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McFadden E, Heneghan C. The impact of vaginal surgical mesh devices on consultation rates by type and health care provider in UK primary care: A cohort study in the Clinical Practice Research Datalink. Maturitas 2023; 178:107829. [PMID: 37716135 DOI: 10.1016/j.maturitas.2023.107829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES To examine consultation rates by type of consultation and health care provider in women with stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP), with and without surgical mesh implants. STUDY DESIGN Longitudinal open cohort study from April 2006 to November 2018 in the Clinical Practice Research Datalink (CPRD). MAIN OUTCOME MEASURES Rates of consultations with general practitioners (GPs), nurses, other clinicians and administrators by consultation type (face-to-face, telephone or administrative), and types of administrative consultations, estimated using negative binomial regression. RESULTS Of 220,544 women eligible for inclusion, 74 % (n = 162,687) had SUI, 37 % (n = 82,123) had POP, and 11 % (n = 24,266) had both. Face-to-face consultation rates were stable over time, at about 9 per year. Administrative consultations with GPs and administrators increased between 2006 and 2018, but averaged 31 per year. After adjustment, for both SUI and POP mesh surgery, there were lower rates of face-to-face consultations with GPs, higher rates of face-to-face consultations with other clinicians, higher rates of telephone consultations with GPs and other clinicians, and higher rates of administrative consultations with GPs, nurses and administrators. The higher rate of consultations with GPs coded as administrative consisted of results recording and administrative codes, and the higher rates of consultations with administrators were coded as repeat issue, other, administration and third-party consultations. CONCLUSIONS Caring for women with mesh places a higher administrative burden on GPs and administrators. There may be potential to reduce this workload through a more streamlined care pathway.
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Affiliation(s)
- Emily McFadden
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
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Ács J, Szabó A, Fehérvári P, Harnos A, Skribek B, Tenke M, Szarvas T, Nyirády P, Ács N, Hegyi P, Majoros A. Safety and Efficacy of Vaginal Implants in Pelvic Organ Prolapse Surgery: A Meta-analysis of 161 536 Patients. Eur Urol Focus 2023:S2405-4569(23)00243-2. [PMID: 37968187 DOI: 10.1016/j.euf.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT Among the many surgical treatments for pelvic organ prolapse (POP), better results can be achieved with the use of vaginal implants. However, owing to perceived complications, vaginal implant surgeries have been restricted or banned in many countries. OBJECTIVE To assess the real value of vaginal implants in POP surgery and compare the safety and efficacy of operations with and without implants. EVIDENCE ACQUISITION A systematic search was performed in three medical databases. Randomised controlled trials and observational studies comparing the safety and efficacy of vaginal POP surgery with implants versus native tissue were included. Safety outcomes were defined as different types of complications (functional and non-functional) and reoperations for complications. Efficacy outcomes were parameters of anatomical success and the rate of reoperations due to recurrence. A multivariate meta-analysis framework was used to estimate pooled odds ratios (ORs) with confidence intervals (CIs) with simultaneous control for study correlations and estimation of multiple correlated outcomes. EVIDENCE SYNTHESIS We included 50 comparative studies in the analysis. Rates of reoperation for complications (OR 2.15, 95% CI 1.20-3.87), vaginal erosion (OR 14.05, 95% CI 9.07-21.77), vaginal bleeding (OR 1.67, 95% CI 1.25-2.23), and de novo stress urinary incontinence (OR 1.44, 95% CI 1.18-1.75) were significantly higher in the implant group. Rates of anatomical success (OR 3.22, 95% CI 2.06-5.0) and reoperation for recurrence (OR 0.55, 95% CI 0.36-0.85) were superior in the implant group. CONCLUSIONS POP surgeries with vaginal implants are more effective than surgeries without implants, with acceptable complication rates. Therefore, the complete prohibition of implants for POP surgeries should be reconsidered. PATIENT SUMMARY We compared vaginal surgery with and without implants for repair of pelvic organ prolapse. Despite higher complication rates, vaginal implants provide better long-term results overall than surgery without implants.
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Affiliation(s)
- Júlia Ács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Urology, Semmelweis University, Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Urology, Semmelweis University, Budapest, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Andrea Harnos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Benjamin Skribek
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Martin Tenke
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Urology, Semmelweis University, Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, Semmelweis University, Budapest, Hungary; Department of Urology, University of Duisburg-Essen and German Cancer Consortium, Essen, Germany
| | - Péter Nyirády
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Attila Majoros
- Department of Urology, Semmelweis University, Budapest, Hungary.
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Hosni W, Schmidt CM, Mallmann P, Ludwig S. Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse. BMC Urol 2023; 23:48. [PMID: 36991400 PMCID: PMC10061786 DOI: 10.1186/s12894-023-01213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse is a bothersome condition affecting many women at advanced age, but also frequently observed in young women with certain risk factors. Various surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. The vaginal bilateral sacrospinous colposuspension surgery (BSC) with ultralight mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus. The objective of this study is to evaluate the anatomical and functional outcomes of bilateral sacrospinous colposuspension with ultralight mesh in 30 Patients treated with the vaginal single incision standardized technique. METHODS In this retrospective study, 30 patients were treated by BSC for significant vaginal, uterovaginal or cervical prolapse. A simultaneous anterior colporrhaphy, posterior colporrhaphy or both were performed when indicated. Anatomical and functional outcomes were assessed 1 year postoperatively using the Pelvic Organ Prolapse Quantification system (POP-Q) and the standardised Prolapse Quality of Life (P-QOL) questionnair. RESULTS The POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were asymptomatic and expressed high satisfaction one year after surgery. No intraoperative adverse events were recorded for all patients. Only minimal postoperative complications were recorded and they all resolved completely with conservative management. CONCLUSION This study highlights the functional and anatomical outcomes of the minimally invasive vaginal bilateral sacrospinal colposuspension with ultralight mesh for the management of apical prolapse. The one year postoperative results of the proposed procedure reflect excellent outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects. TRIAL REGISTRATION The study protocol was approved by the Ethics Committee at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered).
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Affiliation(s)
- Wael Hosni
- Department of Obstetrics & Gynecology, Marienhospital Brühl, A teaching hospital of the University of Cologne, Cologne, Germany.
| | - Carl-Michael Schmidt
- Department of Obstetrics & Gynecology, Marienhospital Brühl, A teaching hospital of the University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics & Gynecology, University hospital, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics & Gynecology, University hospital, Cologne, Germany
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Lozo S, Chill HH, Botros C, Goldberg RP, Gafni-Kane A. Long term surgical outcomes of vaginal colposuspension using the Uphold Lite™ mesh system vs. vaginal vault uterosacral ligament suspension for treatment of apical prolapse. Eur J Obstet Gynecol Reprod Biol 2023; 280:150-153. [PMID: 36493584 DOI: 10.1016/j.ejogrb.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/29/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The aim of this study is to compare long-term outcomes (7-10 years) between vaginal hysterectomy with uterosacral ligament suspension (VHUSLS) and sacrospinous hysteropexy with the Uphold™ Lite mesh System (SHU) for management of apical prolapse. METHODS Patients undergoing VHUSLS or SHU from 2008 to 2012 at a single tertiary referral center were included. Patients were contacted, asked to return for physical examination, and to complete the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Our primary outcome was anatomic failure defined as Stage 2 POP or higher of any compartment. The secondary outcome was subjective changes in symptoms based upon PFDI-20 responses. RESULTS Two-hundred and two women were identified to have undergone the index surgeries from 2008 to 2012. Sixty-three agreed to return for follow up symptom evaluation and examination (30 VHUSLS and 33 SHU). Baseline characteristics were similar between groups. Clinical cure was high for both groups reaching 93.4 % and 94.0 % for the VHUSLS and SHU groups, respectively (p = 0.721). Anatomical success was lower with 44.7 % and 66.7 % of patients in the VHUSLS and SHU groups, respectively, meeting criteria for success (p = 0.138). There were no mesh complications among patients returning for exams. However, two patients who were contacted and were not interested in this study reported mesh complications and need for additional surgeries. Anterior vaginal wall support was noted to be significantly better supported for SHU (Ba -2.03 ± 0.75 vs -1.42 ± 0.92, p = 0.008). There were no differences between groups for overall PFDI-20 scores postoperatively. However, SHU patients reported higher rates of stress urinary incontinence compared to VHUSLS patients. CONCLUSION In women with apical prolapse, VHUSLS and SHU afford similar long-term outcomes. SHU patients reported higher rates of stress urinary incontinence.
