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Yang J, Zhang K, Han J, Wang Y, Yao Y, Wang H. Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse. Gynecol Obstet Invest 2021; 87:30-37. [PMID: 34818651 DOI: 10.1159/000520979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design:This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. METHODS The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. RESULTS A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. LIMITATION The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. CONCLUSION Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however,concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.
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Affiliation(s)
- Junfang Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Kun Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jinsong Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yiting Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ying Yao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Huifang Wang
- Department of Obstetrics and Gynecology, First Hospital of Qinhuangdao, Qinhuangdao, China
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Khandwala S, Cruff JP, Williams C. Experience with Prolift Mesh System for Correction of Uterovaginal Prolapse: Analysis of 149 Cases. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Salil Khandwala
- Advanced Urogynecology of Michigan, PC, Dearborn, MI, USA
- Beaumont Health System, Wayne, MI, USA
| | - Jason Paul Cruff
- Advanced Urogynecology of Michigan, PC, Dearborn, MI, USA
- Beaumont Health System, Wayne, MI, USA
| | - Cheau Williams
- Colquitt Regional Medical Center, Moultrie, GA, USA
- Medical College of Georgia, Augusta, GA, USA
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Abstract
OBJECTIVES There are few quality measures that allow for optimization of care for pelvic organ prolapse (POP). In coordination with the American Urogynecologic Society (AUGS), a prior group agreed upon health care provider-reported data elements that are important for large-scale quality measurement. The primary objective was to review existing patient-reported outcome (PRO) measurement tools for POP and consider where improvements are needed for inclusion in a quality measurement tool. A secondary objective was to discuss enhanced strategies to improve the quality of care for women with mesh complications. METHODS The AUGS Scientific Committee convened a 1-day meeting titled "Deciding our Future: Consensus Conference on Prolapse Outcomes and Best Practices for Mesh Complications." Speakers discussed the current state of POP outcome measurement and meaningful ways of measuring and improving quality. Furthermore, past and future work for standardization of care regarding mesh complications was discussed. RESULTS Conference participants included invited speakers, representatives from AUGS and partner societies, 5 patient representatives from the AUGS Patient Advisory Committee, and 38 registered participants from academic institutions, community practices, and industry. Participants developed a roadmap for incorporating PROs into a national POP quality improvement registry. Participants also discussed important gaps in our knowledge of treatment of mesh complications and previewed proposed terminology and treatment algorithms. CONCLUSIONS Using appropriate methodology, existing PRO measurement tools can be collapsed into one concise tool for POP quality measurement. Over the next year, work will continue toward this goal. Proposed updates to mesh terminology and treatment algorithms will be published separately.
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Long-term follow-up of patients treated by transvaginal mesh repair for anterior prolapse. Eur J Obstet Gynecol Reprod Biol 2018; 230:124-129. [PMID: 30269022 DOI: 10.1016/j.ejogrb.2018.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/17/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study was to assess 5 years outcome of transvaginal single incision mesh surgery (SIMS) for anterior pelvic organ prolapse (POP). STUDY DESIGN This was a prospective study including all patients from January 2009 to December 2012 who underwent SIMS for symptomatic anterior prolapse stage ≥2, according to POP Quantification (POP-Q). Symptoms and quality of life were assessed using validated questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact questionnaire (PFIQ-7), and Prolapse/ Incontinence Sexual Questionnaire (PISQ-12). Main outcome was subjective success (question 3 of PFDI-20 score = 0). Mesh-related complications, objective and functional outcomes were used as the secondary outcomes. RESULTS 270 patients were included in the study. Median follow-up was 5,7 years [4,5-8,2]. Subjective success rate was 86,6% at 5 years. Objective success rate was 53,1% at 5 years. At 5 years, composite failure (subjective + objective) occurred for 17 patients (12%), 7 patients with direct recurrence and 10 with indirect recurrence. Re-treatment was performed in six patients (2,8%; 3 hysterectomies for apical recurrence and 3 posterior repairs for posterior recurrence). One case (0,4%) of asymptomatic mesh exposure occurred. The reoperation rate for mesh-related complications was 3,4%. At 5 years, de novo dyspareunia rate was 11,7%, 3,9% considered as mesh-related. A significant improvement was noted for symptoms and quality of life. CONCLUSION Five-year results demonstrate that vaginal mesh surgery provides a durable and safe repair of anterior compartment prolapse with a low rate of mesh-related complications and reoperations. Between the 2- and 5-year follow-up, patient satisfaction and associated improvements in prolapse-specific symptoms were sustained and minimal new morbidity occurred.
