Comparison of UpholdTM Vaginal Mesh Procedure with Hysterectomy or Uterine Preservation for the Treatment of Pelvic Organ Prolapse

Abstract

Hysterectomy is the empirical treatment for female pelvic organ prolapse (POP) without robust evidence to prove its efficacy. Uphold transvaginal mesh (TVM) system is an innovated device with smaller area, superior anterior/apical support with single incision to treat POP. The prospective cohort study aims to evaluate Uphold TVM’s performance with or without concomitant hysterectomy. Inclusion criteria specify patients suffering from stage 2 or more anterior/apical prolapse without previous hysterectomy. Exclusion criteria specify those with contraindications to uterine preservation, such as leiomyomas, adenomyosis, endometrial hyperplasia, abnormal uterine bleeding, postmenopausal bleeding, cervical dysplasia, receiving tamoxifen treatment, family history of gynecology cancer, or colon cancer and incapability to be routinely followed. Thirty patients are recruited in the hysterectomy group and 66 patients in the hysteropexy group. The results demonstrate that patients with Uphold mesh only experience longer vaginal length, shorter operation duration, less blood loss and less post-operation pain. The performance in anatomical correction, lower urinary tract symptoms improvement, de novo dyspareunia, urodynamic study parameters and mesh extrusion rates are comparable with or without uterus preservation. The information is useful in pre-operation counseling, when the patient can make an educated choice whether or not to receive concomitant hysterectomy.

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

“…TVM surgeries have become popular in the last several years due to the favorable surgical outcomes and the easy approach, regardless of hysteropexy or hysterectomy surgeries 7,8 . However, there are public concerns regarding the safety of TVM since the long-term evidence is still insufficient.…”

Letter to the editor: The negative predictive value of preoperative urodynamics for stress urinary incontinence following prolapse surgery

“…TVM surgery is clinically effective in repairing POP, despite a safety warning issued by the US Food and Drug Administration (USFDA) in 2017. We found that women had significant prolapse reduction after being treated with single-incision vaginal meshes [2]. A short-term anatomical success rate as high as 98% can be achieved [2].…”

“…We found that women had significant prolapse reduction after being treated with single-incision vaginal meshes [2]. A short-term anatomical success rate as high as 98% can be achieved [2]. The incidence of de novo stress urinary incontinence (SUI) after POP surgery has been reported to be 11% by Tsia-Shu Lo et al and 25% by Kasturi et al [3,4].…”

The clinical and urodynamic outcomes of single-incision mesh surgery using the Uphold system for the treatment of pelvic organ prolapse

“…Intraoperative complications www.nature.com/scientificreports/ apical compartment 6,10,[15][16][17][18][19][20][21] and 77.6% to 97% in the anterior compartment 6,[16][17][18][19]21,22 . This outcome was more similar between different studies compared to the heterogeneous outcome of sacrospinous ligament fixation 4 .…”

“…The Uphold system can be applied either with hysterectomy or with uterine conservation. We previously evaluated the Uphold system's performance among women with or without concomitant hysterectomy and found comparable outcomes in both groups 6 . On the basis of this study, uterine preservative pelvic reconstruction surgery is much more performed than hysterectomy in our clinical practice, and in this study, the data revealed consistency regarding the issue of uterine sparing or hysterectomy.…”