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Cadiz MRM, Aguinaldo JKS. Outcomes of Abdominal Apical Suspension Using Mesh in a Tertiary Training Hospital: A Seven-year Retrospective Review. ACTA MEDICA PHILIPPINA 2024; 58:46-53. [PMID: 39006991 PMCID: PMC11239997 DOI: 10.47895/amp.v58i11.8968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background Pelvic organ prolapse (POP) is an inconvenience that can affect a woman's well-being. Reconstructive pelvic floor surgery involves repairing defects in the endopelvic fascia and pelvic floor musculature as close to the physiologic and anatomic norm. The cornerstone of successful prolapse repair is a strong apical support. Objective The aim of the study is to determine the outcomes of abdominal sacrocolpopexy (ASC) and abdominal sacrohysteropexy (ASH) in the Philippines. Methods The study utilized a descriptive study design to compare the pre-operative and post-operative Pelvic Organ Prolapse Quantification Score (POP-Q Score), presence of mesh complications, and urinary/bowel symptoms in patients operated within 2010-2016 in a Philippine tertiary training hospital. Based on recovered charts and inclusion/exclusion criteria, this study sampled 34 of 50 patient records. Statistical measures of median and range were used to describe pre-operative and post-operative POP-Q scores in any two follow-ups within 6-, 12-, 18-, and 24-month interval. The objective success rate and incidence of urinary/bowel symptoms were described using frequencies and percentages. Presence of any mesh erosion was noted for each follow-up. McNemar's test was applied to assess the comparative occurrence of each symptom comparing between the pre-operative and first follow-up periods. Results ASC had a success rate of 73.7% at six months and 56.3% at 12 months post-surgery. ASH showed an 84.6% success rate at six months and 71.4% at 12 months. Apical support has a 97% success rate without affecting the anterior or posterior compartments. Out of 20 ASC patients, 5 (25%) exhibited anterior compartment descent, whereas two out of 14 ASH patients (14.2%) had the same condition. It is observed that the anterior vaginal wall has the higher tendency to descend after reconstructive surgery, independent of route or technique. In addition, not all patients with surgical prolapse beyond -1 experienced symptomatic vaginal bulges. Overall, a notable decrease in the occurrence of urine symptoms was seen after the surgery. No mesh erosion was seen within the initial two years of follow-up but there was a single reported instance of abdominal hernia, an uncommon consequence. CONCLUSION This study demonstrated that ASC and ASH have good success rate in apical support; however, descent of the anterior or posterior compartment diminishes the overall success rate in terms of over-all objective POP-Q score. Both resulted to improvement in symptoms with minimal complications.
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Affiliation(s)
- Mary Rani M. Cadiz
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila
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Goh YM, Lim SH, Chua HL, Han HC, Lee JC. Long-Term Outcomes of Restorelle® Direct Fix Anterior Mesh in the Treatment of Pelvic Organ Prolapse. Cureus 2024; 16:e63513. [PMID: 39081408 PMCID: PMC11288286 DOI: 10.7759/cureus.63513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 08/02/2024] Open
Abstract
Objective The objective of this study was to evaluate the efficacy and long-term outcomes of the use of Restorelle® Direct Fix (Coloplast, Humlebæk, Denmark) anterior mesh for transvaginal surgical management of anterior compartment prolapse. Methods A retrospective case series review was conducted for 123 patients who underwent surgery for Baden-Walker Grade three and four anterior compartment prolapse with the Restorelle Direct Fix anterior mesh between July 1, 2017 and September 30, 2018 in a single center. Follow-up was conducted at one, six, 12, 24, and 36 months after treatment. A standardized questionnaire and pelvic examination were conducted at each visit to assess operative complications and subjective and objective cure rates. Results Sixty patients were included in the analysis with a three-year follow-up rate of 70.0%. At three years post-operatively, subjective and objective cure rates were 97.7% and 95.3% respectively. Seven (11.7%) patients complained of de novo stress urinary incontinence, four (6.7%) complained of de novo urge urinary incontinence and one (1.7%) complained of symptomatic recurrence. Significantly, six (10.0%) patients had transvaginal mesh exposure over the three-year follow-up, mostly presenting within the first year. One (2.4%) patient developed new asymptomatic mesh erosion at the 36-month visit and one patient required mesh loosening one month post-surgery. Conclusions Management of anterior compartment prolapse with transvaginal surgery using the Restorelle® Direct Fix anterior mesh was associated with good subjective and objective cure rates. However, significant rates of post-operative mesh exposure were noted within three years post-surgery, which hinders the recommendation of this device for augmentation of repair for anterior compartment prolapse.
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Affiliation(s)
- Yi Man Goh
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Shu Hui Lim
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Hong Liang Chua
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - How Chuan Han
- Department of Urogynaecology, HC Han Clinic for Women, Mount Elizabeth Novena Specialist Center, Singapore, SGP
| | - Jill C Lee
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP
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Zhang Z, Guo J, Tian W, Zhang Y, Zhang Y, Sun T, Duan J, Bao X, Wang Y, Ye Y, Gao Q, Shi H, Morse AN, Chen J, Zhu L. Efficacy and safety of transvaginal mesh repair in a cohort with a minimum of 10-year follow-up. SCIENCE CHINA. LIFE SCIENCES 2024; 67:1061-1068. [PMID: 38418758 DOI: 10.1007/s11427-023-2508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/11/2023] [Indexed: 03/02/2024]
Abstract
Although transvaginal mesh (TVM) repair is no longer used in some countries, long-term outcomes after TVM surgery are of great importance globally. However, reports with follow-up >10 years are limited. Thus, this study aimed to report outcomes in a prospective cohort with at least 10 years of follow-up. Women with stage III-IV symptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary hospital. The main outcome measure was symptomatic failure. Secondary outcomes included anatomic failure, recurrence, patient satisfaction, complications, and reoperation. The Kaplan-Meier curve was used to estimate the cumulative failure rate. Of the 121 patients enrolled in the study, 103 (85.1%) completed a median follow-up of 11 years. The estimated probability rates of symptomatic and anatomic failure were 17.6% and 8.8% in 11 years, respectively. The estimated incidence of symptomatic failure increased by 8.2% between 5 and 11 years; however, the corresponding rate for anatomic failure was 3.7%. The most common complication was vaginal mesh exposure, and its estimated probability increased from 19.3% to 28.4% from 5 to 11 years, respectively. Office trimming resolved 80.0% of vaginal exposures. These patients did not report decreased overall satisfaction. Patients with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room (5.8% by 11 years) had lower satisfaction rates (P<0.01) and were defined as having severe mesh exposure. The rates of postoperative pain, reoperation, and Patient Global Impression of Improvement ⩾2 were 2.5%, 3.3%, and 94.2%, respectively. The results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal wall. Vaginal mesh exposure was common in women who were largely not sexually active; however, 80% of the cases could be managed in the outpatient clinic, which did not affect patient satisfaction.
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Affiliation(s)
- Zhibo Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
| | - Jianbin Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
| | - Weijie Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
- Department of Gynecology, Guizhou Provincial People's Hospital, Medical College of Guizhou University, Guiyang, 550002, China
| | - Ye Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Tianshu Sun
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jiali Duan
- Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xinmiao Bao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
| | - Yuan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
- Department of Pathology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yang Ye
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
| | - Qianqian Gao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
| | - Honghui Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China
| | | | - Juan Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China.
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Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C. Transvaginal mesh or grafts or native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2024; 3:CD012079. [PMID: 38477494 PMCID: PMC10936147 DOI: 10.1002/14651858.cd012079.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Pelvic organ prolapse is the descent of one or more of the pelvic organs (uterus, vaginal apex, bladder, or bowel) into the vagina. In recent years, surgeons have increasingly used grafts in transvaginal repairs. Graft material can be synthetic or biological. The aim is to reduce prolapse recurrence and surpass the effectiveness of traditional native tissue repair (colporrhaphy) for vaginal prolapse. This is a review update; the previous version was published in 2016. OBJECTIVES To determine the safety and effectiveness of transvaginal mesh or biological grafts compared to native tissue repair or other grafts in the surgical treatment of vaginal prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and two clinical trials registers (March 2022). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing different types of vaginal repair (mesh, biological graft, or native tissue). DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed risk of bias, and extracted data. The primary outcomes were awareness of prolapse, repeat surgery, and recurrent prolapse on examination. MAIN RESULTS We included 51 RCTs (7846 women). The certainty of the evidence was largely moderate (ranging from very low to moderate). Transvaginal permanent mesh versus native tissue repair Awareness of prolapse at six months to seven years was less likely after mesh repair (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.73 to 0.95; I2 = 34%; 17 studies, 2932 women; moderate-certainty evidence). This suggests that if 23% of women are aware of prolapse after native tissue repair, between 17% and 22% will be aware of prolapse after permanent mesh repair. Rates of repeat surgery for prolapse were lower in the mesh group (RR 0.71, 95% CI 0.53 to 0.95; I2 = 35%; 17 studies, 2485 women; moderate-certainty evidence). There was no evidence of a difference between the groups in rates of repeat surgery for incontinence (RR 1.03, 95% CI 0.67 to 1.59; I2 = 0%; 13 studies, 2206 women; moderate-certainty evidence). However, more women in the mesh group required repeat surgery for the combined outcome of prolapse, stress incontinence, or mesh exposure (RR 1.56, 95% CI 1.07 to 2.26; I2 = 54%; 27 studies, 3916 women; low-certainty evidence). This suggests that if 7.1% of women require repeat surgery after native tissue repair, between 7.6% and 16% will require repeat surgery after permanent mesh repair. The rate of mesh exposure was 11.8% and surgery for mesh exposure was 6.1% in women who had mesh repairs. Recurrent prolapse on examination was less likely after mesh repair (RR 0.42, 95% CI 0.32 to 0.55; I2 = 84%; 25 studies, 3680 women; very low-certainty evidence). Permanent transvaginal mesh was associated with higher rates of de novo stress incontinence (RR 1.50, 95% CI 1.19 to 1.88; I2 = 0%; 17 studies, 2001 women; moderate-certainty evidence) and bladder injury (RR 3.67, 95% CI 1.63 to 8.28; I2 = 0%; 14 studies, 1997 women; moderate-certainty evidence). There was no evidence of a difference between the groups in rates of de novo dyspareunia (RR 1.22, 95% CI 0.83 to 1.79; I2 = 27%; 16 studies, 1308 women; moderate-certainty evidence). There was no evidence of a difference in quality of life outcomes; however, there was substantial heterogeneity in the data. Transvaginal absorbable mesh versus native tissue repair There was no evidence of a difference between the two methods of repair at two years for the rate of awareness of prolapse (RR 1.05, 95% CI 0.77 to 1.44; 1 study, 54 women), rate of repeat surgery for prolapse (RR 0.47, 95% CI 0.09 to 2.40; 1 study, 66 women), or recurrent prolapse on examination (RR 0.53, 95% CI 0.10 to 2.70; 1 study, 66 women). The effect of either form of repair was uncertain for bladder-related outcomes, dyspareunia, and quality of life. Transvaginal biological graft versus native tissue repair There was no evidence of a difference between the groups at one to three years for the outcome awareness of prolapse (RR 1.06, 95% CI 0.73 to 1.56; I2 = 0%; 8 studies, 1374 women; moderate-certainty evidence), repeat surgery for prolapse (RR 1.15, 95% CI 0.75 to 1.77; I2 = 0%; 6 studies, 899 women; moderate-certainty evidence), and recurrent prolapse on examination (RR 0.96, 95% CI 0.71 to 1.29; I2 = 53%; 9 studies, 1278 women; low-certainty evidence). There was no evidence of a difference between the groups for dyspareunia or quality of life. Transvaginal permanent mesh versus any other permanent mesh or biological graft vaginal repair Sparse reporting of primary outcomes in both comparisons significantly limited any meaningful analysis. AUTHORS' CONCLUSIONS While transvaginal permanent mesh is associated with lower rates of awareness of prolapse, repeat surgery for prolapse, and prolapse on examination than native tissue repair, it is also associated with higher rates of total repeat surgery (for prolapse, stress urinary incontinence, or mesh exposure), bladder injury, and de novo stress urinary incontinence. While the direction of effects and effect sizes are relatively unchanged from the 2016 version of this review, the certainty and precision of the findings have all improved with a larger sample size. In addition, the clinical relevance of these data has improved, with 10 trials reporting 3- to 10-year outcomes. The risk-benefit profile means that transvaginal mesh has limited utility in primary surgery. Data on the management of recurrent prolapse are of limited quality. Given the risk-benefit profile, we recommend that any use of permanent transvaginal mesh should be conducted under the oversight of the local ethics committee in compliance with local regulatory recommendations. Data are not supportive of absorbable meshes or biological grafts for the management of transvaginal prolapse.
