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Goh YM, Lim SH, Chua HL, Han HC, Lee JC. Long-Term Outcomes of Restorelle® Direct Fix Anterior Mesh in the Treatment of Pelvic Organ Prolapse. Cureus 2024; 16:e63513. [PMID: 39081408 PMCID: PMC11288286 DOI: 10.7759/cureus.63513] [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] [Accepted: 06/16/2024] [Indexed: 08/02/2024] Open
Abstract
Objective The objective of this study was to evaluate the efficacy and long-term outcomes of the use of Restorelle® Direct Fix (Coloplast, Humlebæk, Denmark) anterior mesh for transvaginal surgical management of anterior compartment prolapse. Methods A retrospective case series review was conducted for 123 patients who underwent surgery for Baden-Walker Grade three and four anterior compartment prolapse with the Restorelle Direct Fix anterior mesh between July 1, 2017 and September 30, 2018 in a single center. Follow-up was conducted at one, six, 12, 24, and 36 months after treatment. A standardized questionnaire and pelvic examination were conducted at each visit to assess operative complications and subjective and objective cure rates. Results Sixty patients were included in the analysis with a three-year follow-up rate of 70.0%. At three years post-operatively, subjective and objective cure rates were 97.7% and 95.3% respectively. Seven (11.7%) patients complained of de novo stress urinary incontinence, four (6.7%) complained of de novo urge urinary incontinence and one (1.7%) complained of symptomatic recurrence. Significantly, six (10.0%) patients had transvaginal mesh exposure over the three-year follow-up, mostly presenting within the first year. One (2.4%) patient developed new asymptomatic mesh erosion at the 36-month visit and one patient required mesh loosening one month post-surgery. Conclusions Management of anterior compartment prolapse with transvaginal surgery using the Restorelle® Direct Fix anterior mesh was associated with good subjective and objective cure rates. However, significant rates of post-operative mesh exposure were noted within three years post-surgery, which hinders the recommendation of this device for augmentation of repair for anterior compartment prolapse.
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Affiliation(s)
- Yi Man Goh
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Shu Hui Lim
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Hong Liang Chua
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - How Chuan Han
- Department of Urogynaecology, HC Han Clinic for Women, Mount Elizabeth Novena Specialist Center, Singapore, SGP
| | - Jill C Lee
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP
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Mehrotra V, Pearl J, Sheyn D, Wherley SD. Evaluation of Outcomes Between the Top-down Versus the Bottom-up Approach for Retropubic Midurethral Sling. Int Urogynecol J 2024; 35:849-854. [PMID: 38376548 PMCID: PMC11052804 DOI: 10.1007/s00192-024-05731-5] [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: 08/27/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Retropubic midurethral sling (MUS) placement is the gold standard for the treatment of stress urinary incontinence in the USA. The procedure can be approached from either a top-down or a bottom-up direction, but there is a paucity of contemporary data regarding outcomes between these approaches. The aim of this study was to provide updated clinical outcomes data. METHODS This was a retrospective cohort study of women undergoing the retropubic MUS procedure alone or at the time of pelvic organ prolapse repair between 2010 and 2020 at a single academic medical center. The electronic medical record was used to extract demographic data, operative approach, and perioperative complications. The primary outcome was a composite incidence of any perioperative complication. RESULTS Of the 309 patients analyzed, 140 (45.3%) underwent top-down and 169 (54.7%) underwent bottom-up retropubic MUS placement. Patients undergoing top-down MUS placement were more likely to be older (mean age 58 vs 54, p=0.02), have a history of diabetes mellitus (20% vs 8.9%, p=0.004), and have had a prior hysterectomy (27% vs 16%, p=0.02). They were less likely to have a concurrent anterior (p<0.001) or posterior repair (p<0.001). Patients undergoing the top-down procedure were less likely to experience sling exposure (p=0.02); complications in the two groups were otherwise similar. CONCLUSIONS The top-down approach to retropubic MUS placement was associated with lower rates of mesh erosion in this population of patients. Neither approach is associated with an increased overall risk of complications or de novo overactive bladder symptoms.
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Affiliation(s)
- Vidushri Mehrotra
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - John Pearl
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Sheyn
- Female Pelvic Medicine, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Susan D Wherley
- Urogynecology and Reconstructive Pelvic Surgery Fellow, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Hașegan A, Mihai I, Teodoru CA, Matacuta IB, Dura H, Todor SB, Ichim C, Tanasescu D, Grigore N, Bolca CN, Mohor CI, Mohor CI, Bacalbașa N, Bratu DG, Boicean A. Exploring the Challenges of Using Minimal Invasive Surgery to Treat Stress Urinary Incontinence: Insights from a Retrospective Case-Control Study. Diagnostics (Basel) 2024; 14:323. [PMID: 38337839 PMCID: PMC10855614 DOI: 10.3390/diagnostics14030323] [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: 12/19/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105-1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.
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Affiliation(s)
- Adrian Hașegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Ionela Mihai
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Cosmin Adrian Teodoru
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Ioana Bogdan Matacuta
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Horațiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Denisa Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Nicolae Grigore
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | | | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Călin Ilie Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Nicolae Bacalbașa
- Surgery Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
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Chen YC, Chen HW, Kuo HC. Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography. World J Urol 2023; 41:3083-3089. [PMID: 37775546 DOI: 10.1007/s00345-023-04639-x] [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: 07/10/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To investigate the prevalence of bladder neck incompetence (BNI) and the anatomic differences between different types of urinary incontinence (UI) and overactive bladder (OAB) by transrectal sonography, and to investigate these differences among those with stress UI (SUI) or mixed UI (MUI) who exhibited de novo or persistent OAB symptoms following anti-incontinence surgery. METHODS A retrospective analysis was conducted on a total of 184 patients with SUI, MUI, urge UI (UUI), or OAB dry who underwent transrectal ultrasound between 2017 and 2022. The presence of BNI and urethral incompetence assessed by transrectal ultrasound were recorded in all included patients, and recorded preoperatively and postoperatively among patients with SUI and MUI who underwent anti-incontinence surgery. RESULTS Among the patients, 91%, 84%, 76%, and 71% exhibited BNI in MUI, SUI, UUI, OAB dry group, respectively. Significantly higher rate of patients with BNI were found in MUI than in OAB dry group. Patients with OAB symptoms after anti-incontinence surgery exhibited significantly higher rates of BNI and urethral incompetence than those who did not have postoperative OAB symptoms. Among MUI patients with preoperative BNI, significantly lower rate of postoperative BNI and urethral incompetence was observed in individuals who had improved OAB symptoms after surgery, compared to those without improvement. CONCLUSION A higher BNI rate was observed in the MUI group. A significantly higher BNI rate was observed in women with OAB symptoms after anti-incontinence surgery. Patients with MUI had improved OAB symptoms if BNI was successfully corrected after anti-incontinence surgery.
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Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hao-Wei Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, No.707 Sec.3, Zhongyang Rd., Hualien City, 970473, Taiwan, ROC.
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