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Takeyama M, Kuwata T, Kashihara H, Kato C, Watanabe M. Is transvaginal mesh surgery with polytetrafluoroethylene mesh ORIHIME ® feasible for anterior pelvic organ prolapse?-Randomized comparative study between ORIHIME ® and Polyform™. Int J Urol 2024. [PMID: 38840427 DOI: 10.1111/iju.15506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Transvaginal mesh surgery for pelvic organ prolapse has been widely performed in Japan, but polypropylene mesh has not been used in Japan since the ban on TVM using polypropylene mesh in the United States. Currently, polytetrafluoroethylene mesh ORIHIME® is the only mesh available for TVM in Japan. Although polytetrafluoroethylene is a safe material, its low coefficient of friction and insufficient adhesion to the surrounding tissue make it difficult to maintain the mesh position when it is used in the transvaginal mesh surgery. The aim of this study was to evaluate the feasibility of TVM-A2 using ORIHIME®. METHODS One hundred cases of TVM-A2 were included in the study. The patients were randomly assigned to two groups: the ORIHIME® group (Group O) and the PolyformTM group (Group P). With 50 patients in each group, the complications and recurrences up to the fourth year were compared. Surgeries were performed using the TVM-A2 method. Statistical analysis was performed using EZR. RESULTS There were no significant differences in baseline parameters between the two groups. We observed no perioperative complications, and saw one case of postoperative abscess formation in Group O, which resolved successfully after incision and drainage. The 4-year recurrence rate was significantly higher in Group O. CONCLUSION As the recurrence rate was significantly higher in Group O, we conclude that TVM-A2 using ORIHIME® which is the same procedure as TVM-A2 using polypropylene mesh is not feasible in repairing the pelvic organ prolapse.
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Affiliation(s)
| | - Tomoko Kuwata
- Urogynecology Center, First Towakai Hospital, Osaka, Japan
| | | | - Chikako Kato
- Urogynecology Center, First Towakai Hospital, Osaka, Japan
| | - Masaki Watanabe
- Urology Department, Kitasaito Hospital, Asahikawa, Hokkaido, Japan
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Soda T, Kiuchi H, Koida Y, Imanaka T, Oida T, Matsuoka Y, Sekii K. Transvaginal Polytetrafluoroethylene Mesh Surgery for Pelvic Organ Prolapse: One-Year Safety and Efficacy Results. Urology 2024; 186:131-138. [PMID: 38367711 DOI: 10.1016/j.urology.2024.01.017] [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: 10/04/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the polytetrafluoroethylene (PTFE) mesh by comparing conventionally used polypropylene (PP) mesh in tension-free vaginal mesh (TVM) surgery for pelvic organ prolapse (POP). METHODS We conducted an observational cohort study of patients who underwent TVM using a PTFE or PP mesh. PTFE was used from June 2019 to May 2021, and PP mesh from January 2018 to May 2019. Outcomes included POP recurrence, perioperative complications, and patient satisfaction. Restricted mean survival time was used to analyze POP recurrence, comparing the time to recurrence between the two groups at 1year after TVM. RESULTS Of 171 patients, 104 underwent PP mesh placement (PP group) and 67 underwent PTFE mesh placement (PTFE group). POP recurrence was observed in 10 and nine patients in the PP and PTFE groups, respectively. The mean time until the recurrence in the PTFE group was significantly shorter than that in the PP group (restricted mean survival time difference: -20.3days; 95% CI, -40.1 to -0.5; P = .044). Subgroup analysis revealed the meantime until recurrence was significantly shorter in the PTFE group for postoperative periods 3months or less, ages >70years, and POP stage ≥3. There were no intervention cases in either group and no significant differences in the perioperative complications. Patient satisfaction was greater in the PTFE group after 3months postoperatively. CONCLUSION TVM surgery with a PTFE mesh is more prone to recurrence than that with a PP mesh, but with higher patient satisfaction. Within 3months of surgery, elderly patients and those with advanced-stage POP require care to prevent recurrence.
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Affiliation(s)
- Tetsuji Soda
- Department of Urology, Osaka Central Hospital, Osaka, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka Central Hospital, Osaka, Japan.