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Affiliation(s)
- Svjetlana Lozo
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, NYC, NY, USA
| | - Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA.
| | - Carolyn Botros
- Atlantic Urogynecology Associates, Department of Obstetrics and Gynecology, Morristown, NJ, USA
| | - Roger P Goldberg
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Adam Gafni-Kane
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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Zullo MA, Schiavi MC, Luffarelli P, Bracco G, Iuliano A, Grilli D, Esperto F, Cervigni M. Efficacy and safety of anterior vaginal prolapse treatment using single incision repair system: Multicentric study. Taiwan J Obstet Gynecol 2022; 61:646-651. [PMID: 35779915 DOI: 10.1016/j.tjog.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Up to 80% of all POP surgical procedures are due to anterior vaginal wall prolapse. The aim of this study is to evaluate the efficacy and safety of transvaginal anterior mesh for POP surgical repair. MATERIALS AND METHODS 153 consecutive patients with symptomatic or recurrent anterior vaginal prolapse undergoing surgical single-incision mesh (Calistar S) were prospectively enrolled in the study. Preoperative evaluation was performed collecting urogynecological history and performing a clinical exam, 3-day voiding diary and urodynamic testing. All incontinent patients completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Operative time, blood loss, perioperative and postoperative complications were prospectively recorded. Postoperative follow-up was scheduled at 1, 6, and 12 months with a urogynecological interview and examination. Success rate was assessed at 1, 6 and 12 months postoperatively. RESULTS The median follow-up was 16.4 months. None of patients had intraoperative complications. Eight patients (5%) required surgical intervention for complications (5 patients (3%) for haematoma and 3 (2%) for vaginal erosion). At 12 months of follow up 130 out of 140 patients (93%) gained the subjective cure criterion, while 129 out of 140 patients (92%) obtained the objective cure criterion. Eleven (7.8%) patients experienced stage 2 or higher prolapse recurrence and three of them with a stage ≥3 underwent reintervention. No significant differences were recorded in primary outcome at 1, 6 or 12 months postoperatively. CONCLUSIONS Anterior compartment prolapse repair by Calistar S (single-incision vaginal mesh) is an effective and safe procedure without significant complications.
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Affiliation(s)
- Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University of Rome, Rome, Italy
| | | | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Gianluca Bracco
- Department of Gynecological and Obstetric, San Luca Hospital, Lucca, Italy
| | - Alessandro Iuliano
- Department of Gynecological and Obstetric, San Pietro Hospital, Roma, Italy
| | - Debora Grilli
- Department of Gynecological and Obstetric, Sandro Pertini Hospital, Rome, Italy; Department of Gynecological and Obstetric, Tor Vergata University of Rome, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Levy G, Padoa A, Marcus N, Beck A, Fekete Z, Cervigni M. Surgical treatment of advanced anterior wall and apical vaginal prolapse using the anchorless self-retaining support implant: long-term follow-up. Int Urogynecol J 2022; 33:3067-3075. [PMID: 35022836 PMCID: PMC8754555 DOI: 10.1007/s00192-021-05045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Following health notification by the FDA in 2008 of serious complications with transvaginal mesh for anterior pelvic organ prolapse, there has been a return to native tissue repairs. Earlier work with a self-retaining support (SRS) implant showed a high anatomical success rate with minimal implant-related complications over a medium-term follow-up. It is proposed that post-implant complications are more a consequence of the method of mesh anchoring rather than the implant itself. Our system incorporates an ultralight mesh with a frame that provides level I, II, and III support without the need for fixation. The first long-term outcomes of SRS implantation are presented. METHODS A prospective multicenter trial was conducted using two consecutive identical protocols of the use of the SRS implant in women with symptomatic anterior compartment prolapse extending their follow-up to 36 months. Anatomical success (Pelvic Organ Prolapse Quantification stage 0 or 1 or a Ba ≤ -2) was recorded along with subjective success as defined by regular quality-of-life (PFDI-20 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire) assessments. RESULTS Sixty-seven patients completed 36 months of follow-up. Mean Ba measurements improved from 3.1 (-1 to 6) cm to -2.8 (-1 to -3) cm and C point from 0.4 (-8 to 6) cm to -6.9 (-10 cm to 1) cm. accumulating to a significant anatomical success rate of 94.3%. Subjective success based on question #3 of the PFDI-20, analyzed for the index surgical compartment, reached 95.7%. Post-operative complications included 2 cases of urinary retention, 1 minor frame exposure, 1 case of delayed voiding dysfunction, and 2 cases of de novo stress urinary incontinence. Untreated pre-operative second-degree Bp measurements had increased in 27% at follow-up. CONCLUSION The long-term outcome of the SRS implant shows an excellent subjective and objective success with minimal risk of complications or need for reintervention.
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Affiliation(s)
- Gil Levy
- Assuta University Hospital, Ashdod, Israel.
| | | | | | - Anat Beck
- Maynei Hayeshua Hospital, Bnei Brak, Israel
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d'Altilia N, Mancini V, Falagario U, Chirico M, Illiano E, Balzarro M, Annese P, Busetto GM, Bettocchi C, Cormio L, Sanguedolce F, Schiavina R, Brunocilla E, Costantini E, Carrieri G. Are Two Meshes Better than One in Sacrocolpopexy for Pelvic Organ Prolapse? Comparison of Single Anterior versus Anterior and Posterior Vaginal Mesh Procedures. Urol Int 2021; 106:282-290. [PMID: 34839298 DOI: 10.1159/000519818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sacrocolpopexy (SC) is the main treatment option for the repair of anterior and apical pelvic organ prolapse (POP). Indications and technical aspects are not standardized, and the question remains whether it is necessary to place a mesh on both anterior and posterior vaginal walls, particularly in cases with only minor or no posterior compartment prolapse. The present study aimed to compare the anatomical and functional outcomes of single anterior mesh only versus anterior and posterior mesh procedures in SC. MATERIALS AND METHODS Our prospectively maintained database on POP was used to identify patients who had undergone either abdominal or mini-invasive SC from January 2006 to October 2019. Patients with symptomatic or unmasked stress urinary incontinence (SUI) were not included in the study and were treated using the pubo-vaginal cystocele sling procedure. Objective outcomes included clinical evaluation of pre-existing or de novo POP by the halfway system and POP-q classifications, as well as the development of de novo SUI. Subjective outcomes were assessed using the Pelvic Floor Impact Questionnaire (PFIQ-7) with questions on bladder, bowel, and vaginal functions. Persistent or de novo constipation and overactive bladder were defined as bowel symptoms and urinary urgency/frequency/urinary incontinence after surgery. RESULTS Ninety-five women with symptomatic anterior and apical POP underwent SC. Forty-one patients were treated with only anterior vaginal mesh (group A), and 54 with anterior and posterior mesh (group B). There were no differences between the pre- and post-operative characteristics of the 2 groups. In group B, there were 2 blood transfusions, 1 wound dehiscence, and 3 mesh erosions/extrusion after abdominal SC (Clavien-Dindo II), and in group A, there was 1 ileal lesion after laparoscopic SC (Clavien-Dindo III). There were no differences between the 2 groups in either anatomical or functional outcomes during 3 years of follow-up. CONCLUSIONS SC with single anterior vaginal mesh has similar results to SC with combined anterior/posterior mesh, regardless of the surgical approach. The single anterior mesh may reduce the risk of complications (mesh erosion/extrusion), and offers better subjective outcomes with improved quality of life. Anterior/posterior mesh may be justified in the presence of clinically significant posterior POP.
