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Experimental comparison of abdominal wall repair using different methods of enhancement by small intestinal submucosa graft. Int Urogynecol J 2009; 20:435-41. [PMID: 19139799 DOI: 10.1007/s00192-008-0793-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/08/2008] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To assess the biomechanical properties of full-thickness abdominal wall defects, either using Native tissues, with or without Overlay, and by substitution of the Defect by small intestinal submucosa mesh. METHODS Seventy-two rats were divided into three groups according to repair method (Native, Overlay or Defect). At 7, 14, 30, and 90 days, six rats were sacrificed to measure tensile strength, collagen ingrowth, and host response. RESULTS Explants had comparable strength at 30 days, the majority rupturing at the interface. Afterwards, the Native group was more resistant than both small intestine submucosa (SIS) groups with a more organized fibrotic scar on histology at 90 days. CONCLUSIONS SIS augmentation of native tissue repair does not increase strength. Replacement of abdominal wall by SIS is equally strong when compared to the SIS-augmented group; however, materials preferably rupture at the site of the implant itself.
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Caquant F, Collinet P, Debodinance P, Berrocal J, Garbin O, Rosenthal C, Clave H, Villet R, Jacquetin B, Cosson M. Safety of Trans Vaginal Mesh procedure: retrospective study of 684 patients. J Obstet Gynaecol Res 2008; 34:449-56. [PMID: 18937698 DOI: 10.1111/j.1447-0756.2008.00820.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. METHODS The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse >or=3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. RESULTS The mean age of patients was 63.5 years (30-94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. CONCLUSION Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study.
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Affiliation(s)
- Fréderic Caquant
- Gynaecological Surgery, Hospital Jeanne de Flandre, Lille Cedex, France
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A prospective, randomized, controlled study comparing Gynemesh®, a synthetic mesh, and Pelvicol®, a biologic graft, in the surgical treatment of recurrent cystocele. Int Urogynecol J 2008; 20:75-81. [PMID: 18923805 DOI: 10.1007/s00192-008-0732-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
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Inherited pelvic organ prolapse in the mouse: preliminary evaluation of a new murine model. Int Urogynecol J 2008; 20:19-25. [PMID: 18802654 DOI: 10.1007/s00192-008-0723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 08/27/2008] [Indexed: 02/03/2023]
Abstract
The objective of this study was to report the initial anatomic, radiographic, and genetic evaluations of a novel form of spontaneous pelvic organ prolapse (S-POP) in mice. We observed S-POP in a colony of UPII-SV40T transgenic mice developed for studies on bladder cancer. We utilized magnetic resonance imaging and necropsy to characterize this finding. We have established a breeding colony to identify inheritance patterns and for future studies. Selective breeding isolated the S-POP phenotype from the transgene. In contrast to other animal models, the S-POP mouse does not require an obligatory antecedent event to manifest pelvic organ prolapse. Necropsy and imaging demonstrate significant displacement of the pelvic organs distal to the pelvic floor in both sexes. The appearance of the POP is similar to that seen in the human female phenotype. Preliminary breeding studies indicate an autosomal dominant inheritance pattern. This mouse may be an effective animal model for the study of POP in humans.
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Review of synthetic mesh-related complications in pelvic floor reconstructive surgery. Int Urogynecol J 2008; 20:103-11. [DOI: 10.1007/s00192-008-0717-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 08/17/2008] [Indexed: 02/03/2023]
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Rehman J, Chugtai B, Sukkarich T, Khan SA. Extraperitoneal laparoscopic removal of eroded midurethral sling: a new technique. J Endourol 2008; 22:365-8. [PMID: 18294043 DOI: 10.1089/end.2007.0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Erosion of a midurethral sling is common in women who are treated for stress urinary incontinence. This complication is usually managed by retropubic exploration. We report a novel technique to manage erosion in patients who refuse retropubic exploration. PATIENTS AND METHODS Two women (ages 47 and 53 years) with stress urinary incontinence were treated with a midurethral sling. Postoperatively, at 24 and 22 months, respectively, the sling had eroded through the high urethra near the bladder neck. A three-port extraperitoneal laparoscopic approach was used to remove the urethral slings and repair the bladder. RESULTS The procedure was accomplished in 80 and 75 minutes, respectively, with no complications. Both patients remained continent. CONCLUSION A minimally invasive extraperitoneal surgical technique can be used to manage midurethral sling erosion in women.
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Affiliation(s)
- Jamil Rehman
- Department of Urology, State University of New York, Stony Brook Health Sciences Center, Stony Brook, New York 11794-8093, USA.
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Wu MP. The Use of Prostheses in Pelvic Reconstructive Surgery: Joy or Toy? Taiwan J Obstet Gynecol 2008; 47:151-6. [DOI: 10.1016/s1028-4559(08)60072-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol 2008; 15:188-96. [PMID: 18312989 DOI: 10.1016/j.jmig.2007.11.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 11/10/2007] [Accepted: 11/21/2007] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To estimate the incidence of mesh-related complications including mesh erosion/extrusion rates in patients undergoing laparoscopic sacral colpopexy, with or without concurrent hysterectomy, using macroporous soft polypropylene mesh. DESIGN Historical cohort study (Canadian Task Force classification II-2). SETTING Private urogynecology clinic. PATIENTS A total of 446 consecutive patients with uterovaginal or vaginal vault prolapse underwent laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh from January 2003 through January 2007. In all, 402 consecutive patients met enrollment criteria. Two groups of patients were identified: (1) those receiving concurrent hysterectomy (n = 130); and (2) those with a history of hysterectomy (n = 272). INTERVENTIONS Patients were treated with laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh in conjunction with other laparoscopic and/or vaginal procedures. MEASUREMENTS AND MAIN RESULTS Data were collected in the form of chart reviews and patient questionnaires. Comparisons were made between groups 1 and 2. Patient demographics, history, mesh erosion/extrusion rates, and mesh-related complications were analyzed. Length of follow-up was 1 to 54 months with a median follow-up time of 12 months. No statistically significant differences existed between 2 groups in rates of mesh erosion/extrusion or other mesh-related complications. Overall vaginal mesh erosion/extrusion rate was 1.2% (95% CI 0.5%-2.7%) with an associated mesh revision rate of 1.2% (95% CI 0.5%-2.7%). Patients with concurrent hysterectomy had an erosion/extrusion rate of 2.3% (3/130) as compared with 0.7% (2/272) in patients with a history of hysterectomy, p = .18. No cases of mesh erosion through organs and tissues other than vaginal mucosa were observed. Cuff abscess occurred in 1 patient with concurrent hysterectomy, with an overall infection rate of 0.3% (95% CI 0.01%-1.2%). One more patient developed an inflammatory reaction to the mesh. Excision of exposed mesh was performed in all 5 patients with mesh extrusion. Vaginal approach to excision was uniformly used. Laparoscopic removal of the entire mesh took place in 4 patients with persistent pelvic pain, in 1 patient with cuff abscess, and in one patient with a questionable mesh reaction. An estimated 975 to 17 000 patients were required in each group to achieve power to detect a statistically significant difference in rate of mesh-related complications in this study. CONCLUSION Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1% in our study. No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy. The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study.