| | - Yohei Koida
- Department of Urology, Osaka Central Hospital, Osaka, Japan
| | - Takahiro Imanaka
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Oida
- Department of Urology, Suita Tokushukai Hospital, Suita, Japan
| | - Yasuhiro Matsuoka
- Department of Urology, Japan Community Health Organization Osaka Hospital, Osaka, Japan
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Okamura K, Hirabayashi T, Suzuki T, Koike M, Matsuura F, Suzuki A, Yoshino Y. Transvaginal mesh surgery for pelvic organ prolapse without blind maneuver. J Obstet Gynaecol Res 2023; 49:1036-1042. [PMID: 36597262 DOI: 10.1111/jog.15538] [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: 09/23/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
AIM To present the techniques of transvaginal mesh surgery for pelvic organ prolapse without the blind maneuver and elucidate its safety and efficacy. METHODS This retrospective study included 45 women with a mean age of 77.9 years old. We investigated surgical outcomes including complications, anatomical recurrence rates, and changes in both subjective symptoms and quality of life. RESULTS The surgery required 111 ± 18 min and blood loss was 40 ± 24 g. Minor injuries of the bladder and rectum occurred in two and one patient, respectively. The urethral catheter was removed on postoperative day 1.1 and patients were discharged on postoperative day 4.4. No one experienced voiding dysfunction requiring catheterization. Wound infections occurred in two patients but they subsided with only antibiotics administered. Five patients had anatomical recurrence during a median follow-up of 17 months. Of these, two underwent reoperation and the remaining three were solely followed-up because there were no or few associated problems. Chronic pain, mesh erosion, and exposure were absent in all cases. Subjective symptoms and quality of life significantly improved after surgery at 12 months postoperatively. CONCLUSION It is considered that transvaginal mesh surgery without the blind maneuver is a safe and effective way to treat women with pelvic organ prolapse.
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Affiliation(s)
- Kikuo Okamura
- Department of Urology, National Hospital Organization Higashinagoya Hospital, Nagoya, Japan
| | | | - Tomohide Suzuki
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Mayumi Koike
- Department of Urology, National Hospital Organization Higashinagoya Hospital, Nagoya, Japan
| | | | - Akitaka Suzuki
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yasushi Yoshino
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Vardanyan VG, Alekhin AI, Mezhlumova NA, Pevgova GY, Alekhin AA. New aspects in the surgical correction of pelvic organ prolapse. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-4-373-381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Relevance . The relevance of the problem of pelvic prolapse is due to the prevalence of the disease, the tendency to rejuvenation and progression. This, according to the survey, affects the quality of life of women, leads to disruption of sexual functioning, and reduces the ability to work. The methods of surgical treatment that exist in the arsenal of modern operative gynecology can contribute to the development of cicatricial adhesions, infectious complications and recurrence of prolapse, which creates the need for repeated interventions. The development and introduction into practice of new methods of treatment is a natural necessity. The most effective technique for the surgical treatment of genital prolapse is laparoscopic sacrocolpopexy using titanium silk implants. Materials and Methods. A prospective cohort study of 30 patients aged 37 to 74 years with clinical manifestations of grade II-IV prolapse, statistical data analysis and analysis of the results of a survey of patients in the postoperative period in dynamics over 3-6-12 months from 2019 to 2021 was carried out. The study used a three-stage method of surgical assistance (patent dated September 15, 2020 No. 2020130382/14 (054923) in the volume - laparoscopic promontofixation, MacCoul sacro-uterine ligament plasty, colporrhaphy, colpoperineorrhaphy, levatoroplasty. Results and Discussion. It has been established that pregnancy and childbirth are among the main factors provoking the development of pelvic floor muscle failure. The duration of postoperative follow-up in our study was 3-14 months. No complications were diagnosed during this period. In 12 patients (40.0 %) during the first month there were periodic pulling pains in the lower abdomen and perineum, in 2 (6.6 %) - urinary incontinence. Titanium silk has a lower affinity for surrounding tissues compared to polypropylene scaffold systems, which makes it possible to consider it as an alternative material to synthetic analogues and reduce the risk of mesh-associated complications. The resistance of the titanium endoprosthesis to antiseptics and microbial agents predisposes to its long-term use and the absence of the need for replacement. Conclusion. The data obtained make it possible to judge the high efficiency of the developed technique for the surgical treatment of pelvic prolapse of pelvic floor defects in patients with rectocele and cystocele, minimizing the recurrence of the disease and the risk of developing mesh-associated complications, which allows choosing a personalized management strategy for this cohort of patients.
