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Khatri G, Bhosale PR, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Glanc P, Henrichsen TL, Learman LA, Sadowski EA, Saphier CJ, Wasnik AP, Maturen KE. ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females. J Am Coll Radiol 2022; 19:S137-S155. [PMID: 35550798 DOI: 10.1016/j.jacr.2022.02.016] [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] [Received: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Pelvic floor disorders including pelvic organ prolapse (POP), urinary dysfunction, defecatory dysfunction, and complications after pelvic floor surgery are relatively common in the female population. Imaging tests are obtained when the initial clinical evaluation is thought to be incomplete or inconclusive or demonstrates findings that are discordant with patients' symptoms. An integrated imaging approach is optimal to evaluate the complex anatomy and dynamic functionality of the pelvic floor. Fluoroscopic cystocolpoproctography (CCP) and MR defecography are considered the initial imaging tests of choice for evaluation of POP. Fluoroscopic voiding cystourethrography is considered the initial imaging test for patients with urinary dysfunction. Fluoroscopic CCP and MR defecography are considered the initial imaging test for patients with defecatory dysfunction, whereas ultrasound pelvis transrectal is a complementary test in patients requiring evaluation for anal sphincter defects. MRI pelvis without and with intravenous contrast, MRI pelvis with dynamic maneuvers, and MR defecography are considered the initial imaging tests in patients with suspected complications of prior pelvic floor surgical repair. Transperineal ultrasound is emerging as an important imaging tool, in particular for screening of pelvic floor dysfunction and for evaluation of midurethral slings, vaginal mesh, and complications related to prior pelvic floor surgical repair. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Gaurav Khatri
- Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging, UT Southwestern Medical Center, Dallas, Texas; Program Director, Body MRI Fellowship.
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Section Chief of Abdominal Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Director Endometriosis and Chronic Pelvic Pain, Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Lee A Learman
- Dean, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | - Elizabeth A Sadowski
- University of Wisconsin, Madison, Wisconsin; and ACR O-RADS MRI Education Subcommittee Chair
| | - Carl J Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | - Ashish P Wasnik
- Division Chief, Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
| | - Katherine E Maturen
- Associate Chair for Ambulatory Care and Specialty Chair, University of Michigan, Ann Arbor, Michigan
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Borazjani A, Couri BM, Kuang M, Balog BM, Damaser MS. Role of lysyl oxidase like 1 in regulation of postpartum connective tissue metabolism in the mouse vagina†. Biol Reprod 2020; 101:916-927. [PMID: 31403161 DOI: 10.1093/biolre/ioz148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 05/29/2019] [Accepted: 08/08/2019] [Indexed: 12/24/2022] Open
Abstract
Pelvic organ prolapse (POP) in lysyl oxidase like-1 knockout (Loxl1 KO) mice occurs primarily in parous mice and is rare in nulliparous mice. We determined the effect of Loxl1 deficiency on postpartum regulation of connective tissue metabolism genes and degradative enzyme activity in the vagina at 20 days gestation or 4 h, 48 h, 7 days, 15 days, 25 days, 7 weeks, or 12 weeks postpartum. Nulliparous Loxl1 KO and wildtype (WT) mice aged 11, 18, or 23 weeks were controls. Gene expression and enzyme activity were assessed using real-time quantitative reverse transcription PCR and fluorescein conjugated gelatin zymography, respectively. Parity, but not aging, had a significant influence on gene expression both with time postpartum and between KO and WT mice. Mmp2, Timp1, Timp2, Timp3, Timp4, Col1a1, Col3a1, Acta2, and Bmp1 were differentially expressed between KO and WT mice. Correlational analysis of gene-gene pairs revealed 10 significant differences between parous KO and WT groups, 5 of which were due to lack of co-expression of Bmp1 in KO mice. The overall enzyme activity that could be attributed to MMPs was significantly higher in WT compared to KO mice both 25 days and 12 weeks postpartum, and MMP activity was significantly lower 15 days and 25 days postpartum compared to KO nulliparous controls, but not WT. These findings suggest that Loxl1 deficiency combined with parity has a significant impact on postpartum regulation of connective tissue metabolism, particularly as it relates to co-expression of Bmp1 and altered proteolytic activity.