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Affiliation(s)
- Assia A Stepanian
- Center for Women's Care and Reproductive Surgery, Atlanta, GA 30328, USA.
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60
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[Trans obturator tape (TOT) for female stress incontinence. Experience with three years follow-up in 200 patients]. Actas Urol Esp 2008; 31:1141-7. [PMID: 18314653 DOI: 10.1016/s0210-4806(07)73777-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the security and effectiveness of the TOT in the female incontinence surgical treatment according to our experience. PATIENT AND METHOD Prospective study of 200 patients underwent TOT at Gynecology Unit of the Obstetrics and Gynecology Department in Barros Luco-Trudeau Hospital between January 2003 and October 2006. Polypropilene, macropore, mofilament mesh (Prolene) was used. The mean age was 52 years old, parity 3. RESULTS The mean surgical time of TOT was 15 minutes. In 184 (92%) patients obtained cure, 6 (3%) improvement and 10 (5%) fails. Three cases of bladder injury occurred (one perforation with the scissor and two with TOT needle during the learning phase). During the immediately postoperative time: one case of partial urethral obstruction, two cases of urinary infection and three with pain of the legs. During the delayed postoperative time a case of fail was observed after trauma. CONCLUSION According to our experience with 200 cases, the TOT appears as a safe and effective technique in the surgical treatment of the stress urinary incontinence.
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Sentilhes L, Sergent F, Resch B, Verspyck E, Descamps P, Marpeau L. Infracoccygeal sacropexy reinforced with posterior mesh interposition for apical and posterior compartment prolapse. Eur J Obstet Gynecol Reprod Biol 2008; 137:108-13. [DOI: 10.1016/j.ejogrb.2007.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 09/05/2007] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
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Boulanger L, Boukerrou M, Rubod C, Fruchart A, Courcol R, Devos P, Defossez A, Cosson M. Development of an animal model to study meshes used in genital prolapse surgery. Eur J Obstet Gynecol Reprod Biol 2008; 136:254-9. [DOI: 10.1016/j.ejogrb.2007.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 08/22/2007] [Indexed: 10/22/2022]
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Basok EK, Yildirim A, Atsu N, Basaran A, Tokuc R. Cadaveric fascia lata versus intravaginal slingplasty for the pubovaginal sling: surgical outcome, overall success and patient satisfaction rates. Urol Int 2008; 80:46-51. [PMID: 18204233 DOI: 10.1159/000111729] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 10/11/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND A wide variety of surgical procedures has been used to treat female stress urinary incontinence (SUI). The purpose of this study was to compare cadaveric fascia lata (CFL) sling with intravaginal slingplasty (IVS) in the surgical treatment of SUI. METHODS One hundred and thirty-nine women with SUI were randomly assigned to either CFL sling (n = 67) or IVS (n = 72). Concomitant urinary urge incontinence was present in 49 patients (73%) in the CFL sling and 44 patients (61%) in the IVS group. Daily mean pad usage was 4.1 +/- 3.5 in the CFL sling and 2.9 +/- 1.7 in the IVS group. The objective cure rate was evaluated by the pad test, and patient satisfaction rate was assessed by a subjective questionnaire. RESULTS The surgical results of both procedures with a follow-up 12 months were documented. The overall success rate was 79% in the CFL sling and 70.8% in the IVS (p = 0.261). In contrast patient satisfaction rates were 82 and 87.5%, respectively (p = 0.210). Comparison of the CFL sling with IVS showed persistent urinary urge incontinence in 67 and 25% (p = 0.0001) and de novo urinary urge incontinence in 22 and 6.9%, respectively (p = 0.009). The groups did not differ significantly with respect to intraoperative and postoperative complications. CONCLUSIONS There is no statistical difference in the overall success, satisfaction and complication rates in either group. In our series, both procedures were found to be effective, durable and significantly improved quality of life in patients with SUI but long-term results are awaited.
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Affiliation(s)
- Erem Kaan Basok
- Department of Urology, SB Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey.
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64
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Bacteriological analysis of meshes removed for complications after surgical management of urinary incontinence or pelvic organ prolapse. Int Urogynecol J 2008; 19:827-31. [DOI: 10.1007/s00192-007-0537-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 12/02/2007] [Indexed: 10/22/2022]
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Claerhout F, Verbist G, Verbeken E, Konstantinovic M, De Ridder D, Deprest J. Fate of collagen-based implants used in pelvic floor surgery: a 2-year follow-up study in a rabbit model. Am J Obstet Gynecol 2008; 198:94.e1-6. [PMID: 18166318 DOI: 10.1016/j.ajog.2007.05.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 03/21/2007] [Accepted: 05/22/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the long-term host response to 2 different collagen matrices versus macroporous polypropylene mesh. STUDY DESIGN Four full-thickness abdominal wall defects in 35 rabbits were reconstructed with either polypropylene (Prolene), porcine dermal (Pelvicol), or small intestine submucosal collagen matrix (SIS). Animals were sacrificed on day 30, 60, 90, 180, 365, 540, and 720 days to evaluate morphologic and biomechanical properties of explants. RESULTS Prolene provoked a fibrotic reaction within 30 days. SIS was entirely replaced by a thin fibrotic layer within 60 days. Pelvicol was encapsulated, remaining structurally unchanged up to 180 days. Thereafter, half underwent degradation by a foreign body reaction. CONCLUSION Prolene was integrated by an increasingly organised fibrotic scar while SIS was entirely remodelled within 60 days. Pelvicol implants underwent late onset (> or = 180 days) degradation. After 2 years of implantation there were no differences in tensiometric strength between the 3 different materials.
