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Yuan J, Sun B, Ma W, Cai C, Huang Z, Zhou P, Yi L, Liu L, Chen S. Orthogonally woven 3D nanofiber scaffolds promote rapid soft tissue regeneration by enhancing bidirectional cell migration. Bioact Mater 2024; 39:582-594. [PMID: 38883316 PMCID: PMC11179174 DOI: 10.1016/j.bioactmat.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 06/18/2024] Open
Abstract
Repairing large-area soft tissue defects caused by traumas is a major surgical challenge. Developing multifunctional scaffolds with suitable scalability and favorable cellular response is crucial for soft tissue regeneration. In this study, we developed an orthogonally woven three-dimensional (3D) nanofiber scaffold combining electrospinning, weaving, and modified gas-foaming technology. The developed orthogonally woven 3D nanofiber scaffold had a modular design and controlled fiber alignment. In vitro, the orthogonally woven 3D nanofiber scaffold exhibited adjustable mechanical properties, good cell compatibility, and easy drug loading. In vivo, for one thing, the implantation of an orthogonally woven 3D nanofiber scaffold in a full abdominal wall defect model demonstrated that extensive granulation tissue formation with enough mechanical strength could promote recovery of abdominal wall defects while reducing intestinal adhesion. Another result of diabetic wound repair experiments suggested that orthogonally woven 3D nanofiber scaffolds had a higher wound healing ratio, granulation tissue formation, collagen deposition, and re-epithelialization. Taken together, this novel orthogonally woven 3D nanofiber scaffold may provide a promising and effective approach for optimal soft tissue regeneration.
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Affiliation(s)
- Jiayi Yuan
- School of Pharmacy, Jiangsu Ocean University, Lianyungang, 222005, China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325001, China
| | - Bingbing Sun
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325001, China
- Department of Critical Care Medicine, The Air Force Characteristic Medical Center, Air Force Medical University, Beijing, 100000, China
| | - Weixing Ma
- School of Pharmacy, Jiangsu Ocean University, Lianyungang, 222005, China
| | - Chao Cai
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325001, China
| | - Zhenzhen Huang
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325001, China
| | - Peiyi Zhou
- Chongqing Health Center for Women and Children, Chongqing Obstetric and Gynecologic Hospital, Chongqing, China
| | - Lei Yi
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lubin Liu
- Chongqing Health Center for Women and Children, Chongqing Obstetric and Gynecologic Hospital, Chongqing, China
| | - Shixuan Chen
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325001, China
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Restriction of Surgical Options for Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:467-475. [PMID: 38683201 DOI: 10.1097/spv.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
ABSTRACT The purpose of this document is to update the 2013 AUGS Position Statement based on subsequent decisions made by the U.S. Food and Drug Administration, published clinical data, and relevant society and national guidelines related to the use of surgical mesh. Urogynecologists specialize in treating pelvic floor disorders, such as pelvic organ prolapse (POP) and urinary incontinence, and have been actively involved and engaged in the national and international discussions and research on the use of surgical mesh in the treatment of POP and stress urinary incontinence. In 2019, the U.S. Food and Drug Administration ordered manufacturers of transvaginally placed mesh kits for prolapse to stop selling and distributing their devices, stating that the data submitted did not provide a reasonable assurance of safety and effectiveness. Evidence supports the use of mesh in synthetic midurethral sling and abdominal sacrocolpopexy. The American Urogynecologic Society (AUGS) remains opposed to any restrictions that ban currently available surgical options performed by qualified and credentialed surgeons on appropriately informed patients with pelvic floor disorders. The AUGS supports the U.S. Food and Drug Administration's recommendations that surgeons thoroughly inform patients seeking treatment for POP about the risks and benefits of all potential treatment options, including nonsurgical options, native tissue vaginal repairs, or abdominally placed mesh. There are certain clinical situations where surgeons may assert that the use and potential benefit of transvaginal mesh for prolapse outweighs the risk of other routes/types of surgery or of not using mesh. The AUGS recommends that surgeons utilize a shared decision-making model in the decision-making process regarding surgical options, including use of transvaginally placed mesh.