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Affiliation(s)
- Ellen Yeung
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Gold Coast Health, Gold Coast, Australia
| | | | | | - Nir Haya
- Rambam Medical Centre, and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Sheila A Wallace
- Evidence Synthesis Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Mowat
- Greenslopes Hospital, Brisbane, Australia
| | - Christopher Maher
- Wesley and Royal Brisbane and Women's Hospitals, Brisbane, Australia
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Ferdinando Ruffolo A, Giordano C, Lambert B, Salvatore S, Lallemant M, Cosson M. A comparison between the vaginal patch plastron associated with the anterior sacrospinous fixation and the Uphold™ LITE vaginal support system for the treatment of advanced anterior vaginal wall prolapse. Eur J Obstet Gynecol Reprod Biol 2023; 291:162-167. [PMID: 37898047 DOI: 10.1016/j.ejogrb.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE The aim of the present study was to compare efficacy and safety of the vaginal patch plastron (VPP) associated to the anterior sacrospinous fixation (SSLF-A) with a TVM procedure (Uphold™ LITE support-system) for the treatment of the advanced anterior vaginal wall prolapse. STUDY DESIGN Single-center retrospective study. Women with symptomatic anterior prolapse ≥ III stage according to the POP-quantification (POP-Q) system and submitted to the VPP associated with the SSLF-A or to the Uphold™ procedure were included. Primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at 6- and 12-month follow-up. Secondary outcome was to describe peri- and postoperative complications. Pearson chi-square test and exact Fisher test were adopted for categorical variables, while intergroup Mann-Whitney U test and intragroup Wilcoxon Rank Sum Test for continuous variables; the statistical analysis was conducted at 95 % confidence level. RESULTS Fifty-five women in VPP-group and 118 women in Uphold-group were included. At 6-month follow-up, objective anterior relapse in VPP-group (3/55, 5.4 %) was like Uphold-group (5/118, 4.2 %; p = 0.71), as well as objective apical relapse (0/55, 0 % vs 3/118, 2.5 %; p = 0.55); no significant difference emerged in bulge symptoms (1/55, 1.8 % vs 5/118, 4.2 %; p = 0.67). At 12-month follow-up women were telephonically investigated; no significant difference emerged in bulge symptoms (1/55, 1.8 % vs 6/118, 5.1 %; p = 0.43). Reoperation rate for the composite outcome POP relapse, stress urinary incontinence (SUI) and remotion of the TVM resulted lower in the VPP group (1/55, 1.8 % vs 13/118, 11 %; p = 0.03). Post-operative buttock pain (32/55, 58.2 % vs 24/118, 20.3 %; p < 0.0001) and post-operative urinary retention (16/55, 29.1 % vs 6/118, 5.1 %; p < 0.0001) were higher in VPP-group, with a complete resolution between 2 and 3 weeks after treatment. CONCLUSION VPP associated with SSLF-A was as effective as Uphold™ LITE support-system for both anterior and central compartment prolapse treatment at 6- and 12-month follow-up. VPP-group presented a lower reoperation rate for the composite outcome prolapse relapse repair, SUI, and removal of the mesh.
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Affiliation(s)
| | - Celine Giordano
- Department of Obstetrics and Gynecology, McGill University, Montréal, QC, Canada
| | - Benjamin Lambert
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Stefano Salvatore
- Unit of Gynecology and Obstetrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marine Lallemant
- Department of Gynecology, University Hospital of Besançon, 25000 Besançon, France
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000 Lille, France
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Jafarzade A, Ulu I. Sexual dysfunction in patients after cystocele surgery. Is the g-spot a myth or reality? Eur J Obstet Gynecol Reprod Biol 2023; 290:74-77. [PMID: 37738890 DOI: 10.1016/j.ejogrb.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/23/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
The anterior wall of the vagina is very rich in nerves, blood vessels, and exocrine glands. This anatomical region is related to female sexual desire. During the anterior colporrhaphy operation, dissection of the anterior vaginal wall causes damage to this area, which may lead to decreased sexual satisfaction. In the present study, we aimed to investigate sexual function after anterior vaginal wall surgery. METHODS Totally 89 patients who had undergone the anterior colporrhaphy operation between May 2021 and December 2021 were included in the study. The patients' sexual function was investigated before surgery and six months after surgery. The effects on sexual function were determined according to the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. RESULTS According to our study results, orgasm and orgasm intensities decreased after anterior colporrhaphy surgery (p = 0.000; p = 0.000), while sexual desire or arousal did not change (p = 0.405; p = 0.052). In addition, an increase in pain was observed during sexual intercourse after surgery (p = 0.000). No statistically significant difference was observed in the PISQ-12 score before or after anterior colporrhaphy surgery (p = 0.675). CONCLUSION Based on the results of our study, we found a remarkable decrease in orgasm in these patients. Furthermore, we think that it is appropriate to recommend conservative or alternative treatments for the early stages of cystocele. Nevertheless, larger-scale studies may be designed to reveal the importance of this region in sexual function.
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Affiliation(s)
- Aytaj Jafarzade
- Obstetric and Gynecologycal Departman, Liv Hospital Ankara, Turkey.
| | - Ipek Ulu
- Obstetric and Gynecologycal Departman, Koru Hospital Ankara, Turkey
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Gudde A, van Velthoven MJJ, Türkel B, Kouwer PHJ, Roovers JPWR, Guler Z. Vaginal Fibroblast Behavior as a Function of Stiffness Changes in a Polyisocyanide Hydrogel for Prolapse Repair. ACS APPLIED BIO MATERIALS 2023; 6:3759-3767. [PMID: 37589427 PMCID: PMC10521013 DOI: 10.1021/acsabm.3c00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
There is an urgent need for improved outcomes in the treatment of pelvic organ prolapse (POP). Success of primary surgery relies on the load bearing capacity of plicated connective tissue underneath the vaginal wall, which is compromised due to an altered vaginal fibroblast function and collagen composition. There is an important factor in connective tissue repair that relates to changes in stiffness of the vaginal fibroblast microenvironment, which influences cell activity through cellular mechanosensing. The aim of this study is to investigate the effect of stiffness changes on vaginal fibroblast functions that relate to connective tissue healing in prolapse repair. The substrate stiffness was controlled by changing the polymer concentration in the fibrous and strongly biomimetic polyisocyanide (PIC) hydrogel. We analyzed stiffness during cell culture and assessed the consequential fibroblast proliferation, morphology, collagen deposition, and contraction. Our results show that increasing stiffness coincides with vaginal fibroblast alignment, promotes collagen deposition, and inhibits PIC gel contraction. These findings suggest that the matrix stiffness directly influences vaginal fibroblast functionality. Moreover, we observed a buildup in stiffness and collagen, with an enhanced fibroblast and collagen organization on the PIC-substrate, which indicate an enhanced structural integrity of the hydrogel-cell construct. An improved tissue structure during healing is relevant in the functional repair of POP. Therefore, this study encourages future research in the use of PIC gels as a supplement in prolapse surgery, whereby the hydrogel stiffness should be considered.
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Affiliation(s)
- Aksel
N. Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Melissa J. J. van Velthoven
- Department
of Urology, Radboud Institute for Molecular
Life Sciences, Radboud University Medical Centre, Geert Grooteplein Zuid 28, 6525 GA Nijmegen, The Netherlands
- Institute
for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - Betül Türkel
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Paul H. J. Kouwer
- Institute
for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - Jan-Paul W. R. Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Padoa A, Braga A, Fligelman T, Athanasiou S, Phillips C, Salvatore S, Serati M. European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:703-716. [PMID: 37490710 DOI: 10.1097/spv.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
| | | | | | - Stavros Athanasiou
- Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Urogynaecology, Basingstoke, Hampshire, United Kingdom
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Milan, Italy
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Karalis T, Tsiapakidou S, Grimbizis GF, Mikos T. Surgical results in POP/UI surgery after using PVDF compared to other materials. A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 284:110-119. [PMID: 36966589 DOI: 10.1016/j.ejogrb.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/01/2023] [Accepted: 03/18/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES Synthetic materials have been used for the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). During the last 25 years, these materials were composed mostly of polypropylene (PP), whereas recently the use of polyvinylidene difluoride (PVDF) is of increasing interest due to its characteristics. This study aimed to compare the results after SUI/POP surgery using PVDF versus PP materials by synthesizing the data of relevant existing literature. STUDY DESIGN This systematic review and meta-analysis included clinical trials, case-control studies, or cohort studies written in the English language. The search strategy included the electronic databases MEDLINE, EMBASE, and Cochrane, and grey literature (congresses IUGA, EUGA, AUGS, FIGO). All studies have to provide numeric data or odds ratios (OR) of developing a specific outcome in surgeries with PVDF compared with outcomes of other used materials. No restrictions of race or ethnicity were applied, nor chronological restrictions. Exclusion criteria were studies that included patients with cognitive impairment, dementia, stroke, or central nervous system trauma. All studies were screened by two reviewers, initially by title and abstract, and afterward by full text. Disagreements were resolved through mutual consent. All studies were assessed for their quality and bias risk. Data were extracted using a data extraction form formulated in a Microsoft Excel spreadsheet. Our results were divided into studies dealing only with SUI patients, studies dealing only with POP patients, and cumulative analysis of variables expressed in both SUI and POP surgery. The primary outcomes were the rates of post-operative recurrence, mesh erosion, and postoperative pain after surgery with PVDF compared to PP. The secondary outcomes were post-operative sexual dissatisfaction, overall satisfaction rates, hematoma, urinary tract infection, de novo urge incontinence, and reoperation rate. RESULTS No differences in the post-operative rates of SUI/POP recurrence, mesh erosion, and pain were found after surgery with PVDF vs surgery with PP. Patients after SUI surgery with PVDF tapes had statistically significant lower rates of de-novo urgency compared to the PP group [OR = 0.38 (0.18, 0.88), p = 0.01]; patients after POP surgery with PVDF materials had statistically significant lower rates of de-novo sexual dysfunction compared to the PP group [OR = 0.12 (0.03, 0.46), p = 0.002]. CONCLUSIONS This study provided evidence that the use of PVDF in SUI/POP surgeries could be a valid alternative to PP. However our results are limited by uncertainty due to the overall low quality of the existent data. Further research and validation would contribute to better surgical techniques.
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Affiliation(s)
- Tilemachos Karalis
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Tsiapakidou
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigoris F Grimbizis
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Mikos
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Tunn R, Baessler K, Knüpfer S, Hampel C. Urinary Incontinence and Pelvic Organ Prolapse in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:71-80. [PMID: 36647585 PMCID: PMC10080228 DOI: 10.3238/arztebl.m2022.0406] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/01/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pelvic floor disorders are common, especially in pregnancy and after delivery, in the postmenopausal period, and old age, and they can significantly impact on the patient's quality of life. METHODS This narrative review is based on publications retrieved by a selective search of the literature, with special consideration to original articles and AWMF guidelines. RESULTS Pelvic floor physiotherapy (evidence level [EL] 1), the use of pessaries (EL2), and local estrogen therapy can help alleviate stress/urge urinary incontinence and other symptoms of urogenital prolapse. Physiotherapy can reduce urinary incontinence by 62% during pregnancy and by 29% 3-6 months post partum. Anticholinergic and β-sympathomimetic drugs are indicated for the treatment of an overactive bladder with or without urinary urge incontinence (EL1). For patients with stress urinary incontinence, selective serotonin-noradrenaline reuptake inhibitors can be prescribed (EL1). The tension-free tape is the current standard of surgical treatment (EL1); in an observational follow-up study, 87.2% of patients were satisfied with the outcome 17 years after surgery. Fascial reconstruction techniques are indicated for the treatment of primary pelvic organ prolapse, and mesh-based surgical procedures for recurrences and severe prolapse (EL1). CONCLUSION Urogynecological symptoms should be specifically asked about by physicians of all relevant specialties; if present, they should be treated conservatively at first. Structured surgical techniques with and without mesh are available for the treatment of urinary incontinence and pelvic organ prolapse. Preventive measures against pelvic floor dysfunction should be offered during pregnancy and post partum.
