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Ben Zvi M, Weintraub AY, Friedman T, Neuman M, Tsivian A. Minimally invasive meshless and minimal dissection ligament fixation system for apical organ prolapse procedures: A 4-year prospective follow up study. Int J Gynaecol Obstet 2021; 158:657-662. [PMID: 34850393 DOI: 10.1002/ijgo.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE EnPlace™ (formerly named NeuGuide™) is a minimally invasive meshless anchoring system for pelvic organ prolapse (POP) repair designed to provide centro-apical pelvic floor support. We present a 4-year prospective follow up evaluation of this repair system. METHODS This was a single-center longitudinal prospective study of women with advanced POP who underwent pelvic floor apical repair using EnPlace™ with at least 4 years of follow-up. The primary outcome was surgical success defined as anatomical success, no symptoms of vaginal bulging and no need for re-treatment. A standardized validated questionnaire to assess symptom burden was used. RESULTS Fifteen women were enrolled in the study. Two patients were lost to follow-up. The median follow-up was 51 months (range 42-57) with a surgical success rate of 92.3%. One patient (7.7%) reported symptoms of vaginal vault prolapse and underwent a repeated prolapse surgery. Using the UDI-6 questionnaire, an improvement in all domains was seen. CONCLUSION The 4-year prospective follow up suggests that apical repair using the EnPlace™ device may be considered safe and effective for sacrospinous ligament fixation with a sustainable long-term success. This procedure is a minimally invasive meshless addition to pelvic surgeon's armamentarium.
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Affiliation(s)
- Masha Ben Zvi
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Talia Friedman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menahem Neuman
- Urogynecology & Pelvic Floor Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Huang KH, Chen WH, Yang TH, Wu LY, Chang YW, Chuang FC. Comparison of Prolift, Perigee-Apogee, Prosima, and Elevate transvaginal mesh systems in pelvic organ prolapse surgery: Clinical outcomes of a long-term observational study. Low Urin Tract Symptoms 2021; 14:47-56. [PMID: 34409747 DOI: 10.1111/luts.12408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To evaluate and compare the long-term clinical outcomes of four different transvaginal mesh systems. METHODS This retrospective study included 695 patients classified into four groups (Prolift, n = 132; Perigee-Apogee, n = 186; Prosima, n = 60; Elevate; n = 317), with a median follow-up time of 5.8 years (range 0.5-12.2 years). The outcomes were objective anatomic success (Pelvic Organ Prolapse [POP] Quantification system stage ≤1), mesh exposure, and urologic functional assessments. RESULTS For anatomic outcomes, we stepwise analyzed the short-term (within 3 years) and long-term (after 3 years) results. Prolift had the highest long-term success rate (9 years: 82.1%, P = .007). Elevate had a comparable short-term success rate (3 years: 87.5%), but its long-term success rate significantly decreased over time (5 years: 78.6%, 9 years: 66.8%, P = .007). Prosima had the lowest short-term success rate (P = .027). For the long-term mesh exposure rate (9-year cumulative), Elevate had the lowest with 11.1%; next were Perigee-Apogee (18.8%) and Prolift (24.6%); and Prosima had the highest with 39.4%, with a significant difference. In terms of urinary functional results, we observed no significant differences in voiding dysfunction, de novo stress urinary incontinence, or de novo overactive bladder symptoms among the four mesh groups, whether combined with midurethral sling surgery or not. CONCLUSION Different vaginal mesh designs have various advantages and features. Prolift provided the best long-term anatomic success but had a high mesh exposure rate. Elevate gave comparable short-term success but had a decreased long-term success rate. However, Elevate is superior with the lowest long-term mesh exposure rate. Prosima had the worst anatomic correction and highest mesh exposure rates. This study provides a comprehensive long-term comparative result for POP patients and surgeons.