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Stangel-Wójcikiewicz K, Murawski M, Schwarz T, Skotniczny K, Fuchs A, Wolski J, Radwan-Pragłowska J, Janus Ł, Piątkowski M, Kot M, Wróbel A, Wojtysiak D, Urbaniec P. Pelvic Organ Prolapse Reconstruction with the Chitosan-Based Novel Haemostatic Agent in Ovine Model-Preliminary Report. Int J Mol Sci 2024; 25:3801. [PMID: 38612610 PMCID: PMC11011902 DOI: 10.3390/ijms25073801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
This prospective study aimed to assess the feasibility of chitosan biomaterial and subcutaneous gel implantation in an ovine model, with implications for women with genital prolapse. Twenty-four ewes were divided into four groups (n = 6 per group): chitosan type B, chitosan type C, chitosan unmodified injections, and polypropylene mesh. Ovine models were chosen due to their morphological resemblance to human reproductive organs. Animals were sacrificed after 90 days for macroscopic, pathomorphological, and immunohistochemical analysis. In the chitosan type B group, IL-6 and IL-10 levels decreased after 28 days, while chitosan type C and injection groups exhibited higher IL-6 than IL-10 levels. The polypropylene group displayed the highest IL-6 and lowest IL-10 levels. Histological examination of the polypropylene group revealed no degenerative changes or inflammation, whereas chitosan injection induced local inflammation. Other groups exhibited no degenerative changes. Ewes implanted with chitosan displayed reduced inflammation compared to polypropylene-implanted ewes. Chitosan implantation facilitated vaginal tissue healing, in contrast to polypropylene mesh, which led to extrusion. While chitosan holds promise as an alternative to polypropylene mesh, further research is imperative for comprehensive evaluation. This study suggests the potential of a chitosan biomaterial in pelvic organ prolapse treatment, warranting additional investigation.
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Affiliation(s)
- Klaudia Stangel-Wójcikiewicz
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Maciej Murawski
- Department of Animal Nutrition, Biotechnology and Fisheries, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland;
| | - Tomasz Schwarz
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
| | - Krzysztof Skotniczny
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Agnieszka Fuchs
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Jan Wolski
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Julia Radwan-Pragłowska
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Łukasz Janus
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marek Piątkowski
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marta Kot
- Department of Transplantation, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, ul. Wielicka 265, 30-663 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-090 Lublin, Poland;
| | - Dorota Wojtysiak
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
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Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C. Transvaginal mesh or grafts or native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2024; 3:CD012079. [PMID: 38477494 PMCID: PMC10936147 DOI: 10.1002/14651858.cd012079.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Pelvic organ prolapse is the descent of one or more of the pelvic organs (uterus, vaginal apex, bladder, or bowel) into the vagina. In recent years, surgeons have increasingly used grafts in transvaginal repairs. Graft material can be synthetic or biological. The aim is to reduce prolapse recurrence and surpass the effectiveness of traditional native tissue repair (colporrhaphy) for vaginal prolapse. This is a review update; the previous version was published in 2016. OBJECTIVES To determine the safety and effectiveness of transvaginal mesh or biological grafts compared to native tissue repair or other grafts in the surgical treatment of vaginal prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and two clinical trials registers (March 2022). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing different types of vaginal repair (mesh, biological graft, or native tissue). DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed risk of bias, and extracted data. The primary outcomes were awareness of prolapse, repeat surgery, and recurrent prolapse on examination. MAIN RESULTS We included 51 RCTs (7846 women). The certainty of the evidence was largely moderate (ranging from very low to moderate). Transvaginal permanent mesh versus native tissue repair Awareness of prolapse at six months to seven years was less likely after mesh repair (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.73 to 0.95; I2 = 34%; 17 studies, 2932 women; moderate-certainty evidence). This suggests that if 23% of women are aware of prolapse after native tissue repair, between 17% and 22% will be aware of prolapse after permanent mesh repair. Rates of repeat surgery for prolapse were lower in the mesh group (RR 0.71, 95% CI 0.53 to 0.95; I2 = 35%; 17 studies, 2485 women; moderate-certainty evidence). There was no evidence of a difference between the groups in rates of repeat surgery for incontinence (RR 1.03, 95% CI 0.67 to 1.59; I2 = 0%; 13 studies, 2206 women; moderate-certainty evidence). However, more women in the mesh group required repeat surgery for the combined outcome of prolapse, stress incontinence, or mesh exposure (RR 1.56, 95% CI 1.07 to 2.26; I2 = 54%; 27 studies, 3916 women; low-certainty evidence). This suggests that if 7.1% of women require repeat surgery after native tissue repair, between 7.6% and 16% will require repeat