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Affiliation(s)
- Ralf Tunn
- Department of Urogynecology, German Pelvic Floor Center, Alexianer St. Hedwig Hospital, Berlin
| | - Kaven Baessler
- Pelvic Floor CenterFranziskus and St Joseph Hospitals Berlin
| | - Stephanie Knüpfer
- Clinic and Policlinic for Urology and Pediatric Urology, University Hospital of Bonn
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11
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Verhorstert K, Gudde A, Weitsz C, Bezuidenhout D, Roovers JP, Guler Z. Absorbable Electrospun Poly-4-hydroxybutyrate Scaffolds as a Potential Solution for Pelvic Organ Prolapse Surgery. ACS APPLIED BIO MATERIALS 2022; 5:5270-5280. [PMID: 36315937 PMCID: PMC9682484 DOI: 10.1021/acsabm.2c00691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Women with pelvic organ prolapse (POP) have bothersome complaints that significantly affect their quality of life. While native tissue repair is associated with high recurrence rates, polypropylene knitted implants have caused specific implant-related adverse events that have detrimental, often irreversible, effects. We hypothesize that surgical outcome can be improved with a tissue-engineered solution using an absorbable implant that mimics the natural extracellular matrix (ECM) structure, releases estrogen, and activates collagen metabolism by fibroblasts as the main regulators of wound healing. To this aim, we produced electrospun poly-4-hydroxybutyrate (P4HB) scaffolds and biofunctionalized them with estradiol (E2). The cell-implant interactions relevant for POP repair were assessed by seeding primary POP vaginal fibroblasts isolated from patients on electrospun P4HB scaffolds with 1%, 2%, or 5% E2 and without E2. To test our hypothesis on whether ECM mimicking structures should improve regeneration, electrospun P4HB was compared to knitted P4HB implants. We evaluated vaginal fibroblast proliferation, ECM deposition, and metabolism by quantification of collagen, elastin, and matrix metalloproteinases and by gene expression analysis for 28 days. We established effective E2 drug loading with a steady release over time. Significantly higher cell proliferation, collagen-, and elastin deposition were observed on electrospun P4HB scaffolds as compared to knitted P4HB. For this study, physical properties of the scaffolds were more determinant on the cell response than the release of E2. These results indicate that making these electrospun P4HB scaffolds E2-releasing appears to be technically feasible. In addition, electrospun P4HB scaffolds promote the cellular response of vaginal fibroblasts and further studies are merited to assess if their use results in improved surgical outcomes in case of POP repair.
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Affiliation(s)
- Kim Verhorstert
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Aksel Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Carmen Weitsz
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Deon Bezuidenhout
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Jan-Paul Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,
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12
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Levy G, Padoa A, Marcus N, Beck A, Fekete Z, Cervigni M. Surgical treatment of advanced anterior wall and apical vaginal prolapse using the anchorless self-retaining support implant: long-term follow-up. Int Urogynecol J 2022; 33:3067-3075. [PMID: 35022836 PMCID: PMC8754555 DOI: 10.1007/s00192-021-05045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Following health notification by the FDA in 2008 of serious complications with transvaginal mesh for anterior pelvic organ prolapse, there has been a return to native tissue repairs. Earlier work with a self-retaining support (SRS) implant showed a high anatomical success rate with minimal implant-related complications over a medium-term follow-up. It is proposed that post-implant complications are more a consequence of the method of mesh anchoring rather than the implant itself. Our system incorporates an ultralight mesh with a frame that provides level I, II, and III support without the need for fixation. The first long-term outcomes of SRS implantation are presented. METHODS A prospective multicenter trial was conducted using two consecutive identical protocols of the use of the SRS implant in women with symptomatic anterior compartment prolapse extending their follow-up to 36 months. Anatomical success (Pelvic Organ Prolapse Quantification stage 0 or 1 or a Ba ≤ -2) was recorded along with subjective success as defined by regular quality-of-life (PFDI-20 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire) assessments. RESULTS Sixty-seven patients completed 36 months of follow-up. Mean Ba measurements improved from 3.1 (-1 to 6) cm to -2.8 (-1 to -3) cm and C point from 0.4 (-8 to 6) cm to -6.9 (-10 cm to 1) cm. accumulating to a significant anatomical success rate of 94.3%. Subjective success based on question #3 of the PFDI-20, analyzed for the index surgical compartment, reached 95.7%. Post-operative complications included 2 cases of urinary retention, 1 minor frame exposure, 1 case of delayed voiding dysfunction, and 2 cases of de novo stress urinary incontinence. Untreated pre-operative second-degree Bp measurements had increased in 27% at follow-up. CONCLUSION The long-term outcome of the SRS implant shows an excellent subjective and objective success with minimal risk of complications or need for reintervention.
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Affiliation(s)
- Gil Levy
- Assuta University Hospital, Ashdod, Israel.
| | | | | | - Anat Beck
- Maynei Hayeshua Hospital, Bnei Brak, Israel
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da Cunha MNB, Rynkevic R, da Silva MET, Moreira da Silva Brandão AF, Alves JL, Fernandes AA. Melt Electrospinning Writing of Mesh Implants for Pelvic Organ Prolapse Repair. 3D PRINTING AND ADDITIVE MANUFACTURING 2022; 9:389-398. [PMID: 36660296 PMCID: PMC9831559 DOI: 10.1089/3dp.2021.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Over the past decade, melt electrospinning writing has attracted renewed attention. When combined with three-dimensional (3D) printing capabilities, complex 3D structures can be produced, from ultrafine fibers in the absence of toxic solvents, making it particularly attractive to fabricate customized scaffolds and implants for medical applications. This research aimed to develop novel less stiff vaginal mesh implants for pelvic organ prolapse (POP) repair, matching the physiological biomechanics of vaginal tissues. The main objectives, to attain that goal, were: development of a melt electrospinning writing prototype, with additive manufacturing capability, to produce complex structures from micrometer scale fibers, in a direct 3D printing mode; and design and validate new concepts of biodegradable meshes/scaffolds with new geometries, for POP repair. The melt electrospinning writing prototype was built based on different modules. Biodegradable polycaprolactone was used to produce novel implants: three geometries and two fiber configurations were employed. The commercially available Restorelle® (Coloplast) mesh was used as a benchmark. Printed implants were analyzed via scanning electron microscopy (SEM) and uniaxial tensile testing. The SEM images showed that the geometry is generally well produced; however, some minor deviations are visible due to charge interactions. The tensile test results indicated that, regardless of the geometry, the samples showed an elastic behavior for smaller displacements; aplastic behavior dominates later stages. In the physiological range of deformation, the novel meshes (80 μm fiber diameter) matched the tissue properties (p > 0.05). The Restorelle mesh was significantly stiffer than vaginal tissue (p < 0.05) and novel meshes. The precision of the various geometrical patterns and fiber diameters produced highlights the success of the designed and built prototype equipment. Results showed that the biodegradable meshes produced are biomechanically more compatible with native tissue than commercial implants.
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Affiliation(s)
| | - Rita Rynkevic
- Mechanical Department, LAETA, INEGI, Faculty of Engineering, University of Porto, Porto, Portugal
| | | | | | - Jorge Lino Alves
- Mechanical Department, LAETA, INEGI, Faculty of Engineering, University of Porto, Porto, Portugal
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14
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Zhang R, Wang L, Shao Y. The Application of a Multidimensional Prediction Model in the Recurrence of Female Pelvic Organ Prolapse after Surgery. Appl Bionics Biomech 2022; 2022:3077691. [PMID: 35989713 PMCID: PMC9391169 DOI: 10.1155/2022/3077691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The relationship between multiple indicators of women and postoperative recurrence of pelvic organ prolapse was analyzed to establish a model for predicting postoperative recurrence of female pelvic organ prolapse. Methods Three hundred patients with pelvic organ prolapse who underwent pelvic organ prolapse surgery at our hospital were monitored for 1-2 years to determine their prognosis. Whether there was a postoperative recurrence, they were divided into two groups. We collected the relevant data from the two groups of patients before and after surgery. Through single factor and logistic multivariate analysis, we selected the risk factors that may affect the recurrence of patients to construct a prediction model. We verified the identification ability, proofreading ability, and clinical applicability of the model. Results Eighty-four patients with pelvic organ prolapse who had postoperative recurrence were assigned to the recurrence group, and 216 patients were included in the nonrecurrence group. Based on the logistic multivariate analysis results, we constructed a nomogram model containing 5 dimensions of age, BMI, degree of prolapse, pubic fissure, and serum calcium to predict postoperative recurrence. The tests revealed that the model had an excellent identification ability (AUC = 0.910), and the expected recurrence rate was significantly in agreement with the actual recurrence rate (U = -0.007, Brief = 0.087). The Hosmer-Lemeshow goodness-of-fit test demonstrated that the model had good calibration (c2 = 29.352, P = 0.522), and the decision curve showed that the threshold probability was in the range of ~12% to 100%, having a high net benefit value. Conclusion Based on the present study findings, we concluded that the constructed nomogram model has suitable identification, calibration, and clinical applicability.
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Affiliation(s)
- Ruirui Zhang
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, 215200 Jiangsu, China
| | - Liming Wang
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, 215200 Jiangsu, China
| | - Yawei Shao
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, 215200 Jiangsu, China
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15
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Application of Acellular Dermal Matrix in Gynaecology—A Current Review. J Clin Med 2022; 11:jcm11144030. [PMID: 35887793 PMCID: PMC9318528 DOI: 10.3390/jcm11144030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of our study is to draw attention to the multitude of applications of acellular dermal matrix (ADM) in the surgical treatment of urogynaecological disorders, such as reduction in the reproductive organs, and in reconstructive gynaecology. Despite the existence of numerous operational methods and materials, the effectiveness of transvaginal operation is still insufficient. Native tissue operations are often not durable enough, while operations with synthetic materials have numerous side effects, such as infections, hematomas, vaginal erosion, or dyspareunia. Hence, the search continues for a different material with a better efficacy and safety profile than those previously mentioned. It seems that ADM can meet these requirements and be a useful material for urogynaecological surgery. Key words related to the usage of ADM in gynaecological reconstructive surgery were used to search relevant databases (NCBI MedLine, Clinical Key, Clinicaltrials.gov). This manuscript is based on 43 literature sources, 28 (65.11%) of which were released after 2016. Older sources are cited for the purpose of presenting basic science, or other important issues related to the manuscript. ADM seems to be an ideal material for urogynaecological and reconstructive surgery. It has high durability, and thus high effectiveness. Moreover, it does not have the side effects typical for synthetic materials. There are no reports of material rejection, erosion or dyspareunia directly related to the presence of the mesh. Due to the difficulties in obtaining ADM and the need to perform additional tests, this material is not common in routine clinical practice. Therefore, the number of cases and the size of the research groups are insufficient to clearly define the potential of mesh from biological tissue. However, the results are so promising that it is worth considering a wider introduction to the use of this material. Our hope is that increasing clinicians’ awareness of this topic will lead to more studies comparing methods using native tissues or synthetic materials and those using ADM.
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16
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Yeung E, Malacova E, Maher C. Is levator ani avulsion a risk factor for prolapse recurrence? A systematic review and meta-analysis. Int Urogynecol J 2022; 33:1813-1826. [PMID: 35538253 PMCID: PMC9270296 DOI: 10.1007/s00192-022-05217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/06/2022] [Indexed: 11/06/2022]
Abstract
Introduction and hypothesis Levator ani muscle avulsion as a risk factor for prolapse recurrence is not well established. This systematic review was aimed at evaluating the correlation between levator ani avulsion and postoperative prolapse recurrence with meta-analysis, specifically, the risk of subjective or objective prolapse recurrence and reoperation. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (registration number CRD42021256675). A systematic literature search was conducted using PubMed, EMBASE and Cochrane Database of Systematic Reviews to identify all peer-reviewed studies that described levator avulsion in women and investigated operative and postoperative outcomes. All peer-reviewed, English-language cohort studies in those with and without levator avulsion with a minimum of 3 months’ follow-up were included. Pooled unadjusted and adjusted odds ratios were calculated for subjective recurrence, objective recurrence and rates of re-operation. The Cochrane Collaboration Risk of Bias In Non-Randomized Studies (RoBINS) and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools were used to assess the quality of the studies included. Results Twelve studies with a total of 2,637 subjects and a follow-up period 0.3–6.4 years were identified. There were insufficient data to report a pooled adjusted risk for subjective recurrence and reoperation. On low to moderate quality-adjusted data, the pooled odds of objective recurrence was not significantly associated with levator ani avulsion (aOR 1.68; 95% CI 0.78–3.66). Conclusion Levator ani avulsion has not been confirmed as a risk factor for objective prolapse recurrence. Further evidence is needed to investigate the correlation between levator ani avulsion and the risk of subjective recurrence and reoperation. Supplementary information The online version contains supplementary material available at 10.1007/s00192-022-05217-2
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Affiliation(s)
- Ellen Yeung
- Department of Urogynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,The University of Queensland, Saint Lucia, QLD, Australia.
| | - Eva Malacova
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Christopher Maher
- Department of Urogynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,The University of Queensland, Saint Lucia, QLD, Australia
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17
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Current techniques used to perform surgery for anterior and posterior vaginal wall prolapse in South Korea. Obstet Gynecol Sci 2022; 65:273-278. [PMID: 35340135 PMCID: PMC9119735 DOI: 10.5468/ogs.21352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/06/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to evaluate the current surgical techniques for anterior and posterior vaginal wall prolapse repair in South Korea. Methods A web-based questionnaire survey was sent to 780 members of the Korean Society of Obstetrics and Gynecology. The items assessed in the questionnaire were the demographic characteristics and current surgical techniques used for the correction of anterior and posterior vaginal wall prolapse. Results The response rate was 16%. There were variations in the suture materials and methods used for anterior and posterior colporrhaphy. Most respondents used only rapid absorbable suture materials to plicate the fibromuscular layer and close the mucosal layer of the anterior and posterior vaginal wall. Simple interrupted sutures are the most popular suture method for both the fibromuscular and mucosal layers. Thirty-one and eleven percent of the respondents used mesh for surgical correction of anterior and posterior vaginal wall prolapse, respectively. Concomitant perineorrhaphy was routinely performed with posterior vaginal wall repair by 42% of the respondents, whereas 58% performed perineorrhaphy only in cases with perineal defects. Conclusion There is considerable diversity in the current surgical techniques for anterior and posterior vaginal wall prolapse repair in Korea. Further research is required to standardize the surgical techniques.
