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Lin FC, Gilleran JP, Powell CR, Atiemo HO. To mesh or not mesh "apical prolapse," that is the question! Neurourol Urodyn 2024. [PMID: 38623999 DOI: 10.1002/nau.25469] [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: 01/10/2024] [Revised: 03/16/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
Surgical approaches for pelvic organ prolapse have evolved over the last 30 years and is a popular topic for debate, particularly when discussing apical prolapse. Transvaginal native tissue repairs remain the mainstay of POP surgeries, however, transabdominal approaches continue to evolve. Use of interposition material, such as synthetic polypropylene mesh, is the standard when performing an abdominal sacrocolpopexy, however, use of autologous fascia can be considered. This debate article provides an overview of this subject and highlights the value of different approaches to apical prolapse. The authors were asked to support their approach in various scenarios including:extremes of age, prior hysterectomy and intact uterus, desire to avoid mesh, sexual activity, and presence of comorbidities. In discussing common patient scenarios, ultimate decision making on specific POP surgeries is determined by patient preference and goals.
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Affiliation(s)
- Frank C Lin
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jason P Gilleran
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - C R Powell
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Baird CE, Chughtai B, Bradley CS, Kobashi K, Jung M, Sedrakyan A, Andrews S, Ferriter A, Cornelison T, Marinac-Dabic D. Development of a coordinated registry network for pelvic organ prolapse technologies. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000076. [PMID: 36393893 PMCID: PMC9660621 DOI: 10.1136/bmjsit-2020-000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The accumulation of data through a prospective, multicenter Coordinated Registry Network (CRN) could be a robust and cost-effective way to gather real-world evidence on the performance of pelvic organ prolapse (POP) technologies for device-based and intervention-based studies. To develop the CRN, a group of POP experts consisting of representatives from professional societies, the Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements important to assess POP technologies. Design A Delphi method approach was employed to achieve consensus on a core minimum dataset for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by the study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via conference call. This process was repeated twice over a 6-month time period during which consensus was achieved. Results Twenty-one experts participated in the effort and proposed 120 data elements. Participation rates in the first and second round of the Delphi survey were 95.2% and 71.4%, respectively. The working group reached final consensus among responders on 90 data elements capturing relevant general medical and surgical history, procedure and discharge, short-term and long-term follow-up, device factors, and surgery and surgeon factors. Conclusions The CRN successfully developed a set of core data elements to support the study of POP technologies through convening an expert panel on POP technologies and using the Delphi method. These standardized data elements have the potential to influence patient and provider decisions about treatments and include important outcomes related to efficacy and safety.
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Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Kathleen Kobashi
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Mary Jung
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ann Ferriter
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Terri Cornelison
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
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Gomelsky A, Athanasiou S, Choo M, Cosson M, Dmochowski RR, Gomes CM, Monga A, Nager CW, Ng R, Rovner ES, Sand P, Tomoe H. Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence. Neurourol Urodyn 2018; 38:825-837. [DOI: 10.1002/nau.23895] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/23/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Alex Gomelsky
- Department of UrologyLouisiana State University Health Sciences CenterShreveportLouisiana
| | - Stavros Athanasiou
- 1st Department of Obstetrics and GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Myung‐Soo Choo
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | | | - Roger R. Dmochowski
- Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleTennessee
| | - Cristiano M. Gomes
- Division of UrologyUniversity of Sao Paulo School of MedicineSao PauloBrazil
| | - Ash Monga
- University Hospital SouthamptonSouthamptonUK
| | - Charles W. Nager
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San DiegoSan DiegoCalifornia
| | - Roy Ng
- Division of Urogynaecology and Pelvic Reconstructive Surgery, Department of Obstetrics and GynaecologyNational University HospitalSingapore
| | - Eric S. Rovner
- Department of UrologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Peter Sand
- Division of Urogynecology, NorthShore University Health System, University of ChicagoPritzker School of MedicineSkokieIllinois
| | - Hikaru Tomoe
- Department of UrologyTokyo Women's Medical University Medical Center EastTokyoJapan
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Goodall EJ, Cartwright R, Stratta EC, Jackson SR, Price N. Outcomes after laparoscopic removal of retropubic midurethral slings for chronic pain. Int Urogynecol J 2018; 30:1323-1328. [PMID: 30229269 DOI: 10.1007/s00192-018-3756-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Midurethral slings (MUS) are an established treatment for stress urinary incontinence (SUI), with good objective outcomes and low rates of complications. However, large population-based registry studies highlighted long-term complications from polypropylene slings including erosion, dyspareunia and chronic pain. With recent highly negative media coverage, many women are presenting with chronic pain attributed to the mesh to request complete removal. The available literature provides limited evidence on safety, symptom resolution and incontinence following MUS removal. METHODS We identified all patients who underwent laparoscopic removal of MUS mesh at our hospital between 2011 and 2016. We extracted data from medical records to assess operative safety and contacted all patients by questionnaire that incorporated pain scales, symptom severity and satisfaction. RESULTS A total of 56 women were assessed. Removal occurred at a median of 44 months following sling insertion (range 3-192). Mean operative time was 74 min (range 44-132). Two patients were returned to theatre (one at 24 hours and one at 14 days) to evacuate a retropubic haematoma, but no visceral injuries occurred. The median inpatient stay was 2 days (range 1-7). Of the 46% of patients who returned the questionnaire (n = 26), 88% said they would recommend the procedure. There was a median 6-point decrease in pain scores (10-point numerical scale, p < 0.0001); 44.6% reported worsening SUI, more common with removal of the suburethral mesh [odds ratio (OR) 10.72 95% confidence interval (CI) 1.10-104]. CONCLUSIONS Laparoscopic removal of MUS is feasible and effective but carries a risk of worsening SUI.
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Affiliation(s)
- Elizabeth J Goodall
- John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Rufus Cartwright
- John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Emily C Stratta
- John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Simon R Jackson
- John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Natalia Price
- John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK
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Mueller ER. Use of Transvaginal Mesh: What the Surgeon Should Consider. J Urol 2017; 198:755-756. [PMID: 28736208 DOI: 10.1016/j.juro.2017.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Elizabeth R Mueller
- Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology, and Urology, Loyola University Stritch School of Medicine, Maywood, Illinois
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