surgery after permanent mesh repair. The rate of mesh exposure was 11.8% and surgery for mesh exposure was 6.1% in women who had mesh repairs. Recurrent prolapse on examination was less likely after mesh repair (RR 0.42, 95% CI 0.32 to 0.55; I2 = 84%; 25 studies, 3680 women; very low-certainty evidence). Permanent transvaginal mesh was associated with higher rates of de novo stress incontinence (RR 1.50, 95% CI 1.19 to 1.88; I2 = 0%; 17 studies, 2001 women; moderate-certainty evidence) and bladder injury (RR 3.67, 95% CI 1.63 to 8.28; I2 = 0%; 14 studies, 1997 women; moderate-certainty evidence). There was no evidence of a difference between the groups in rates of de novo dyspareunia (RR 1.22, 95% CI 0.83 to 1.79; I2 = 27%; 16 studies, 1308 women; moderate-certainty evidence). There was no evidence of a difference in quality of life outcomes; however, there was substantial heterogeneity in the data. Transvaginal absorbable mesh versus native tissue repair There was no evidence of a difference between the two methods of repair at two years for the rate of awareness of prolapse (RR 1.05, 95% CI 0.77 to 1.44; 1 study, 54 women), rate of repeat surgery for prolapse (RR 0.47, 95% CI 0.09 to 2.40; 1 study, 66 women), or recurrent prolapse on examination (RR 0.53, 95% CI 0.10 to 2.70; 1 study, 66 women). The effect of either form of repair was uncertain for bladder-related outcomes, dyspareunia, and quality of life. Transvaginal biological graft versus native tissue repair There was no evidence of a difference between the groups at one to three years for the outcome awareness of prolapse (RR 1.06, 95% CI 0.73 to 1.56; I2 = 0%; 8 studies, 1374 women; moderate-certainty evidence), repeat surgery for prolapse (RR 1.15, 95% CI 0.75 to 1.77; I2 = 0%; 6 studies, 899 women; moderate-certainty evidence), and recurrent prolapse on examination (RR 0.96, 95% CI 0.71 to 1.29; I2 = 53%; 9 studies, 1278 women; low-certainty evidence). There was no evidence of a difference between the groups for dyspareunia or quality of life. Transvaginal permanent mesh versus any other permanent mesh or biological graft vaginal repair Sparse reporting of primary outcomes in both comparisons significantly limited any meaningful analysis. AUTHORS' CONCLUSIONS While transvaginal permanent mesh is associated with lower rates of awareness of prolapse, repeat surgery for prolapse, and prolapse on examination than native tissue repair, it is also associated with higher rates of total repeat surgery (for prolapse, stress urinary incontinence, or mesh exposure), bladder injury, and de novo stress urinary incontinence. While the direction of effects and effect sizes are relatively unchanged from the 2016 version of this review, the certainty and precision of the findings have all improved with a larger sample size. In addition, the clinical relevance of these data has improved, with 10 trials reporting 3- to 10-year outcomes. The risk-benefit profile means that transvaginal mesh has limited utility in primary surgery. Data on the management of recurrent prolapse are of limited quality. Given the risk-benefit profile, we recommend that any use of permanent transvaginal mesh should be conducted under the oversight of the local ethics committee in compliance with local regulatory recommendations. Data are not supportive of absorbable meshes or biological grafts for the management of transvaginal prolapse.
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Affiliation(s)
- Ellen Yeung
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Gold Coast Health, Gold Coast, Australia
| | | | | | - Nir Haya
- Rambam Medical Centre, and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Sheila A Wallace
- Evidence Synthesis Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Mowat
- Greenslopes Hospital, Brisbane, Australia
| | - Christopher Maher
- Wesley and Royal Brisbane and Women's Hospitals, Brisbane, Australia
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Devassy R, Naem A, Krentel H, De Wilde RL. Modified Oxford technique of colpopexy for the treatment of uterine and vaginal vault prolapse: a retrospective pilot cohort study. Front Surg 2023; 10:1222950. [PMID: 37456150 PMCID: PMC10349534 DOI: 10.3389/fsurg.2023.1222950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Pelvic organ prolapse is a common health issue that affects 30.8% of women. Laparoscopic sacrocolpopexy and colpopectopexy are two of the most common procedures to restore the pelvic anatomy. Mesh application on the other hand carries an increased complications risk over the short and long terms. The aim of this study is to provide a basis for meshless sacrocolpopexy and colpopectopexy. Methods This study is a retrospective cohort pilot study that analyzed the data of patients with a pelvic organ prolapse according to the pelvic organ prolapse quantification system and underwent the modified technique for sacrocolpopexy and colpopectopexy. Descriptive statistics were used to express the different variables. Results A total of 36 patients met the inclusion criteria and provided consent for the participation in this study. The majority of patients were postmenopausal. 22 out of 36 patients received a previous prolapse surgery. All patients presented with reducible vaginal lump. Dyspareunia and sexual dysfunction were the most commonly reported symptoms. The intraoperative complications rate was 0%. Only one patient had a postoperative persistent urinary retention that was managed medically. Discussion Sacrocolpopexy and colpopectopexy seems to be a safe alternative to the mesh-based pelvic surgeries with a very low rate of intraoperative complications and favorable follow up outcomes.