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18
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Liu Z, Sharen G, Wang P, Chen L, Tan L. Clinical and pelvic floor ultrasound characteristics of pelvic organ prolapse recurrence after transvaginal mesh pelvic reconstruction. BMC Womens Health 2022; 22:102. [PMID: 35379231 PMCID: PMC8981864 DOI: 10.1186/s12905-022-01686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Recurrence of pelvic organ prolapse (POP) after transvaginal mesh (TVM) implantation pelvic floor reconstruction surgery remains an unresolved problem in clinical practice. In this retrospective observational study, clinical and pelvic floor ultrasound (PFUS) parameters were analyzed in order to identify high-risk factors of POP recurrence.
Methods The clinical and PFUS data from September 2013 to November 2019 of patients who underwent TVM were retrospectively analyzed. The patients with prolapse recurrence on postoperative follow-up diagnosed by PFUS were selected as case group, the clinical and PFUS parameters of them were compared with the control group in which the patients had no sign of prolapse recurrence. Univariate and multivariate regression analyses were performed based on age, BMI, gravidity, parity, surgical history (non-POP hysterectomy and incontinence-or-POP surgery), preoperative POP stage, follow-up in years, levator avulsion and hiatal area (HA) on Valsalva. Results Altogether 102 patients entered the study and the median interval between PFUS and TVM surgery was 2.5 years. Univariate analysis showed that levator avulsion and HA were significantly different between case group and control; multivariate regression analysis showed that only HA was related to prolapse recurrence after TVM (OR = 1.202, 95% CI 1.100–1.313, P < 0.001). The area under the ROC curve was 0.775 (95% CI 0.684–0.867, P < 0.001). Conclusions Hiatal area on Valsalva was related to prolapse recurrence after TVM surgery and it is an important parameter for postoperative follow-up of TVM surgery.
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Affiliation(s)
- Zhenzhen Liu
- Department of Ultrasound Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Gaowa Sharen
- Department of Health Management, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Pan Wang
- Department of Ultrasound, The Sixth Hospital of Beijing, Beijing, China
| | - Liyuan Chen
- Department of Ultrasound, Bozhou People's Hospital Affiliated to Anhui University of Technology, Anhui Province, China
| | - Li Tan
- Department of Ultrasound Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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Aitbayeva B, Iskakov S, Smailova L. Mini-review: Modern Concept of Pelvic Organ Prolapse. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Symptomatic pelvic organ prolapse (POP) has been increasing in recent years for both developed and developing countries. By 2050, as the adult population grows, the number of women with symptomatic POP will increase by 46%. Due to the increasing number of complications after surgery among women with POP, the current understanding of treatment has become extremely important for researchers and practitioners. There are many novel conservative and surgical treatment approaches under investigation. However, some primary surgical treatments show an approximate 30–50% risk of repeated pelvic floor reconstruction. Therefore, the review aims to summarize several conservative treatment options and identify critical areas of need for future research.
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Deblaere S, Hauspy J, Hansen K. Mesh exposure following minimally invasive sacrocolpopexy: a narrative review. Int Urogynecol J 2022; 33:2713-2725. [DOI: 10.1007/s00192-021-04998-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
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Fuschi A, Martoccia A, Al Salhi Y, Maggi M, Capone L, Suraci PP, Antonioni A, Bozzini G, Illiano E, Costantini E, Zucchi A, Cervigni M, Carbone A, Pastore AL. Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension. Langenbecks Arch Surg 2022; 407:1693-1700. [PMID: 35113228 DOI: 10.1007/s00423-022-02458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement. MATERIALS AND METHODS Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6 months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR). RESULTS At 6 months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001). CONCLUSIONS Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Martina Maggi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Capone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Alice Antonioni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Alessandro Zucchi
- Department of Translationals Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mauro Cervigni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy.
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22
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Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial. Int Urogynecol J 2022; 33:2021-2030. [PMID: 35044477 DOI: 10.1007/s00192-021-05071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The main objective of the study was to evaluate the rates of de novo stress urinary (SUI) and postoperative dyspareunia after both sacrocolpopexy/hysteropexy (SCP) and vaginal mesh surgery. METHODS A prospective, multicenter, randomized, open-label study with two parallel groups treated by either SCP or Uphold Lite vaginal mesh was carried out. Study participants were ≥ 50 and < 80 years old patients with Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 who were considered eligible for reconstructive surgery and who were sexually active with no dyspareunia and free from bothersome SUI at presentation. Women were assessed before surgery and at 4-8 weeks and 11-13 months after using validated measures including POP-Q, Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Patient Global Impression of Improvement (PGI-I). Data were also collected for health economics evaluation. RESULTS Of the required sample of 156 women, 42 women (19 SCP and 23 vaginal mesh) were only recruited owing to the discontinuation of vaginal mesh worldwide. The median follow-up was 376 days. The rates of bothersome de novo SUI were similar in the SCP and Uphold vaginal mesh groups (15.79 vs 15.00%, OR 0.95 [95% CI 0.22-4.14]). Among 30 sexually active patients at follow-up, the rates of women reporting de novo dyspareunia "usually or always" were 6.7% after SCP vs 13.3% after vaginal mesh (p = 1). Health economics evaluation showed a cost saving of 280€ in favor of the Uphold vaginal mesh technique, but no significant difference in the total cost (2,934.97€ for SCP vs 3,053.26€ for Uphold vaginal mesh). CONCLUSIONS Bothersome de novo SUI and de novo dyspareunia occurred in approximately 15% and 23% of our study cohorts, with no significant difference between sacrocolpopexy/hysteropexy and anterior/apical vaginal mesh surgery. However, these results should be interpreted with caution owing to the small sample size.
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23
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Kotani Y, Murakamsi K, Kai S, Yahata T, Kanto A, Matsumura N. Comparison of Surgical Results and Postoperative Recurrence Rates by Laparoscopic Sacrocolpopexy with Other Surgical Procedures for Managing Pelvic Organ Prolapse. Gynecol Minim Invasive Ther 2021; 10:221-225. [PMID: 34909379 PMCID: PMC8613493 DOI: 10.4103/gmit.gmit_127_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/10/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: Pelvic organ prolapse (POP) is relatively high for a gynecologic disease. Laparoscopic sacrocolpopexy (LSC) is currently the main surgical option for managing POP. The priority of the surgical treatment is preventing recurrence after the surgery. We presented the surgical outcome and recurrence rate of LSC and compared the data of LSC with that of other surgical procedures for managing POP to examine the effectiveness of LSC over other them. Materials and Methods: We compared the results of 138 cases of LSC with other conventional procedures, namely 30 cases of total vaginal hysterectomy (TVH) combined with colporrhaphy anterior and posterior, 66 cases of the Manchester operation, and 68 cases of colpocleisis. We compared the age, body mass index, operative time, blood loss volume, postoperative hospital stay duration, rate of complications, recurrence rate, reoperation rate, and the cumulative recurrence rate after 10 years. Results: The complication rate of LSC, TVH, the Manchester operation, and colpocleisis was 2.2%, 3.3%, 3.0%, and 4.4%; the recurrence rate 2.8%, 3.5%, 4.5%, and 8.7%; and the cumulative recurrence rate after 10 years 3.7%, 4.6%, 8.8%, and 18.2%. There was no significant difference between LSC and the other three groups. Conclusion: LSC seems to be an effective surgical option that requires a higher skill level than other surgical methods and has a longer operative time, lesser operative invasion, and a lower long-term recurrence rate. We will actively recommend LSC to those when appropriate.
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Affiliation(s)
- Yasushi Kotani
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kosuke Murakamsi
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sayaka Kai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tamaki Yahata
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Akiko Kanto
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
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24
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Abhari RE, Izett-Kay ML, Morris HL, Cartwright R, Snelling SJB. Host-biomaterial interactions in mesh complications after pelvic floor reconstructive surgery. Nat Rev Urol 2021; 18:725-738. [PMID: 34545239 DOI: 10.1038/s41585-021-00511-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
Polypropylene (PPL) mesh is widely used in pelvic floor reconstructive surgery for prolapse and stress urinary incontinence. However, some women, particularly those treated using transvaginal PPL mesh placement for prolapse, experience intractable pain and mesh exposure or extrusion. Explanted tissue from patients with complications following transvaginal implantation of mesh is typified by a dense fibrous capsule with an immune cell-rich infiltrate, suggesting that the host immune response has a role in transvaginal PPL mesh complications through the separate contributions of the host (patient), the biological niche within which the material is implanted and biomaterial properties of the mesh. This immune response might be strongly influenced by both the baseline inflammatory status of the patient, surgical technique and experience, and the unique hormonal, immune and microbial tissue niche of the vagina. Mesh porosity, surface area and stiffness also might have an effect on the immune and tissue response to transvaginal mesh placement. Thus, a regulatory pathway is needed for mesh development that recognizes the roles of host and biological factors in driving the immune response to mesh, as well as mandatory mesh registries and the longitudinal surveillance of patients.
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Affiliation(s)
- Roxanna E Abhari
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
| | - Matthew L Izett-Kay
- Department of Urogynaecology, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Hayley L Morris
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Rufus Cartwright
- Department of Urogynaecology, London North West Hospitals NHS Trust, London, UK.,Department of Epidemiology & Biostatistics, Imperial College London, London, UK
| | - Sarah J B Snelling
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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25
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Balzarro M, Rubilotta E, Mancini V, Serati M, Gubbiotti M, Braga A, Saleh O, Torrazzina M, Malanowska E, Serni S, Carrieri G, Antonelli A, Marzi VL. Wound dehiscence prevalence and relationship with prosthetic material extrusion in women underwent anterior colpotomy. Ther Adv Urol 2021; 13:17562872211058246. [PMID: 34819996 PMCID: PMC8606916 DOI: 10.1177/17562872211058246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: To assess the prevalence of anterior vaginal wall dehiscence in women who
underwent anterior vaginal wall colpotomy for pelvic organ prolapse or
stress urinary incontinence and to evaluate the influence of suture
materials and techniques on wound dehiscence. Materials and Methods: This multicenter, prospective study enrolled naïve women for urogynecological
surgery affected by anterior vaginal wall defect or stress urinary
incontinence. Performed surgical procedures were anterior vaginal wall
repair (AVWR) with native tissue (N-AVWR) or polypropylene mesh (M-AVWR),
trans-obturator polypropylene in-out middle urethral sling (MUS). Used
suture materials were Vicryl 2-0, Vicryl Rapide 2-0, and Monocryl 3-0.
Suture techniques were running interlocking or interrupted. Follow-up was
performed daily during hospitalization and in outpatient clinic after 10–14,
30 days, and after 3 months. Results: A total of 1139 patients were enrolled. AVWR were 790: 89.1% N-AVWR, and
10.9% M-AVWR. Polypropylene MUS were 349. Women with prosthetic implantation
were 38.2%, while 61.8% had native tissue repair. Overall Vicryl was used in
53.9%, Vicryl Rapide in 37.4%, and Monocryl in 8.7%. Overall running
interlocking sutures were 66.5%, while interrupted were 33.5%. Overall wound
dehiscence prevalence was 0.9% (10/1139). Wound dehiscence rate of 0.6%
(5/790) was documented in AVWR: 0.3% (2/704) in N-AVWR, and 3.5% (3/86) in
M-AVWR. Among women underwent MUS, 1.4% (5/349) showed wound dehiscence. In
patients who underwent prosthetic surgery, the overall dehiscence prevalence
was 1.8% (8/435). A statistically significant higher rate of wound
dehiscence was found in women with implanted prosthetic materials. Discussion: We reported for the first time the prevalence of wound dehiscence in females
who underwent colpotomy for AVWR or MUS. Wound dehiscence occurrence was
low, but non-negligible. We found that this complication was poorly
associated to the suture methods and materials, while prosthetic material
represented a risk factor for wound healing.
