1
|
Chen YP, Lo TS, Chien YH, Kuo YH, Liu SJ. In Vitro and In Vivo Drug Release from a Nano-Hydroxyapatite Reinforced Resorbable Nanofibrous Scaffold for Treating Female Pelvic Organ Prolapse. Polymers (Basel) 2024; 16:1667. [PMID: 38932015 PMCID: PMC11207985 DOI: 10.3390/polym16121667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
Pelvic prolapse stands as a substantial medical concern, notably impacting a significant segment of the population, predominantly women. This condition, characterized by the descent of pelvic organs, such as the uterus, bladder, or rectum, from their normal positions, can lead to a range of distressing symptoms, including pelvic pressure, urinary incontinence, and discomfort during intercourse. Clinical challenges abound in the treatment landscape of pelvic prolapse, stemming from its multifactorial etiology and the diverse array of symptoms experienced by affected individuals. Current treatment options, while offering relief to some extent, often fall short in addressing the full spectrum of symptoms and may pose risks of complications or recurrence. Consequently, there exists a palpable need for innovative solutions that can provide more effective, durable, and patient-tailored interventions for pelvic prolapse. We manufactured an integrated polycaprolactone (PCL) mesh, reinforced with nano-hydroxyapatite (nHA), along with drug-eluting poly(lactic-co-glycolic acid) (PLGA) nanofibers for a prolapse scaffold. This aims to offer a promising avenue for enhanced treatment outcomes and improved quality of life for individuals grappling with pelvic prolapse. Solution extrusion additive manufacturing and electrospinning methods were utilized to prepare the nHA filled PCL mesh and drug-incorporated PLGA nanofibers, respectively. The pharmaceuticals employed included metronidazole, ketorolac, bleomycin, and estrone. Properties of fabricated resorbable scaffolds were assessed. The in vitro release characteristics of various pharmaceuticals from the meshes/nanofibers were evaluated. Furthermore, the in vivo drug elution pattern was also estimated on a rat model. The empirical data show that nHA reinforced PCL mesh exhibited superior mechanical strength to virgin PCL mesh. Electrospun resorbable nanofibers possessed diameters ranging from 85 to 540 nm, and released effective metronidazole, ketorolac, bleomycin, and estradiol, respectively, for 9, 30, 3, and over 30 days in vitro. Further, the mesh/nanofiber scaffolds also liberated high drug levels at the target site for more than 28 days in vivo, while the drug concentrations in blood remained low. This discovery suggests that resorbable scaffold can serve as a viable option for treating female pelvic organ prolapse.
Collapse
Affiliation(s)
- Yi-Pin Chen
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan;
| | - Yu-Han Chien
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.C.); (Y.-H.K.)
| | - Yi-Hua Kuo
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.C.); (Y.-H.K.)
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.C.); (Y.-H.K.)
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, Taoyuan 33305, Taiwan
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Lo TS, Harun F, Chua S, Shen YH, Tan YL, Hsieh WC. Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up. J Formos Med Assoc 2024; 123:331-339. [PMID: 37996329 DOI: 10.1016/j.jfma.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND PURPOSE We present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. METHODS This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. RESULTS Objective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. CONCLUSION The UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Yu-Hua Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ Healthcare Group, Sarawak, Malaysia
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC
| |
Collapse
|
4
|
Capobianco G, Sechi I, Muresu N, Saderi L, Piana A, Farina M, Dessole F, Virdis G, De Vita D, Madonia M, Petrillo M, Sotgiu G. Native tissue repair (NTR) versus transvaginal mesh interventions for the treatment of anterior vaginal prolapse: Systematic review and meta-analysis. Maturitas 2022; 165:104-112. [DOI: 10.1016/j.maturitas.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 10/31/2022]
|
5
|
Chen YP, Lo TS, Lin YT, Chien YH, Lu CJ, Liu SJ. Fabrication of Drug-Eluting Polycaprolactone/poly(lactic- co-glycolic Acid) Prolapse Mats Using Solution-Extrusion 3D Printing and Coaxial Electrospinning Techniques. Polymers (Basel) 2021; 13:polym13142295. [PMID: 34301052 PMCID: PMC8309226 DOI: 10.3390/polym13142295] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
We developed biodegradable drug-eluting prolapse mats using solution-extrusion 3D printing and coaxial electrospinning techniques. The mats were composed of polycaprolactone (PCL) mesh and lidocaine-, estradiol-, metronidazole-, and connective tissue growth factor (CTGF)-incorporated poly(lactic-co-glycolic acid) (PLGA) nanofibers that mimic the structure of the natural extracellular matrix of most connective tissues. The mechanical properties of degradable prolapse membrane were assessed and compared to commercial non-degradable polypropylene knitted meshes clinically used for pelvic organ prolapse (POP) repair. The release behaviors of the drug-loaded hybrid degradable membranes were also characterized. The experimental results suggest that 3D-printed PCL meshes exhibited comparable strengths to commercial POP meshes and survived through 10,000 cycles of fatigue test without breakage. Hybrid PCL meshes/PLGA nanofibrous membranes provided a sustainable release of metronidazole, lidocaine, and estradiol for 4, 25, and 30 days, respectively, in vitro. The membranes further liberated high levels of CTGF for more than 30 days. The animal tests show that the mechanical property of PCL mesh decreased with time, mainly due to degradation of the polymers post-implantation. No adverse effect of the mesh/nanofibers was noted in the histological images. By adopting solution-extrusion 3D printing and coaxial electrospinning, degradable drug-eluting membranes can be fabricated for POP applications.