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Ubertazzi EP, Soderini HFE, Saavedra Sanchez AJM, Fonseca Guzman C, Paván LI. Long-term outcomes of transvaginal mesh (TVM) In patients with pelvic organ prolapse: A 5-year follow-up. Eur J Obstet Gynecol Reprod Biol 2018; 225:90-94. [PMID: 29680466 DOI: 10.1016/j.ejogrb.2018.03.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the overall outcomes and complication rates of the transvaginal mesh (TVM) placed for the management of pelvic organ prolapse (POP) at 5-years follow up. STUDY DESIGN Retrospective cohort study in Urogynecology section in a single center in Argentina. Patients with prolapse stage II or higher were included. Seventy-six patients had TVM surgery for POP and 72 (95%) were available for the 5-year follow-up period. RESULTS The cure rate using the combined criteria (leading edge ≤0 according to Pelvic Organ Prolapse Quantification System (POP-Q), no bulge symptoms and no new treatment for prolapse) was 79.2% (57/72) (95% CI 68-88%). Only 5.5% (4/72) (95% CI 1.5-13.6) were re-operated for prolapse recurrence. Mesh exposure occurred in 16.6% of cases (n = 12; 95%CI 8.9-27.3). The incidence of de-novo dyspareunia was 13.3% (2/15) (95%CI 1-40) CONCLUSIONS: We observed that TVM is a durable treatment for prolapse and that adverse events were acceptable without severe complications at 5-year follow-up.
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Affiliation(s)
- Enrique P Ubertazzi
- Department of gynecology - Urogynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Hector F E Soderini
- Department of gynecology - Urogynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Camilo Fonseca Guzman
- Department of gynecology - Urogynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Lucila I Paván
- Department of gynecology - Urogynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Takazawa N, Fujisaki A, Yoshimura Y, Tsujimura A, Horie S. Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse. Investig Clin Urol 2018. [PMID: 29520390 PMCID: PMC5840118 DOI: 10.4111/icu.2018.59.2.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to evaluate the clinical outcomes and complications of transvaginal minimal mesh repair without using commercially available kits for treatment of pelvic organ prolapse (POP). Materials and Methods This retrospective cohort study involved 91 women who underwent surgical management of POP with originally designed small mesh between July 2014 and August 2015. This mesh is 56% smaller than the mesh widely used in Japan, and it has only two arms delivered into each right and left sacrospinous ligament. The main study outcome was the anatomic cure rate defined as recurrence of POP quantification (POP-Q) stage II or more. We also assessed changes in the overactive bladder symptom score (OABSS) and prolapse quality of life questionnaire (P-QOL) and evaluated adverse events. Finally, we compared patient backgrounds between the patients with and without recurrence. Results Prolapse recurred in 10 of 91 patients (11.0%), and all patients with recurrence were diagnosed as POP-Q stage II. As adverse events, only mesh erosion occurred in two (2.2%) and pelvic pain in one (1.1%) of the 91 patients. The OABSS and P-QOL were significantly improved by the operation. When we compared patient backgrounds between the patients with and without recurrence, body mass index was the only factor influencing affecting recurrence. Conclusions Transvaginal minimal mesh repair resulted in successful outcomes with low mesh-related complications and anatomic recurrence at one year. Furthermore, significant improvement in QOL was offered by this procedure. Our minimal mesh technique should be considered as one treatment option for the management of POP.