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Affiliation(s)
- Nicola d'Altilia
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Ugo Falagario
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Marco Chirico
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Matteo Balzarro
- Department of Urology, University of Verona, Azienda Ospedaliero-Universitaria, Verona, Italy
| | - Pasquale Annese
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Francesca Sanguedolce
- Department of Pathology, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
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Grisales T, Ackerman AL, Rogo-Gupta LJ, Kwan L, Raz S, Rodriguez LV. Improvement in dyspareunia after vaginal mesh removal measured by a validated questionnaire. Int Urogynecol J 2021; 32:2937-46. [PMID: 34351464 DOI: 10.1007/s00192-021-04923-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/12/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine the effect of the surgical removal of vaginally placed prolapse and incontinence mesh on sexual function. We hypothesize that patients with painful complications of mesh will experience improvement in dyspareunia and sexual function after mesh removal. METHODS The eligible cohort consisted of 133 women who presented with a new onset of pain attributed to mesh-augmented incontinence or prolapse surgery and who elected to undergo mesh removal between 1 August 2012 and 1 July 2013. Sexual function symptoms were assessed before and after mesh removal surgery using the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Multivariate analysis was performed to identify predictors of improvement in dyspareunia. RESULTS Ninety-four patients undergoing mesh removal completed a pre-operative questionnaire, 63 of whom also completed a post-operative questionnaire. After mesh removal, there was a nearly 50% reduction in the proportion of women reporting always experiencing post-operative pain with intercourse among those experiencing pre-operative pain. There was a statistically significant quantitative improvement in pain with intercourse after mesh removal based on mean change score of PISQ-12 question 5 "How often do you experience pain with intercourse?". In multivariate analysis, only history of vaginal delivery was associated with symptom improvement. CONCLUSION Removal of transvaginal prolapse mesh is associated with improvement in self-reported dyspareunia based on a standardized question on a validated instrument in a small cohort of women. Although larger studies are needed to confirm the relationship between mesh-augmented surgeries and post-procedural dyspareunia, these data suggest that consideration of mesh removal is a reasonable step for patients with painful intercourse attributed to mesh-augmented prolapse and incontinence surgeries.
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Furtado Meinberg M, Cardoso Brandão W, Andrade Werneck R, Zarnowski Passos M, da Silva-Filho AL. Evaluation of the quality of information available on the internet on vaginal meshes. Eur J Obstet Gynecol Reprod Biol 2021; 264:330-335. [PMID: 34365137 DOI: 10.1016/j.ejogrb.2021.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the quality of information on the internet about vaginal meshes available to the general population. STUDY DESIGN The terms "vaginal sling," "sling vagina," "vaginal mesh," "mesh vagina," "vaginal tape," and "tape vagina" were used every time on three major search engines, and the first 10 websites retrieved by each search engine were selected and evaluated using the DISCERN questionnaire. The websites were divided into four categories based on the type of agency that created the website. These included websites created by private health institutions, non-private health institutions, and non-health institutions and websites for encyclopedias, libraries, articles and scientific papers. They were compared in terms of the reliability, information quality, and total DISCERN score. RESULTS The survey yielded 98 different websites; after applying the exclusion criteria, 62 sites were selected. Websites for articles, magazines, libraries, and encyclopedias and those by non-private health services had significantly high scores for the reliability dimension of the DISCERN tool as compared to the other two website categories (p < 0.05). Regarding the quality of information, websites for non-specific health services and those for articles, magazines, libraries, and encyclopedias presented significantly lower scores as compared to the other two website categories. Websites for non-specific health services had significantly lower average total DISCERN points when compared to other website categories. The websites for private health services and those for articles, magazines, libraries, and encyclopedias had significantly lower DISCERN scores than the websites for non-private health services did. CONCLUSION Our findings showed that the quality of information regarding vaginal meshes on the first 10 websites on major search engines was moderate.
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Affiliation(s)
- Mariana Furtado Meinberg
- Faculdade de Medicina da, Universidade Federal de Minas Gerais, Fundação Hospitalar de Minas Gerais, Belo Horizonte 30.130-100, Brazil.
| | - Wladmir Cardoso Brandão
- Computer Science Department of Pontifícia, Universidade Católica de Minas Gerais, Belo Horizonte 31.980-110, Brazil
| | - Rogéria Andrade Werneck
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30.130-100, Brazil
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O'Neill J. Lessons from the vaginal mesh scandal: enhancing the patient-centric approach to informed consent for medical device implantation. Int J Technol Assess Health Care 2021; 37:e53. [PMID: 33843515 DOI: 10.1017/S0266462321000258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The vaginal mesh scandal, in which thousands of women were irreversibly maimed by polypropylene mesh, revealed multilevel failures in medical device regulation and implantation, demonstrating that patient-centric care has not yet fully transcended from policy into practice. In law, informed consent is considered by a two-stage test: reasonable treatment and patient information disclosure. The standard of reasonable treatment is determined according to what is deemed acceptable in accordance with a body of medical opinion. However, such bodies of medical opinion were vulnerable to external influence from device manufactures. Vaginal mesh manufacturers were found to have had financial links to research, royal colleges, and influential clinicians, which then influenced the basis of the evidence-based practice that often guides such bodies of medical opinion. According to the Independent Medicines and Medical Device Safety Report, patients' mesh complications were also frequently under-reported and patient-based evidence of harm disregarded. Patients were also not sufficiently informed of the material risks or reasonable alternatives to mesh, which is required of the second stage of informed consent pertaining to information disclosure. This paper makes the following recommendations: that conflict of interest disclosure be mandated, that greater value be afforded to patient-based evidence to improve evaluation of treatments, and that information disclosure for informed consent should relate to the risks, benefits, and alternatives to the surgical procedure and medical device. This will ensure that patients can evaluate whether surgeons are offering unbiased treatment options and are also informed of the potential long-term risks associated with device implantation.
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Chill HH, Navon I, Reuveni-Salzman A, Cohen A, Dick A, Shveiky D. Vaginal Colposuspension Using the Uphold Lite Mesh System versus Transvaginal Hysterectomy with Uterosacral Ligament Suspension for Treatment of Apical Prolapse: A Comparative Study. J Minim Invasive Gynecol 2021; 28:1759-1764. [PMID: 33713835 DOI: 10.1016/j.jmig.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 03/06/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To compare clinical and anatomic outcomes as well as patient satisfaction in women undergoing vaginal colposuspension using the Uphold Lite system (Boston Scientific Corporation, Marlborough, MA) and transvaginal hysterectomy with uterosacral ligament suspension (VUSLS) for the treatment of apical prolapse. DESIGN Retrospective cohort study. SETTING Female pelvic medicine and reconstructive surgery unit at a university-affiliated tertiary medical center. PATIENTS Women with apical prolapse who underwent either vaginal colposuspension using the Uphold Lite system (uterine-preserving as well as after previous hysterectomy) or VUSLS from 2010 to 2019. Excluded were women with 1 month or less of follow-up. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 164 women were included in the study: 112 women underwent VUSLS, and 52 underwent colposuspension using the Uphold Lite mesh system. Age, body mass index, maximal birth weight, comorbidity rates, and pelvic organ prolapse severity were similar between the groups. The clinical cure rate was similarly high in both groups, with 91.1% in the women who underwent VUSLS and 88.5% in those in the Uphold Lite group (p = .60). No differences were noted between the groups with regard to anatomic cure rate or composite outcome success rate (73.9% vs 76.0%, p = .77 and 70.3% vs 74.0%, p = .63, in the VUSLS and Uphold Lite groups, respectively). An advantage was noted in the VUSLS group with regard to patient satisfaction with 98.1% of the women stating that their condition was very much better (Patient Global Impression of Improvement questionnaire: A) or much better (Patient Global Impression of Improvement questionnaire: B) compared with 83.9% of the women in the Uphold Lite group (p = .023). In an attempt to assess the association between different variables and the composite outcome, a multivariate analysis was performed in which increased body mass index, menopausal status, and increased preoperative genital hiatus were found to decrease composite outcome success. CONCLUSION Vaginal colposuspension using the Uphold Lite system and VUSLS for the treatment of apical prolapse have comparable results with high clinical success rates.