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Affiliation(s)
- Ali Borazjani
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Bruna M Couri
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.,Department of Obstetrics & Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Mei Kuang
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Brian M Balog
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.,Department of Chemical & Biomedical Engineering, Cleveland State University, Cleveland, OH, USA.,Department of Obstetrics & Gynecology, Cleveland Clinic, Cleveland, OH, USA.,Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA
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Shafaat S, Mangir N, Regureos SR, Chapple CR, MacNeil S. Demonstration of improved tissue integration and angiogenesis with an elastic, estradiol releasing polyurethane material designed for use in pelvic floor repair. Neurourol Urodyn 2018; 37:716-725. [DOI: 10.1002/nau.23510] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/08/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Sarah Shafaat
- Department of Materials Science and Engineering; Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
| | - Naside Mangir
- Department of Materials Science and Engineering; Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
- Royal Hallamshire Hospital; Urology Clinic; Sheffield United Kingdom
| | - Sabiniano R. Regureos
- Department of Materials Science and Engineering; Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
| | | | - Sheila MacNeil
- Department of Materials Science and Engineering; Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
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Transcriptional Regulation of Connective Tissue Metabolism Genes in Women With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2017; 23:44-52. [PMID: 27636223 DOI: 10.1097/spv.0000000000000337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to compare differences in expressions and relationships between key genes involved in extracellular matrix metabolism and tissue cellularity in women with and without pelvic organ prolapse (POP). METHODS A total of 80 biopsies (anterior cuff, posterior cuff, and/or leading edge) were obtained from 30 women: n = 10 premenopausal without POP (controls), n = 10 premenopausal with POP, and n = 10 postmenopausal with POP. Quantitative reverse-transcriptase polymerase chain reaction was used to assess gene expression of bone morphogenetic protein 1 (BMP1), collagen types I (COL1) and III (COL3), relaxin family peptide receptor 1 (RXFP1), matrix metallopeptidase 2, and TIMP metallopeptidase inhibitors 2 and 3. Hematoxylin and eosin staining was used to assess cellularity of the connective tissue layer. Kruskal-Wallis test, Mann-Whitney U test, Pearson correlation, or linear regression analyses were used, as appropriate. RESULTS Bone morphogenetic protein 1 expression was significantly up-regulated in patients with POP compared with controls. Bone morphogenetic protein 1 expression was correlated with COL1 expression in all groups but only correlated with TIMP metallopeptidase inhibitor 3 expression in controls. Similarly, COL3 expression was correlated with RXFP1 expression in women with POP but not in controls. The degree of dependence (slope of the regression line) between COL1 and COL3 expressions was significantly elevated in premenopausal women with POP compared with the other 2 groups. The slopes between COL1-COL3, COL3-matrix metallopeptidase 2, COL1-RXFP1, and COL3-RXFP1 expressions were significantly lower in postmenopausal women compared with premenopausal women with POP. No differences were found in overall tissue cellularity. CONCLUSIONS Bone morphogenetic protein 1 expression may play a significant role in the pathophysiology of POP. The finding that BMP1 expression was correlated with COL1 expression in all groups suggests a conserved association between BMP1 and collagen synthesis in the vaginal wall. The elevated slope between COL1 and COL3 expressions may be associated with early (premenopausal) development of POP. The expression of RXFP1 in postmenopausal women and its altered intergene regulation suggests a role for RXFP1 in connective tissue metabolism outside pregnancy.
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Plata M, Bravo-Balado A, Robledo D, Castaño JC, Averbeck MA, Plata MA, Cataño JG, Caicedo JI, Trujillo CG. Trends in pelvic organ prolapse management in Latin America. Neurourol Urodyn 2017; 37:1039-1045. [PMID: 28877368 DOI: 10.1002/nau.23392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/04/2017] [Indexed: 01/19/2023]
Abstract
AIMS To describe practice patterns and perspectives regarding pelvic organ prolapse (POP) management among urologists, gynecologists, and urogynecologists in Latin America (LATAM). METHODS A cross-sectional study was conducted from April to September 2016 using a 37-item internet-based survey applied to members of urologic and gynecologic associations from 18 countries. Participants were asked about their background and practice patterns. Descriptive statistics were employed. RESULTS A total of 673 responses were obtained. Most came from Colombia (33.6%) and Brazil (24.7%). The number of practitioners who perform at least one POP procedure per month and were eligible to finish the survey was 529 (78.6%), out of which 323 (61.0%) were urologists, 156 (29.5%) gynecologists, and 50 (9.5%) urogynecologists. Mesh-based POP repairs were used by 57.1% of participants. Out of non-mesh users, the most frequent vaginal procedures were sacrospinous fixation (30%), colporrhaphy (25%), and uterosacral fixation (12%). Regarding the impact of FDA warnings, 75.2% participants indicated that the use of mesh has declined, and 41.9% considered this has had a negative effect in the use of incontinence tapes as well. Only two physicians reported legal disputes related to mesh procedures, and 75.8% said they would still indicate mesh repairs in certain cases. CONCLUSIONS This is the first report on POP practice patterns in LATAM. Preferences regarding surgical management of POP are not very different from international trends. Despite intense scrutiny and media exposure, mesh-based procedures are still largely used in LATAM.