Collapse
Affiliation(s)
- Yi-Pin Chen
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou, School of Medicine, Chang Gung University, Taoyuan 33305, Taiwan;
| | - Yu-Ting Lin
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.L.); (Y.-H.C.); (C.-J.L.)
| | - Yu-Han Chien
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.L.); (Y.-H.C.); (C.-J.L.)
| | - Chia-Jung Lu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.L.); (Y.-H.C.); (C.-J.L.)
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.L.); (Y.-H.C.); (C.-J.L.)
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan 33305, Taiwan
- Correspondence: ; Tel.: +886-3-211-8166; Fax: +886-3-211-8558
| |
Collapse
|
6
|
Immunochemical and urodynamic outcomes after polypropylene mesh explant from the pelvic wall of rats. Int Urogynecol J 2021; 33:1839-1848. [PMID: 34037814 DOI: 10.1007/s00192-021-04842-7] [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: 01/14/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To analyze the immunochemical and urodynamic outcomes after partial versus complete excision of transvaginal polypropylene mesh (PPM) from pelvic walls of rats. METHODS Forty-eight female Sprague-Dawley (SD) rats were randomly distributed into seven groups: control, mesh total removal 60 days (M-T 60D), mesh total removal 180 days (M-T 180D), mesh partial removal 60 days (M-H 60D), mesh partial removal 180 days (M-H 180D), sham 60 days (Sham 60D), and sham 180 days (Sham 180D). In the mesh groups, PPM was inserted and partially (0.3 × 0.3 cm) or completely removed 30 days later. In the Sham group, the space between the vagina and bladder was dissected without placing or removing the synthetic mesh at day 1 and day 30 later. Urodynamic studies, immunochemical analysis, and Western blot were done at days 60 and 180. RESULTS The M-T 60D voiding pressure was significantly decreased compared to the Sham 60D and M-H 60D. The voiding interval of M-T 60D was significantly shorter than that of M-H 60D. In the M-T 60D and M-T 180D groups, the leak point pressure was significantly less than in their corresponding sham groups. IL-1 and TNF-α were significantly more intense in M-T 60D compared to M-H 60D and Sham 60D. NGF was significantly greater in M-T 60D compared to Sham 60D. There were no significant differences in MMP-2 and CD-31s throughout the group. CONCLUSION Total mesh excision incites a host inflammatory response and transitory lower urinary tract dysfunction. Despite the good outcomes after total excision, the invasiveness and surgical risk associated with repeated procedures should not be underestimateded.
Collapse
|
7
|
Wong NKL, Cheung RYK, Lee LL, Wan OYK, Choy KW, Chan SSC. Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:631-638. [PMID: 32898286 DOI: 10.1002/uog.23109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/29/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Mesh repair surgery for pelvic organ prolapse (POP) has been suspended in some countries owing to concerns about its associated complications. However, mesh repair has been shown to reduce the risk of prolapse recurrence after surgery. In view of this controversy, our aim was to assess the incidence of subjective and objective recurrence of POP following mesh repair surgery vs native-tissue repair in women with Stage-III or Stage-IV POP. METHODS This was a prospective observational study of women who presented with Stage-III or Stage-IV POP and received primary prolapse surgery between 2013 and 2018. Transperineal ultrasound was performed before the operation and volumes were analyzed offline to assess the presence of levator ani muscle (LAM) avulsion. All women were counseled on either mesh repair or native-tissue reconstruction. The mesh-repair group was followed up for up to 5 years and the native-tissue-repair group for up to 2 years after the operation. Prolapse symptoms and POP quantification (POP-Q) staging were assessed at follow-up. Subjective recurrence of POP was defined as symptoms of prolapse (vaginal bulge sensation or dragging sensation) reported by the patient. Objective recurrence was defined as POP-Q ≥ Stage II. The subjective and objective recurrences of prolapse were compared between women with and those without mesh use. Multivariate regression analysis was used to identify risk factors for the recurrence of POP. RESULTS A total of 154 Chinese women with Stage-III or Stage-IV prolapse were recruited. Of these, 104 (67.5%) underwent mesh repair (transabdominal in 57 women and transvaginal in 47 women) and 50 (32.5%) had native-tissue repair surgery. Ninety-five (61.7%) women had LAM avulsion. Both the subjective POP recurrence rate (4.8% vs 20.0%; P = 0.003) and the objective recurrence rate (20.2% vs 46.0%; P = 0.001) were significantly lower in the mesh-repair group than in the native-tissue-repair group. On multivariate logistic regression analysis, mesh repair was associated significantly with a reduced risk of subjective recurrence (odds ratio (OR), 0.20 (95% CI, 0.07-0.63)) and of objective recurrence (OR, 0.16 (95% CI, 0.07-0.55)) of prolapse. On subgroup analysis of women with LAM avulsion, mesh repair significantly reduced the risk of subjective recurrence (OR, 0.24 (95% CI, 0.07-0.87)) and objective recurrence (OR, 0.23 (95% CI, 0.09-0.57)) of POP. The incidence of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. CONCLUSIONS Mesh repair surgery, compared with native-tissue repair, was associated with a 5-fold reduction in the risk of subjective recurrence and a 6-fold reduction in the risk of objective recurrence of prolapse in women with Stage-III or Stage-IV POP. In women with concomitant LAM avulsion, mesh repair surgery was associated with a 4-fold reduction in both objective and subjective recurrence of POP. The rate of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. The benefit of mesh surgery for these high-risk women appears to outweigh the risks of mesh complications, and it could be a treatment option for this group of women. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- N K L Wong