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Kusuda M, Kagami K, Takahashi I, Nozaki T, Sakamoto I. Comparison of transvaginal mesh surgery and robot-assisted sacrocolpopexy for pelvic organ prolapse. BMC Surg 2022; 22:268. [PMID: 35820857 PMCID: PMC9275127 DOI: 10.1186/s12893-022-01702-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pelvic organ prolapse (POP) is greatly affecting the quality of life (QOL) of women. There are some surgical techniques for POP repair, for example, transvaginal mesh surgery (TVM), laparoscopic sacrocolpopexy (LSC), and robot-assisted sacrocolpopexy (RSC). In the United States and Europe, the number of TVM has rapidly decreased since 2011 due to complications and safety concerns and has shifted to LSC/RSC. In Japan, RSC has increased after the insurance coverage of RSC in 2020. Therefore, we compared the surgical outcomes of TVM and RSC in POP surgery. Methods We retrospectively collected POP surgery underwent TVM or RSC at our hospital and compared the operative time, blood loss, postoperative hospital stay, postoperative complications, and preoperative and postoperative stress urinary incontinence (SUI) of two groups. Preoperative and postoperative SUI were classified into 3 groups: “improved preoperative SUI”, “persistent preoperative SUI” and “de novo SUI”, which occurred for the first time in patients with no preoperative SUI, and compared incidence rate. The Mann–Whitney U test and Fisher’s exact test were used to compare the two groups, and P < 0.05 was considered statistically significant. Results From August 2011 to July 2021, 76 POP surgery was performed and they were classified into two groups: TVM group (n = 39) and RSC group (n = 37). There was no difference in patient age and BMI between the TVM and RSC groups. The median of operative time was 78.0 vs. 111.0 min (p = 0.06), blood loss was 20.0 ml vs. 5.0 ml (p < 0.05), and postoperative hospital stay was 4.0 days vs. 3.0 days (p < 0.05), with less blood loss and shorter postoperative hospital stay in the RSC group. There was no difference in postoperative complications between the TVM and RSC groups (17.9% vs. 16.2%, p = 1.00). De novo SUI was 25.6% vs. 5.4% (p < 0.05) in the TVM and RSC groups, of which 23.1% vs. 5.4% (p < 0.05) occurred within 3 months of surgery. Conclusion RSC is more beneficial and less invasive for patients with pelvic organ prolapse than TVM. In addition, de novo SUI as postoperative complication of RSC was lower than of TVM.
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Affiliation(s)
- Mayuko Kusuda
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Keiko Kagami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Ikumi Takahashi
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Takahiro Nozaki
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Ikuko Sakamoto
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan.
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Wang JY, Wang ZQ, Liang SC, Li GX, Shi JL, Wang JL. Plastic surgery for giant metastatic endometrioid adenocarcinoma in the abdominal wall: A case report and review of literature. World J Clin Cases 2022; 10:6702-6709. [PMID: 35979309 PMCID: PMC9294911 DOI: 10.12998/wjcc.v10.i19.6702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/01/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endometrial cancer (EC) is a common gynecological malignancy, but metastasis to the abdominal wall is extremely rare. Therefore, an appropriate treatment approach for large metastatic lesions with infection remains a great challenge.
CASE SUMMARY We report the case of a 65-year-old woman who developed abdominal metastasis of endometrioid adenocarcinoma, as defined by International Obstetrics and Gynecology stage II, in which the lesion was complicated by infection. A right hemicolectomy was performed for colon metastasis in relation to her initial gynecological cancer 3 years ago. When admitted to our department, a complete resection of the giant abdominal wall lesion was performed, and a Bard composite mesh was used to reconstruct the abdominal wall. A local flap was used to close the resultant large defect in the external covering of the abdomen. The patient underwent chemotherapy following cytoreductive surgery. Pathology revealed metastasis of EC, and molecular subtyping showed copy number high of TP53 mutation, implying a poor prognosis.
CONCLUSION When EC patients develop giant abdominal wall metastasis, a plastic surgeon should be included before contemplating resection of tumors.
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Affiliation(s)
- Jing-Yuan Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Zhi-Qi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Si-Chen Liang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Guang-Xue Li
- Department of Plastic Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Jing-Li Shi
- Department of Pathology, Peking University People’s Hospital, Beijing 100044, China
| | - Jian-Liu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
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Abhari RE, Izett-Kay ML, Morris HL, Cartwright R, Snelling SJB. Host-biomaterial interactions in mesh complications after pelvic floor reconstructive surgery. Nat Rev Urol 2021; 18:725-738. [PMID: 34545239 DOI: 10.1038/s41585-021-00511-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
Polypropylene (PPL) mesh is widely used in pelvic floor reconstructive surgery for prolapse and stress urinary incontinence. However, some women, particularly those treated using transvaginal PPL mesh placement for prolapse, experience intractable pain and mesh exposure or extrusion. Explanted tissue from patients with complications following transvaginal implantation of mesh is typified by a dense fibrous capsule with an immune cell-rich infiltrate, suggesting that the host immune response has a role in transvaginal PPL mesh complications through the separate contributions of the host (patient), the biological niche within which the material is implanted and biomaterial properties of the mesh. This immune response might be strongly influenced by both the baseline inflammatory status of the patient, surgical technique and experience, and the unique hormonal, immune and microbial tissue niche of the vagina. Mesh porosity, surface area and stiffness also might have an effect on the immune and tissue response to transvaginal mesh placement. Thus, a regulatory pathway is needed for mesh development that recognizes the roles of host and biological factors in driving the immune response to mesh, as well as mandatory mesh registries and the longitudinal surveillance of patients.
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Affiliation(s)
- Roxanna E Abhari
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
| | - Matthew L Izett-Kay
- Department of Urogynaecology, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Hayley L Morris
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Rufus Cartwright
- Department of Urogynaecology, London North West Hospitals NHS Trust, London, UK.,Department of Epidemiology & Biostatistics, Imperial College London, London, UK
| | - Sarah J B Snelling
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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