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Affiliation(s)
- Filip Claerhout
- Centre for Surgical Technologies, Faculty of Medicine, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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66
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Cho JK, Chung BS, Cho ST. A Comparison of Traditional Anterior Colporrhaphy and Cystocele Repair with Monofilament Polypropylene Mesh Repair (Gynemesh PS™). Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.7.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jin Kuk Cho
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Byung Soo Chung
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Sung Tae Cho
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
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Effect of host response (incorporation, encapsulation, mixed incorporation and encapsulation, or resorption) on the tensile strength of graft-reinforced repair in the rat ventral hernia model. Am J Obstet Gynecol 2007; 197:638.e1-6. [PMID: 18060961 DOI: 10.1016/j.ajog.2007.08.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 07/05/2007] [Accepted: 08/21/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether the elicited histologic response to synthetic and xenograft materials affected the tensile strength of mesh-reinforced repairs in the rat ventral hernia model. STUDY DESIGN Hernias were repaired with Gynemesh, Pelvicol, Pelvisoft, or Surgisis (representing incorporation, encapsulation, mixed incorporation and encapsulation, or resorption responses) and were compared with a suture-plicated control. Six animals per group were killed at 1 and 3 months after graft implantation. Preimplantation tensile strength was also measured for each graft material and native rat abdominal wall. RESULTS Before implantation, Pelvicol had significantly higher adjusted tensile strength when compared with the rat abdominal wall (P < .001) or the other graft materials (P <or= .05). However, no difference in adjusted tensile strength was observed among the groups at 1 and 3 months after implantation. CONCLUSION The elicited histologic response did not affect the adjusted tensile strength of xenograft or synthetic mesh-reinforced repairs when compared with suture controls.
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Handel LN, Frenkl TL, Kim YH. Results of Cystocele Repair: A Comparison of Traditional Anterior Colporrhaphy, Polypropylene Mesh and Porcine Dermis. J Urol 2007; 178:153-6; discussion 156. [PMID: 17499285 DOI: 10.1016/j.juro.2007.03.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE Because traditional anterior colporrhaphy can have a high recurrence rate, we assessed the recurrence rate of 3 methods of cystocele repair, including 1) traditional anterior colporrhaphy, 2) repair using porcine dermis interposition graft and 3) repair using polypropylene mesh. Additionally, we compared the rate of erosion of porcine dermal graft with that of polypropylene mesh. MATERIALS AND METHODS The records of patients who underwent cystocele repair by the same urologist using porcine dermal graft, polypropylene mesh or traditional repair from January 1999 to August 2005 were reviewed. Data were collected on history, physical examination, outcomes and complications. Using the Baden-Walker system a cystocele of grade 2 or higher on followup examination was considered recurrence. RESULTS A total of 119 patients underwent cystocele repair from January 1999 to August 2005. Followup was available on 99 patients and it averaged 13.5 months (range 2 to 46). Of the patients 56 (57%) underwent cystocele repair using porcine dermal graft, 25 (25%) received polypropylene mesh and 18 (18%) underwent traditional repair. Of the 99 patients 22 (22%) had cystocele recurrence. Based on the type of repair 36% of patients (20 of 56) with porcine dermal grafts had recurrence compared to 4% (1 of 25) and 6% (1 of 18) using polypropylene and traditional repair, respectively. Mean time to cystocele recurrence was 4.9 months (range 0.5 to 20). A total of 12 patients (21%) had extrusion of porcine grafts through the anterior vaginal wall incision compared to 1 (4%) with polypropylene mesh. CONCLUSIONS In our patient population the short-term failure rate for anterior vaginal wall prolapse using porcine dermis interposition graft was higher than that for traditional anterior colporrhaphy or polypropylene mesh. In addition, the incidence of vaginal extrusion of porcine graft was unacceptably high. Porcine dermis is a less suitable material for cystocele repair than polypropylene mesh or traditional anterior colporrhaphy. Prospective, randomized trials are necessary to determine the true efficacy and complication rates of these graft materials for anterior vaginal wall prolapse repair.
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Affiliation(s)
- LiAnn N Handel
- Rhode Island Hospital, Brown University, Providence, Rhode Island, and Merck and Co., Inc., Rahway, New Jersey, USA
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Deffieux X, Huel C, de Tayrac R, Bottero J, Porcher R, Gervaise A, Bonnet K, Frydman R, Fernandez H. [Vaginal mesh extrusion after transvaginal repair of cystocele using a prosthetic mesh: Treatment and functional outcomes]. ACTA ACUST UNITED AC 2007; 35:678-84. [PMID: 17088768 DOI: 10.1016/s0368-2315(06)76463-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe management of vaginal mesh erosion following transvaginal repair of acystocele by placement of a polypropylene mesh. MATERIALS AND METHOD Retrospective analysis of 34 consecutive cases of vaginal mesh erosion following transvaginal repair of cystocele using synthetic mesh (Gynemesh or Gynemesh-Soft). We have analyzed the results of both medical and surgical management of this complication. Furthermore, we also assessed sexual and urinary morbidity in women with mesh erosion (n = 34) and in women who had undergone the same procedure but without mesh erosion (n = 111). RESULTS Among the 34 patients with vaginal mesh erosion, 23 (68%) have undergone local therapy using Colposeptine (Chlorquinaldol + Promestriène). In 12 (52%) cases no modification of the surface of the erosion was observed. In 6 (26%) cases, a decrease of the surface of the mesh erosion was observed. In 5 (22%) cases the mesh erosion had completely disappeared, with a follow-up of 2 to 9 months. Nineteen symptomatic patients (19/32, 59%) required partial (n = 18) or complete (n = 1) excision of the mesh, associated with vaginal mucosal closure, under general anaesthesia. Duration of operation ranged from 15 to 40 minutes for partial excision of the mesh. This procedure was successful in 14 cases (77%). Four women required repeated resection of the mesh because of recurrence. The incidence of de novo dyspareunia was 12% in patients with vaginal mesh erosion, and 11% in patients without mesh erosion (p = 0.81). The incidence of urge urinary symptoms and voiding dysfunction symptoms was respectively 8% versus 9% (p = 0.95), and 8% versus 10% (p = 0.81) in the 2 groups. CONCLUSION Management of vaginal mesh 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.