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - R Y K Cheung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - L L Lee
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - O Y K Wan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - K W Choy
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | | |
Collapse
|
8
|
Sun MJ, Chuang YL, Lau HH, Lo TS, Su TH. The efficacy and complications of using transvaginal mesh to treat pelvic organ prolapse in Taiwan: A 10-year review. Taiwan J Obstet Gynecol 2021; 60:187-192. [PMID: 33678316 DOI: 10.1016/j.tjog.2021.01.031] [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] [Accepted: 10/13/2020] [Indexed: 10/22/2022] Open
Abstract
Transvaginal mesh (TVM) insertion for the treatment of pelvic organ prolapse (POP) is significantly associated with lower failure rates, although its use remains controversial due to the potential risk of mesh-related complications. In this review, we collected the published literature regarding the use of TVM to treat POP in an attempt to assess both the efficacy and complications related to TVM usage in Taiwan. We searched 25 English language articles using PubMed related to TVM in Taiwan from 2010 to 2019. The present article focuses on the efficacy and complications of TVM and analyzes the data. There were 25 studies on TVM selected for this review. Regarding their success rate, 21 out of the 22 studies (95.5%) had more than a 90% objective success rate. Twenty studies (90.9%) had less than 10% major complications of TVM. Twenty out of the 25 studies (80.0%) had 5% or less mesh exposure. For self-cut TVM and the later single-incision TVM, both the complication rates and exposure rates decreased. The rate of de novo dyspareunia ranged from 2.6% to 14.3%, and the incidence decreased yearly from 2011 to 2019. This review showed both the high treatment efficacy and low complication rate of TVM usage for the short-term treatment of POP in Taiwan. However, a longer-term study is needed to draw a conclusion regarding the safety of this treatment.
Collapse
Affiliation(s)
- Mou-Jong Sun
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.
| | - Yu-Li Chuang
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hui-Hsuan Lau
- Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan; Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Chang Gung University, School of Medicine, Taoyuan, Taiwan
| | - Tsung-Hsien Su
- Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan; Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| |
Collapse
|
9
|
Lo TS, Ng KL, Huang TX, Chen YP, Lin YH, Hsieh WC. Author's Reply. J Minim Invasive Gynecol 2020; 28:146-147. [PMID: 32835866 DOI: 10.1016/j.jmig.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 11/18/2022]
|
10
|
Reoperation rate and outcomes following the placement of polypropylene mesh by the vaginal route for cystocele: very long-term follow-up. Int Urogynecol J 2020; 32:929-935. [PMID: 32780172 DOI: 10.1007/s00192-020-04455-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim was to evaluate the reoperation rate and outcomes in women who underwent transvaginal non-absorbable monofilament polypropylene mesh placement for the treatment of cystocele. METHODS The retrospective cohort study included 63 patients who underwent transvaginal surgery using a synthetic polypropylene mesh (Gynemesh™) for cystocele. Patients were evaluated using a clinical examination (POP-Q) and validated questionnaires (PGI-I, PFDI-20, PFIQ-7) at 18 years of follow-up (median 18 years [IQR 16-19]). Cumulative death rate was 13 out of 63 (20%) and rate of total loss to follow-up was 21 out of 50 (42%). Finally, among the 63 women who underwent surgery, 29 completed maximum follow-up and 21 underwent a clinical examination. RESULTS The cumulative reoperation rate was 35% (22 out of 63). Three patients were reoperated on because of recurrence of pelvic organ prolapse. Among the 63 patients initially operated, vaginal mesh exposure occurred in 16 (25%) during follow-up and 11 women (17%) needed a reintervention for vaginal mesh exposure. One patient was reoperated on for bladder mesh exposure. Among the 29 women who completed follow-up, the overall postoperative improvement rate was 93% after 18 years (PGI-I: 1-3). Mean overall satisfaction rate was 80 out of 100. Functional success rate was 76% (22 out of 29) and anatomical success rate was 62% (13 out of 21). The median score of the POP-DI-6 was 4.1 (IQR: 0-11) and the median score of the PFDI-20 was 30.7 (IQR: 13-60) in the 29 women who completed maximum follow-up. CONCLUSION At very long-term follow-up, the recurrence rate of cystocele following polypropylene mesh placement by the vaginal route remained low and the satisfaction rate was high. However, we found high cumulative reoperation and mesh exposure rates.
