Exploring the basic science of prolapse meshes

Liang, Rui; Knight, Katrina; Abramowitch, Steve; Moalli, Pamela

doi:10.1097/gco.0000000000000313

Cited by 43 publications

(37 citation statements)

References 34 publications

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“…These results could be explained by some characteristics of the mesh. Indeed the evolution of the mesh kit decreasing the mesh biomaterial load may decrease the risk of mesh exposure . Another explanation could be the difference in implantation techniques.…”

Section: Discussionmentioning

confidence: 99%

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Clinical evaluation of the Uphold LITE mesh for the surgical treatment of anterior and apical prolapse: A prospective, multicentre trial

Allegre

Debodinance²,

Dematteï

et al. 2019

Neurourology and Urodynamics

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Aims To evaluate the safety and efficacy of the Uphold LITE mesh in the treatment of pelvic organ prolapse at 12‐month follow‐up. Methods Women undergoing a mesh surgery due to an anterior prolapse plus a symptomatic anterior prolapse (classed as pelvic organ prolapse quantification stage ≥2) were included in this prospective, multicentre, observational study. The primary endpoint was a composite outcome including a good anatomical correction, no prolapse symptoms, and no reintervention for an anterior or apical recurrent prolapse within 12 months of surgery. Secondary outcomes included safety, improvements in quality of life (QoL), and risk factor for recurrence. This study was registered with ClinicalTrials.gov, number NCT01559168. Results A total of 121 patients were included. Symptomatic and anatomic cure rates were 94% (95 of 101) and 76.8% (76 of 99), respectively. The composite success rate was 72.4% (71 of 98). The rate of reoperation for apical or anterior recurrent prolapse was 3.9% (4 of 103). Anatomical anterior or apical recurrence occurred in 18.2% (18 of 97) and 7.2% (7 of 97) of patients, respectively. The composite success rate was significantly higher in centres where more than 30 patients had been treated (80% vs 50%; P = .045). The rate of serious complication was 5.4% (6 of 111). Improvements were recorded in QoL including sexual function. Conclusions The Uphold LITE mesh procedure provides satisfactory outcomes in the treatment of anterior and apical prolapse, particularly in high‐volume centres. The rates of adverse effects and reintervention for recurrent prolapse were acceptable.

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Section: Discussionmentioning

confidence: 99%

“…Indeed the evolution of the mesh kit decreasing the mesh biomaterial load may decrease the risk of mesh exposure. 22 Another explanation could be the difference in implantation techniques. Experience with the use of synthetic mesh has revealed the importance of depth of mesh implantation.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the Uphold LITE mesh for the surgical treatment of anterior and apical prolapse: A prospective, multicentre trial

Allegre

Debodinance²,

Dematteï

et al. 2019

Neurourology and Urodynamics

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“…The difference in outcomes between our study and the study of Prolift outcomes can be partly attributed to the mesh characteristics. The weight of the Prolift system is 42.7g/m 2 compared to 26g/m 2 for Elevate [26].…”

Section: Discussionmentioning

confidence: 92%

Outcomes of Single Incision Anchored Anterior Vaginal Mesh Repair for Recurrent Vaginal Prolapse

Loganathan

2020

COGO

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Objective: To report the safety and efficacy of single incision anchored anterior vaginal mesh repair for women with recurrent anterior vaginal prolapse.Methods: Retrospective study of women with recurrent anterior vaginal prolapse, Stage 2 or beyond, who underwent single incision anchored vaginal mesh repair with Anterior Elevate (American Medical Systems, Minnetonka, USA) between June 2012 and October 2016. Pre-operatively, the Prolapse Quality-of-Life questionnaire (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were completed. Post-operatively, women completed the P-QOL, PISQ-12 and the global impression of improvement questionnaire (PGI-I). Preoperative POP-Q and post operative POP-Q examination at up to 24 months follow up were recorded. At average follow up of 36 months, participants were interviewed via telephone using questions from the P-QOL, PISQ and PGI-I.Results: 45 women had single incision anterior vaginal mesh kit repair for recurrent prolapse. Postoperatively, 85% of women reported cure of their prolapse symptoms. At 24 months, 80.0% had POP-Q stage 0 or 1 in the anterior compartment, and 93.8% achieved anatomical cure of apical prolapse (point C above 0). During structured telephone interview at mean follow up of 36 months, on PGI-I, 70% reported feeling ‘much better’ or ‘very much better’.Conclusion: Vaginal surgery using single incision lightweight mesh kits can be an effective approach for women with recurrent anterior vaginal prolapse, resulting in subjective and objective cure rates of over 80% with reasonable safety profile up to 60 months postoperatively.

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“…Different polymer processing technologies can lead to considerable differences in the final product and tissue response to it ( Table 2) .The monofilament can then be woven or knitted 51 . Knitted meshes are preferable to woven meshes for use in the pelvic floor as they are more porous and flexible; furthermore, woven meshes are associated with an increased complication rate as the filaments of the woven mesh can slide together resulting in interfibre spaces that allow bacteria in but not immune cells 52 . After knitting, the mesh is cleaned of the residual chemicals, cut into shape and sterilized by autoclaving or highpressure steam.…”

Section: [H1] the Evolution Of Surgical Meshmentioning

confidence: 99%

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

et al. 2019

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Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The issue surrounding the risk:benefit ratio when using the vaginal meshes is complex in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of premarket clearance of these products , have contributed to occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques. [H1] IntroductionVaginal meshes that are currently used in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can result in life-changing complications in some women who have vaginal mesh implants 1 . These adverse outcomes are now considered a major public health problem; New Zealand becoming the first country in the world to ban the use of transvaginal POP mesh products while still allowing transvaginal SUI meshes (except minislings) in December 2017 2 . In the UK, two public enquiries performed by the Scottish (in 2015) 3 and English (in 2017) 4 governments, in part, as a result of pressure from patient groups led to suspension of vaginal mesh products, both for SUI and POP, from July 2018 onwards 5 . The newest guidance by the National Institute of Health and Care Excellence (NICE) in the UK recommends that retropubic sling materials can be offered to women with SUI if nonsurgical management has failed 6 . In response, the British Society of Urogynaecologists expressed strong disagreement with the decision to suspend the use of vaginal mesh for SUI, but not POP, stating that this decision would deprive many women of an effective and safe treatment option as demonstrated by level I evidence 7 8 . Mesh manufacturers are currently facing lawsuits in the USA and Europe 9 . The issue with mesh repairs for SUI and POP is complex, as the vaginal mesh is implanted in the female pelvic floor in several different ways with very different outcomes in efficacy and complication outcomes. When used as a tape to treat SUI, many patients are effectively cured with the benefits outweighing the risks 10,11 , whereas when used for transvaginal POP repair, complications are more frequent 12 with...

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Exploring the basic science of prolapse meshes

Cited by 43 publications

References 34 publications

Clinical evaluation of the Uphold LITE mesh for the surgical treatment of anterior and apical prolapse: A prospective, multicentre trial

Clinical evaluation of the Uphold LITE mesh for the surgical treatment of anterior and apical prolapse: A prospective, multicentre trial

Outcomes of Single Incision Anchored Anterior Vaginal Mesh Repair for Recurrent Vaginal Prolapse

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

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