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Affiliation(s)
- Kuan-Hui Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Hsin Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Ying Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Wei Chang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fei-Chi Chuang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Impact of Genital Hiatus Size on Anatomic Outcomes After Mesh-Augmented Sacrospinous Ligament Fixation. Female Pelvic Med Reconstr Surg 2021; 27:564-568. [PMID: 33411455 DOI: 10.1097/spv.0000000000000986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective is to compare anatomic outcomes at medium term after mesh-augmented sacrospinous ligament fixation among women categorized by their preoperative and postoperative genital hiatus size. METHODS We performed a retrospective cohort study in women undergoing Uphold mesh-augmented sacrospinous ligament fixation between 2010 and 2017. We compared 3 groups: (1) women with a wide genital hiatus preoperatively and 6 weeks postoperatively ("Persistently Wide" cohort), (2) women with a wide genital hiatus preoperatively but normal hiatus 6 weeks postoperatively ("Improved" cohort), and (3) women with a normal genital hiatus preoperatively and 6 weeks postoperatively ("Stably Normal" cohort). We defined a wide hiatus as 4 cm or greater and a normal hiatus as less than 4 cm. The primary outcome was anatomic failure, defined as recurrent prolapse beyond the hymen or retreatment for prolapse with surgery or pessary. RESULTS Ninety-seven women were included in the study. Overall, mean age was 68 years (±7.15 years), mean body mass index was 28.36 kg/m2 (±5.34 kg/m2) and mean follow up time was 400 ± 216 days. Anatomic failure did not differ between groups (Persistently Wide, 15.4%; Improved, 11.1%; Stably Normal, 10.0%; P = 0.88). In logistic regression, the odds of anatomic failure remained similar among all groups (P = 0.93). CONCLUSIONS A persistently wide genital hiatus alone was not associated with anatomic failure in this small study cohort. Therefore, surgical reduction of the genital hiatus with level III support procedures may not affect prolapse recurrence at the time of mesh-augmented sacrospinous ligament fixation. Further studies are needed to confirm this relationship and investigate other potential mechanisms for these findings.
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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
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Weintraub AY, Zvi MB, Yohay D, Neymeyer J, Reuven Y, Neuman M, Tsivian A. Safety and short term outcomes of a new truly minimallyinvasive mesh-less and dissection-less anchoring system for pelvic organ prolapse apical repair. Int Braz J Urol 2017; 43:533-539. [PMID: 28191790 PMCID: PMC5462146 DOI: 10.1590/s1677-5538.ibju.2016.0356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the safety and short term outcomes of a new, truly minimallyinvasive, mesh-less and dissection-less anchoring system for pelvic floor apical repair. METHODS A prospective study was conducted using the NeuGuide™ device system for pelvic floor apical repair. The primary effectiveness outcome was centro-apical pelvic floor prolapse by POP-Q after six months. The primary safety outcome was intra-operative, immediate (first 48 h) post-operative complications and adverse effects after six months. A standardized questionnaire (UDI-6) to assess quality of life at entry and during follow-up visits was used. Patients' six months-follow-up and evaluation are reported. RESULTS The mean age of the study population (n=10) was 63.8±12.0 years. All patients had a previous prolapse surgery. Five had a previous hysterectomy and two had stress urinary incontinence symptoms. During surgery six patients had a concurrent colporrhaphy. There was no injury to the bladder, rectum, pudendal nerves, or major pelvic vessels and no febrile morbidity was recorded. At six months, no cases of centro-apical recurrence were noted. Patients were satisfied with the procedure and had favorable quality of life scores. Using the UDI-6 questionnaire an improvement, in all domains was seen. Moreover, although the sample size was small, the improvement in urge and overflow incontinence related domains were demonstrated to be statistically significant. CONCLUSIONS This new NeuGuide™ device allows rapid and safe introduction of a suspending suture through the sacrospinous ligament and makes sacrospinous ligament fixation easy to perform, while avoiding dissection and mesh complications.