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Affiliation(s)
- Naoko Takazawa
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Urology, Yotsuya Medical Cube, Tokyo, Japan
| | - Akiko Fujisaki
- Department of Urology, Yotsuya Medical Cube, Tokyo, Japan
| | | | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
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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
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Prospective long-term results, complications and risk factors in pelvic organ prolapse treatment with vaginal mesh. Eur J Obstet Gynecol Reprod Biol 2017; 211:62-67. [PMID: 28192733 DOI: 10.1016/j.ejogrb.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/23/2016] [Accepted: 02/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the long-term results and complications of pelvic organ prolapse treatment with transvaginal mesh. STUDY DESIGN Prospective observational study of 75 women who underwent surgery between 2005 and 2008 by the same surgeon. 44 patients (58,7%) underwent concomitant treatment of stress urinary incontinence. Anatomical criterion for failure was prolapse grade >I in any compartment. Analysis of functional features consisted of an assessment of urinary, sexual, and defecation symptoms, and pelvic pain. Subjective global evaluation of the treatment was carried out through the Visual Analogue Scale (VAS). Analysis of the early and late complications and their medical or surgical management was performed. Evaluation of risk factors for failure of treatment and extrusion was carried out through logistic regression. RESULTS The median follow-up was 5,3 years. The anatomical results showed correction in 91,3% of the patients. Median subjective VAS evaluation: 9/10. Urinary symptoms improved after the surgery. Constipation and dyspareunia rates worsened. Pelvic pain improved. There were two early complications: one rectal perforation, repaired intraoperatively and one pulmonary embolism, managed medically. Late complications: 9 extrusions (3 managed with topical oestrogen, 3 with expectant management, and 3 reoperated, one twice), one cervix elongation and one forgotten gauze (both reoperated), 4 de novo pain managed successfully conservatively. 58,8% of the complications occurred after one year. Risk factors analyzed showed no statistical significance. CONCLUSIONS Vaginal mesh provides favorable anatomical, functional and subjective outcomes in long-term follow-up. The number of complications is relatively low, but many complications occurred a long-time after surgery.
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Geller EJ, Babb E, Nackley AG, Zolnoun D. Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders. J Minim Invasive Gynecol 2017; 24:67-73. [PMID: 27773810 PMCID: PMC5248587 DOI: 10.1016/j.jmig.2016.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/28/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Single university hospital. PATIENTS Women who have undergone surgery with pelvic mesh implant for treatment of pelvic floor disorders including prolapse and incontinence. INTERVENTIONS Telephone interviews to assess pain, sexual function, and general health. MEASUREMENTS AND MAIN RESULTS Pain was measured by the McGill Short-Form Pain Questionnaire for somatic pain, Neuropathic Pain Symptom Inventory for neuropathic pain, Pennebaker Inventory of Limbic Languidness for somatization, and Female Sexual Function Index (FSFI) for sexual health and dyspareunia. General health was assessed with the 12-item Short-Form Health Survey. Among 160 enrolled women, mean time since surgery was 20.8 ± 10.5 months, mean age was 62.1 ± 11.2 years, 93.8% were white, 86.3% were postmenopausal, and 3.1% were tobacco users. Types of mesh included midurethral sling for stress incontinence (78.8%), abdominal/robotic sacrocolpopexy (35.7%), transvaginal for prolapse (6.3%), and perirectal for fecal incontinence (1.9%), with 23.8% concomitant mesh implants for both prolapse and incontinence. Our main outcome, self-reported pelvic pain at least 1 year after surgery, was 15.6%. Women reporting pain were younger, with fibromyalgia, worse physical health, higher somatization, and lower surgery satisfaction (all p < .05). Current pelvic pain correlated with early postoperative pelvic pain (p < .001), fibromyalgia (p = .002), worse physical health (p = .003), and somatization (p = .003). Sexual function was suboptimal (mean FSFI, 16.2 ± 12.1). Only 54.0% were sexually active, with 19.0% of those reporting dyspareunia. CONCLUSION One in 6 women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early postoperative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection.