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Affiliation(s)
- Henry H Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Chill, Reuveni-Salzman, and Shveiky); Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem.
| | - Ido Navon
- Department of Obstetrics and Gynecology, Hebrew University of Jerusalem School of Medicine (Dr. Cohen and Mr. Navon), Jerusalem, Israel
| | - Adi Reuveni-Salzman
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Chill, Reuveni-Salzman, and Shveiky); Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hebrew University of Jerusalem School of Medicine (Dr. Cohen and Mr. Navon), Jerusalem, Israel
| | - Aharon Dick
- Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Chill, Reuveni-Salzman, and Shveiky); Department of Obstetrics and Gynecology (Drs. Chill, Reuveni-Salzman, Dick, and Shveiky), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
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Hobson DTG, Kinman CL, Gaskins JT, Francis SL, McKenzie CM, Stewart JR, Gupta AS, Meriwether KV. Comparative analyses of attitude, knowledge, and recollection of preoperative counseling regarding pelvic mesh among women with or without a mesh-related complication. Arch Gynecol Obstet 2021; 303:1263-70. [PMID: 33392720 DOI: 10.1007/s00404-020-05919-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Our objective was to compare the recollection of preoperative counseling regarding mesh for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) among women with or without a mesh-related complication (MRC). We hypothesized that the patients who had MRC would better recollect counseling regarding complications associated with mesh. METHODS We conducted a retrospective cohort study among women who had prior implantation of synthetic, non-absorbable mesh for POP and/or SUI at least 3 months prior who presented with or without a MRC. The primary outcome was the proportion of women who recalled being counseled preoperatively about the risk of mesh exposure. RESULTS Ninety-six women were included in the final analysis (50 MRC; 46 no MRC). MRC women presented further in time from the index surgery [median 69 months [IQR 26-115] vs 12 months (IQR 6-64), p < 0.01]. After adjustment for time since surgery and age, MRC women were significantly less likely to recall being counseled about the possibility of any MRC [19/50 (38%) vs 32/44 (73%), aOR 0.29, 95% CI 0.11-0.79, p = 0.01]. They were also less likely to report they would undergo the same surgery again 5-point Likert scale [median 3 (IQR 1-4) vs 5 (IQR 3-5), 5-point Likert scale, p < 0.01], less satisfied with their mesh surgery [median 1 (IQR 1-3) vs 5 (IQR 3-5), 5-point Likert scale, p < 0.01] and recommended improved preoperative counseling [27/50 (54%) vs 6/46 (13%), p < 0.01]. CONCLUSION Women who experienced MRC were less likely to recall being counseled about the possibility of MRC and report more unmet needs regarding perioperative counseling than women without MRC.
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Kuszka A, Brandt A, Niesel A, Lutz H, Mengel M, Ulrich D, Fünfgeld C. 3 Year outcome after treatment of uterovaginal prolapse with a 6-point fixation mesh. Eur J Obstet Gynecol Reprod Biol 2020; 255:160-4. [PMID: 33130379 DOI: 10.1016/j.ejogrb.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The aim of this study was to describe the intermediate outcome of a single-incision 6-point fixation transvaginal mesh for the treatment of primary and recurrent pelvic organ prolapse (POP). STUDY DESIGN This was a prospective cohort study including consecutive patients undergoing POP repair with the InGYNious anterior transvaginal mesh. Inclusion criteria were women with symptomatic stage II POP or higher. Exclusion criteria were the unwillingness or inability to give written informed consent, malignant diseases, neuro-muscular disorders, chronic pain syndrome or previous radiation in the pelvis. Every study participant completed a structured questionnaire, a urogynecological examination according to the IUGA-ICS POP-Q staging system and the validated P-QoL questionnaire before the operation and three years postoperatively. RESULTS 254 patients were included into the study, 179 were available for the three-year follow-up (70 %). Sixteen patients (8.2 %) had undergone reoperation for recurrent or de novo prolapse (12/16 patients underwent reoperation in the posterior compartment) and were excluded from the objective outcome analysis. In the final study group, all POP-Q measurements, urge urinary incontinence and voiding dysfunction were significantly improved. The de novo SUI rate was 27/ 120 (23 %) in women without reoperation for SUI and/ or POP and without primary SUI. No serious adverse events occurred. Four (1.5 %) patients had mesh exposure at the one-year follow-up and been treated with local oestrogen. At three-year follow-up, no new mesh exposure was seen. De novo dyspareunia rate was low (n = 5 (3 %)). CONCLUSIONS In this study, the objective outcome three years after anterior POP repair with the InGYNious transvaginal mesh was good. The reoperation rate both for mesh related problems or prolapse were rare.
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Abstract
PURPOSE OF REVIEW To discuss considerations and current evidence for the diagnosis and management of vaginal mesh exposures following female mesh-augmented anti-incontinence and pelvic organ prolapse surgery. RECENT FINDINGS Since the introduction of mesh into female pelvic surgery, various applications have been reported, each with their own unique risk profile. The most commonly encountered mesh-related complication is vaginal mesh exposure. Current evidence on the management of vaginal mesh exposure is largely limited to observational studies and case series, though this is continuing to expand. We present a synthesis of the available data, as well as clinical and surgical approaches to managing this complication. It is important for surgeons to be familiar with the management of vaginal mesh exposures. Depending on the patient's presentation and goals, there is a role for conservative measures, mesh revision, or mesh excision. Further study is warranted to standardize mesh resection techniques and explore non-surgical treatments.
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Chill HH, Gutman-Ido E, Navon I, Reuveni-Salzman A, Haj-Yahya R, Shveiky D. Laparoscopic uterosacral ligament suspension versus vaginal colposuspension using the Uphold Lite™ mesh system: clinical outcome and patient satisfaction. Int Urogynecol J 2021; 32:1513-8. [PMID: 33084960 DOI: 10.1007/s00192-020-04563-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to compare clinical and anatomical outcomes between laparoscopic uterosacral ligament suspension (LUSLS) and vaginal colposuspension using the Uphold Lite™ mesh system for the treatment of apical prolapse. METHODS We performed a comparative, retrospective cohort study. All women who underwent either vaginal colposuspension with the Uphold Lite™ System or LUSLS for treatment of apical prolapse between 2010 and 2019 were included. The groups were compared with regard to demographic, pre-operative, intra-operative, and post-operative data. Outcome measures included clinical and anatomical cure, as well as a composite outcome. The PGI-I questionnaire was used to determine patient satisfaction. RESULTS One-hundred and nineteen women met the inclusion criteria, including 70 women who underwent LUSLS and 49 women who underwent vaginal colposuspension with the Uphold Lite™ mesh system. At a mean follow-up of 31.7 (SD = 18.1) months, the clinical cure rate was high for both groups, reaching 98.6% in the LUSLS group compared with 89.8% in the Uphold group (NS). Anatomical cure rate was 83.6% in the LUSLS group compared with 69.7% for the Uphold group (NS). With regard to the composite outcome, no difference was found, although a trend towards a higher success rate was noted in the LUSLS group (83.6% vs 66.7%, p = 0.055). Patient satisfaction measured using the PGI-I questionnaire was high, at 98.6% in the LUSLS group and 87.8% in the Uphold group (NS). CONCLUSION Laparoscopic uterosacral ligament suspension and vaginal colposuspension using the Uphold Lite™ mesh system both have high clinical cure rates.