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Affiliation(s)
- Adi Y. Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Masha Ben Zvi
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Joerg Neymeyer
- Department of Urology, Charitè University, Berlin, Germany
| | - Yonatan Reuven
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Menahem Neuman
- Urogynecology, Department of Obstetrics and Gynecology, Galilee Hospital, and the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
- Assuta Medical Centers, Tel Aviv and Rishon Le-Zion, Israel
| | - Alex Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tsivian M, Weintraub AY, Neuman M, Tsivian A. Introducing a true minimally invasive meshless and dissectionless anchoring system for pelvic organ prolapse repair. Int Urogynecol J 2015; 27:601-6. [PMID: 26531297 DOI: 10.1007/s00192-015-2875-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/16/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to demonstrate the biomechanical properties, feasibility, and potential advantages over conventional techniques of this new anchoring device, NeuGuide™. METHODS We evaluated the pull-out forces required to pull the NeuGuide™ anchor elements from a uniform porcine ligament and a cadaver ligament. We also evaluated the function of the NeuGuide™ and the characteristics of the device for the establishment of verification evidence ensuring the reliability and feasibility of the device. We also evaluated the safety and performance of the NeuGuide™ procedure in female cadavers by palpating the sacro-spinous ligament in real time. We assessed the ability to deploy and fixate the anchor to the sacro-spinous ligament and to stitch the sutures from both sides of the vaginal apex to the cervix, without damaging the surrounding structures. RESULTS All 12 anchors were inserted into the porcine ligament and the cadaver sacro-spinous ligaments successfully (mean pull-out force 34.13 ± 4.32 and 35.68 ± 9.28 respectively). None of the measured forces were below 20 N. No statistically significant difference was noted in the pull-out forces between the porcine and the cadavers (p = 0.60), between the two cadavers (p = 0.19) and between the right and left sacro-spinous ligaments. No abnormalities or malfunctions were noted in the functional performance of the device. Upon laparotomy, dissection of the cadavers revealed that the sacro-spinous ligaments were reached safely with no damage to the surrounding organs and tissues. CONCLUSIONS This novel anchoring device (NeuGuide™) is aimed at facilitating a durable, easy, and short procedure for sacro-spinous ligament fixation with hypothetically fewer operative complications.
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Affiliation(s)
- Masha Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
| | - Menahem Neuman
- Urogynecology, Department of Obstetrics and Gynecology, Galilee Hospital, and the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Assuta Medical Centers, Tel Aviv-Yafo, Israel
| | - Alex Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rogowski A, Bienkowski P, Tarwacki D, Szafarowska M, Samochowiec J, Sienkiewicz-Jarosz H, Jerzak M, Baranowski W. Retrospective comparison between the Prolift and Elevate anterior vaginal mesh procedures: 18-month clinical outcome. Int Urogynecol J 2015; 26:1815-20. [DOI: 10.1007/s00192-015-2772-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/19/2015] [Indexed: 01/19/2023]
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Korahanis N, Goron A, Farache C, Panel L, Courtieu C. [Transvaginal repair of genital prolapse using a light-weight mesh by the vaginal route]. Prog Urol 2014; 24:518-25. [PMID: 24875571 DOI: 10.1016/j.purol.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the results associated with the transvaginal repair of genital prolapse using a tension free light-weight polypropylene mesh. PATIENTS AND METHODS One hundred and fifteen patients have been treated in a single centre. Pre-operative and operative data and complications were recorded. Patients were examined at 1, 6 and 12 months. Anatomical failure was defined as follows: Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. RESULTS Seventy-seven (67%) patients completed 6 months follow-up and 45 (39%) patients completed 12 months follow-up. Finally, 70 (61%) patients were lost to follow-up, including 2 deaths (not related to surgery). Mean age was 66 years. All patients were treated with an anterior and apical and 20 patients were additionally treated with a posterior mesh. Among the 77 patients who completed 6 months follow-up, the complications reported were: 2 (2%) bladder injuries, 1 (1%) hematoma, 1 (1%) bleeding>200 mL and 1 (1%) vaginal mesh exposure. At one year, 6 (7%) patients suffered from urinary stress incontinence, 5 (4%) suffered from urgency and 4 (5%) had dyspareunia. Among the 45 patients who completed 12 months follow-up, functional success was 95% and anatomical success was 77%. CONCLUSION In this series, the placement of a light-weight transvaginal polypropylene mesh was associated with good functional results and a moderate prevalence of complications. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Korahanis
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France.
| | - A Goron
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
| | - C Farache
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
| | - L Panel
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
| | - C Courtieu
- Service gynécologie, clinique mutualiste Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
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