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Affiliation(s)
- Elizabeth J Geller
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Emma Babb
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrea G Nackley
- Center for Pain Research and Innovation, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Denniz Zolnoun
- Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Thames SF, White JB, Ong KL. The myth: in vivo degradation of polypropylene-based meshes. Int Urogynecol J 2016; 28:285-297. [DOI: 10.1007/s00192-016-3131-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022]
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SONG W, KIM TH, CHUNG JW, CHO WJ, LEE HN, LEE YS, LEE KS. Anatomical and Functional Outcomes of Prolift Transvaginal Mesh for Treatment of Pelvic Organ Prolapse. Low Urin Tract Symptoms 2016; 8:159-164. [DOI: 10.1111/luts.12090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Wan SONG
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Tae Heon KIM
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jin Woo CHUNG
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Won Jin CHO
- Department of Urology; Chosun University Hospital, Chosun University School of Medicine; Gwangju Korea
| | - Ha Na LEE
- Department of Urology; Ewha Womans University Medical Center, Seoul Seonam Hospital; Seoul Korea
| | - Young Suk LEE
- Department of Urology; Samsung Changwon Hospital, Sungkyunkwan University School of Medicine; Changwon Korea
| | - Kyu-Sung LEE
- Department of Urology; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
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Cosson M, Jacquetin B. [Vaginal meshes for POP cure: What is the state of play beginning 2016?]. ACTA ACUST UNITED AC 2016; 45:525-30. [PMID: 27236719 DOI: 10.1016/j.jgyn.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- M Cosson
- CHRU Jeanne-de-Flandres, avenue Eugène-Avinée, 59037 Lille cedex, France; Faculté de médecine Henri-Warembourg, université Lille Nord de France, Lille, France; LML, UMR CNRS 8107, boulevard Paul-Langevin, 59650 Villeneuve-d'Ascq, France
| | - B Jacquetin
- CHRU d'Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; Faculté de médecine, université d'Auvergne, Clermont-Ferrand, France.
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Meyer I, McGwin G, Swain TA, Alvarez MD, Ellington DR, Richter HE. Synthetic Graft Augmentation in Vaginal Prolapse Surgery: Long-Term Objective and Subjective Outcomes. J Minim Invasive Gynecol 2016; 23:614-21. [PMID: 26922879 DOI: 10.1016/j.jmig.2016.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report long-term objectives and subjective outcomes in women who underwent prolapse surgery with a synthetic graft augmentation. DESIGN Retrospective analysis (Canadian Task Force classification II-3). SETTING University hospital in the southeastern United States. PATIENTS Women with symptomatic pelvic organ prolapse who underwent transvaginal graft augmentation using the Prolift mesh system between July 2006 and December 2008 for a minimum 5-year follow-up. INTERVENTIONS Subjects completed the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ), and the Patient Satisfaction Questionnaire. Subjects also underwent postoperative physical examination with Pelvic Organ Prolapse Quantification (POP-Q) and vaginal pain/stricture assessment. Long-term postoperative findings were compared with preoperative baseline data. MEASUREMENTS AND MAIN RESULTS Of 208 eligible subjects, 70 completed the questionnaires only, and 48 of these 70 provided both postoperative examination and questionnaire data. The mean duration of follow-up was 7.0 ± 0.7 years (range, 5.8-8.1 years). POP-Q measurements of Ba (point B anterior), Bp (B posterior), C (cervix), GH (genital hiatus), PB (perineal body), and overall pelvic organ prolapse stage were significantly improved (all p < .001 except for PB, p = .006). PFIQ-7 (total, Urinary Impact Questionnaire, and Pelvic Organ Prolapse Impact Questionnaire) and PFDI-20 (total, Urinary Distress Inventory, and Pelvic Organ Prolapse Distress Inventory) scores significantly improved (all p < .001). No differences were noted in the colorectal-anal subscales (Colorectal-Anal Impact Questionnaire and Colorectal-Anal Distress Inventory) and PISQ scores at >5-year follow-up (all p > .05). Satisfaction rates were 15.7% for not at all, 35.7% for somewhat, and 48.6% for completely satisfied. Complications included graft exposure (n = 3; 6%) and dyspareunia (n = 25; 36%). CONCLUSION Women undergoing transvaginal prolapse surgery using a synthetic graft continue to have positive objective and subjective outcomes, leading to significantly improved quality of life at a minimum 5-year follow-up.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas A Swain
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mitchell D Alvarez
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - David R Ellington
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL
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Moen M, Gebhart J, Tamussino K. Systematic reviews of apical prolapse surgery: are we being misled down a dangerous path? Int Urogynecol J 2015; 26:937-9. [PMID: 25963061 DOI: 10.1007/s00192-015-2733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Moen
- Illinois Urogynecology, Ltd, 1875 Dempster St, Suite 665, Park Ridge, IL, 60068, USA,
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15
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Outcomes of trocar-guided Gynemesh PS™ versus single-incision trocarless Polyform™ transvaginal mesh procedures. Int Urogynecol J 2014; 26:71-7. [DOI: 10.1007/s00192-014-2467-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
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16
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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.