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Affiliation(s)
- Rajesh Devassy
- Dr. Rajesh Devassy’s Centre of Excellence in Gynecological Minimal Access Surgery and Oncology, Dubai London Clinic & Specialty Hospital, Dubai, United Arab Emirates
| | - Antoine Naem
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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Baekelandt J, Matak L, Merckx M, Housmans S, Deprest J, Tollens T. Posterior rectus fascia prolapse (PREFAP) repair: a new native tissue approach to pelvic organ prolapse via vaginal natural orifice transluminal endoscopic surgery. Arch Gynecol Obstet 2023; 307:2041-2045. [PMID: 37042995 DOI: 10.1007/s00404-023-07021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is a common condition in women. During lifetime, up to 40% of all women will develop (POP). MATERIALS AND METHODS Between June and December 2021, five patients were successfully treated via vNOTES Posterior Rectus Fascia Prolapse ( PREFAP) repair. No intra-operative complications or conversions occurred. CONCLUSION In this study we demonstrated a new technique for prolapse repair, harvesting the autologous posterior rectus fascia sheath via vaginal natural orifice transluminal endoscopic surgery (vNOTES) as an alternative for a synthetic mesh.
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Affiliation(s)
- Jan Baekelandt
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium.
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Louvain, Belgium.
| | - Luka Matak
- Department of Obstetrics and Gynecology, General Hospital Zadar, Zadar, Croatia
| | - Micaelle Merckx
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
| | - Susanne Housmans
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Louvain, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Louvain, Belgium
| | - Tim Tollens
- Department of Surgery, Imelda Hospital, Bonheiden, Belgium
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Reid FM, Aucott L, Glazener CMA, Elders A, Hemming C, Cooper KG, Freeman RM, Smith ARB, Hagen S, Kilonzo M, Boyers D, MacLennan G, Norrie J, Breeman S. PROSPECT: 4- and 6-year follow-up of a randomised trial of surgery for vaginal prolapse. Int Urogynecol J 2023; 34:67-78. [PMID: 36018353 PMCID: PMC9834125 DOI: 10.1007/s00192-022-05308-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to compare the mid-term results of native tissue, biological xenograft and polypropylene mesh surgery for women with vaginal wall prolapse. METHODS A total of 1348 women undergoing primary transvaginal repair of an anterior and/or posterior prolapse were recruited between January 2010 and August 2013 from 35 UK centres. They were randomised by remote allocation to native tissue surgery, biological xenograft or polypropylene mesh. We performed both 4- and 6-year follow-up using validated patient-reported outcome measures. RESULTS At 4 and 6 years post-operation, there was no clinically important difference in Pelvic Organ Prolapse Symptom Score for any of the treatments. Using a strict composite outcome to assess functional cure at 6 years, we found no difference in cure among the three types of surgery. Half the women were cured at 6 years but only 10.3 to 12% of women had undergone further surgery for prolapse. However, 8.4% of women in the mesh group had undergone further surgery for mesh complications. There was no difference in the incidence of chronic pain or dyspareunia between groups. CONCLUSIONS At the mid-term outcome of 6 years, there is no benefit from augmenting primary prolapse repairs with polypropylene mesh inlays or biological xenografts. There was no evidence that polypropylene mesh inlays caused greater pain or dyspareunia than native tissue repairs.
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Affiliation(s)
- Fiona M Reid
- Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road Campus, Manchester, M13 0JH, UK.