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Affiliation(s)
- Matteo Balzarro
- Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Piazzale Stefani n1, 37126 Verona, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Verona, Italy
| | - Vito Mancini
- Section of Urology and Renal Transplantation, University of Foggia, Policlinico di Foggia, Foggia, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | | | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Omar Saleh
- Department of Surgery, Urology, Morgagni Pierantoni Hospital, Forli, Italy
| | - Marco Torrazzina
- Unità Operativa Complessa of Obstetrics and Gynecology, Magalini Hospital, Villafranca di Verona, Italy
| | - Ewelina Malanowska
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Sergio Serni
- Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Carrieri
- Section of Urology and Renal Transplantation, University of Foggia, Policlinico di Foggia, Foggia, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Verona, Italy
| | - Vincenzo Li Marzi
- Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
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Improvement in dyspareunia after vaginal mesh removal measured by a validated questionnaire. Int Urogynecol J 2021; 32:2937-2946. [PMID: 34351464 DOI: 10.1007/s00192-021-04923-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/12/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine the effect of the surgical removal of vaginally placed prolapse and incontinence mesh on sexual function. We hypothesize that patients with painful complications of mesh will experience improvement in dyspareunia and sexual function after mesh removal. METHODS The eligible cohort consisted of 133 women who presented with a new onset of pain attributed to mesh-augmented incontinence or prolapse surgery and who elected to undergo mesh removal between 1 August 2012 and 1 July 2013. Sexual function symptoms were assessed before and after mesh removal surgery using the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Multivariate analysis was performed to identify predictors of improvement in dyspareunia. RESULTS Ninety-four patients undergoing mesh removal completed a pre-operative questionnaire, 63 of whom also completed a post-operative questionnaire. After mesh removal, there was a nearly 50% reduction in the proportion of women reporting always experiencing post-operative pain with intercourse among those experiencing pre-operative pain. There was a statistically significant quantitative improvement in pain with intercourse after mesh removal based on mean change score of PISQ-12 question 5 "How often do you experience pain with intercourse?". In multivariate analysis, only history of vaginal delivery was associated with symptom improvement. CONCLUSION Removal of transvaginal prolapse mesh is associated with improvement in self-reported dyspareunia based on a standardized question on a validated instrument in a small cohort of women. Although larger studies are needed to confirm the relationship between mesh-augmented surgeries and post-procedural dyspareunia, these data suggest that consideration of mesh removal is a reasonable step for patients with painful intercourse attributed to mesh-augmented prolapse and incontinence surgeries.
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27
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Clark-Patterson GL, Roy S, Desrosiers L, Knoepp LR, Sen A, Miller KS. Role of fibulin-5 insufficiency and prolapse progression on murine vaginal biomechanical function. Sci Rep 2021; 11:20956. [PMID: 34697337 PMCID: PMC8546087 DOI: 10.1038/s41598-021-00351-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open
Abstract
The vagina plays a critical role in supporting the pelvic organs and loss of support leads to pelvic organ prolapse. It is unknown what microstructural changes influence prolapse progression nor how decreased elastic fibers contributes to vaginal remodeling and smooth muscle contractility. The objective for this study was to evaluate the effect of fibulin-5 haploinsufficiency, and deficiency with progressive prolapse on the biaxial contractile and biomechanical function of the murine vagina. Vaginas from wildtype (n = 13), haploinsufficient (n = 13), and deficient mice with grade 1 (n = 9) and grade 2 or 3 (n = 9) prolapse were explanted for biaxial contractile and biomechanical testing. Multiaxial histology (n = 3/group) evaluated elastic and collagen fiber microstructure. Western blotting quantified protein expression (n = 6/group). A one-way ANOVA or Kruskal-Wallis test evaluated statistical significance. Pearson's or Spearman's test determined correlations with prolapse grade. Axial contractility decreased with fibulin-5 deficiency and POP (p < 0.001), negatively correlated with prolapse grade (ρ = - 0.80; p < 0.001), and positively correlated with muscularis elastin area fraction (ρ = - 0.78; p = 0.004). Circumferential (ρ = 0.71; p < 0.001) and axial (ρ = 0.69; p < 0.001) vaginal wall stresses positively correlated with prolapse grade. These findings demonstrated that fibulin-5 deficiency and prolapse progression decreased vaginal contractility and increased vaginal wall stress. Future work is needed to better understand the processes that contribute to prolapse progression in order to guide diagnostic, preventative, and treatment strategies.
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Affiliation(s)
| | - Sambit Roy
- Department of Animal Sciences, Reproductive and Developmental Sciences Program, Michigan State University, East Lansing, 48824, USA
| | - Laurephile Desrosiers
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, New Orleans, 70121, USA
| | - Leise R Knoepp
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, New Orleans, 70121, USA
| | - Aritro Sen
- Department of Animal Sciences, Reproductive and Developmental Sciences Program, Michigan State University, East Lansing, 48824, USA
| | - Kristin S Miller
- Department of Biomedical Engineering, Tulane University, New Orleans, 70118, USA.
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Alexandridis V, Teleman P, Rudnicki M. Efficacy and safety of pelvic organ prolapse surgery with porcine small intestinal submucosa graft implantation. Eur J Obstet Gynecol Reprod Biol 2021; 267:18-22. [PMID: 34689022 DOI: 10.1016/j.ejogrb.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/16/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The ideal implant material for the surgical repair of pelvic organ prolapse in women is yet to be found. This retrospective study aims to evaluate a porcine small intestinal submucosa (SIS) graft (Surgisis™). STUDY DESIGN We reviewed the medical records of women that were operated upon for pelvic organ prolapse using implantation of SIS graft and we examined the short-term complications and recurrence rates. RESULTS A total of 155 surgical procedures were reviewed. SIS graft was placed in the anterior, posterior and middle compartments in 93 (60%), 71 (45.8%) and 13 (8.4%) cases, respectively. At three-month follow-up, 22.6% of anterior graft repairs displayed anatomical recurrence (POP-Q stage ≥ 2), compared to 4.8% of posterior and none of the middle compartment graft repairs. During the three postoperative months, 56% of the women were recorded with complications, mostly urinary retention (19%) and pain (12%). The incidence of grade III complications was 5.3%. Persistent complications at three months were observed in 28% of all cases. Logistic regression analysis showed that previous prolapse surgery at the same compartment was a significant predictor for recurrence of prolapse after SIS graft application, whereas lower age, smoking and longer duration of surgery were significant predictors for the development of complications. Younger women had higher risk of developing pain postoperatively. CONCLUSION Pain and urinary tract symptoms hold a central position in the complications profile of SIS graft-augmented prolapse surgery. The relatively high recurrence rates do not suggest a clear benefit from SIS graft use.
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Affiliation(s)
- Vasileios Alexandridis
- Department of Clinical Sciences, Lund University, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Sweden.
| | - Pia Teleman
- Department of Clinical Sciences, Lund University, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Sweden
| | - Martin Rudnicki
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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29
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NAGER CW, VISCO AG, RICHTER HE, RARDIN CR, KOMESU Y, HARVIE HS, ZYCZYNSKI HM, PARAISO MFR, MAZLOOMDOOST D, SRIDHAR A, THOMAS S. Effect of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: 5-year results of a randomized clinical trial. Am J Obstet Gynecol 2021; 225:153.e1-153.e31. [PMID: 33716071 PMCID: PMC8328912 DOI: 10.1016/j.ajog.2021.03.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/25/2021] [Accepted: 03/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vaginal hysterectomy with suture apical suspension is commonly performed for uterovaginal prolapse. Sacrospinous hysteropexy with graft (vaginal mesh hysteropexy) is an alternative, although in 2019 the Food and Drug Administration removed this mesh product from the United States market. OBJECTIVE Our objective was to compare the efficacy and adverse events of these 2 procedures. STUDY DESIGN At 9 clinical sites in the United States National Institutes of Health and National Institute of Child Health and Human Development Pelvic Floor Disorders Network, 183 postmenopausal women requesting vaginal surgery for symptomatic uterovaginal prolapse were enrolled in a multisite randomized superiority clinical trial, comparing a sacrospinous hysteropexy with graft (hysteropexy) with a vaginal hysterectomy with uterosacral ligament suspension (hysterectomy). Participants consented to remain masked to treatment assignment for the study duration. Study visits were conducted at 6-month intervals through 60 months. The primary treatment failure composite outcome (retreatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with survival modeling. Secondary outcomes included complications or adverse events, individual anatomic measures of the pelvic organ prolapse quantification examination, and presence, severity, and impact and bother of prolapse, urinary, bowel, and pain symptoms as measured by validated questionnaires. The 3-year published results suggested better primary outcomes with sacrospinous hysteropexy with graft, but the differences were not statistically significant (P=.06). This study reports the 5-year outcomes. RESULTS A total of 183 women with a mean age of 66 years were randomized between April 2013 and February 2015; 93 were randomized to hysteropexy and 90 were randomized to hysterectomy. Notably, 175 were included in the trial, and 156 (89%) completed the 5-year follow-up. The primary outcome showed fewer failures for hysteropexy than hysterectomy through 5 years (adjusted hazard ratio, 0.58; 95% confidence interval, 0.36-0.94; P=.03), with failure rates of 37% vs 54%, respectively, resulting in a difference of -18% (95% confidence interval, -33% to -3%) at 5 years. With the exception of the Urogenital Distress Inventory, no group differences were demonstrated in patient-reported pelvic floor symptoms, prolapse symptoms, bowel function symptoms, general quality of life, body image, or pelvic pain. At their last visit through 5 years, 70% of participants (129 of 183) reported they remained masked to their treatment with no difference in masking between groups. Adverse events for hysteropexy vs hysterectomy included mesh exposure (8% vs 0%), granulation tissue after 12 weeks (1% vs 12%), and suture exposure after 12 weeks (3% vs 21%), respectively. CONCLUSION Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery, sacrospinous hysteropexy with graft resulted in a lower composite failure rate than vaginal hysterectomy through 5 years. There were no meaningful differences in patient-reported outcomes between groups. Our results suggest that this vaginal mesh hysteropexy procedure should be made available to patients.
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Affiliation(s)
- Charles W. NAGER
- Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego Health, San Diego, CA
| | | | - Holly E. RICHTER
- University of Alabama At Birmingham, Dept. OB/GYN, Birmingham, AL
| | | | | | | | - Halina M. ZYCZYNSKI
- Magee-Womens Research Institute, Dept. of Obstetrics, Gynecology, and Reproductive Sciences, Pittsburgh, PA
| | | | - Donna MAZLOOMDOOST
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817
| | - Amaanti SRIDHAR
- RTI International, Biostatistics and Epidemiology Division, Research Triangle Park, NC
| | - Sonia THOMAS
- RTI International, Biostatistics and Epidemiology Division, Research Triangle Park, NC
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Kanji S, Pascali D, Clancy AA. Short term complications in mesh augmented vaginal repair of pelvic organ prolapse are not higher when compared with native tissue repair. Int Urogynecol J 2021; 33:1941-1947. [PMID: 34331076 DOI: 10.1007/s00192-021-04915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Accumulating evidence regarding the negative long-term consequences of transvaginal mesh-based procedures for pelvic organ prolapse has led to a sharp decline in mesh-based procedures. We aimed to evaluate the short-term complications of mesh-based procedures for carefully selected patients with pelvic organ prolapse after Food and Drug Administration warnings. METHODS A retrospective database review of the ACS NSQIP database was completed to examine 30-day complications including re-operation, prolonged length of stay, blood transfusion, surgical site infection, urinary tract infection, readmission and wound dehiscence in mesh-augmented and native tissue-based transvaginal procedures for pelvic organ prolapse. RESULTS A total of 36,234 patients were included in the analysis, with only 7.1% (2574 women) having mesh-augmented repair. Using a multivariable logistical regression analysis adjusting for confounders, we found that the primary composite outcome (re-operation, hospital stay, blood transfusion and surgical site infection) was less common in the mesh group compared with the native tissue repair group (adjusted OR 0.80, CI 0.67-0.95, p = 0.009). The secondary outcomes (urinary tract infection, re-admission and wound dehiscence) were not different between the group. CONCLUSION These results suggest that in well-chosen patients, short-term complications are not increased when using transvaginal mesh for pelvic organ prolapse repair.
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Affiliation(s)
- Sarah Kanji
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dante Pascali
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Aisling A Clancy
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, The Ottawa Hospital, Ottawa, ON, Canada. .,University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Barber E, Kleiner I, Tairy D, Bar J, Ginath S. The effectiveness of McCall culdoplasty following vaginal hysterectomy in advanced stages of uterine prolapse. Int Urogynecol J 2021; 32:2143-2148. [PMID: 34181067 DOI: 10.1007/s00192-021-04890-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Following vaginal hysterectomy (VH), fixation of the vaginal vault is needed to prevent post-operative recurrence/exacerbation of vault prolapse. The effectiveness of McCall culdoplasty in cases of advanced prolapse is unclear. We aimed to compare the effectiveness of McCall culdoplasty following VH in patients with mild versus advanced stages of uterine prolapse. METHODS In this retrospective study, the Pelvic Floor Distress Inventory (PFDI-20) was utilized to compare the subjective results of vaginal hysterectomy plus McCall culdoplasty between women with mild uterine prolapse stage 2 (mild prolapse group) and advanced uterine prolapse stages 3-4 (advanced prolapse group). The primary outcome, the subjective awareness of prolapse, was analyzed as well as all other aspects of PFDI-20. A sample size of 130 was calculated. RESULTS The mild prolapse group consisted of 26 (19.3%) patients and the advanced prolapse group consisted of 109 (80.7%) patients. There were no differences between the groups in demographic and clinical characteristics. The rates of concomitant prolapse and incontinence surgeries, performed at the time of VH and post-operative complications. were the same between groups. The mean follow-up was more than 5 years in both groups. Awareness of prolapse was similar between the groups (11.5% in the mild prolapse group and 5.5% in the advanced prolapse group, p = 0.374). There was no significant correlation between the stage of apical prolapse before surgery and awareness of prolapse after the surgery (r = 0.0132, p = 0.879). All aspects of the PFDI-20 questionnaire were similar in the two groups. CONCLUSION McCall culdoplasty was found to have an equal subjective effectiveness following VH in both mild and advanced stages of uterine prolapse.