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Ma Y, Kang J, Zhang Y, Ma C, Wang Y, Zhu L. Changes in voiding function after trans vaginal mesh repair for advanced anterior vaginal prolapse. Eur J Obstet Gynecol Reprod Biol 2020; 255:29-33. [PMID: 33070087 DOI: 10.1016/j.ejogrb.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study evaluated changes in voiding function at 3 months and 1 year after transvaginal mesh (TVM) repair in women with advanced anterior vaginal prolapse (AVP) and identified predictive risk factors of postoperative voiding dysfunction (PVD). STUDY DESIGN Women with stage≥3 AVP who underwent TVM repair surgery were included in this retrospective cohort study. Voiding dysfunction was defined as an average flow rate (Qave)<10 ml/s, a maximum flow rate (Qmax)<15 ml/s, or a postvoid residual volume (PVR)>50 ml. Pre- and postoperative voiding function was assessed by uroflowmetry, PVR examination, and the Urinary Distress Inventory-6 (UDI-6) and the Urinary Impact Questionnaire-7 (UIQ-7). Statistical analyses were performed using paired-sample t tests, χ2 tests, and multivariate logistic regression. RESULTS Sixty-two women were included in this study, uroflowmetry data were available for 35 of them at 1-year follow-up. Forty-three percent of women showed evidence of voiding dysfunction preoperatively. The PVR decreased significantly from baseline to 1 year postoperatively (17.97 ± 38.48 vs. 0.00 ± 0.00, p < 0.001). Voiding difficulties decreased significantly postoperatively (55 % vs. 5%, p<0.001); frequency, urgency and urinary incontinence symptoms did not exhibit significant improvement (p>0.05). The UDI-6 and UIQ-7 indicated significant improvement postoperatively (both p<0.001). Multivariate analysis identified low Qave as an independent predictor of PVD (odds ratio, 0.40; 95 % CI, 0.16-0.98). CONCLUSION Nearly half of the patients had advanced AVP accompanied by preoperative voiding dysfunction. Improvement in voiding function was observed at 3 months and could last for one year postoperatively.
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Affiliation(s)
- Yidi Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ye Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Congcong Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
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Shoureshi PS, Lee W, Kobashi KC, Sajadi KP. Media coverage of the 2019 United States Food and Drug Administration ordered withdrawal of vaginal mesh products for pelvic organ prolapse. Int Urogynecol J 2020; 32:375-379. [PMID: 32601782 DOI: 10.1007/s00192-020-04401-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS On April 16, 2019, the United States Food and Drug Administration announced a withdrawal on sales and distribution of transvaginal mesh products for pelvic organ prolapse. The aim of this study was to asses online user behavior on pelvic-mesh related articles after the withdrawal and to evaluate article accuracy. MATERIALS AND METHODS We used Google Trends© to identify the terms related to pelvic mesh that experienced increased activity after the FDA announcement. The terms were analyzed for worldwide social media engagement (Facebook, Twitter, Pinterest, and Reddit) between April 16-19, 2019. The top ten lay press articles shared for each term were evaluated. We also examined the top ten Google search results for each term on June 6, 2019, in the US to evaluate what information was available after peak interest subsided. RESULTS During peak activity in April, 30 unique articles were identified after the FDA announcement. Two (6.7%) did not mention the April 2019 FDA announcement. Seven (23%) discussed mesh for stress urinary incontinence. After peak interest on June 6, 2019, Google identified 26 unique articles for the four terms. Seven (27%) did not mention the FDA announcement, and 3 (12%) mentioned mesh for incontinence. CONCLUSIONS Internet search patterns and social media behavior following the April 2019 ordered withdrawal on transvaginal mesh for pelvic organ prolapse reveal that some of the most disseminated information did not accurately or thoroughly distinguish the type of mesh discussed. This could lead to negative consequences for other mesh indications in female pelvic medicine and reconstructive surgery.
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Affiliation(s)
- Poone S Shoureshi
- Department of Urology, Oregon Health and Science University, 3303 S.W. Bond Avenue, Mail Code CH10U, Portland, OR, 97939, USA.
| | - Wai Lee
- Department of Urology, Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Kamran P Sajadi
- Department of Urology, Oregon Health and Science University, 3303 S.W. Bond Avenue, Mail Code CH10U, Portland, OR, 97939, USA
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Renard N, Bartolo S, Giraudet G, Declas E, Rubod C, Cosson M. Feasibility of vaginal mesh for anterior vaginal wall prolapse in an ambulatory setting: A retrospective case series. J Gynecol Obstet Hum Reprod 2020; 49:101684. [PMID: 31926349 DOI: 10.1016/j.jogoh.2020.101684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Vaginal mesh has been proven to be an effective aid in the treatment of cystocele. Could an ambulatory approach be feasible for the Uphold Lite®-mesh? HYPOTHESIS We investigate the feasibility of an ambulatory approach of Uphold Lite® insertion in a well-selected population. Risk factors for a non-successful ambulatory approach are identified. METHODOLOGY We conducted a retrospective case series of 236 women who underwent Uphold Lite® vaginal mesh insertion for the treatment of pelvic organ prolapse at our center. Indications for surgery were symptomatic anterior and/or apical prolapse, stages POPQ≥2. We compared women having an ambulatory approach, to those having a one day hospitalization planned but needed to stay. Comparisons between percentages were calculated using the chi-square or Fisher's exact test, depending on the number of women in each group. The mean comparisons were performed using the Student t-test, and the median test comparisons by the Kruskal-Wallis test. A difference was considered significant if p<0.05. RESULTS The most common reason for staying (85.7% of all ambulatory failures) after Uphold® surgery is the presence of an elevated post void residual. This complication was more found in the following: surgery in the afternoon, use of high-dose morphinics in general anesthesia, and in women with a higher parity. CONCLUSIONS Our study shows that Uphold® surgery in a one-day setting is feasible and safe. Women desiring this approach should be counselled on the 42.6% risk of one-day failure though, mostly due to non-validation of a post void residual. General anesthesia with high-dose morphinics, a higher parity, and surgery in the afternoon are risk factors for failure of an ambulatory protocol.
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Affiliation(s)
- N Renard
- department of Obstetrics and Gynaecology, St Vincentius Hospital Antwerp, Belgium.
| | - S Bartolo
- department of Obstetrics and Gynaecology, Centre Hospitalier de Douai, France
| | - G Giraudet
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| | - E Declas
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| | - C Rubod
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| | - M Cosson
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
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Ugianskiene A, Davila GW, Su TH. FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence. Int J Gynaecol Obstet 2019; 147:147-155. [PMID: 31353463 DOI: 10.1002/ijgo.12932] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/21/2019] [Accepted: 07/26/2019] [Indexed: 11/07/2022]
Abstract
The use of synthetic mesh implantation for the surgical management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) has grown in popularity since mesh was marketed for widespread use in the early 1990s. As mesh usage has expanded, patterns of previously unexpected complications have become apparent. In the United States and other countries, the increase in reported outcomes (both positive and negative) has led to the initiation of medico-legal actions by patients reporting negative effects of the implanted mesh. As a result, several national and professional societies have convened expert panels to publish summaries of reported outcomes and provide clinical recommendations regarding mesh use. Despite their recommendations and further dissemination of the potential complications reported after urogynecologic mesh use, the popularity of mesh use for POP and SUI has continued to expand, with apparent geographic and national patterns. As the largest global association focusing on women's health, FIGO, via its Urogynecology and Pelvic Floor Committee, has reviewed published national recommendations regarding the use of mesh, and has summarized them for the FIGO membership to help disseminate important recommendations to surgeons who may not be aware of the existence and content of these recommendations.