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Affiliation(s)
- Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Juan C Castaño
- Department of Urology, Clínica Universitaria CES, Universidad CES and Pontificia Universidad Bolivariana, Medellín, Colombia
| | - Márcio A Averbeck
- Department of Urology, Mae de Deus Center Hospital, Porto Alegre, Brasil
| | - Manuel A Plata
- Department of Gynecology, Obstetrics and Human Reproduction, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Juan G Cataño
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Juan I Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Carlos G Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
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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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Vashaghian M, Ruiz-Zapata AM, Kerkhof MH, Zandieh-Doulabi B, Werner A, Roovers JP, Smit TH. Toward a new generation of pelvic floor implants with electrospun nanofibrous matrices: A feasibility study. Neurourol Urodyn 2016; 36:565-573. [DOI: 10.1002/nau.22969] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mahshid Vashaghian
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
- Department of Oral Cell Biology; ACTA-University of Amsterdam and VU University, MOVE Research Institute; Amsterdam The Netherlands
| | - Alejandra M. Ruiz-Zapata
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
| | - Manon H. Kerkhof
- Department of Obstetrics and Gynaecology; VU University Medical Center; Amsterdam The Netherlands
| | - Behrouz Zandieh-Doulabi
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
- Department of Oral Cell Biology; ACTA-University of Amsterdam and VU University, MOVE Research Institute; Amsterdam The Netherlands
| | - Arie Werner
- Department of Materials; ACTA-University of Amsterdam and VU University, MOVE Research Institute; Amsterdam The Netherlands
| | - Jan Paul Roovers
- Department of Obstetrics and Gynecology; University of Amsterdam, Academic Medical Center; Amsterdam The Netherlands
| | - Theo H. Smit
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
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Yonguc T, Bozkurt IH, Sen V, Aydogdu O, Yonguc GN, Gunlusoy B. Double-sling procedure for the surgical management of stress urinary incontinence with concomitant anterior vaginal wall prolapse. Int Urol Nephrol 2015; 47:1611-7. [PMID: 26329739 DOI: 10.1007/s11255-015-1085-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the safety, efficacy of double-sling procedure (DS) for the surgical management of stress urinary incontinence (SUI) with concomitant anterior wall prolapse (AVWP) and to identify if less synthetic material implantation will decrease the complication rates without decreasing the high cure rates. METHODS We reviewed the women who underwent DS in two institutions from January 2009 to December 2013. In DS, there are two transobturator tapes inserted from two different routes for the surgical management of SUI with concomitant AVWP. POP-Q was used for anatomical evaluation of prolapse. SUI was assessed by cough stress test and ICIQ-SF questionnaire. We accepted that the patient was satisfied if the visual analog scale score was ≥80. The severity of urinary incontinence was classified by ICIQ-SF. The women were evaluated at the 3 and 12 months and annually. RESULTS A total of 74 women met the requirements for inclusion and had sufficient records for analysis. The mean follow-up period was 35.4 months (range 12-60). Operative time was 33.2 ± 6.2. The objective cure and subjective success rates of SUI were 87.8 and 93.2 %, respectively. The satisfaction from the surgery was also high with 86.5 % rate. The anatomical success in our series was rather high with 96 % rate. Our overall complication rate was 12.2 %. Mesh extrusion rate was 0 %. CONCLUSIONS Double-sling procedure is feasible, efficient, and safe. Reducing the mesh size did not have a detrimental effect on the outcomes of SUI treatment and simultaneous AVWP repair.