Collapse
|
11
|
Lo TS, Ng KL, Huang TX, Chen YP, Lin YH, Hsieh WC. Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year. J Minim Invasive Gynecol 2020; 28:107-116. [PMID: 32416263 DOI: 10.1016/j.jmig.2020.05.002] [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] [Received: 02/29/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. DESIGN Retrospective cohort study. SETTING Tertiary-care university hospital. PATIENTS Patients with symptomatic anterior or apical POP stage III and above. INTERVENTIONS All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. MEASUREMENTS AND MAIN RESULTS Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre- and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. CONCLUSION A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh); Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Taiwan (Drs. Lo and Chen); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei (Dr. Lo), Taiwan.
| | - Kai Lyn Ng
- Department of Obstetrics and Gynaecology, National University Hospital of Singapore (Dr. Ng), Singapore
| | - Ting-Xuan Huang
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh)
| | - Yi-Pin Chen
- Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Taiwan (Drs. Lo and Chen)
| | - Yi-Hao Lin
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh); Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin)
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh)
| |
Collapse
|
12
|
Lo TS, Uy-Patrimonio MC, Kao CC, Chua S, Huang TX, Wu MP. Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes. Sci Rep 2020; 10:1944. [PMID: 32029796 PMCID: PMC7005146 DOI: 10.1038/s41598-020-58594-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Patients with pelvic organ prolapse (POP) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUI-UD) and detrusor overactivty(DO) would co-exist in a number of patients. Management entails relieving the obstructive element. To determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUI-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-UD. Main outcome measures: Objective cure- absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure- assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. Improvement of SUIUD and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. Ergo, vaginal PRS cures symptoms of MUI-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China. .,Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Ma Clarissa Uy-Patrimonio
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines
| | - Chuan Chi Kao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
| | - Sandy Chua
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines
| | - Ting-Xuan Huang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
| | - Ming-Ping Wu
- Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan.,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| |
Collapse
|
13
|
Long-term Outcomes of Self-Management Gellhorn Pessary for Symptomatic Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2019; 26:e47-e53. [PMID: 31393340 DOI: 10.1097/spv.0000000000000770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to estimate the long-term survival and to identify adverse events associated with the use of Gellhorn pessaries over a 9-year period. METHODS This was a retrospective case series study at a tertiary urogynecology unit in Taiwan. Between January 2009 and June 2017, 93 patients who opted for self-management Gellhorn pessaries to treat symptomatic pelvic organ prolapse (POP) and who were continuously followed-up were enrolled. Long-term use was defined as use for longer than 1 year. Length of use, factors that predicted discontinuation, and adverse events were analyzed and reviewed by chart or telephone inquiry. RESULTS The cumulative probabilities of continued pessary use at 1 and 5 years were 62.4% and 47.2%, respectively. Of those who discontinued use, 34 (70.8%) participants discontinued use within 1 year, and the mean duration of use was 13.7 months (range, 0-75 months; median, 5 months). Most of the participants stopped using the pessary because of bothersome adverse events such as pessary expulsion, vaginal pain, de novo urinary incontinence, and erosion/infection. CONCLUSIONS Self-management Gellhorn pessary was safe and relatively effective and increased patients' autonomy and ability to manage their POP. One third of the patients discontinued use by 1 year, and half of the patients discontinued use at 5 years.
Collapse
|
14
|
Wallace SL, Syan R, Sokol ER. Surgery for Apical Vaginal Prolapse after Hysterectomy: Transvaginal Mesh-Based Repair. Urol Clin North Am 2018; 46:103-111. [PMID: 30466695 DOI: 10.1016/j.ucl.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Several transvaginal mesh products have been marketed to address vaginal vault prolapse. Although data are limited, prolapse recurrence rates and subjective outcome measures seem to be equivalent for vaginal mesh compared with native tissue apical prolapse repair, and the different vaginal meshes have not proven superior to one another. Given the known unique complications specific to vaginal mesh with equivalent outcomes for the apical vaginal prolapse, it is reasonable to reserve mesh use for specific high-risk cases, such as patients with large apical prolapse recurrence after native tissue repair who are not candidates for sacrocolpopexy.
Collapse
Affiliation(s)
- Shannon L Wallace
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Grant S287, Stanford, CA 94305, USA.
| | - Raveen Syan
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S287, Stanford, CA 94305, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology (by Courtesy), Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room G304a, Stanford, CA 94305, USA; Department of Urology (by Courtesy), Stanford University School of Medicine, 300 Pasteur Drive, Room G304a, Stanford, CA 94305, USA
| |
Collapse
|
15
|
Lo TS, Pue LB, Tan YL, Hsieh WC, Kao CC, Uy-Patrimonio MC. Anterior-apical single-incision mesh surgery (uphold): 1-year outcomes on lower urinary tract symptoms, anatomy and ultrasonography. Int Urogynecol J 2018; 30:1163-1172. [DOI: 10.1007/s00192-018-3691-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023]
|
16
|
Curtiss N, Duckett J. A long-term cohort study of surgery for recurrent prolapse comparing mesh augmented anterior repairs to anterior colporrhaphy. ACTA ACUST UNITED AC 2018; 15:1. [PMID: 29375283 PMCID: PMC5762801 DOI: 10.1186/s10397-017-1035-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/21/2017] [Indexed: 11/10/2022]
Abstract
Background There are safety concerns regarding the use of mesh in vaginal surgery with a call for long-term follow-up data. This study was designed to evaluate the long-term safety and efficacy of vaginal repairs performed for recurrent cystocele using Perigee (non-absorbable trans-obturator) mesh. Methods A retrospective consecutive cohort of 48 women who underwent surgery for recurrent prolapse between March 2007 and December 2011 in a single centre was reviewed. Satisfaction was assessed using the patient global impression of improvement (PGI-I). Symptoms were assessed with the pelvic floor distress inventory (PFDI). Women were questioned regarding pain, sexual activity and pelvic floor surgery performed since the original procedure and examined for erosion. Women were compared to 25 controls from a consecutive cohort of repeat anterior colporrhapies. Results The mean length of follow-up was 6.5 years (78 months; range 48–106). Significantly more women in the mesh group reported that they were “much better” or “very much better” (69 vs 40% p = 0.02). The rate of mesh erosion at follow-up was 11.6%. Two women in the mesh group required surgical excision of eroded mesh in the operating room (4%). The reoperation rate for a combination of de novo stress incontinence, recurrent prolapse and mesh exposure was similar in each group (33% mesh vs 32% native tissue). Conclusions A vaginal mesh repair using a non-absorbable trans-obturator mesh has improved satisfaction compared to an anterior colporrhaphy.