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20
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Illiano E, Giannitsas K, Li Marzi V, Natale F, Manicini V, Costantini E. No Treatment Required for Asymptomatic Vaginal Mesh Exposure. Urol Int 2019; 103:223-227. [PMID: 31230054 DOI: 10.1159/000501287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is no specific recommendation for the management of asymptomatic vaginal mesh erosions post antiincontinence or prolapse surgery, but revision or excision may represent overtreatment. We hypothesize that asymptomatic vaginal exposures remain asymptomatic during follow-up and do not require any intervention. METHODS We evaluated a "no treatment" approach by prospectively following-up women with asymptomatic vaginal exposures after antiincontinence and pelvic organ prolapse surgery. After a 1-month course of vaginal oestrogen, they underwent the "wait and see" protocol. It consisted of no treatment. Women were followed-up every 3 months, for the first year and then every 6 months with history, clinical examination with measurement of size of the exposure, and the evaluation of possible infection signs or vaginal discharge. RESULTS Forty women were followed-up for a median of 33.52 months (range 8-48 months). All exposures were ≤1 cm (mean 6.5 ± 1.5 mm, range 4-10 mm), patients were asymptomatic and without pain. During the observation period, the size of the exposure did not change and all women remained asymptomatic. DISCUSSION/CONCLUSION No treatment seems to be required for asymptomatic and small vaginal mesh exposures after prolapse or incontinence surgery.
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Affiliation(s)
- Ester Illiano
- Department of Andrology and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy,
| | | | - Vincenzo Li Marzi
- Department of Urology Clinic, Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Urogynecology Unit, San Carlo di Nancy Hospital, Rome, Italy
| | - Vito Manicini
- Department of Urology Clinic, University of Foggia, Foggia, Italy
| | - Elisabetta Costantini
- Department of Andrology and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
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Antosh DD, Yurteri-Kaplan LA, Shveiky D, Liu M, Heisler C, Hegde A, Grimes CL. FPMRS challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases : Series 3: Challenging recurrent prolapse in a medically complicated patient. Int Urogynecol J 2019; 30:1039-1043. [PMID: 31037413 DOI: 10.1007/s00192-019-03955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
This case presents the work-up and management of a spina bifida patient with recurrent prolapse. Four international experts also provide their evaluation of and approach to this complex case. According to the literature, little is known regarding the approach to the management of this specific patient population.
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Affiliation(s)
- Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Ladin A Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Madalena Liu
- Department of Urology, Monash University, Melborune, Australia
| | - Chris Heisler
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA
| | - Aparna Hegde
- Tata Center for Urogynecology and Pelvic Health, Cama Hospital, Grant Government Medical College, Mumbai, India
- Center for Urogynecology and Pelvic Health, New Delhi, India
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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22
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Abstract
The use of vaginal mesh in prolapse surgery has created enormous controversy and unprecedented media interest; it has become the most emotive topic in urogynecology today. The US Food and Drug Administration 510(k) system allowed the proliferation of mesh products which were rapidly adopted by surgeons internationally. The importance of a firm understanding of the biomechanical properties of tissue and implants, surgical skill, patient selection, communication skills, informed consent, and high-quality research are all important lessons we can learn from the mesh story. These lessons need to be applied to all novel treatments in the field of urogynecology and beyond.
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Affiliation(s)
- D Karmakar
- a Department of Urogynaecology , Mercy Hospital, Heidelberg , Melbourne , Australia
| | - L Hayward
- b Immediate Past President of the International Urogynecological Association, Department of Women's Health , Middlemore Hospital , Auckland , New Zealand
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Chene G, Cerruto E, Formont C, Lebail-Carval K, Chabert P, Lamblin G, Mellier G, Nohuz E. [How I do… easily a vaginal sacrospinous colpopexy using an isthmic posterior mesh]. ACTA ACUST UNITED AC 2018; 47:321-323. [PMID: 30503236 DOI: 10.1016/j.gofs.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 10/27/2022]
Affiliation(s)
- G Chene
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France; Université Claude-Bernard Lyon 1, EMR 3738, 69000 Lyon, France.
| | - E Cerruto
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - C Formont
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - K Lebail-Carval
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - G Lamblin
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
| | - E Nohuz
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France
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Kowalik CR, Lakeman MME, de Kraker AT, Roovers JPWR. Effects of mesh-related complications in vaginal surgery on quality of life. Int Urogynecol J 2018; 30:1083-1089. [PMID: 29909555 PMCID: PMC6586912 DOI: 10.1007/s00192-018-3680-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis Vaginal mesh surgery is subject of debate due to the impact of mesh-related complications on patient’s lives. Not all of these complications are symptomatic. Restoration of the anatomy and improvement of pelvic floor function as a result may counter the experienced discomfort related to adverse events. We hypothesized that health-related quality of life (HR-QoL) is comparable in women after vaginal mesh surgery regardless of the presence or absence of a mesh-specific complication. Methods This was a cross-sectional study of 128 women who had vaginal mesh surgery in a Dutch university hospital between 2007 and 2012. HR-QoL was measured in women with and without mesh complications using standardized QoL questionnaires Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire (IIQ), Defecation Distress Inventory (DDI), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). Complications were scored according to the International Urogynecological Association (IUGA) complication classification. Comparisons between groups were performed with Student’s t test and analysis of variance (ANOVA) test. Results In 29 (23%) women, a mesh-related complication occurred. The domain scores of the UDI-6, DDI, IIQ, and PISQ showed no statistically significant differences between women with and without a mesh-related complication. A post hoc analysis showed similar HR-QoL for those in whom the complication had been resolved and those with persistent symptoms of the complication. Conclusion Mesh surgery imposes specific complications. When counseling patients about the potential adverse events related to vaginal mesh surgery, it is important to inform them that mesh-related complications do not negatively affect QoL related to micturition, defecation, and sexual functioning.
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Affiliation(s)
- Claudia R. Kowalik
- Department of Obstetrics and Gynecology, Academic Medical Center, Room H4-272, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Mariëlle M. E. Lakeman
- Department of Obstetrics and Gynecology, BovenIJ ziekenhuis, Statenjachtstraat 1, Po box 37610, 1030 BD Amsterdam, The Netherlands
| | - Alyde T. de Kraker
- Department of Obstetrics and Gynecology, Academic Medical Center, Room H4-272, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Jan Paul W. R. Roovers
- Department of Obstetrics and Gynecology, Academic Medical Center, Room H4-240-1, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Trochez RD, Lane S, Duckett J; BSUG. The use of synthetic mesh for vaginal prolapse in the UK: a review of cases submitted to the British Society of Urogynaecology database. Int Urogynecol J 2018; 29:899-904. [PMID: 29532124 DOI: 10.1007/s00192-018-3595-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The use of mesh for vaginal prolapse gained popularity during the 1990s. More recently, concerns have been raised regarding the safety of mesh procedures. Mesh can be inserted vaginally, laparoscopically or via an open abdominal route, but there are few data comparing the outcomes. Most previous published data relate to small numbers of procedures. METHODS This was a review of data submitted to the British Society of Urogynaecology (BSUG) database of all cases reporting the use of mesh placed vaginally or abdominally (open or laparoscopic) between January 2006 and December 2016. The primary outcome was based on the reported patient global impression of improvement (PGI-I). RESULTS A total of 6,709 cases of mesh prolapse repair were entered during the study period. Women in the laparoscopic group had a lower BMI and were younger. Significantly more patients in the open group (96.4%) described themselves as very much better or much better compared with the laparoscopic group (91%) and the vaginal mesh group (90.7%; p < 0.001). Only 0.5% of patients reported that they were worse or very much worse. CONCLUSIONS This dataset suggests that the effectiveness of mesh repair might be good regardless of the route of insertion. The improvement in PGI-I seems to be greatest with open sacrocolpopexy.