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Affiliation(s)
- Elad Barber
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel. .,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilia Kleiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Anglès-Acedo S, Ros-Cerro C, Escura-Sancho S, Palau-Pascual MJ, Bataller-Sánchez E, Espuña-Pons M, Carmona-Herrera F. Female sexuality before and after sacrocolpopexy or vaginal mesh: is vaginal length one of the key factors? Int Urogynecol J 2021; 33:143-152. [PMID: 34061234 DOI: 10.1007/s00192-021-04697-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to demonstrate that laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx) versus anterior vaginal mesh (AVM) results in a longer vaginal length without impacting sexual activity or function. METHODS We performed a secondary analysis of sexual outcomes of a previous randomized control trial comparing LSC-Cx and AVM in 120 women (60/group) with symptomatic POP stage ≥ 3. We evaluated sexually active (SA) and non-sexually active women (NSA) using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA-Revised (PISQ-IR) preoperatively and 1 year postoperatively. Multivariate logistic and linear regression models were built to assess the impact of different variables on sexual activity and function, respectively. RESULTS Among 120 women included, no statistically significant differences were found between vaginal length and preoperative dyspareunia (20.7% AVM vs. 22,8% LSC-Cx) comparing SA to NSA women and LSC-Cx to AVM. Vaginal length was significantly longer after LSC-Cx versus AVM (p < 0.001). The postoperative dyspareunia rate was 17.2% AVM versus 10.5% LSC-Cx. Partnered women were significantly more likely to be SA than unpartnered women before (OR = 19.04; p = 0.006) and after surgery (OR = 36.28; p = 0.002). Only dyspareunia was independently associated with sexual function pre- (B = -0.431; p = 0.017) and postoperatively (B = -0.3 96; p = 0.007). CONCLUSIONS Vaginal length was greater following LSC-Cx compared to AVM. While vaginal length has no impact on female sexuality pre- and postoperatively, the most important factors were "having a partner" for sexual activity and dyspareunia for sexual function. Persistence of dyspareunia was higher after AVM. LSC-Cx should be considered in women with POP undergoing mesh surgery with future sexual expectations.
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Affiliation(s)
- Sònia Anglès-Acedo
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Ros-Cerro
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Sílvia Escura-Sancho
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - M José Palau-Pascual
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Eduardo Bataller-Sánchez
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Espuña-Pons
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Francisco Carmona-Herrera
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Verhorstert KWJ, Gudde AN, Kortz BS, Limpens J, Roovers JWR, Hooijmans CR, Guler Z. Animal experimental research assessing urogynecologic surgical mesh implants: Outcome measures describing the host response, a systematic review and meta-analysis. Neurourol Urodyn 2021; 40:1107-1119. [PMID: 33951222 PMCID: PMC8359983 DOI: 10.1002/nau.24677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/17/2021] [Accepted: 04/05/2021] [Indexed: 12/27/2022]
Abstract
Aim Before the introduction of new biomaterials for prolapse surgery, animal studies on the host response are required. Unfortunately, large variation in study design hampers obtaining an overview of the safety and efficacy, and translation to clinical practice. Our aim is to systematically review the literature on all outcome measures describing the host response in animal studies assessing the biocompatibility of urogynecologic surgical mesh implants for prolapse surgery. Furthermore, by meta‐analysis, we aim to assess the effect of implantation and compare this to control animals receiving sham surgery or native tissue repair. Methods We performed a systematic search from inception to August 2020. Since this is an explorative study we included original, controlled, and noncontrolled animal studies describing any host response to the implant. Quantitative outcome measures reported ≥10 times in ≥2 articles were eligible for meta‐analysis. Results Fifty articles were included in the qualitative synthesis and 36 articles were eligible for meta‐analysis. In total, 154 outcome measures were defined and classified into (1) histomorphology, (2) biomechanics and, (3) macroscopic morphology. Animals with vaginal implants demonstrated significantly increased M1 and M2 macrophages, MMP‐2, neovascularization, TNF‐α, and stiffness, and lower vaginal contractility compared to control animals. Conclusion The host response significantly differs in animals after vaginal mesh implantation compared to control animals, both pro‐ and anti‐inflammatory. However, we observed a paucity in the uniformity of reported outcomes. For future animal studies, we propose the development of a core outcome set, which ideally predicts the host response in women.
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Affiliation(s)
- Kim W. J. Verhorstert
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Aksel N. Gudde
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Brita S. Kortz
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jan‐Paul W. R. Roovers
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Carlijn R. Hooijmans
- Department for Health Evidence unit SYRCLERadboud University Medical CenterNijmegenThe Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Chiang CH, Hsu CS, Ding DC. The Comparison of Outcomes of Transvaginal Mesh Surgery with and without Midline Fascial Plication for the Treatment of Anterior Vaginal Prolapse: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10091888. [PMID: 33925536 PMCID: PMC8123832 DOI: 10.3390/jcm10091888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to compare the clinical outcomes of transvaginal mesh (TVM) surgery with and without midline fascial plication for anterior prolapse repair. This is a prospective randomized trial in a teaching hospital. This study compared patients with anterior vaginal wall prolapse (POP-Q Ba > −1) who were randomly assigned to either transvaginal mesh (TVM, Avaulta SoloTM, CR Bard. Inc., Covington, GA, USA polypropylene mesh delivery system) (group A, n = 32) or TVM with concomitant midline fascial plication (group B, n = 32). The outcomes of anatomy correction and life quality were evaluated using a pelvic organ prolapse quantification system and questionnaires. Sixty-four patients were included from January 2011 through April 2014 in this study. Group A had a mean age of 63.7 years and a body mass index (BMI) of 25.4 kg/m2. Group B had a mean age of 62.9 years and a BMI of 25.4. The mean follow-up duration was 18.6 months (range 12–50). At the 12-month follow-up, anatomic recurrence was higher in Group A (5/31, 16.1%) than in Group B (1/30, 3.3%) but without statistical significance (p = 0.19). Improvements in symptoms and quality of life were not significantly different between the two groups. Mesh extrusion was detected in three of 61 patients (4.9%): two from group A (6.7%) and one from Group B (3.2%). TVM with concomitant midline fascia repair for anterior vaginal prolapse had a comparable anterior support and mesh exposure rate compared with TVM alone. Trial Registration: IRB-B09904021
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Affiliation(s)
- Ching-Hsiang Chiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chun-Shuo Hsu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Obstetrics and Gynecology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chayi 622, Taiwan
- Correspondence: (C.-S.H.); (D.-C.D.); Tel.: +886-3-8561825-13383 (D.-C.D.); Fax: +886-3-8577161 (D.-C.D.)
| | - Dah-Ching Ding
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Chung-Yang Rd., Sec. 3, Hualien 970, Taiwan
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: (C.-S.H.); (D.-C.D.); Tel.: +886-3-8561825-13383 (D.-C.D.); Fax: +886-3-8577161 (D.-C.D.)
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McVey A, Qu LG, Chan G, Perera M, Brennan J, Chung E, Gani J. What a mesh! An Australian experience using national female continence surgery trends over 20 years. World J Urol 2021; 39:3931-3938. [PMID: 33837448 DOI: 10.1007/s00345-021-03691-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the evolution of female continence surgical practice in Australia over the last 20 years and observe whether vaginal mesh controversies impacted these trends. MATERIALS AND METHODS From January 2000 to December 2019, medicare benefit schedule codes for female continence procedures were identified and extracted for: mesh sling, fascial sling, bulking agent, female urethral prosthesis, colposuspension, and removal of sling. Population-adjusted incidences per 100,000 persons were calculated using publicly available demographic data. Three discrete phases were defined over the study time frame for analysis: 2000-2006; 2006-2017, and 2017-2019. Interrupted time-series analyses were conducted to assess for impact on incidence at 2006 and 2017. RESULTS There were 119,832 continence procedures performed in Australia from 2000 to 2019, with the mid-urethral sling (MUS) the most common (72%). The majority of mesh (n = 63,668, 73%) and fascial sling (n = 1864, 70%) procedures were in women aged < 65 years. Rates of mesh-related procedures steeply declined after 2017 (initial change: -21 cases per 100,000; subsequent rate change: -12 per 100,000, p < 0.001). Non-mesh related/bulking agents increased from + 0.34 during 2006-2017 to + 2.1 per 100,000 after 2017 (p < 0.001). No significant change in mesh extraction was observed over 2006-2017 (+ 0.06 per 100,000, p = 0.192). There was a significant increase in mesh extraction procedures after 2017 (0.83 per 100,000, p < 0.001). CONCLUSION Worldwide, controversy surrounding vaginal mesh had a significant impact on Australian continence surgery trends. The most standout trends were observed after the 2017 Australian class-action lawsuit and Senate Inquiry.
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Affiliation(s)
- Aoife McVey
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Liang G Qu
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Garson Chan
- Department of Urology, Austin Health, Melbourne, VIC, Australia
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marlon Perera
- Department of Urology, Austin Health, Melbourne, VIC, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Janelle Brennan
- Department of Urology, Bendigo Health, Bendigo, VIC, Australia
| | - Eric Chung
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Johan Gani
- Department of Urology, Austin Health, Melbourne, VIC, Australia
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Naumann G, Hüsch T, Mörgeli C, Kolterer A, Tunn R. Mesh-augmented transvaginal repair of recurrent or complex anterior pelvic organ prolapse in accordance with the SCENIHR opinion. Int Urogynecol J 2021; 32:819-827. [PMID: 32970175 PMCID: PMC8009781 DOI: 10.1007/s00192-020-04525-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the performance of mesh-augmented repair of anterior pelvic organ prolapse (POP) with or without apical vaginal wall involvement in women with recurrent or complex prolapse. METHODS This multicenter cohort study included women undergoing surgery with Calistar S (Promedon, Argentina) for anterior POP between 2016 and 2018. The SCENIHR opinion was considered for patient selection, surgeon's experience and choice of implant. Patients were prospectively invited to assess effectiveness and safety by anamnesis, validated questionnaires and pelvic examination. A composite endpoint defined by POP-Q ≤ 1, absence of a vaginal bulge symptom and repeated surgery for POP was used to define treatment success. Descriptive statistics were applied. McNemar or Wilcoxon signed rank tests were used as paired samples tests. The significance level was set at 5%. RESULTS A total of 107 non-fertile women with a mean age of 70.6 years were enrolled. Ninety-three (86.9%) women presented with recurrent prolapse. The mean follow-up time was 18.5 months. Treatment success was achieved in 76% of cases according the composite endpoint, with 98% reaching POP-Q ≤ 1 and a significant improvement in quality of life (p < 0.001). Mesh exposure occurred in six (5.6%) patients, although none required further surgery. Four (3.7%) patients reported dyspareunia, and a single (0.9%) patient displayed a prominence due to mesh folding. CONCLUSIONS Mesh-augmented repair of anterior POP is effective and safe in women with recurrent or complex prolapse. Hence, in a select patient population, the benefits of mesh-augmented POP repair still outweigh the risks.
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Affiliation(s)
- Gert Naumann
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany.
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
- Promedon GmbH, Clinical Research, Kolbermoor, Germany
| | - Claudia Mörgeli
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
| | - Anna Kolterer
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | - Ralf Tunn
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
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Naumann G. Quo Vadis Urogynecology 2020 - Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse. Geburtshilfe Frauenheilkd 2021; 81:183-190. [PMID: 33574622 PMCID: PMC7870286 DOI: 10.1055/a-1302-7803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/01/2020] [Indexed: 12/15/2022] Open
Abstract
The current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patient's state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.