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christine Hemming
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Kevin G Cooper
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Robert M Freeman
- Department of Obstetrics and Gynaecology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Anthony R B Smith
- Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road Campus, Manchester, M13 0JH, UK
| | - Suzanne Hagen
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher institute, University of Edinburgh, Edinburgh, UK
| | - Suzanne Breeman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Zhou Q, Lu M, Li GS, Peng GL, Song YF. Knowledge mapping and visualization analysis of pelvic organ prolapse repair with mesh from 2001 to 2021. Front Bioeng Biotechnol 2023; 11:1104724. [PMID: 37091336 PMCID: PMC10113510 DOI: 10.3389/fbioe.2023.1104724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Aims: In recent decades, extensive attention has been paid to the application of mesh to repair pelvic floor defects. However, a large body of related literature has not been system summarized. The purpose of this study is to summarize and visualize the literature on pelvic organ prolapse (POP) repair with mesh using bibliometrics. Methods: Medical literature regarding POP repair with mesh were searched and obtained in the Web of Science™ Core (WoSCC) database from 2001 to 2021. Microsoft Excel 2020, CiteSpace and VOSviewer were used to conduct the bibliometric and knowledge-map analysis. Results: In the past 20 years, a total of 2,550 articles and reviews have been published in 35 journals, and the published and cited results show a growing trend. Cosson M and International Urogynecology Journal were the authors and journals with the highest output, respectively. The United States, France and the United Kingdom are among the top three countries/organizations in relevant publications in worldwide. 584 key words in the literature are divided into 8 clusters, which are mainly related to prolapse type, risk factors, surgical methods, imaging, quality of life and bioengineering. Using clinical research and tissue engineering technology to reduce mesh complications is the current hot spot in this field. Conclusion: Reasonable application of mesh and avoiding mesh complications are still the most concerned topics in POP research. Although clinical research, surgical improvement, biological mesh and bioengineering technology have shown promising results, it is still urgent to carry out clinical transformation application research.
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Affiliation(s)
- Quan Zhou
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
- *Correspondence: Quan Zhou, ; Yan-Feng Song,
| | - Man Lu
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Guo-Sheng Li
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Gan-Lu Peng
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Yan-Feng Song
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
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Lua-Mailland LL, Wallace SL, Khan FA, Kannikal JJ, Israeli JM, Syan R. Review of Vaginal Approaches to Apical Prolapse Repair. Curr Urol Rep 2022; 23:335-344. [PMID: 36355328 DOI: 10.1007/s11934-022-01124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW To review recent literature and provide up-to-date knowledge on new and important findings in vaginal approaches to apical prolapse surgery. RECENT FINDINGS Overall prolapse recurrence rates following transvaginal apical prolapse repair range from 13.7 to 70.3% in medium- to long-term follow-up, while reoperation rates for prolapse recurrence are lower, ranging from 1 to 35%. Subjective prolapse symptoms remain improved despite increasing anatomic failure rates over time. The majority of studies demonstrated improvement in prolapse-related symptoms and quality of life in over 80% of patients 2-3 years after transvaginal repair, with similar outcomes with and without uterine preservation. Contemporary studies continue to demonstrate the safety of transvaginal native tissue repair with most adverse events occurring within the first 2 years. Transvaginal apical prolapse repair is safe and effective. It is associated with long-term improvement in prolapse-related symptoms and quality of life despite increasing rates of prolapse recurrence over time. Subjective outcomes do not correlate with anatomic outcomes.
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Affiliation(s)
- Lannah L Lua-Mailland
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA.
| | - Shannon L Wallace
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
| | | | | | | | - Raveen Syan
- Department of Urology, Miller School of Medicine, Miami, FL, USA
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Bø K, Anglès-Acedo S, Batra A, Brækken IH, Chan YL, Jorge CH, Kruger J, Yadav M, Dumoulin C. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J 2022; 33:2633-2667. [PMID: 35980443 PMCID: PMC9477909 DOI: 10.1007/s00192-022-05324-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. METHODS An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0-10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0-10). RESULTS After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. CONCLUSIONS There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, The Norwegian School of Sport Sciences, PO Box 4014, Ullevål stadion, 0806, Oslo, Norway.
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
| | | | - Achla Batra
- Department of Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Ingeborg Hoff Brækken
- Kolbotn Physical Institute, Nordre Follo Municipality, Nordre Follo, Norway
- The Pelvic Floor Centre, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Yi Ling Chan
- Department of Obstetrics and Gynaecology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Cristine Homsi Jorge
- Department of Health Science Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Manisha Yadav
- Paropakar Maternity and women's hospital, Thapathali, Kathmandu, Nepal
| | - Chantale Dumoulin
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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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]
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