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Affiliation(s)
- X Deffieux
- Service de Gynécologie-Obstétrique, Hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de Trivaux, 92140 Clamart.
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Mathé ML, Lavigne JP, Oliva-Lauraire MC, Guiraud I, Marès P, de Tayrac R. Comparaison de différents biomatériaux destinés à la chirurgie vaginale dans un modèle in vivo d'infection de prothèse chez le rat. ACTA ACUST UNITED AC 2007; 35:398-405. [PMID: 17434330 DOI: 10.1016/j.gyobfe.2007.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 02/21/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to develop an animal model of prosthetic infection and compare in vivo bacterial infectiosity of different biomaterials used in vaginal surgery. MATERIALS AND METHODS We implanted 36 prostheses of poly(lactic acid) with 94% L forms (PLA94), in a model of incisional abdominal hernia in Wistar rats. Bacterial inoculation was done just after implantation with three strains of Escherichia coli of variable virulence, two different concentrations and two different times of inoculation (during surgery or 48 hours after). All meshes were explanted and animals sacrificed on day 30 after intervention. Bacteriology and histology were then performed. In the same way, three materials used in vaginal surgery (knitted light-weight polypropylene [PP], thermoformed PP [Uratape] and polyurethane coated poly[ethylene terephtalate] [PTFE]) were tested and compared to the PLA94 using the same protocol. RESULTS All inoculated prostheses were still infected at day 30 after implantation with the same E. coli strain. There was a significant difference in bacterial infectiosity linked to virulence of the inoculated strain (p=.005) and the amount injected (P<0.001). Infectiosity was significantly lower for PLA94 when compared to the three other prostheses (P=0.008). The most important infectiosity was seen with PTFE and thermoformed PP. For histologists, PLA94 also gave the weakest inflammatory reaction. DISCUSSION AND CONCLUSION An original animal model of prosthetic infection allowed us to compare in vivo bacterial infectiosity of different biomaterials used in vaginal surgery and to demonstrate that the PLA94 mesh induces a milder risk of infection than polypropylene.
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Affiliation(s)
- M-L Mathé
- Service de gynécologie-obstétrique, CHU de Carémeau, Place du Professeur-Robert-Debré, Nîmes cedex 09, France
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Amblard J, Cosson M, Dabadie-Louasil C, Debodinance P, Fatton B, Jacquetin B. Du TVM au Prolift® (Gynecare): évolution d’une technique de renfort prothétique pour la cure de prolapsus par voie vaginale à propos d’une série multicentrique rétrospective de 794 patientes (684 TVM/110 Prolift®). ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s11608-007-0100-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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73
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Sola V, Pardo J, Ricci P, Guiloff E. Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair. Int Braz J Urol 2007; 32:410-4; discussion 415. [PMID: 16953907 DOI: 10.1590/s1677-55382006000400005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.
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Affiliation(s)
- Vicente Sola
- Urogynecology and Vaginal Surgery Unit, Gynecology and Obstetrics Department, Las Condes Clinic, Chile University Clinical Campus, Santiago, Chile.
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74
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Trabuco EC, Klingele CJ, Gebhart JB. Xenograft use in reconstructive pelvic surgery: a review of the literature. Int Urogynecol J 2007; 18:555-63. [PMID: 17225930 DOI: 10.1007/s00192-006-0288-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
Abstract
Xenografts, bovine or porcine acellular collagen bioprostheses derived from dermis, pericardium, or small-intestine submucosa, were introduced to overcome synthetic mesh-related complications. Although there are eight commercially available xenografts, there is a paucity of empiric information to justify their use instead of the use of synthetic grafts. In addition, limited data are available about which graft characteristics are important and whether graft-reinforced repairs reduce recurrences and improve outcomes. To address these knowledge gaps, we conducted a Medline search of published reports on xenografts in animal and human trials. Histologic host response to implanted xenograft material depends primarily on chemical cross-linking and porosity, and it is limited to four responses: resorption, incorporation, encapsulation, and mixed. No clinical data unequivocally demonstrate an improved benefit to graft-reinforced repair.
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Affiliation(s)
- Emanuel C Trabuco
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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75
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Affiliation(s)
- Pamela A Moalli
- Department of Obstetrics and Gynecology, Division of Urogynecology & Reconstructive Pelvic Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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76
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Paraiso MFR, Barber MD, Muir TW, Walters MD. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 2006; 195:1762-71. [PMID: 17132479 DOI: 10.1016/j.ajog.2006.07.026] [Citation(s) in RCA: 231] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 07/10/2006] [Accepted: 07/20/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to compare outcomes of 3 different rectocele repair techniques. STUDY DESIGN One hundred six women with stage II or greater posterior vaginal wall prolapse were randomly assigned to either posterior colporrhaphy (n = 37), site-specific rectocele repair (n = 37), or site-specific rectocele repair augmented with a porcine small intestinal submucosa graft (Fortagen, Organogenesis, Inc, Canton, MA; n = 32). Subjects underwent a physical examination and completed 3 validated pelvic floor instruments at baseline and 6 months, 1 year, and 2 years after surgery. Anatomic failure was defined as pelvic organ prolapse quantitation system (POPQ) point Bp > or = -2 at 1 year. RESULTS Of 106 subjects who enrolled, 105 underwent surgery and of those 105, 98 subjects returned (93%) with a mean follow-up of 17.5 +/- 7 months. After 1 year, those subjects who received graft augmentation had a significantly greater anatomic failure rate (12/26; 46%) than those who received site-specific repair alone (6/27; 22%) or posterior colporraphy (4/28; 14%), P = .02. There was a significant improvement in prolapse and colorectal scales and overall summary scores of the Pelvic Floor Distress Inventory short form 20 (PFDI-20), the Pelvic Floor Impact Questionnaire short form 7 (PFIQ-7) after surgery in all groups (P < .001 for each) with no differences between groups. The proportion of subjects with functional failures was 15% overall, and not significantly different between groups. There was no significant change in the rate of dyspareunia 1 year after surgery and there were no differences between groups. Overall sexual function as measured by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) improved significantly in all groups postoperatively (P < . 001), with no differences between groups. CONCLUSION Posterior colporraphy and site-specific rectocele repair result in similar anatomic and functional outcomes. The addition of a porcine-derived graft does not improve anatomic outcomes. All 3 methods of rectocele repair result in significant improvements in symptoms, quality of life, and sexual function.