Collapse
Affiliation(s)
- Natasha Curtiss
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent ME7 5NY UK
| | - Jonathan Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent ME7 5NY UK
| |
Collapse
|
17
|
Lo TS, Al-Kharabsheh AM, Tan YL, Pue LB, Hsieh WC, Uy-Patrimonio MC. Single incision anterior apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery at 36 months follow-up. Taiwan J Obstet Gynecol 2017; 56:793-800. [DOI: 10.1016/j.tjog.2017.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/25/2022] Open
|
18
|
Abstract
OBJECTIVE To update clinical practice guidelines on graft and mesh use in transvaginal pelvic organ prolapse repair based on systematic review. DATA SOURCES Eligible studies, published through April 2015, were retrieved through ClinicalTrials.gov, MEDLINE, and Cochrane databases and bibliography searches. METHODS OF STUDY SELECTION We included studies of transvaginal prolapse repair that compared graft or mesh use with either native tissue repair or use of a different graft or mesh with anatomic and symptomatic outcomes with a minimum of 12 months of follow-up. TABULATION, INTEGRATION, AND RESULTS Study data were extracted by one reviewer and confirmed by a second reviewer. Studies were classified by vaginal compartment (anterior, posterior, apical, or multiple), graft type (biologic, synthetic absorbable, synthetic nonabsorbable), and outcome (anatomic, symptomatic, sexual function, mesh complications, and return to the operating room). We found 66 comparative studies reported in 70 articles, including 38 randomized trials; quality of the literature has improved over time, but some outcomes still show heterogeneity and limited power. In the anterior vaginal compartment, synthetic nonabsorbable mesh consistently showed improved anatomic and bulge symptom outcomes compared with native tissue repairs based on meta-analyses. Other subjective outcomes, including urinary incontinence or dyspareunia, generally did not differ. Biologic graft or synthetic absorbable mesh use did not provide an advantage in any compartment. Synthetic mesh use in the posterior or apical compartments did not improve success. Mesh erosion rates ranged from 1.4-19% at the anterior vaginal wall, but 3-36% when mesh was placed in multiple compartments. Operative mesh revision rates ranged from 3-8%. CONCLUSION Synthetic mesh augmentation of anterior wall prolapse repair improves anatomic outcomes and bulge symptoms compared with native tissue repair. Biologic grafts do not improve prolapse repair outcomes in any compartment. Mesh erosion occurred in up to 36% of patients, but reoperation rates were low.
Collapse
|
19
|
Lo TS, Yusoff FM, Kao CC, Jaili S, Uy Patrimonio MC. A 52-month follow-up on the transvaginal mesh surgery in vaginal cuff eversion. Taiwan J Obstet Gynecol 2017; 56:346-352. [DOI: 10.1016/j.tjog.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/25/2022] Open
|
20
|
Hsieh HY, Tsai CP, Liu CK, Shen PS, Hung YC, Hung MJ. Factors that affect outcomes of prolapse repair using single-incision vaginal mesh procedures. Neurourol Urodyn 2017; 37:298-306. [PMID: 28431204 DOI: 10.1002/nau.23292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/15/2017] [Indexed: 12/23/2022]
Abstract
AIMS Single-incision vaginal mesh (SIVM) procedures for pelvic organ prolapse (POP) differed in mesh fabrication and implantation that may affect treatment outcomes. We aim to evaluate and compare the safety and effectiveness of two SIVM procedures, and explore factors that may have associations with surgical effectiveness. METHODS Our data of using two SIVM procedures for a total (anterior and posterior) vaginal mesh repair were studied. Patients who had ≧stage 2 POP and underwent either Elevate (n = 85) using anchored, lightweight meshes or Prosima procedures (n = 95) using non-anchored, original meshes were assessed. A detailed comparison of 1 year outcomes was made. RESULTS Of the 180 patients, 172 (95.6%) attended the 1-year follow-up. Demographic data were similar between groups except a higher average age (64.5 vs 60.4, P = 0.001) was noted in the Elevate (n = 84) group compared to the Prosima (n = 88) group. Surgical results were also similar except a significantly higher objective cure (POP stage ≦1) rate (89.3% vs 78.4%, P = 0.042) was noted in the Elevate group. The safety profile favored Elevate with a lower, but not statistically significant, rate (4.7% vs 12.5%, P = 0.106) of vaginal mesh exposure. After a statistical analysis, we found anatomic recurrence (POP stage ≧2) after the SIVM procedures had strong (P < 0.05) associations with "early surgical cases," "Prosima procedure," "advanced cystocele (Ba > +3 cm)," and "prior prolapse repair," respectively. CONCLUSIONS Beyond a learning curve, Elevate performed better than Prosima in POP repair regarding surgical effectiveness. Meanwhile, several predisposing factors that may affect recurrence after SIVM procedures were found.