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Affiliation(s)
- Tarik Yonguc
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | | | - Volkan Sen
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ozgu Aydogdu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Bulent Gunlusoy
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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ACR Appropriateness Criteria pelvic floor dysfunction. J Am Coll Radiol 2014; 12:134-42. [PMID: 25652300 DOI: 10.1016/j.jacr.2014.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 01/23/2023]
Abstract
Pelvic floor dysfunction is a common and potentially complex condition. Imaging can complement physical examination by revealing clinically occult abnormalities and clarifying the nature of the pelvic floor defects present. Imaging can add value in preoperative management for patients with a complex clinical presentation, and in postoperative management of patients suspected to have recurrent pelvic floor dysfunction or a surgical complication. Imaging findings are only clinically relevant if the patient is symptomatic. Several imaging modalities have a potential role in evaluating patients; the choice of modality depends on the patient's symptoms, the clinical information desired, and the usefulness of the test. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions; they are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Demirci F, Birgul K, Demirci O, Demirci E, Akman Y, Karaalp E, Dolgun N. Perioperative complications in vaginal mesh procedures using trocar in pelvic organ prolapse repair. J Obstet Gynaecol India 2014; 63:328-31. [PMID: 24431669 DOI: 10.1007/s13224-013-0396-0] [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: 10/09/2012] [Accepted: 02/10/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to document intraoperative and early postoperative complications associated with the use of vaginal mesh with trocar in pelvic organ prolapse (POP) repair. METHODS This is a retrospective review of 120 cases of vaginal repair of POP using vaginal mesh. Of the 120 patients, 31 underwent anterior mesh repair (Light mesh 10, Avaulta 1, Perigee 1, and Prolift 19); 35 underwent posterior mesh repair (Light mesh 2, Posterior IVS 17, and Prolift 16); and 54 underwent anterior and posterior mesh (total) repair (Light mesh 8, Prolift 32, and Prolift M 14). RESULTS Three bladder injuries (2.5%) and one distal rectal injury (0.8%) occurred during dissection. Three of four organ injuries (75%) had previous prolapse repair. Overall four patients (3%) required transfusion. Urinary retention exceeding 5 days occurred in four patients. Three of them (60%) also underwent TVT-O. Groin pain occurred in two patients one of whom underwent TVT-O. Gluteal pain occurred in one patient. Early mesh exposure occurred in the vaginal cuff of a patient who underwent hysterectomy. CONCLUSIONS The vaginal mesh procedures may be done with relatively few perioperative complications. However, there is a need for more randomized controlled trials with long-term follow-up to clarify its postoperative long-term complications and morbidities.
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Affiliation(s)
| | | | - Oya Demirci
- Zeynep Kamil Women's Health and Maternity Hospital, Istanbul, Turkey
| | - Elif Demirci
- Zeynep Kamil Women's Health and Maternity Hospital, Istanbul, Turkey
| | | | - Erhan Karaalp
- Goztepe Education and Research Hospital, Medeniyet University, Dr. Erkin Street, 34170 Istanbul, Turkey
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Montesino-Semper MF, Jimenez-Calvo JM, Cabases JM, Sanchez-Iriso E, Hualde-Alfaro A, García-García D. Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes. Eur J Obstet Gynecol Reprod Biol 2013; 171:180-6. [DOI: 10.1016/j.ejogrb.2013.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 08/02/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- Ian Beckley
- Department of Urology, St James’s University Hospital, UK
| | - Neil Harris
- Department of Urology, St James’s University Hospital, UK
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A comprehensive view on the actual trend in pelvic organ prolapse repair. ACTA ACUST UNITED AC 2012; 38:884-93. [DOI: 10.1007/s00261-012-9960-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
With increasing use of synthetic material in pelvic organ prolapse repair, the reporting and incidence of associated complications also have increased. The role of synthetic mesh in pelvic organ prolapse repair remains controversial and it is a therapeutic dilemma whether to continue its use in patients with poor native tissues, despite the recent public safety notification provided by the U.S. Food and Drug Administration. In this article, we review the biomaterials used in pelvic organ prolapse repair and discuss the outcomes and associated complications, paying emphasis to the benefits and the risks.
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Menchen LC, Wein AJ, Smith AL. An appraisal of the Food and Drug Administration warning on urogynecologic surgical mesh. Curr Urol Rep 2012; 13:231-9. [PMID: 22434331 DOI: 10.1007/s11934-012-0244-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Currently, there is no consensus on the use of mesh in transvaginal surgical repairs for the treatment of pelvic organ prolapse. This review recapitulates and assesses the recent U. S. Food and Drug Administration (FDA) warnings about the use of surgical mesh in transvaginal pelvic organ prolapse repair and summarizes the responses of the national organizations that represent the health care providers most invested in treating patients with transvaginal surgical mesh. Mesh exposure or extrusion through the vaginal wall, true mesh erosion into viscera, and infection are the major complications that are currently used to define the safety of synthetic mesh use. Other potential adverse postsurgical outcomes that can affect quality of life, sexual function, and patient satisfaction include dyspareunia, "hispareunia" (ie, complaints of a sexual partner), prosthetic contraction or prominence, vaginal shortening, pelvic pain, urinary dysfunction, and failure of the repair. These outcomes are frequently attributed to mesh use, and can result in expense, frustration, and the need for further medical and surgical interventions for patients undergoing treatment for pelvic floor disorders. Information regarding the FDA's reports on the use of surgical mesh in pelvic organ prolapse repair should be made available to patients at the time of surgical planning and should be used as an adjunct in the process of obtaining informed consent.