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77
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Konstantinovic ML, Pille E, Malinowska M, Verbeken E, De Ridder D, Deprest J. Tensile strength and host response towards different polypropylene implant materials used for augmentation of fascial repair in a rat model. Int Urogynecol J 2006; 18:619-26. [PMID: 17031489 DOI: 10.1007/s00192-006-0202-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 08/03/2006] [Indexed: 10/24/2022]
Abstract
We compared inflammatory response, fibrosis and biomechanical properties of different polypropylene materials from one manufacturer (Tyco Healthcare) in a rat model for primary fascial repair. Full-thickness abdominal wall defects were primarily repaired using 'overlay' technique. Multifilament implants were Surgipro SPM and SPMW, the latter a wider-weave type of the former. Monofilament SPMM implants and polypropylene suture repair (Surgipro II) served as controls. Explants were evaluated macroscopically and changes in thickness, shrinkage and tensile strength were measured. Inflammatory and connective tissue response was assessed on haematoxylin-eosin and Movat stains. Immunohistochemistry was done to localise rat macrophages/monocytes. Multifilament materials induced a shorter acute inflammatory response and more pronounced chronic inflammatory reaction compared to monofilament implants. Macrophages could be found deep in interstices 7.5 by 12.5 microm. No difference in collagen deposition and neovascularisation was observed. At 90 days time point, explants reconstructed with tighter woven multifilament SPM were weaker than sutured or SPMM controls. Overall shrinkage of 10% was comparable for all groups.
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Affiliation(s)
- Maja L Konstantinovic
- Centre for Surgical Technologies, Faculty of Medicine, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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78
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Ihedioha U, Leung E, Chung L, Burgess G, Hendry D, O'dwyer PJ. A complex fistula caused by an eroding pelvic mesh sling. Hernia 2006; 11:75-8. [PMID: 17024307 DOI: 10.1007/s10029-006-0140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 08/14/2006] [Indexed: 11/30/2022]
Abstract
Pelvic mesh slings are increasingly used to create abdomino-pelvic partitions. This procedure is usually safe and carries low morbidity and mortality rates. However, we report a case of a 60-year-old male with a history of an abdomino-perineal resection for a low rectal carcinoma followed by adjuvant radiotherapy, who presented with an entero-vesicle-cutaneous fistula as a result of the polypropylene mesh eroding into his small bowel. He had to have a total cystectomy, small bowel resection and mesh removal in order to alleviate his symptoms.
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Affiliation(s)
- Ugo Ihedioha
- Professorial Unit of Surgery, Western Infirmary, Glasgow, G11 6NT, UK.
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79
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Nikolova G, Lee H, Berkovitz S, Nelson S, Sinsheimer J, Vilain E, Rodríguez LV. Sequence variant in the laminin gamma1 (LAMC1) gene associated with familial pelvic organ prolapse. Hum Genet 2006; 120:847-56. [PMID: 17021862 DOI: 10.1007/s00439-006-0267-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 09/07/2006] [Indexed: 01/30/2023]
Abstract
Pelvic organ prolapse is a common condition, affecting up to a third of women throughout their lifetime. Genetic factors are believed to account for about 30% of the incidence, and are the least understood component of the disorder. Familial cases, particularly those in which prolapse manifests in young women, are especially valuable in the effort to find the genes involved. We recently reported autosomal dominant transmission as the most likely mode of inheritance, based on a collection of families with high incidence of prolapse. Of greatest interest was a family in which three generations of female relatives suffered from prolapse at a very young age. A genome-wide linkage scan performed using the Affymetrix GeneChip Human mapping 10K array identified ten regions with a LOD score of 1.5, the maximum possible for this family. Candidate genes within those regions were analyzed for expression in vaginal tissue by RT-PCR. Of the genes confirmed to be expressed, LAMC1 was further evaluated by sequencing and select single nucleotide polymorphism (SNP) genotyping for causative sequence variants in affected family members. We identified one such SNP, rs10911193. The rare T variant segregating with the condition is present at a frequency of 4.9% in the general population and 22% among probands from our cohort of families. It affects the binding site for NFIL3, a transcription factor that we verified to be co-expressed in vaginal tissue. Altogether these data suggest that a polymorphism in the promoter of LAMC1 may increase the susceptibility to early-onset pelvic organ prolapse.
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Affiliation(s)
- Ganka Nikolova
- Department of Human Genetics, University of California, 695 Charles Young Drive South, Gonda Room 5506, Los Angeles, CA, 90095-7088, USA
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80
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Synthetic biomaterials for pelvic floor reconstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2006. [DOI: 10.1007/s11884-006-0013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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81
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Winters JC, Fitzgerald MP, Barber MD. The use of synthetic mesh in female pelvic reconstructive surgery. BJU Int 2006; 98 Suppl 1:70-6; discussion 77. [PMID: 16911608 DOI: 10.1111/j.1464-410x.2006.06309.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Christian Winters
- Obstetrics/Gynecology and Urology, Loyola University Medical Center, Maywood, IL, USA.
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82
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Abstract
PURPOSE OF REVIEW The success in the use of the tension-free midurethral sling procedures (tension-free vaginal tape, suprapubic arch, transobturator tape) has dramatically altered the approach to the surgical management of stress urinary incontinence in women and marked a resurgence in the use of mesh. We will analyze the characteristics of synthetic meshes and explain the rationale for using monofilament materials with larger pore sizes. Thus, the purpose of this review is to introduce the surgeon to a variety of commercially available mesh materials and the characteristics that make mesh suitable for use as sling grafts. RECENT FINDINGS Type I macroporous mesh materials appear most suitable for transvaginal implantation. Utilization of these materials in a minimally invasive retropubic or transobturator approach, promising early and intermediate follow-up data has been achieved. The outcome of these procedures in women with urethral hypermobility and genuine stress incontinence seems clear. No controlled data, however, exist to define the role of these procedures in difficult cases of stress incontinence. Newer generations of minimally invasive slings may offer treatment alternatives in these difficult cases. SUMMARY Minimally invasive slings using Type I mesh materials are safe and effective. 'Hybrid' type slings may offer alternatives in difficult cases of stress urinary incontinence.