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Affiliation(s)
- Erdogan Nohuz
- Department of Obstetrics and Gynecology, General Hospital of Thiers, Route du Fau, 63300, Thiers, France,
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Obinata D, Yamaguchi K, Ito A, Murata Y, Ashikari D, Igarashi T, Sato K, Mochida J, Yamanaka Y, Takahashi S. Lower urinary tract symptoms in female patients with pelvic organ prolapse: Efficacy of pelvic floor reconstruction. Int J Urol 2013; 21:301-7. [DOI: 10.1111/iju.12281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/14/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Daisuke Obinata
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Kenya Yamaguchi
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Akiko Ito
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Yasutaka Murata
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Daisaku Ashikari
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Tomohiro Igarashi
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Katsuhiko Sato
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Junichi Mochida
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Yataro Yamanaka
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
| | - Satoru Takahashi
- Department of Urology; Nihon University School of Medicine; Tokyo Japan
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Frankman EA, Alperin M, Sutkin G, Meyn L, Zyczynski HM. Mesh exposure and associated risk factors in women undergoing transvaginal prolapse repair with mesh. Obstet Gynecol Int 2013; 2013:926313. [PMID: 24194763 PMCID: PMC3782123 DOI: 10.1155/2013/926313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/07/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. To determine frequency, rate, and risk factors associated with mesh exposure in women undergoing transvaginal prolapse repair with polypropylene mesh. Methods. Retrospective chart review was performed for all women who underwent Prolift Pelvic Floor Repair System (Gynecare, Somerville, NJ) between September 2005 and September 2008. Multivariable logistic regression was performed to identify risk factors for mesh exposure. Results. 201 women underwent Prolift. Mesh exposure occurred in 12% (24/201). Median time to mesh exposure was 62 days (range: 10-372). When mesh was placed in the anterior compartment, the frequency of mesh exposure was higher than that when mesh was placed in the posterior compartment (8.7% versus 2.9%, P = 0.04). Independent risk factors for mesh exposure were diabetes (AOR = 7.7, 95% CI 1.6-37.6; P = 0.01) and surgeon (AOR = 7.3, 95% CI 1.9-28.6; P = 0.004). Conclusion. Women with diabetes have a 7-fold increased risk for mesh exposure after transvaginal prolapse repair using Prolift. The variable rate of mesh exposure amongst surgeons may be related to technique. The anterior vaginal wall may be at higher risk of mesh exposure as compared to the posterior vaginal wall.