Collapse
Affiliation(s)
- Hsiao-Yun Hsieh
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Pei Tsai
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Ku Liu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pao-Sheng Shen
- Department of Statistics, Tunghai University, Taichung, Taiwan
| | - Yao-Ching Hung
- Department of Obstetrics and Gynecology, China Medical University School of Medicine, Taichung, Taiwan
| | - Man-Jung Hung
- Department of Obstetrics and Gynecology, China Medical University School of Medicine, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Asia University Hospital, Taichung, Taiwan.,Department of Biotechnology, Asia University, Taichung, Taiwan
| |
Collapse
|
21
|
Lo T, Nagashu S, Hsieh W, Uy‐Patrimonio MC, Yi‐Hao L. Predictors for detrusor overactivity following extensive vaginal pelvic reconstructive surgery. Neurourol Urodyn 2017; 37:192-199. [DOI: 10.1002/nau.23273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Tsia‐Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial HospitalKeelung Medical CenterKeelung, TaiwanPeople's Republic of China
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
- Department of Obstetrics and Gynaecology, Chang Gung Memorial HospitalXiamen Medical CenterXiamenPeople's Republic of China
- Chang Gung UniversitySchool of MedicineTaoyuan, TaiwanPeople's Republic of China
| | - Shailaja Nagashu
- Department of Obstetrics and GynaecologyPeoples Education Society Medical College and Research CentreKuppam, Andhra PradeshIndia
- Fellow, Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
| | - Wu‐Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
| | - Ma Clarissa Uy‐Patrimonio
- Fellow, Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
- Department of Obstetrics and GynecologyDr. Pablo O. Torre Memorial HospitalBacolod CityPhilippines
| | - Lin Yi‐Hao
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan, TaiwanPeople's Republic of China
| |
Collapse
|
22
|
Lo TS, Shailaja N, Hsieh WC, Uy-Patrimonio MC, Yusoff FM, Ibrahim R. Predictors of voiding dysfunction following extensive vaginal pelvic reconstructive surgery. Int Urogynecol J 2016; 28:575-582. [PMID: 27647467 DOI: 10.1007/s00192-016-3144-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/28/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to identify the predictors of postoperative voiding dysfunction in women following extensive vaginal pelvic reconstructive surgery. METHODS We enrolled 1,425 women who had pelvic organ prolapse of POP-Q stage III or IV and had undergone vaginal pelvic reconstructive surgery with or without transvaginal mesh insertion from January 2006 to December 2014. All subjects were required to complete a 72-h voiding diary, and the IIQ-7, UDI-6, POPDI-6 and PISQ-12 questionnaires. Urodynamic study was performed preoperatively and postoperatively. RESULTS Of the 1,425 women, 54 were excluded due to incomplete data, and 1,017 of the remaining 1,371 (74.2 %) had transvaginal mesh surgery and 247 (18 %) had concurrent midurethral sling insertion. Of 380 women (27.7 %) with preoperative voiding dysfunction, 37 (9.7 %) continued to have voiding dysfunction postoperatively. Of the remaining 991 women (72.3 %) with normal preoperative voiding function, 11 (1.1 %) developed de novo voiding dysfunction postoperatively. The overall incidence of postoperative voiding dysfunction was 3.5 % (48/1,371). Those with concurrent midurethral sling insertion were at higher risk of developing voiding dysfunction postoperatively (OR 3.12, 95 % CI 1.79 - 5.46, p < 0.001). Diabetes mellitus, preoperative detrusor pressure at maximal flow (Dmax) <10 cm H2O and postvoid residual volume ≥200 ml were significant risk factors for the development of postoperative voiding dysfunction (OR 3.07, 1.84 and 2.15, respectively; 95 % CI 1.69 - 5.60, 1.39 - 2.91 and 1.10 - 3.21, respectively). CONCLUSIONS Diabetes mellitus, concurrent midurethral sling insertion, preoperative Dmax <10 cm H2O and postvoid residual volume ≥200 ml in patients with advanced pelvic organ prolapse were risk factors for the development of postoperative voiding dysfunction after vaginal pelvic reconstructive surgery. Therefore, counseling is worthwhile before considering vaginal pelvic reconstructive surgery.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, 222, Maijin Road, Keelung, Taiwan, 204, Republic of China. .,Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Nagashu Shailaja
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynaecology, Peoples Education Society Medical College and Research Centre, Kuppam, Andhra Pradesh, India