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Affiliation(s)
- Christopher C Roth
- Department of Urology, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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83
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Naumann G, Kolbl H. Operative Therapie bei Genitaldeszensus der Frau: Pro und Kontra der Verwendung von Mesh-Materialien. ACTA ACUST UNITED AC 2006; 46:96-104. [PMID: 16778448 DOI: 10.1159/000092631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The development of different mesh materials has led to an improvement of the individual surgical correction of genital prolapse. Macroporous monofilamentous synthetic meshes seem to be the optimal material in case of recurrent prolapse or of severe insufficiency of the pelvic floor. The use of biological meshes shows a markedly better tolerance with fewer infections or erosions despite the lack of evidence-based information on their long-term efficacy and safety. The surgical correction of genital prolapse has to carefully consider all risks and benefits in order to improve quality of life. In this respect, mesh materials can be particularly advantageous in the recurrent situation.
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Affiliation(s)
- Gert Naumann
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Johannes-Gutenberg-Universität, Mainz, Deutschland.
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84
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Altman D, Anzen B, Brismar S, Lopez A, Zetterström J. Long-term outcome of abdominal sacrocolpopexy using xenograft compared with synthetic mesh. Urology 2006; 67:719-24. [PMID: 16566983 DOI: 10.1016/j.urology.2005.10.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2005] [Revised: 09/24/2005] [Accepted: 10/17/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the clinical outcome after abdominal sacrocolpopexy using a porcine dermal graft compared with a synthetic mesh. METHODS Patients with vaginal vault prolapse Stage II or worse (Baden-Walker staging), underwent sacrocolpopexy using a synthetic mesh (n = 25) or porcine collagen graft (n = 27). The subjective outcome was measured using validated questionnaires. RESULTS The mean clinical follow-up from surgery was 7.1 months for the xenograft compared with 7.4 months for the synthetic cohort. At clinical follow-up, vaginal vault prolapse Stage II was present in 8 (29%) of 27 patients in the xenograft cohort and 6 (24%) of 25 patients in the synthetic mesh cohort (no significant difference). The mean follow-up from surgery to survey was 2.5 years in the xenograft cohort and 4.3 years in the synthetic cohort. None of the patients in either cohort had undergone a secondary sacrocolpopexy. No significant differences were found between the cohorts regarding surgical morbidity other than more patients experiencing fever for 1 to 3 days in the xenograft cohort (P < 0.001). No significant differences were found in lower urinary tract symptoms, anorectal symptoms, or quality-of-life variables between the two cohorts. CONCLUSIONS Abdominal sacrocolpopexy using a porcine dermal graft was comparable to synthetic mesh in terms of subjective and anatomic outcomes at mid to long-term follow-up.
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Affiliation(s)
- Daniel Altman
- Pelvic Floor Center, Danderyd Hospital, Stockholm, Sweden.
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85
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Boulanger L, Boukerrou M, Lambaudie E, Defossez A, Cosson M. Tissue integration and tolerance to meshes used in gynecologic surgery: An experimental study. Eur J Obstet Gynecol Reprod Biol 2006; 125:103-8. [PMID: 16169657 DOI: 10.1016/j.ejogrb.2005.07.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2004] [Revised: 06/01/2005] [Accepted: 07/26/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the tissue integration of and tolerance to five different mesh types used in genital prolapse surgery to provide mechanical support. STUDY DESIGN We placed five different meshes (Vicryl, Vypro, Prolene, Prolene soft, and Mersuture) on the peritoneums of 12 pigs. After 10 weeks, we used light microscopy to analyze the tissue integration of and tolerance to these meshes. We looked for inflammation, vascularization, fibroblasts, collagen fibers and the organization of connective tissue. RESULTS The absorbable prostheses made of polyglactin 910 (Vicryl) and the non-absorbable prostheses made of polypropylene (Prolene and Prolene soft) induced the least severe inflammatory reactions. Tissue integration was best with the polypropylene meshes, which allowed the development of a well-organized, fibrous, mature, connective tissue. CONCLUSION The tissue response to prosthetic meshes depends on the material used and its structure. This work highlights the feasibility of carrying out experimental studies to test the tolerance to and integration of biomaterials used in gynecology. Such studies need to be carried out whenever new prostheses become available to validate their use in common practice.
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Affiliation(s)
- Loïc Boulanger
- Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Eugène Avinée, 59037 Lille Cedex, France.
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86
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Deffieux X, de Tayrac R, Huel C, Bottero J, Gervaise A, Bonnet K, Frydman R, Fernandez H. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J 2006; 18:73-9. [PMID: 16391882 DOI: 10.1007/s0192-005-0041-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 10/19/2005] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- X Deffieux
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 157, rue de la Porte-de-Trivaux, BP 405, 92140 Clamart, France.
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87
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Choi YS, Choo MS, Lee KS. Efficacy and Safety of Cystocele Repair Reinforced with a Monofilament Polypropylene Mesh. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.6.640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yang Su Choi
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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88
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Abstract
Pelvic organ prolapse and stress urinary incontinence increase with age. The increasing proportion of the aging female population is likely to result in a demand for care of pelvic floor prolapse and incontinence. Experimental evidence of altered connective tissue metabolism may predispose to pelvic floor dysfunction, supporting the use of biomaterials, such as synthetic mesh, to correct pelvic fascial defects. Re-establishing pelvic support and continence calls for a biomaterial to be inert, flexible, and durable and to simultaneously minimize infection and erosion risk. Mesh as a biomaterial has evolved considerably throughout the past half century to the current line that combines ease of use, achieves good outcomes, and minimizes risk. This article explores the biochemical basis for pelvic floor attenuation and reviews various pelvic reconstructive mesh materials, their successes, failures, complications, and management.
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Affiliation(s)
- Matthew E Karlovsky
- Department of Urology, Long Island Jewish Medical Center, 270-05 76 Avenue, New Hyde Park, NY 11040, USA
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89
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Abstract
With an ageing population, increasing numbers of women are presenting with pelvic floor disorders. The lifetime risk of undergoing prolapse or incontinence surgery in the USA is 1 in 11. With a recognized reoperation rate exceeding 30% for prolapse surgery, attempts are being made to improve our primary surgical outcomes. The introduction of synthetic and biological prostheses have been proposed to reduce recurrence rates whilst maintaining vaginal capacity and coital function. The role of synthetic prostheses is well established for use in continence surgery in the form of midurethral slings and for abdominal sacrocolpopexy to correct vault prolapse. However, postoperative morbidity-specifically the risk of mesh erosion-has limited their use for vaginal prolapse surgery. Biological prostheses have been introduced to offer an alternative for use in these repairs. While these grafts largely obviate the problem of erosion there are concerns regarding longevity, and only short-term outcome data are currently available. The role of prosthetics in pelvic floor surgery is an evolving and controversial field. Current and future research should be directed at evaluating the safety and efficacy of specific products and comparison of subjective and objective outcome parameters to standard surgical techniques for pelvic organ prolapse.