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Affiliation(s)
- Elizabeth A. Frankman
- Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Marianna Alperin
- Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Gary Sutkin
- Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Leslie Meyn
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, USA
| | - Halina M. Zyczynski
- Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
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Long-term outcomes of synthetic transobturator nonabsorbable anterior mesh versus anterior colporrhaphy in symptomatic, advanced pelvic organ prolapse surgery. Int Urogynecol J 2013; 25:257-64. [DOI: 10.1007/s00192-013-2200-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
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Jacquetin B, Hinoul P, Gauld J, Fatton B, Rosenthal C, Clavé H, Garbin O, Berrocal J, Villet R, Salet-Lizée D, Debodinance P, Cosson M. Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study. Int Urogynecol J 2013; 24:1679-86. [PMID: 23563891 DOI: 10.1007/s00192-013-2080-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/23/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. METHODS Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. RESULTS Of the 90 women enrolled in the study, 82 (91%) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge <-1 (International Continence Society [ICS] criteria) or above the level of the hymen, was 79% and 87% respectively. A composite criterion of success defined as: leading edge above the hymen (<0) and no bulge symptoms and no reintervention for prolapse was met by 90%, 88% and 84% at the 1-, 3-, and 5-year endpoints respectively. Quality of life improvement was sustained over the 5 years. Over the 5-year follow-up period, a total of only 4 patients (5%) required re-intervention for prolapse, while a total of 14 patients (16%) experienced mesh exposure for which 8 resections needed to be performed. Seven exposures were still ongoing at the 5-year endpoint, all asymptomatic. Only 33 out of 61 (54%) sexually active patients at baseline remained so at 5 years. De novo dyspareunia was reported by 10%, but no new cases at the 5-year endpoint. One patient reported de novo unprovoked mild pelvic pain at 5 years, 5 reported pains during pelvic examination only. CONCLUSIONS Five-year results indicated that TVM provided a stable anatomical repair. Improvements in QOL and associated improvements in prolapse-specific symptoms were sustained. Minimal new morbidity emerged between the 1- and 5-year follow-up.
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Affiliation(s)
- B Jacquetin
- Department of Obstetrics and Gynaecology, Estaing University Hospital, Clermont-Ferrand, France,
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Vaginal Prolapse Repair—Native Tissue Repair versus Mesh Augmentation: Newer Isn’t Always Better. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-012-0170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Where to for pelvic organ prolapse treatment after the FDA pronouncements? A systematic review of the recent literature. Int Urogynecol J 2013; 24:707-18. [PMID: 23306770 DOI: 10.1007/s00192-012-2025-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION With the publication of the updated US Food and Drug Administration (FDA) communication in 2011 on the use of transvaginal placement of mesh for pelvic organ prolapse (POP) it is appropriate to now review recent studies of good quality on POP to assess the safety and effectiveness of treatment options and determine their place in management. METHODS A systematic search for studies on the conservative and surgical management of POP published in the English literature between January 2002 and October 2012 was performed. Studies included were review articles, randomized controlled trials, prospective and relevant retrospective studies as well as conference abstracts. Selected articles were appraised by the authors regarding clinical relevance. RESULTS Prospective comparative studies show that vaginal pessaries constitute an effective and safe treatment for POP and should be offered as first treatment of choice in women with symptomatic POP. However, a pessary will have to be used for the patient's lifetime. Abdominal sacral colpopexy is effective in treating apical prolapse with an acceptable benefit-risk ratio. This procedure should be balanced against the low but non-negligible risk of serious complications. The results of native tissue vaginal POP repair are better than previously thought with high patient satisfaction and acceptable reoperation rates. The insertion of mesh at the time of anterior vaginal wall repair reduces the awareness of prolapse as well as the risk of recurrent anterior prolapse. There is no difference in anatomic and subjective outcome when native tissue vaginal repairs are compared with multicompartment vaginal mesh. Mesh exposure is still a significant problem requiring surgical excision in approximately ≥ 10 % of cases. The ideal mesh has not yet been found necessitating more basic research into mesh properties and host response. Several studies indicate that greater surgical experience is correlated with fewer mesh complications. In women with uterovaginal prolapse uterine preservation is a feasible option which women should be offered. Randomized studies with long-term follow-up are advisable to establish the place of uterine preservation in POP surgery. CONCLUSION Over the last decade treatment of POP has been dominated by the use of mesh. Conservative treatment is the first option in women with POP. Surgical repair with or without mesh generally results in good short-term objective and functional outcomes. However, basic research into mesh properties with host response and comparative studies with long-term follow-up are urgently needed.
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Al-Badr A. Quality of Life Questionnaires for the Assessment of Pelvic Organ Prolapse: Use in Clinical Practice. Low Urin Tract Symptoms 2012; 5:121-8. [PMID: 26663446 DOI: 10.1111/luts.12006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the past decade, the use of quality of life (QOL) questionnaires in the evaluation of pelvic organ prolapse (POP) has become a standard part of most clinical studies. Investigators have attempted to correlate QOL scores with objective findings and treatment efficacy and as outcome measures in comparing different treatment modalities. Many of the QOL questionnaires are available in short forms, making them easier to adapt to clinical settings. This article includes an overview of several validated QOL questionnaires and their application in studies whose results provide useful guidelines for health care professionals who diagnose and manage women with POP.