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Affiliation(s)
- Gert Naumann
- Frauenklinik, Helios Klinikum Erfurt, Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Khandwala S, Cruff J, Williams C. Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery. Sex Med 2021; 9:100281. [PMID: 33450519 PMCID: PMC7930857 DOI: 10.1016/j.esxm.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Despite ample research regarding the impact of reconstructive surgery on anatomic/functional outcomes of pelvic organ prolapse (POP), including incidence of dyspareunia, evidence regarding sexual outcomes is equivocal. AIM To assess changes in sexual function in women followed up for at least 12 months after transvaginal mesh surgery for POP. METHODS We conducted a retrospective review of women who underwent surgery for POP using different mesh products between 2008 and 2019. Baseline demographics were compiled along with intraoperative and postoperative information. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) was used to assess sexual function. MAIN OUTCOME MEASURES Women sexually active before and after surgery were assessed to determine changes in overall and question-specific PISQ-12 responses and potential factors to explain sexual function after surgery. RESULTS 622 women underwent surgery using mesh at our center. 360 (58%) attended at least one visit at a median of 12 months (IQR 11-23 months), with 113 (31%) sexually active at baseline and 247 (69%) sexually inactive. 97 had complete PISQ-12 responses before and after surgery. There was an overall improvement in the median PISQ-12 scores of 2 points (P < .001); improvements persisted when scores were stratified by various factors. Specific improvements were noted in climax (P = .046) and orgasm intensity (P = .002), fear (P < .001) or actual incontinence during intercourse (P = .004), avoidance of intercourse due to prolapse (P < .001), and negative emotions (P < .001). There was a slight positive effect of the baseline PISQ-12 score on the postoperative PISQ-12 score (regression coefficient 0.24, 95% CI: 0.09-0.39), and a stronger negative effect of having a concomitant anal sphincteroplasty (-4.84, 95% CI: -8.42 to -1.25). Preoperative prolapse stage was not associated with postoperative sexual outcomes. There was a weak negative association between the postoperative PISQ-12 and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores [rs(95) = -0.27, P = .008] and a moderate negative association between postoperative PISQ-12 and total Pelvic Floor Distress Inventory short form [rs(94) = -0.42, P < .001]. CONCLUSION Transvaginal mesh surgery appears to positively impact sexual function, and improvements were independent of mesh or baseline prolapse severity. Khandwala S, Cruff J, Williams C. Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery. Sex Med 2021;9:100281.
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Affiliation(s)
- Salil Khandwala
- Advanced Urogynecology of Michigan, P.C., Dearborn, MI, USA; Beaumont Health, Wayne, MI, USA.
| | - Jason Cruff
- Advanced Urogynecology of Michigan, P.C., Dearborn, MI, USA; Beaumont Health, Wayne, MI, USA
| | - Cheau Williams
- Advanced Urogynecology of Michigan, P.C., Dearborn, MI, USA; Beaumont Health, Wayne, MI, USA
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Shi C, Zhao Y, Hu Q, Gong R, Yin Y, Xia Z. Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse. BMC Womens Health 2021; 21:46. [PMID: 33516228 PMCID: PMC7847570 DOI: 10.1186/s12905-021-01192-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain. METHODS A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed. RESULTS A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868-2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952-3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. CONCLUSIONS Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.
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Affiliation(s)
- Chang Shi
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Ying Zhao
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Qing Hu
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Runqi Gong
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yitong Yin
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Zhijun Xia
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
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Lamblin G, Courtieu C, Bensouda-Miguet C, Panel L, Moret S, Chabert P, Chene G, Nohuz E. Outpatient vaginal surgery for pelvic organ prolapse: a prospective feasibility study. ACTA ACUST UNITED AC 2020; 72:19-24. [PMID: 32153159 DOI: 10.23736/s0026-4784.20.04510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the light of recent progress in pelvic organ prolapse surgery, the modalities of hospital admission need reconsidering. This work aims to assess success rate of outpatient (ambulatory) vaginal mesh surgery for genital prolapse. METHODS A prospective observational study was conducted between January 2015 and July 2017, including all patients presenting with POP-Q stage ≥3 anterior and/or apical prolapse. RESULTS Sixty-nine of the 89 eligible patients were treated on an ambulatory basis (group A); 20 required overnight admission (group B): i.e., ambulatory success rate, 77.5%. Mean operative time was 44.9±2.5 min in group A and 62±6.5 min in group B. Reasons for ineligibility for ambulatory management comprised organizational issues at home (10.5%) and excessive home-to-hospital distance (5.7%). The postoperative urinary retention rate was 4.5%. Rates for successful cystocele correction (POP-Q <2) at 2 months were similar in the two groups: 94.2% in group A and 94.4% in group B (P=ns). Mean satisfaction score was 8.6±0.3/10. CONCLUSIONS Outpatient anterior vaginal mesh surgery for prolapse is safe and effective. The current medical-economic context favors ambulatory management. Patient selection, prior information and continuity of care seem primordial.
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Affiliation(s)
- Géry Lamblin
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Christophe Courtieu
- Department of Gynecological Surgery, Beau Soleil Clinic, Montpellier, France
| | - Chloé Bensouda-Miguet
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Laure Panel
- Department of Gynecological Surgery, Beau Soleil Clinic, Montpellier, France
| | - Stéphanie Moret
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Philippe Chabert
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Gautier Chene
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France
| | - Erdogan Nohuz
- Department of Gynecological Surgery and Urogynecology, Femme Mere Enfant University Hospital (HFME), Hospices Civils de Lyon, Lyon, France -
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Verhorstert KW, Guler Z, de Boer L, Riool M, Roovers JPWR, Zaat SAJ. In Vitro Bacterial Adhesion and Biofilm Formation on Fully Absorbable Poly-4-hydroxybutyrate and Nonabsorbable Polypropylene Pelvic Floor Implants. ACS APPLIED MATERIALS & INTERFACES 2020; 12:53646-53653. [PMID: 33210919 PMCID: PMC7716345 DOI: 10.1021/acsami.0c14668] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/02/2020] [Indexed: 05/03/2023]
Abstract
Knitted polypropylene (PP) implants for the correction of pelvic organ prolapse have been associated with complications such as vaginal exposure, infection, and pain. Since certain complications may be linked to bacterial contamination and persistent inflammation, there is a rationale to develop a biocompatible implant that is less prone to bacterial adhesion and biofilm formation. Delayed absorbable materials could meet these requirements and poly-4-hydroxybutyrate (P4HB) might be such a new material for future pelvic floor implants. We studied in vitro bacterial adhesion and biofilm formation on P4HB in comparison to PP. We investigated the influence of both polymers using flat films and compared P4HB and PP implants with different knitting designs. P4HB flat films were demonstrated to be hydrophilic with significantly less Staphylococcus aureus and Escherichia coli cultured from P4HB films than from hydrophobic PP films after 24 h of incubation. On the implants, a higher number of E. coli were cultured after 1 h of incubation from the knitted P4HB implant with the highest density and smallest pore size, compared to other P4HB and PP implants. No differences were observed between the implants for E. coli at later time points or for S. aureus incubation. These results show that in flat films, the polymer influences biofilm formation, demonstrated by a reduced biofilm formation on P4HB compared with PP flat films. In addition, the knitting design may affect bacterial adhesion. Despite certain design and material characteristics that give the knitted P4HB implants a higher surface area, this did not result in more bacterial adhesion and biofilm formation overall. Collectively, these results warrant further (pre)clinical investigations of P4HB pelvic floor implants.
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Affiliation(s)
- Kim W.
J. Verhorstert
- Department
of Obstetrics and Gynecology, Amsterdam Reproduction and Development,
Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The
Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam Reproduction and Development,
Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The
Netherlands
| | - Leonie de Boer
- Department
of Medical Microbiology and Infection Prevention, Amsterdam Institute
for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Martijn Riool
- Department
of Medical Microbiology and Infection Prevention, Amsterdam Institute
for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Jan-Paul W. R. Roovers
- Department
of Obstetrics and Gynecology, Amsterdam Reproduction and Development,
Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The
Netherlands
| | - Sebastian A. J. Zaat
- Department
of Medical Microbiology and Infection Prevention, Amsterdam Institute
for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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Izett-Kay ML, Aldabeeb D, Kupelian AS, Cartwright R, Cutner AS, Jackson S, Price N, Vashisht A. Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study. Int Urogynecol J 2020; 31:2595-2602. [PMID: 32620978 PMCID: PMC7679361 DOI: 10.1007/s00192-020-04396-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/12/2020] [Indexed: 10/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in pelvic floor surgery. This study is aimed at determining the incidence of mesh-associated complications and reoperation following this procedure. METHODS This was a cross-sectional postal questionnaire study of women who underwent laparoscopic mesh sacrohysteropexy between 2010 and 2018. Potential participants were identified from surgical databases of five surgeons at two tertiary urogynaecology centres in the UK. The primary outcome was patient-reported mesh complication requiring removal of hysteropexy mesh. Secondary outcomes included other mesh-associated complications, reoperation rates and Patient Global Impression of Improvement (PGI-I) in prolapse symptoms. Descriptive statistics and Kaplan-Meier survival analyses were used. RESULTS Of 1,766 eligible participants, 1,121 women responded (response proportion 63.5%), at a median follow-up of 46 months. The incidence of mesh complications requiring removal of hysteropexy mesh was 0.4% (4 out of 1,121). The rate of chronic pain service use was 1.8%, and newly diagnosed systemic autoimmune disorders was 5.8%. The rate of reoperation for apical prolapse was 3.7%, and for any form of pelvic organ prolapse it was 13.6%. For PGI-I, 81.4% of patients were "much better" or "very much better". CONCLUSIONS Laparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required.
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Affiliation(s)
- Matthew L Izett-Kay
- Urogynaecology and Pelvic Floor Unit, University College London Hospitals, Clinic 2, Lower Ground Floor, EGA Wing, 235 Euston Road, London, NW12BU, UK.
- UCL EGA Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Dana Aldabeeb
- UCL EGA Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
| | - Anthony S Kupelian
- Urogynaecology and Pelvic Floor Unit, University College London Hospitals, Clinic 2, Lower Ground Floor, EGA Wing, 235 Euston Road, London, NW12BU, UK
| | - Rufus Cartwright
- Department of Urogynaecology, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford, Headington, OX3 9DU, UK
| | - Alfred S Cutner
- Urogynaecology and Pelvic Floor Unit, University College London Hospitals, Clinic 2, Lower Ground Floor, EGA Wing, 235 Euston Road, London, NW12BU, UK
| | - Simon Jackson
- Department of Urogynaecology, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford, Headington, OX3 9DU, UK
| | - Natalia Price
- Department of Urogynaecology, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford, Headington, OX3 9DU, UK
| | - Arvind Vashisht
- Urogynaecology and Pelvic Floor Unit, University College London Hospitals, Clinic 2, Lower Ground Floor, EGA Wing, 235 Euston Road, London, NW12BU, UK
- UCL EGA Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
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Bugge C, Adams EJ, Gopinath D, Stewart F, Dembinsky M, Sobiesuo P, Kearney R. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database Syst Rev 2020; 11:CD004010. [PMID: 33207004 PMCID: PMC8094172 DOI: 10.1002/14651858.cd004010.pub4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pelvic organ prolapse is a common problem in women. About 40% of women will experience prolapse in their lifetime, with the proportion expected to rise in line with an ageing population. Women experience a variety of troublesome symptoms as a consequence of prolapse, including a feeling of 'something coming down' into the vagina, pain, urinary symptoms, bowel symptoms and sexual difficulties. Treatment for prolapse includes surgery, pelvic floor muscle training (PFMT) and vaginal pessaries. Vaginal pessaries are passive mechanical devices designed to support the vagina and hold the prolapsed organs back in the anatomically correct position. The most commonly used pessaries are made from polyvinyl-chloride, polythene, silicone or latex. Pessaries are frequently used by clinicians with high numbers of clinicians offering a pessary as first-line treatment for prolapse. This is an update of a Cochrane Review first published in 2003 and last published in 2013. OBJECTIVES To assess the effects of pessaries (mechanical devices) for managing pelvic organ prolapse in women; and summarise the principal findings of relevant economic evaluations of this intervention. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 January 2020). We searched the reference lists of relevant articles and contacted the authors of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in at least one arm of the study. DATA COLLECTION AND ANALYSIS Two review authors independently assessed abstracts, extracted data, assessed risk of bias and carried out GRADE assessments with arbitration from a third review author if necessary. MAIN RESULTS We included four studies involving a total of 478 women with various stages of prolapse, all of which took place in high-income countries. In one trial, only six of the 113 recruited women consented to random assignment to an intervention and no data are available for those six women. We could not perform any meta-analysis because each of the trials addressed a different comparison. None of the trials reported data about perceived resolution of prolapse symptoms or about psychological outcome measures. All studies reported data about perceived improvement of prolapse symptoms. Generally, the trials were at high risk of performance bias, due to lack of blinding, and low risk of selection bias. We downgraded the certainty of evidence for imprecision resulting from the low numbers of women participating in the trials. Pessary versus no treatment: at 12 months' follow-up, we are uncertain about the effect of pessaries compared with no treatment on perceived improvement of prolapse symptoms (mean difference (MD) in questionnaire scores -0.03, 95% confidence interval (CI) -0.61 to 0.55; 27 women; 1 study; very low-certainty evidence), and cure or improvement of sexual problems (MD -0.29, 95% CI -1.67 to 1.09; 27 women; 1 study; very low-certainty evidence). In this comparison we did not find any evidence relating to prolapse-specific quality of life or to the number of women experiencing adverse events (abnormal vaginal bleeding or de novo voiding difficulty). Pessary versus pelvic floor muscle training (PFMT): at 12 months' follow-up, we are uncertain if there is a difference between pessaries and PFMT in terms of women's perceived improvement in prolapse symptoms (MD -9.60, 95% CI -22.53 to 3.33; 137 women; low-certainty evidence), prolapse-specific quality of life (MD -3.30, 95% CI -8.70 to 15.30; 1 study; 116 women; low-certainty evidence), or cure or improvement of sexual problems (MD -2.30, 95% -5.20 to 0.60; 1 study; 48 women; low-certainty evidence). Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25, 95% CI 4.70 to 1205.45; 1 study; 97 women; low-certainty evidence). Adverse events included increased vaginal discharge, and/or increased urinary incontinence and/or erosion or irritation of the vaginal walls. Pessary plus PFMT versus PFMT alone: at 12 months' follow-up, pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15, 95% CI 1.58 to 2.94; 1 study; 260 women; moderate-certainty evidence). At 12 months' follow-up, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median (interquartile range (IQR)) POPIQ score: pessary plus PFMT 0.3 (0 to 22.2); 132 women; PFMT only 8.9 (0 to 64.9); 128 women; P = 0.02; moderate-certainty evidence). Pessary plus PFMT may slightly increase the risk of abnormal vaginal bleeding compared with PFMT alone (RR 2.18, 95% CI 0.69 to 6.91; 1 study; 260 women; low-certainty evidence). The evidence is uncertain if pessary plus PFMT has any effect on the risk of de novo voiding difficulty compared with PFMT alone (RR 1.32, 95% CI 0.54 to 3.19; 1 study; 189 women; low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain if pessaries improve pelvic organ prolapse symptoms for women compared with no treatment or PFMT but pessaries in addition to PFMT probably improve women's pelvic organ prolapse symptoms and prolapse-specific quality of life. However, there may be an increased risk of adverse events with pessaries compared to PFMT. Future trials should recruit adequate numbers of women and measure clinically important outcomes such as prolapse specific quality of life and resolution of prolapse symptoms. The review found two relevant economic evaluations. Of these, one assessed the cost-effectiveness of pessary treatment, expectant management and surgical procedures, and the other compared pessary treatment to PFMT.