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
| | - Ma Clarissa Uy-Patrimonio
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines
| | - Faridah Mohd Yusoff
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynaecology, Hospital Sultanah Nur Zahirah, Kuala, Terengganu, Malaysia
| | - Rami Ibrahim
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Department of Obstetrics and Gynecology, Albashir Hospital, Amman, Jordan
| |
Collapse
|
23
|
Weintraub AY, Neuman M, Reuven Y, Neymeyer J, Marcus-Braun N. Efficacy and safety of skeletonized mesh implants for advanced pelvic organ prolapse: 12-month follow-up. World J Urol 2016; 34:1491-8. [DOI: 10.1007/s00345-016-1792-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/12/2016] [Indexed: 11/25/2022] Open
|
24
|
Long-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J 2016; 27:1069-74. [PMID: 26837782 DOI: 10.1007/s00192-015-2939-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/18/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to report long-term subjective and objective outcomes after the transvaginal mesh (TVM) procedure in long-term. Possible late-onset complications were of particular interest. METHODS This was a retrospective analysis of TVM performed using Prolift™ transvaginal mesh measuring subjective outcome using validated questionnaires. Objective outcome was assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system using two definitions: POP-Q stage ≤ 1, and vaginal wall prolapse at or above the hymen or vaginal apex not descending below the upper third of the vagina. Complications were reported with the Prosthesis/Graft Complication Classification Code designed by the International Continence Society/International Urogynecological Association (ICS/IUGA). RESULTS Of 195 patients, 161 (82.6 %) participated this study after a median of 7 years. The scores in questionnaires evaluating urinary (UI) or anal incontinence and constipation or pelvic floor symptoms were low, indicating favorable surgical outcomes. Altogether, 80.1 % of patients were satisfied with the procedure. Anatomical cure was 56.4 % and 69.3 % depending on the definition used. Reoperation due to POP in any compartment was performed in 16.2 % of patients. Mesh exposure rate was 23 %, most of these being asymptomatic and of late onset. CONCLUSIONS Outcome of the TVM procedure was satisfactory. Anatomical cure was inferior to subjective cure. Mesh exposure rate was high; most exposures observed in the long-term were of late onset and were asymptomatic.
Collapse
|
25
|
Globerman D, Robert M. Heterogeneity in post-intervention prolapse and urinary outcome reporting: a one-year review of the International Urogynecology Journal. Int Urogynecol J 2015; 26:1373-8. [PMID: 25944659 DOI: 10.1007/s00192-015-2720-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This review aimed to examine post-intervention prolapse, incontinence, and overactive bladder outcome measures published in the International Urogynecology Journal over the previous year and to report on the heterogeneity in outcome reporting. METHODS All original article abstracts published in the print version of the International Urogynecology Journal in 2014 were reviewed for possible inclusion. Those reporting on prolapse and/or incontinence and/or overactive bladder outcomes following a urogynecological intervention were analyzed. Articles were reviewed for all reported outcomes. Outcomes were categorized as primary or secondary and objective or subjective. RESULTS Of 117 original articles published, 45 were reviewed. Among primary outcomes, 9 different outcomes were reported for prolapse and 11 for incontinence and overactive bladder. For prolapse, 6 different objective and 13 subjective outcomes were reported. For incontinence, 21 objective and 36 subjective outcomes were reported. Three different definitions were used for the outcome of "prolapse cure," 3 for "prolapse recurrence," and 4 for "stress incontinence cure." Several validated and non-validated questionnaires in addition to single unvalidated questions were used to measure subjective outcomes. CONCLUSIONS This research highlights the diversity in outcome reporting for prolapse, incontinence, and overactive bladder after an intervention in the last year of publications alone. This can lead to serious challenges in the generation of higher order evidence, such as systematic reviews and meta-analyses. As a subspecialty, we need to aim for more cohesive reporting so as to allow for robust comparison and evidence dissemination.