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Affiliation(s)
- Ahmed Al-Badr
- Department of Urogynecology and Pelvic Reconstructive Surgery, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Jacquetin B. Traditional native tissue vs mesh-augmented pelvic organ prolapse repairs: providing an accurate interpretation of current literature. Comment. Int Urogynecol J 2012; 24:181-2. [DOI: 10.1007/s00192-012-1974-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse. Int Urogynecol J 2012; 24:363-70. [PMID: 22930214 DOI: 10.1007/s00192-012-1918-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 10/28/2022]
Abstract
Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.
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Use of mesh in vaginal pelvic organ prolapse surgery: prolapse surgery-an overview. J Obstet Gynaecol India 2012; 61:381-3. [PMID: 22851817 DOI: 10.1007/s13224-011-0065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
Since 2004, use of synthetic mesh has increased in vaginal surgery for the treatment of pelvic organ prolapse. However, concerns exist about the safety and efficacy of transvaginally placed mesh. Based on the currently available limited data, although many patients undergoing mesh-augmented vaginal repairs heal well without problems, there seems to be a small but significant group of patients who experience permanent and life-altering sequelae, including pain and dyspareunia, from the use of vaginal mesh. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society provide background information on the use of vaginally placed mesh for the treatment of pelvic organ prolapse and offer recommendations for practice.
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Miller D, Milani AL, Sutherland SE, Navin B, Rogers RG. Informed surgical consent for a mesh/graft-augmented vaginal repair of pelvic organ prolapse. Consensus of the 2nd IUGA Grafts Roundtable: optimizing safety and appropriateness of graft use in transvaginal pelvic reconstructive surgery. Int Urogynecol J 2012; 23 Suppl 1:S33-42. [PMID: 22395291 DOI: 10.1007/s00192-012-1680-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 01/16/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Complex issues surround informed surgical consent for pelvic reconstructive surgery. METHODS Vaginally placed mesh/grafts are used with the intent to increase durability of the repair but potentially introduce unique complications, offering new challenges in informed surgical consent counseling. RESULTS Informed consent is a process that takes place throughout the entire consultation with the patient. A written document often accompanies that process. This paper outlines necessary components of informed surgical consent and the theory behind each component. CONCLUSIONS We explore elements that should be included in the consent process with regard to expected benefits, alternatives, and material risks that are specific to the use of a mesh/graft-augmented vaginal repair of prolapse. Included is an appendix that may serve as a template for the creation of a surgeon's own written informed consent document.
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Affiliation(s)
- Dennis Miller
- Division of Urogynecology, Wheaton Franciscan Healthcare, 201 N Mayfair Rd, Wauwatosa, WI 53217, USA.
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Medium-term clinical outcomes following surgical repair for vaginal prolapse with tension-free mesh and vaginal support device. Int Urogynecol J 2011; 23:487-93. [PMID: 22143448 DOI: 10.1007/s00192-011-1600-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was designed to evaluate clinical outcomes ≥2 years following surgery with polypropylene mesh and vaginal support device (VSD) in women with vaginal prolapse, in a prospective, multi-center setting. METHODS Patients re-consented for this extended follow-up (n = 110), with anatomic evaluation using Pelvic Organ Prolapse Quantification (POP-Q) and validated questionnaires to assess pelvic symptoms and sexual function. Complications were recorded (safety set; n = 121). RESULTS Median length of follow-up was 29 months (range 24-34 months). The primary anatomic success, defined as POP-Q 0-I, was 69.1%; however, in 84.5% of the cases, the leading vaginal edge was above the hymen. Pelvic symptoms and sexual function improved significantly from baseline (p < 0.01). Mesh exposure rate was 9.1%. Five percent reported stress urinary incontinence and 3.3% required further prolapse surgery. CONCLUSION These results indicate this non-anchored mesh repair is a safe and effective treatment for women with symptomatic vaginal prolapse in the medium term.
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