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Affiliation(s)
- Colin Birch
- Division of Urogynaecology, Department of Obstetrics and Gynecology, Foothills Medical Centre, North Tower, 1441-29th Street, NW Calgary, Alta., Canada T2N 4J8.
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90
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Rodríguez LV, Bukkapatnam R, Shah SM, Raz S. Transvaginal paravaginal repair of high-grade cystocele central and lateral defects with concomitant suburethral sling: Report of early results, outcomes, and patient satisfaction with a new technique. Urology 2005; 66:57-65. [PMID: 16194709 DOI: 10.1016/j.urology.2005.06.126] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 06/23/2005] [Indexed: 11/27/2022]
Abstract
Baden-Walker classification grade III-IV (pelvic organ prolapse quantification [POP-Q] system stage III-IV) cystocele is associated with a constellation of abnormalities including urethral hypermobility, lateral defect, central defect, and concomitant vault and posterior wall prolapse. We describe a new transvaginal paravaginal technique to correct this group of abnormalities and report on our early results. We prospectively evaluated patients with high-grade cystocele who underwent repair with the new transvaginal paravaginal repair. Preoperative evaluation included history and physical examination, dynamic pelvic magnetic resonance imaging, urodynamics, and symptom questionnaire. All patients first underwent a distal urethral polypropylene sling surgery. After repair of the central defect of the cystocele, a paravaginal repair of the lateral defect was performed by using a circular 5 cm x 5 cm soft polypropylene mesh attached proximally to the sacrouterine/cardinal ligament, distally to the bladder neck, and laterally to the infralevator obturator fascia. Postoperative evaluation at 3-month intervals included history and physical examination using the POP-Q system, a voiding dysfunction and incontinence symptom questionnaire, the validated short form of the Urogenital Distress Inventory (UDI-6), a validated global quality-of-life question, and a postvoid residual. We performed the repair in 98 patients with a mean age of 65 years (range, 40 to 86 years). Of these, 26% underwent concomitant vaginal hysterectomy, 45% had enterocele repair, and 94% had rectocele repair. There were 2 complications, including transient ureteral obstruction due to bladder wall hematoma and 1 patient who presented with a recurrent enterocele requiring surgical repair. No patient experienced urinary retention. De novo stress urinary incontinence was seen in 3 patients; de novo urge incontinence was seen in 2 patients. Postoperative POP-Q scores showed 85% of patients with stage 0-I, 13% with stage II, and 2% with stage III anterior vaginal wall prolapse. Of patients with preoperative stress urinary incontinence, 70% reported never experiencing symptoms under any circumstances. Quality of life improved from 4.7 to 1 (P < 0.005). Transvaginal paravaginal repair of grade III-IV cystocele using soft polypropylene mesh fixed to the obturator fascia, sacrouterine ligaments, and bladder neck area provides excellent support of the central defect repair as well as repair of the lateral defect. The operation is safe, simple, and outpatient based, and provides excellent anatomic results with minimal complications. Concomitant distal polypropylene sling did not increase the rate of complications and did not compromise results of stress urinary incontinence surgery.
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Affiliation(s)
- Larissa V Rodríguez
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, California 90024, USA.
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91
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Abstract
Pelvic organ prolapse, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of American women. This article, designed for the practicing clinician, highlights the clinical importance of prolapse, its pathophysiology, and approaches to diagnosis and therapy. Prolapse encompasses a range of disorders, from asymptomatic altered vaginal anatomy to complete vaginal eversion associated with severe urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial and may operate under a "multiple-hit" process in which genetically susceptible women are exposed to life events that ultimately result in the development of clinically important prolapse. The evaluation of women with prolapse requires a comprehensive approach, with attention to function in all pelvic compartments based on a detailed patient history, physical examination, and limited testing. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often challenging for the clinician to determine which symptoms are attributable to the prolapse itself and will therefore improve or resolve once the prolapse is treated. When treatment is warranted based on specific symptoms, prolapse management choices fall into 2 broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive (eg, sacral colpopexy) or obliterative (eg, colpocleisis). Concomitant symptoms require additional management. Virtually all women with prolapse can be treated and their symptoms improved, even if not completely resolved.
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Affiliation(s)
- Anne M Weber
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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92
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Karlovsky ME, Thakre AA, Rastinehad A, Kushner L, Badlani GH. Biomaterials for pelvic floor reconstruction. Urology 2005; 66:469-75. [PMID: 16140060 DOI: 10.1016/j.urology.2005.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 01/31/2005] [Accepted: 03/01/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew E Karlovsky
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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93
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Hoefter E, Holm C, Dornseifer U, Sturtz G, Stenzl A, Stenzel A, Ninkovic M. Der freie und gestielte Muskeltransfer als Therapieoption in der urologischen Chirurgie. Urologe A 2005; 44:743-50. [PMID: 15983821 DOI: 10.1007/s00120-005-0862-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Various demands of reconstruction define restoration technique. The basic principle involves optimal anatomical and functional reconstruction with concurrent minimal donor-site morbidity. Dependent on the aetiology of the defect, there are various reconstructive possibilities available for obtaining an optimal result. An immediate single stage reconstruction, with the best possible result for the individual patient as the primary consideration, can be carried out by interdisciplinary teams. In this overview, the most common indications and principles of flap choice are presented in relation to the reconstructive requirements necessary for early rehabilitation of the patient or the earlier start of necessary adjuvant therapy.
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Affiliation(s)
- E Hoefter
- Abteilung für Plastische, Rekonstruktive und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Bogenhausen der Technischen Universität München-Städt, Klinikum München GmbH, München.
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94
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Abstract
BACKGROUND Several complications are associated with healing after pelvic reconstructive surgery for stress urinary incontinence. These include infection, hemorrhage, erosion, and fistula formation. CASE A 67-year-old woman presented with simultaneously draining vaginal and suprapubic sinuses. Examination revealed a vagino-abdominal fistula. Surgical excision found an abscess around synthetic material from a previous bladder-neck suspension. CONCLUSION Unusual fistulation can occur remotely from anti-incontinence surgery, especially when graft materials are used.