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Affiliation(s)
- Carol Bugge
- School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Elisabeth J Adams
- Department of Urodynamics, Liverpool Women's Hospital, Liverpool, UK
| | - Deepa Gopinath
- Department of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Australia
| | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Melanie Dembinsky
- School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Pauline Sobiesuo
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rohna Kearney
- The Warrell Unit, Department of Gynaecology, St Mary's Hospital, Manchester University Foundation NHS Trust, Manchester, UK
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Management of Vaginal Mesh Exposures Following Female Pelvic Reconstructive Surgery. Curr Urol Rep 2020; 21:57. [PMID: 33125530 DOI: 10.1007/s11934-020-01002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW To discuss considerations and current evidence for the diagnosis and management of vaginal mesh exposures following female mesh-augmented anti-incontinence and pelvic organ prolapse surgery. RECENT FINDINGS Since the introduction of mesh into female pelvic surgery, various applications have been reported, each with their own unique risk profile. The most commonly encountered mesh-related complication is vaginal mesh exposure. Current evidence on the management of vaginal mesh exposure is largely limited to observational studies and case series, though this is continuing to expand. We present a synthesis of the available data, as well as clinical and surgical approaches to managing this complication. It is important for surgeons to be familiar with the management of vaginal mesh exposures. Depending on the patient's presentation and goals, there is a role for conservative measures, mesh revision, or mesh excision. Further study is warranted to standardize mesh resection techniques and explore non-surgical treatments.
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Merriman AL, Kennelly MJ. Biologic Grafts for Use in Pelvic Organ Prolapse Surgery: a Contemporary Review. Curr Urol Rep 2020; 21:52. [PMID: 33098501 DOI: 10.1007/s11934-020-01013-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Pelvic organ prolapse (POP) is a common condition and there is a plethora of surgical techniques available to address this problem. We present a review of biologic grafts, including the latest literature to help guide a surgeon's choice on the type of biologic materials to augment repairs. RECENT FINDINGS Since the 2019 Food and Drug Administration (FDA) ban on mesh, including xenograft, there is a sparsity of biologic graft products available for POP repairs. This has led to a significant decrease in surgical application. Surgeons must be familiar with the biochemical properties, processing, and clinical application of biologic grafts prior to use. They should also be familiar with alternative operative techniques that utilize autografts, although there is limited outcome data on these techniques. With heightened awareness of mesh and its complications, biologic grafts have made a resurgence. Surgeons must be well versed on their available options. Current literature is limited, and studies have not demonstrated superiority of biologic graft over native tissue repairs for prolapse. Nevertheless, there is a role for these types of biologic graft material in specific patient populations. Future studies are warranted.
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Affiliation(s)
- Amanda L Merriman
- Atrium Health, Division of Urogynecology and Pelvic Surgery, 2001 Vail Avenue, Charlotte, NC, 28207, USA.
| | - Michael J Kennelly
- Atrium Health, Division of Urogynecology and Pelvic Surgery, 2001 Vail Avenue, Charlotte, NC, 28207, USA
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Kato K, Suzuki S, Nagayama J, Yamamoto S. Ureteral exposures with stone formation after transvaginal mesh prolapse surgery. Int Urogynecol J 2020; 32:223-225. [PMID: 33048181 DOI: 10.1007/s00192-020-04556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Shoji Suzuki
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Jun Nagayama
- Department of Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Shigeki Yamamoto
- Department of Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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Efficacy of surgical revision of mesh complications in prolapse and urinary incontinence surgery. Int Urogynecol J 2020; 32:2257-2264. [PMID: 33034678 PMCID: PMC8346427 DOI: 10.1007/s00192-020-04543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/14/2020] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Women with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We hypothesized that mesh resection would alleviate symptoms and aimed to evaluate risks and benefits in these women. METHODS We carried out a cross-sectional study. Primary outcome was improvement specified as better, unchanged or worsened symptoms after mesh revision surgery. Secondary outcomes were health-related quality of life (HrQol) scores of validated questionnaires, surgical characteristics and physical findings at follow-up visits. Descriptive data were reported with mean and medians. Associations were calculated with Spearman correlation coefficient and chi-square test to determine statistical differences between groups. RESULTS Fifty-nine women who underwent mesh revision surgery between 2009 and 2016 were included. After a median follow-up of 1.7 (IQR: 1.1-2.4) years, 44 women (75%) reported improvement of symptoms. No significant surgical or patient characteristics were identified that could differentiate which patients did or did not experience cure or complications.A trend was observed to better HrQol scores in women who reported overall improvement after mesh revision surgery. Seventeen (29%) women needed a subsequent operation after mesh removal. CONCLUSIONS This cross-sectional study shows that mesh revision surgery alleviates symptoms in 75% of women with mesh-related complications. Type of revision surgery and individual characteristics did not seem to matter to the individual chance of cure or complications. These data can facilitate the counseling of women considering mesh revision surgery.
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Mercer‐Jones MA, Brown SR, Knowles CH, Williams AB. Position statement by the Pelvic Floor Society on behalf of the Association of Coloproctology of Great Britain and Ireland on the use of mesh in ventral mesh rectopexy. Colorectal Dis 2020; 22:1429-1435. [PMID: 28926174 PMCID: PMC7702115 DOI: 10.1111/codi.13893] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
The following position statement forms part of a response to the current concerns regarding use of mesh to perform rectal prolapse surgery. It highlights the actions being pursued by the Pelvic Floor Society (TPFS) regarding clinical governance in relation to ventral mesh rectopexy (VMR). The following are summary recommendations. Available evidence suggests that mesh morbidity for VMR is far lower than that seen in transvaginal procedures (the main subject of current concern) and lower than that observed following other abdomino-pelvic procedures for urogenital prolapse, e.g. laparoscopic sacrocolpopexy. VMR should be performed by adequately trained surgeons who work within a multidisciplinary team (MDT) framework. Within this, it is mandatory to discuss all patients considered for surgery at an MDT meeting. Clinical outcomes of surgery and any complications resulting from surgery should be recorded in the TPFS-hosted national database (registry) available for this purpose; in addition, all patients should be considered for entry into ongoing and planned UK/European randomized studies where this is feasible. A move towards accreditation of UK units performing VMR will improve performance and outcomes in the long term. An enhanced programme of training including staged porcine, cadaveric and preceptorship sessions will ensure the competence of surgeons undertaking VMR. Enhanced consent forms and patient information booklets are being developed, and these will help both surgeons and patients. There is weak observational evidence that technical aspects of the procedure can be optimized to reduce morbidity rates. Suture material choice may contribute towards morbidity. The available evidence is insufficient to support the use of one mesh over another (biologic vs synthetic); however, the use of polyester mesh is associated with increased morbidity.
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Affiliation(s)
| | | | - C. H. Knowles
- National Bowel Research CentreBlizard InstituteQueen Mary University LondonLondonUK
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Repair of Posterior Vaginal Wall Defect Using Biologic Graft for Stage III-POP-Q Pelvic Organ Prolapse in a Patient with History of a J-Pouch. Case Rep Obstet Gynecol 2020; 2020:8892014. [PMID: 32802533 PMCID: PMC7403897 DOI: 10.1155/2020/8892014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022] Open
Abstract
Surgical correction is considered in women with symptomatic pelvic organ prolapse (POP). There is an expected increase in the prevalence of surgical correction due to an aging population within the United States. Individuals with previous colorectal surgery present a unique challenge considering the changes in pelvic anatomy. This case discusses the challenges of posterior colporrhaphy in a patient with previous, remote J-pouch surgery. In traditional posterior colporrhaphy, randomized controlled trials have not shown any benefit of graft augmentation (Maher, 2016). However, the utilization of a biologic graft to improve anatomical correction is discussed in this unique case. Short term anatomical success was obtained without immediate complications in the postoperative period. In a patient with a history of ulcerative colitis with colorectal resection and a J-pouch, surgery can be challenging due to alterations of pelvic anatomy. Modification of the standard surgical approach may be required to achieve success.
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Anglès-Acedo S, Ros-Cerro C, Escura-Sancho S, Palau-Pascual MJ, Bataller-Sánchez E, Espuña-Pons M, Carmona-Herrera F. Sexual activity and function in women with advanced stages of pelvic organ prolapse, before and after laparoscopic or vaginal mesh surgery. Int Urogynecol J 2020; 32:1157-1168. [PMID: 32767064 DOI: 10.1007/s00192-020-04406-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The differential impact of specific pelvic organ prolapse (POP) surgery on sexual activity and function is unknown. Our primary aim was to analyse sexual inactivity and function in women with symptomatic advanced stages of POP and the changes incurred after laparoscopic or vaginal mesh surgery. METHODS We performed a secondary analysis of sexual outcomes of a previously published randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx) and anterior vaginal mesh (AVM) in 120 women (60/group) with symptomatic anterior POP stage ≥ 3 and apical ≥ 2. Sexual activity and function were assessed preoperatively and 1 and 2 years postoperatively using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA-Revised (PISQ-IR). RESULTS Sexual activity was recovered in 42.9% of non-sexually active (NSA) women 1 year postoperatively, mainly in women with higher preoperative POP-related subscale scores of the PISQ-IR, which indicated a negative preoperative sexuality by POP. Recovery of sexual activity was greater after LSC-Cx, albeit not significantly (2 years: 35.5% AVM vs. 45% LSC-Cx). Among sexually active (SA) women preoperatively remaining SA postoperatively, the difference in the mean PISQ-IR summary score significantly improved [mean baseline difference - 2 years; all: 0.3 (95% CI 0.1 to 0.5) p = 0.001; AVM 0.19 (95% CI -0.1 to -0.5) p > 0.05; LSC-Cx 0.37 (95% CI 0.1 to 0.7) p = 0.003]. Preoperative dyspareunia was significantly reduced after LSC-Cx (baseline: 24.6%, 2 years: 9.8%, p = 0.0448), but not after AVM (baseline: 20.7%, 2 years: 18.2%, p = 0.7385). CONCLUSIONS Most women reported improved sexual activity and function 2 years after LSC-Cx or AVM, mainly because of enhanced POP-related subscales in both NSA and SA women. Recovery of sexual activity and improved sexual function were greater after LSC-Cx compared to AVM, likely related to less postoperative dyspareunia.
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Affiliation(s)
- Sònia Anglès-Acedo
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Ros-Cerro
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Sílvia Escura-Sancho
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - M José Palau-Pascual
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Eduardo Bataller-Sánchez
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Espuña-Pons
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Francisco Carmona-Herrera
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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