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Abstract
In light of the legal issues and the shortage of data on histopathological findings, we summarized our experience on how explanted vaginal mesh specimens were managed in a surgical pathology practice during the last 5 years. Clinical history and pathology reports were collected from 155 women undergoing transvaginal tape excision. The degree of chronic inflammation, fibrosis, foreign-body giant cell reactions, the number of capillary vessels and nerve fibers, and the presence or absence of adipose tissue were recorded. Among the 155 patients, 65 (41.9%) were active medicolegal cases, with a significant increase in recent years. The main medical indications for mesh excision were pelvic pain, mesh erosion, voiding dysfunction, genital organ prolapse, and vaginal bleeding. In most cases, mild to moderate chronic inflammation with a mild degree of foreign-body giant cell reaction and minimal to mild fibrosis were found in explanted mesh specimens. The specimens were well vascularized without any evidence of nerve abnormality. Patient age correlated negatively with vaginal pain (P = .007) but positively with erosion (P = .005). In addition, the presence of adipose tissue within the explanted mesh correlated significantly with pelvic pain (P = .016). Overall, there was good tissue integration in all specimens. Considering the significant increase in the number of lawsuits in recent years, we recommend that all explanted vaginal mesh specimens be examined microscopically as well as grossly. A list of microscopic findings, including the presence or absence of adipose tissue, is suggested.
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Affiliation(s)
- Li Li
- Department of Pathology, Shandong University, School of Medicine, Jinan, Shandong, 250012, PR China; Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Xiaoyuan Wang
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, 250014, PR China
| | - Ji Young Park
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Pathology, School of Medicine, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Hao Chen
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Yiying Wang
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Wenxin Zheng
- Department of Pathology, Shandong University, School of Medicine, Jinan, Shandong, 250012, PR China; Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, 75390, TX.
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Abstract
Introduction and hypothesis To assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and changes in practice since a previous similar survey. Methods An online questionnaire survey (Typeform Pro) was emailed to British Society of Urogynaecology (BSUG) members. They included urogynaecologists working in tertiary centres, gynaecologists with a designated special interest in urogynaecology and general gynaecologists. The questionnaire included case scenarios encompassing contentious issues in the surgical management of POP and was a revised version of the questionnaire used in the previous surveys. The revised questionnaire included additional questions relating to the use of vaginal mesh and laparoscopic urogynaecology procedures. Results Of 516 BSUG members emailed, 212 provided completed responses.. For anterior vaginal wall prolapse the procedure of choice was anterior colporrhaphy (92% of respondents). For uterovaginal prolapse the procedure of choice was still vaginal hysterectomy and repair (75%). For posterior vaginal wall prolapse the procedure of choice was posterior colporrhaphy with midline fascial plication (97%). For vault prolapse the procedure of choice was sacrocolpopexy (54%) followed by vaginal wall repair and sacrospinous fixation (41%). The laparoscopic route was preferred for sacrocolpopexy (62% versus 38% for the open procedure). For primary prolapse, vaginal mesh was used by only 1% of respondents in the anterior compartment and by 3% in the posterior compartment. Conclusion Basic trends in the use of native tissue prolapse surgery remain unchanged. There has been a significant decrease in the use of vaginal mesh for both primary and recurrent prolapse, with increasing use of laparoscopic procedures for prolapse. Electronic supplementary material The online version of this article (10.1007/s00192-017-3476-3) contains supplementary material, which is available to authorized users.
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Barros-Pereira I, Valentim-Lourenço A, Fonseca A, Melo B, Henriques A, Ribeirinho A. A retrospective analysis of the effectiveness of anterior pelvic organ prolapse repair with Prolift versus Elevate vaginal mesh. Int J Gynaecol Obstet 2017; 139:192-196. [PMID: 28718906 DOI: 10.1002/ijgo.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/28/2017] [Accepted: 07/14/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the effectiveness of anterior pelvic organ prolapse (POP) repair using Prolift (Ethicon, Somerville, NJ, USA) or Elevate (American Medical Systems, Minnetonka, MN, USA) vaginal mesh at 12 months of follow-up. METHODS A retrospective study was undertaken using the records for the first 50 Prolift procedures in 2007-2009 and the first 50 Elevate procedures in 2013-2015 performed at a tertiary urogynecology unit in Lisbon, Portugal. Postoperative follow-up occurred at 3, 6, and 12 months. The primary outcome was surgical efficacy using subjective and objective measures (vaginal bulge symptoms and POP quantification system according to the Weber criteria, respectively) at 12 months. RESULTS Improvement according to the Weber criteria was noted for 10 (25%) of 40 women in the Prolift group and 21 (48%) of 44 in the Elevate group at 12 months (P=0.032). Additionally, the Ba point was higher with Elevate than with Prolift (-2.2 ± 1.1 vs -1.5 ± 1.5; P=0.031). Vaginal bulge symptoms were reported at 12 months by 7 (18%) women in the Prolift group and 3 (7%) in the Elevate group (P=0.021). CONCLUSION Differences in anatomic results were apparent between the two vaginal mesh groups 12 months after surgery.
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Affiliation(s)
- Isabel Barros-Pereira
- Clínica Universitária de Obstetrícia e Ginecologia, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Alexandre Valentim-Lourenço
- Clínica Universitária de Obstetrícia e Ginecologia, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Andreia Fonseca
- Clínica Universitária de Obstetrícia e Ginecologia, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Bruna Melo
- Hospital do Divino Espirito Santo, Ponta Delgada, Autonomous Region of the Azores, Portugal
| | - Alexandra Henriques
- Clínica Universitária de Obstetrícia e Ginecologia, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Ana Ribeirinho
- Clínica Universitária de Obstetrícia e Ginecologia, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
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Levy G, Padoa A, Fekete Z, Bartfai G, Pajor L, Cervigni M. Self-retaining support implant: an anchorless system for the treatment of pelvic organ prolapse-2-year follow-up. Int Urogynecol J 2018; 29:709-14. [PMID: 28710613 DOI: 10.1007/s00192-017-3415-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/26/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The search for an improved vaginal mesh prompted the development of a new anchorless implant. The objective was to report on outcome after 2 years of a technique using a self-retaining support (SRS) implant. METHODS Patients with anterior vaginal wall prolapse, with/without apical prolapse, were recruited. Participants underwent surgical repair using the SRS device. Demographic data, pre-surgical Pelvic Organ Prolapse Quantification (POP-Q) scoring, quality of life (QoL) questionnaires (Pelvic Floor Distress Inventory Short Form 20 [PFDI-20], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire 12 [PISQ-12]), and surgical data were collected. Patients were followed at 2 weeks, 2, 6, 12, and 24 months after surgery. Objective anatomical success was defined using the NIH criteria. RESULTS Twenty women were recruited for the study with an average age of 62.1 years and an average parity of 4.0 deliveries. Average BMI was 28. Pre-operative mean POP-Q measurements were Aa =1.40 (-1 to 3) cm, Ba = 2.3 (-1 to 6) cm and C = 0.4 (-7 to 6) cm. Surgical time averaged 31.2 min. Estimated blood loss averaged 165 ml. No intra-operative complications were observed. One case (5%) of frame erosion was documented 8 months after surgery. At 2 years' follow-up, mean POP-Q measurements were: Aa = -2.95 (-3 to -2) cm, Ba = -2.85 (-3 to -2) cm, and C point -6.90 (-10 to -3) cm. Seventeen (85%) patients had stage 0 and 3 patients (15%) had stage 1. No mesh erosions or chronic pelvic pain were documented at follow-up. The total PFDI score at follow-up was decreased by 92.8 points (p < 0.0001). CONCLUSIONS At 2 years' follow-up, the SRS implant was found to be safe, showing no intra-operative or immediate post-operative complications. All women presented with POP-Q measurements of the anterior and apical compartment at normal value (Ba ≤ -2 cm) and statistically significant subjective improvement.