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Affiliation(s)
- Dobie L Giles
- Department of Obstetrics and Gynecology Department, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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95
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Tate SB, Franco AVM, Fynes MM. Tension-free vaginal tape exposure presenting as a recurrent sterile paraurethral abscess. Int Urogynecol J 2005; 16:420-3. [PMID: 15846455 DOI: 10.1007/s00192-005-1290-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 01/25/2005] [Indexed: 11/27/2022]
Abstract
We report a case of tension-free vaginal tape (TVT) exposure presenting as a recurrent sterile paraurethral abscess at 25 months and 40 months following successful continence surgery and describe the management of this problem.
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Affiliation(s)
- Susan B Tate
- Department of Reconstructive Pelvic Surgery and Urogynaecology Unit, St. George's Hospital Medical School, 4th Floor Lanesborough Wing, Blackshaw Road, Tooting, SW17 0RE, London, UK
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96
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Deprest J, Claerhout F, Zheng F, Konstantinovic M, Spelzini F, Guelinckx I, Pottier C, Verbeken E, De Ridder D. Synthetic and biodegradable prostheses in pelvic floor surgery. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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97
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Abstract
In the past decade, sling surgery has become the preferred technique for the management of female stress urinary incontinence. A greater understanding of the pathogenesis of stress urinary incontinence and a greater durability and effectiveness for sling surgery has allowed this technique to become the benchmark for treatment of female stress urinary incontinence. As a consequence, a multitude of products have been developed using various techniques and materials to perform sling surgery. This article reviews the materials and techniques available and the complications associated with each. Most importantly, the outcomes are discussed so that the readers can best understand the impact of these surgeries on our patients.
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Affiliation(s)
- Raviender Bukkapatnam
- University of California at Los Angeles, Division of Female Urology, Reconstructive Surgery, and Urodynamics, Department of Urology, 924 Westwood Blvd; #520, Los Angeles, CA 90024, USA
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98
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Bai SW, Kim EH, Shin JS, Kim SK, Park KH, Lee DH. A comparison of different pelvic reconstruction surgeries using mesh for pelvic organ prolapse patients. Yonsei Med J 2005; 46:112-8. [PMID: 15744813 PMCID: PMC2823036 DOI: 10.3349/ymj.2005.46.1.112] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study was carried out in order to compare the effects in different surgeries using mesh in pelvic organ prolapse patients whose leading points were C. Thirty-nine patients were categorized into 3 groups: group A pelvic reconstruction with hysterectomy; group B hysterectomy prior to pelvic reconstruction; and group C pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and age, BMI, admission days, operation time, post-operative stage and complications were observed and results were analyzed and compared. All patients who were operated upon converted to stage one month following the operation, and no further change was observed except in one patient. Group admission days were not significantly different, but tended to be lower in group C. Group average operation times between 'group A and B' and 'group A and C' were statistically different. No significant difference was observed in post-operative complications between the groups, but 3 members of group A developed erosion, whereas no erosion occurred in groups B and C. Pelvic reconstruction using mesh is a highly efficient method of treating pelvic organ prolapse. Improvements in stage and post-operative complications were not significantly different in the groups. However, uteropexy showed a shorter operation time, fewer admission days, and less erosion due to mesh than conventional pelvic reconstruction with hysterectomy.
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Affiliation(s)
- Sang Wook Bai
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
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99
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Achtari C, Hiscock R, O'Reilly BA, Schierlitz L, Dwyer PL. Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J 2005; 16:389-94. [PMID: 15657636 DOI: 10.1007/s00192-004-1272-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 11/28/2004] [Indexed: 11/29/2022]
Abstract
The objective of this study was to identify the risk factors associated with the occurrence of mesh erosion (ME) during the first 6 post-operative months in patients having undergone transvaginal repair of pelvic organ prolapse (POP) with Atrium or Vypro II mesh. We retrospectively reviewed the records of 198 consecutive patients who underwent vaginal reconstructive surgery reinforced either by Atrium or Vypro II mesh between February 1999 and July 2003. Univariable and multivariable logistic regression was performed to assess associations between measured covariates and ME. Fourteen patients [7.1%, 95% confidence interval (CI): 3.9-11.6] developed vaginal ME. We found that, in the Vypro II mesh patients, the surgeon experienced in the technique had less erosions than less experienced surgeons (2.9 vs 15.6%, p=0.02). There was no statistically significant difference between the monofilament polypropylene (Atrium) and the composite polypropylene/polyglactin 910 (Vypro II) mesh (7.2 vs 6.9%, p=0.41) when adjusted for surgeon experience and patient age. There was no association between mesh type (Atrium or Vypro II) and vaginal ME following transvaginal repair of POP. Surgeon experience and patient age were associated with ME.
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Affiliation(s)
- Chahin Achtari
- Urogynaecology Department, Mercy Hospital for Women, Clarendon Street, East Melbourne, 3002, Victoria, Australia.
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100
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Solá Dalenz V, Pardo Schanz J, Ricci Arriola P, Guiloff Fische E. Malla de polipropileno monofilamento libre de tensión en la reparación concomitante de cistocele y rectocele. Actas Urol Esp 2005; 29:977-80. [PMID: 16447597 DOI: 10.1016/s0210-4806(05)73380-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We presented our experience in the concomitant correction of cystocele and rectocele with polypropylene monofilament mesh (Gynemesh PS), with transvaginal free tension technique. METHOD During 2004 correction was made in 7 patients, Urogynecologic and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Medium age 54 years old, weight 64 kgs. In four patients we used a third mesh for correction of urinary incontinence by TVT-O. RESULTS They don't present intraoperative complications, neither in immediate or delayed postoperative time. We not observed hematoma, infection, erosion or exposition mesh. Cure of cystocele and rectocele was in the 100% of patients. Complications have not appeared, 4 cases completed three months of observation, 2 cases two months and 1 case one month. DISCUSSION The use of protesic polypropylene multifilament macropore mesh in the concomitant correction of cistocele and rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.
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Affiliation(s)
- V Solá Dalenz
- Unidad de Uroginecología y Cirugía Vaginal, Departamento de Ginecología y Obstetricia, Clínica Las Condes, Santiago, Chile
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