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Affiliation(s)
- Lindsey C Menchen
- Division of Urology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, 19104, USA.
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Current world literature. Curr Opin Obstet Gynecol 2012; 24:355-60. [PMID: 22954767 DOI: 10.1097/gco.0b013e3283585f41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Reynolds WS, Penson D, Dmochowski RR. Trends in Care Delivery for Disorders of the Female Pelvic Floor. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gomelsky A. Vaginal prolapse repair: suture repair versus mesh augmentation: a urology perspective. Urol Clin North Am 2012; 39:335-42. [PMID: 22877716 DOI: 10.1016/j.ucl.2012.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The ideal procedure for pelvic organ prolapse (POP) repair would be associated with a low chance of long-term anatomic recurrence in the corrected compartment and should not predispose the patient to de novo stress urinary incontinence (SUI) or POP in other compartments. The procedure should also improve the woman's quality of life and subjective symptoms of pelvic floor dysfunction, it should be safe, and not be associated with significant immediate and long-term morbidity. Each procedure for POP repair has strong advantages and potential detractors. This article discusses anterior and posterior compartment POP repairs.
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Affiliation(s)
- Alex Gomelsky
- Department of Urology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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20
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Current world literature. Curr Opin Urol 2012; 22:336-45. [PMID: 22677776 DOI: 10.1097/mou.0b013e3283551cbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Do we need meshes in pelvic floor reconstruction? World J Urol 2011; 30:479-86. [DOI: 10.1007/s00345-011-0794-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 10/29/2011] [Indexed: 12/26/2022] Open
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Downing KT. Uterine prolapse: from antiquity to today. Obstet Gynecol Int 2011; 2012:649459. [PMID: 22262975 PMCID: PMC3236436 DOI: 10.1155/2012/649459] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/26/2011] [Accepted: 08/26/2011] [Indexed: 11/17/2022] Open
Abstract
Uterine prolapse is a condition that has likely affected women for all of time as it is documented in the oldest medical literature. By looking at the watershed moments in its recorded history we are able to appreciate the evolution of urogynecology and to gain perspective on the challenges faced by today's female pelvic medicine and reconstructive surgeons in their attempts to treat uterine and vaginal vault prolapse."He who cannot render an account to himself of at least three thousand years of time, will always grope in the darkness of inexperience"-Goethe, Translation of Panebaker.
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Affiliation(s)
- Keith T. Downing
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461, USA
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Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 2010; 24:1899-907. [PMID: 23632800 PMCID: PMC3824218 DOI: 10.1007/s00192-013-2092-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/09/2013] [Indexed: 12/26/2022]
Abstract
Introduction and hypothesis The aim of the study was to compare the efficacy and safety of transvaginal trocar-guided polypropylene mesh insertion with traditional colporrhaphy for treatment of anterior vaginal wall prolapse. Methods This is a randomized controlled trial in which women with advanced anterior vaginal wall prolapse, at least stage II with Ba ≥ +1 cm according to the Pelvic Organ Prolapse Quantification (POP-Q) classification, were randomly assigned to have either anterior colporrhaphy (n = 39) or repair using trocar-guided transvaginal mesh (n = 40). The primary outcome was objective cure rate of the anterior compartment (point Ba) assessed at the 12-month follow-up visit, with stages 0 and I defined as anatomical success. Secondary outcomes included quantification of other vaginal compartments (POP-Q points), comparison of quality of life by the prolapse quality of life (P-QOL) questionnaire, and complication rate between the groups after 1 year. Study power was fixed as 80 % with 5 % cutoff point (p < 0.05) for statistical significance. Results The groups were similar regarding demographic and clinical preoperative parameters. Anatomical success rates for colporrhaphy and repair with mesh placement groups were 56.4 vs 82.5 % (95 % confidence interval 0.068–0.54), respectively, and the difference between the groups was statistically significant (p = 0.018). Similar total complication rates were observed in both groups, with tape exposure observed in 5 % of the patients. There was a significant improvement in all P-QOL domains as a result of both procedures (p < 0.001), but they were not distinct between groups (p > 0.05). Conclusions Trocar-guided transvaginal synthetic mesh for advanced anterior POP repair is associated with a higher anatomical success rate for the anterior compartment compared with traditional colporrhaphy. Quality of life equally improved after both techniques. However, the trial failed to detect differences in P-QOL scores and complication rates between the groups.
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