Collapse
Affiliation(s)
- Dobrochna Globerman
- Division of Urogynecology, Department of Obstetrics and Gynecology, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada,
| | | |
Collapse
|
26
|
Sacrospinous ligament fixation of transvaginal mesh: An innovative concept's 10 years of influence. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
27
|
Lo TS, Bt Karim N, Nawawi EA, Wu PY, Nusee Z. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogynecol J 2015; 26:1313-9. [PMID: 25862240 DOI: 10.1007/s00192-015-2685-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to look for possible predictors preoperatively for the development of de novo stress urinary incontinence (SUI) in urodynamically continent women who underwent pelvic reconstructive surgery (PRS). MATERIALS AND METHODS Medical records of 637 continent women who underwent PRS for severe prolapse from January 2005 to December 2013 in our institutions were included in this study. We excluded women who had urodynamic stress incontinence (UDI) either occult or overt, detrusor overactivity, neurogenic bladder-voiding dysfunction, and previous anti-incontinent surgery. Primary outcome measure was the development of de novo SUI at 6 months to 1 year post operation. RESULTS Of women in this study, 11 % developed postoperative de novo SUI at 6 months to 1 year of follow-up. Women older than 66 years were 2.86 times [95 % confidence interval (CI) 1.01-2.53, p = 0.14], diabetes mellitus (DM) 2.18 times (95 % CI 1.63-4.21, p = 0.002), certain type of transvaginal mesh procedure 3.5 times (95 % CI, p < 0.001), maximum urethral closure pressure (MUCP) < 60 mmH20 4.65 times (95 % CI, 2.87-8.64, p < 0.001), and functional urethral length (FUL) < 2 cm 3.48 times (95 % CI, 2.13-5.83, p < 0.001) at greater risk of developing de novo SUI. CONCLUSIONS Continent women with advanced pelvic organ prolapse (POP) > 66 years, with DM or low MUCP and FUL values during preoperative urodynamic evaluation have higher risk of developing de novo SUI; therefore, we suggest counselling such women for concomitant PRS and anti-incontinent surgery.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Keelung, Keelung Medical Centre, 222, Maijin Road, Keelung, Taiwan, 204, Republic of China,
| | | | | | | | | |
Collapse
|
28
|
Anterior-Apical Single-Incision Mesh Surgery (SIMS): Surgical and Functional Outcomes at 1 Year. J Minim Invasive Gynecol 2015; 22:50-6. [DOI: 10.1016/j.jmig.2014.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/28/2014] [Accepted: 07/02/2014] [Indexed: 11/24/2022]
|
29
|
Lo TS, Bt Karim N, Cortes EFM, Wu PY, Lin YH, Tan YL. Comparison between Elevate anterior/apical system and Perigee system in pelvic organ prolapse surgery: clinical and sonographic outcomes. Int Urogynecol J 2014; 26:391-400. [PMID: 25257810 DOI: 10.1007/s00192-014-2492-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to assess the incidence of de novo stress urinary incontinence (SUI) and sonographic features of implanted transvaginal mesh in continent women treated with Elevate(™) anterior/apical [single-incision mesh (SIM-A)] or Perigee(™) [transvaginal mesh with sacrospinous fixation (TVM + SSF)] in extensive pelvic organ reconstruction surgery. METHODS This prospective observational study was done from May 2010 to January 2013. Patients were recruited from two tertiary centers, and the Elevate(™) and Perigee(™) systems were compared. Patients who had overt or occult SUI, previous prolapse or mesh insertion were excluded. RESULT Fifty-seven patients in the SIM-A group and sixty-one in the TVM + SSF group were analysed. All completed a minimum of 1-year follow-up. Groups were demographically and statistically similar. There was a significantly high incidence of de novo SUI postoperatively in the SIM-A group. The objective and subjective cure rate of pelvic organ prolapse (POP) were comparable between groups, with incidence of mesh erosion in the SIM-A group and three in the TVM + SSF group. Sonographic evaluation showed significant increase in mesh length in the SIM-A group. CONCLUSION Elevate(™) a offered lower incidence of mesh erosion and comparable results on anatomical POP correction; however, incidence of de novo SUI was high. There is an apparent lengthening of implanted Elevate® mesh sonographically.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Keelung, Keelung Medical Center, Keelung, Taiwan, Republic of China,
| | | | | | | | | | | |
Collapse
|
30
|
Nohuz E, Alaboud M, Darcha C, Alloui A, Aublet-Cuvelier B, Jacquetin B. Effectiveness of Hyalobarrier and Seprafilm to prevent polypropylene mesh shrinkage: a macroscopic and histological experimental study. Int Urogynecol J 2014; 25:1081-7. [PMID: 24599179 DOI: 10.1007/s00192-014-2357-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/07/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Polypropylene (PP) mesh shrinkage represents a serious complication, as a significant cause of pain and recurrence of pelvic organ prolapse or ventral hernias, frequently requiring several surgical interventions. The retraction seems to be caused by the host, in response to the implantation, through the occurrence of periprosthetic adhesions and fibrosis. We hypothesized that avoiding the postoperative adhesions can prevent PP mesh shrinkage. METHODS Sixty rats were randomly assigned to three groups. A standardized hernia defect was induced on the abdominal wall, which was repaired using an extraperitoneal PP mesh alone (group 1), with application of a hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm, group 2), or an auto-cross-linked polysaccharide hyaluronan-based solution (Hyalobarrier gel, group 3). Eight weeks after the procedure, a repeat laparotomy was performed. After scoring the adhesion and measuring the mesh surface, a microscopic study of the prosthesis-host tissue interfaces was performed. RESULTS Group 1 displayed a median shrinkage of 29% of the mesh. The Seprafilm group (p = 0.0238) and Hyalobarrier gel group (p = 0.0072) displayed a significantly smaller reduction of 19.12 and 17 %, respectively. Control group 1 displayed a significantly greater adhesion score (30.40) than the Seprafilm (11.67, p = 0.0028) and Hyalobarrier gel groups (11.19, p = 0.0013). The fibrosis was reduced in the Hyalobarrier gel group only. CONCLUSION This experimental study revealed that Hyalobarrier gel and Seprafilm can prevent PP mesh shrinkage and postoperative adhesions. They might be integrated in a mesh size-saving strategy, which should preserve the quality and durability of the surgical repair and limit the postoperative pain.
Collapse
Affiliation(s)
- Erdogan Nohuz
- Department of Obstetrics and Gynecology, General Hospital of Thiers, Route du Fau, 63300, Thiers, France,
| | | | | | | | | | | |
Collapse
|