of concomitant full thickness rectal and pelvic organ prolapse: a case series

Objective

To present our case series of concomitant rectal and pelvic organ prolapse (POP) treated with vaginal colpopexy with synthetic mesh.

Study design

Charts of patients with full thickness rectal prolapse and POP were reviewed for presenting symptoms, physical examination with POP-Q including rectal prolapse evaluation, and perioperative complications and outcomes.

Results

Four patients aged 63-78 were identified with full thickness rectal prolapse and POP. All of them had symptoms related to both conditions. Rectal prolapse protrusion ranged from 2 cm to 3 cm outside the anus. All patients had vaginal mesh colpopexy; two of them with anterior and posterior vaginal mesh and 2 with posterior mesh only. At a follow-up of 6-44 months, all patients had resolution of both POP and rectal prolapse signs and symptoms.

Conclusion

Vaginal colpopexy with mesh may be a unique treatment to address both POP and full thickness rectal prolapse in selected patients. Further research is needed to determine the safety and efficacy of this method.