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Abstract
Female stress urinary incontinence and pelvic organ prolapse are prevalent conditions in adult women. Among treatment alternatives, more traditional methods of surgical intervention have been supplanted by synthetic polypropylene mesh kits. However, novel complications with mesh-related exposure, pelvic pain alone or with dyspareunia, and increased incidence of revision surgeries, resulted in 2 FDA warnings on transvaginal mesh use for prolapse repair. This review examines the anatomy of the vagina and urethra, the etiology of pain related to mesh use, and the relevant surgical techniques for management of this complication along with their outcomes.
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Affiliation(s)
- Dominic Lee
- Department of Urology, St George Hospital, Gray Street, Kogarah 2217, New South Wales, Australia
| | - John Chang
- Department of Urology, St George Hospital, Gray Street, Kogarah 2217, New South Wales, Australia
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
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Carracedo D, López-Fando L, Sánchez M, Jiménez M, Gómez J, Laso I, Rodríguez M, Burgos F. Cost analysis of surgical treatment for pelvic organ prolapse by laparoscopic sacrocolpopexy or trans vaginal mesh. Actas Urol Esp 2017; 41:117-122. [PMID: 27614392 DOI: 10.1016/j.acuro.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/14/2016] [Accepted: 08/01/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The objective of this study is to compare direct costs of repairing pelvic organ prolapse by laparoscopic sacrocolpopexy (LS) against vaginal mesh (VM). Our hypothesis is the correction of pelvic organ prolapse by LS has a similar cost per procedure compared to VM. MATERIAL AND METHODS We made a retrospective comparative analysis of medium cost per procedure of first 69 consecutive LS versus first 69 consecutive VM surgeries. We calculate direct cost for each procedure: structural outlays, personal, operating room occupation, hospital stay, perishable or inventory material and prosthetic material. Medium cost per procedure were calculated for each group, with a 95% confidence interval. RESULTS LS group has a higher cost related to a longer length of surgery, higher operating room occupation and anesthesia; VM group has a higher cost due to longer hospital stay and more expensive prosthetic material. Globally, LS has a lower medium cost per procedure in comparison to VM (5,985.7 €±1,550.8 € vs. 6,534.3 €±1,015.5 €), although it did not achieve statistical signification. CONCLUSIONS In our midst, pelvic organ prolapse surgical correction by LS has at least similar cost per procedure compared to VM.
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Cervigni M, Ercoli A, Levy G. Cadaver study of anchorless implant for the treatment of anterior and apical vaginal wall prolapse. Eur J Obstet Gynecol Reprod Biol 2017; 210:173-176. [PMID: 28056432 DOI: 10.1016/j.ejogrb.2016.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This cadaver study was performed in order to evaluate the feasibility and the anatomical landmarks of a Self-Retaining device, a new unanchored mesh, for the treatment of anterior and apical vaginal prolapse. STUDY DESIGN The Self-retaining device was implanted transvaginally in two cadavers. One cadaver underwent a detailed trans-abdominal dissection of the pelvis and the other cadaver, frozen after the implant placement, underwent a cross section dissection of the pelvis. RESULTS The location of the device was confirmed to be in appropriate anatomical position and in safe distance from any major neurovascular structures in the pelvis. CONCLUSION The self-retaining implant, in its planned location, can be a safe procedure with respect to neighboring neurovascular and muscular pelvic structures. Brief summery: A cadaver study of anchorless implant for safety evaluation of the distance from vital structures. The implant found anatomically safe for use.
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Affiliation(s)
- Mauro Cervigni
- Department of Women's Health and New Life, Catholic University, Rome, Italy
| | - Alfredo Ercoli
- Department of Gynecology, Policlinico Abano Terme, Padua, Italy
| | - Gil Levy
- Division of Female Pelvic Medicine, Maynei Hayeshua Hospital, 17 Povarski St., Bnei Brak, Israel.
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Kowalik CR, Lakeman MME, Oryszczyn JE, Roovers JPWR. Reviewing Patients Following Mesh Repair; The Benefits. Gynecol Obstet Invest 2016; 82:575-581. [PMID: 28030858 DOI: 10.1159/000454925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/01/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The use of synthetic mesh implants for vaginal prolapse surgery is still a subject of debate due to safety concerns. We aimed to explore long-term complications of all women treated with mesh surgery for pelvic organ prolapse (POP) in our centre. METHODS This is a cross-sectional study of 188 women who underwent vaginal mesh surgery in a Dutch University Hospital between 2007 and 2012. The prevalence of mesh exposure, pain symptoms and patient satisfaction has been documented. RESULTS Vaginal mesh surgery was performed in 188 women - in 147 (78%) because of recurrent POP. After a median follow-up of 40 months (range 12-76 months), 11 women (6%) had a symptomatic exposure of whom 8 women underwent surgery. Nine women (5%) had de novo pain following mesh surgery and in 3 women, (2%) this symptom was persistent despite treatment. Eighty-six percent of the responders were satisfied about their treatment. CONCLUSION With this study, we showed that performing a total mesh recall is feasible. The prevalence of persisting symptomatic exposure and persisting pain symptoms was low in our population. Most of the complications we found were treatable. This is also reflected in the high overall satisfaction rate.
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Duckett J, Morley R, Monga A, Hillard T, Robinson D. Mesh removal after vaginal surgery: what happens in the UK? Int Urogynecol J 2016; 28:989-992. [PMID: 27924372 DOI: 10.1007/s00192-016-3217-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is little objective evidence regarding complication rates for mesh procedures outside clinical trials. Current coding poorly collects complications of prolapse and continence surgery using mesh. This survey was designed to identify surgeons performing mesh removal and reporting patterns in the UK. METHODS An electronic questionnaire was sent to all members of the Royal College of Obstetricians and Gynaecologists and members of the Section of Female Neurological and Urodynamic Urology of the British Association of Urologists in the UK. The questionnaire aimed to identify the number of procedures performed for mesh complications and whether they were reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and the patterns of referral and treatment RESULTS: Referral to a colleague in the same hospital was common practice (69 %). Only 27 % of respondents stated that they reported all removals to the MHRA. The numbers of surgical procedures were low, with most respondents performing between one and three procedures each year and many not performing any surgery for a specific mesh complication in the previous year. CONCLUSIONS Removal of exposed, eroded and/or painful vaginally inserted mesh is performed by many different surgeons in a variety of hospital settings in the UK.
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Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK, ME7 5NY.
| | - Roland Morley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Ash Monga
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Tim Hillard
- Poole Hospital NHS Foundation Trust, Poole, Dorset, UK, BH15 2JB
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Dawson ML, Rebecca R, Shah NM, Whitmore KE. A novel approach to mesh revision after sacrocolpopexy. Rev Urol 2016; 18:174-177. [PMID: 27833469 DOI: 10.3909/riu0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery.
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Affiliation(s)
- Melissa L Dawson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine Philadelphia, PA
| | - Rinko Rebecca
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine Philadelphia, PA
| | - Nima M Shah
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine Philadelphia, PA
| | - Kristene E Whitmore
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine Philadelphia, PA
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Cormio L, Liuzzi G, Massenio P, Ruocco N, Di Fino G, Mancini V, Selvaggio O, Carrieri G. Suprapubic-assisted Transurethral Excision of a Vaginal Mesh Eroded Into the Bladder. Urol Case Rep 2016; 3:84-5. [PMID: 26793511 PMCID: PMC4714320 DOI: 10.1016/j.eucr.2015.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022] Open
Abstract
A 56-year-old woman with irritative voiding symptoms and recurrent urinary infections was found to have erosion into the bladder of a tension-free vaginal tape placed 61 months before. To achieve radical excision, a 26Fr Amplatz sheath was placed suprapubically under endoscopic vision. A rigid nephroscope with grasping forceps was used to pull the eroded mesh out of the bladder wall while excising it transurethrally with a resectoscope. Postoperative course was uneventful; 12 months after surgery the patient remains asymptomatic. This novel technique provides an effective means of radically removing a mesh eroded into the bladder either transurethrally or suprapubically.
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Affiliation(s)
- L. Cormio
- Corresponding author. Tel./fax: +39 0881732111
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