Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh

Abstract

Objective To evaluate the effects of prolene mesh on urinary, bowel and sexual function in prolapse surgery.Design Prospective observational study on consecutive women.Setting Two referral uorgynaecological units in Italy.Population Women requiring prolapse repair for anterior or posterior vaginal prolapse.Methods All women were assessed for urinary, bowel, prolapse symptoms and dyspareunia pre-and postoperatively. Urodynamics was performed in selected cases. Surgery consisted of an anterior or posterior repair plus a prolene mesh. Follow up was after 1, 6 and 12 months. The ANOVA test was used for statistical analysis. Main outcome measures Vaginal anatomical restoration, urinary, bowel and sexual function.Results We recruited 63 women (mean age 63 years) with a mean follow up of 17 months. Anatomically, the success rate was 94%. Thirty-two women had an anterior repair. Among this group, the sexual activity rate did not alter but dyspareunia increased by 20%. Urge and stress incontinence did not change postoperatively but urgency improved in 10% and 13% had vaginal erosion of the mesh. Thirty-one women had a posterior repair. Among this group, sexual activity decreased by 12% and dyspareunia increased in 63%. Constipation improved in 15% and anal incontinence in 4%, and 6.5% of women had vaginal erosion of the mesh and one required mesh removal for pelvic abscess. Conclusions Although this study shows good anatomical results with the use of prolene mesh for prolapse repair, there was a high rate of morbidity. We believe that the use of prolene mesh should be abandoned.

Pelvic organ prolapse transvaginal repair by the Prolift system: Evaluation of efficacy and complications after a 4.5 years follow up

“…17,27,[30][31][32] In the present study, the rate of de novo dyspareunia was 13.3%, similar to those observed in larger series. Dyspareunia after POP surgery might be as a result of mesh exposure or mesh shrinkage.…”

Proceedings of the 18th AIUG National Congress

“…Il rischio di erosione sembrerebbe essere correlato al sito anatomico. In uno studio prospettico osservazionale che valutava gli effetti funzionali dell'utilizzo di mesh in polipropilene è stata osservato un più ampio rischio di erosione nel compartimento anteriore (13%) vs il posteriore (6,5%) 19 . Una recente valutazione degli studi pubblicati conclude affermando che l'utilizzo di protesi possa avere un ruolo nella correzione del prolasso anteriore, in relazione al più basso tasso di complicanze rispetto al comparto posteriore, dove aumenta il rischio di alterazioni funzionali quali dispareunia e dolore alla defecazione, sconsigliandone, invece, l'utilizzo nelle procedure di supporto dell'apice vaginale 20 .…”

“…9 pazienti (30%) erano affette da stress incontinence (SUI), 5 (15%) da urgency/frequency senza incontinenza, 3 (9%) da mix incontinence. Prima dell'intervento le pazienti presentavano un punteggio medio dell'UDI-6 di 8 (range 2-15) e dell'IIQ-7 di 8 (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Presentavano inoltre un punteggio medio complessivo all'FSFI di 23 (range 16,3) ed un BDI di 10 (range 7,5-18).…”

“…The increasing variety of available materials and techniques, combined with a lack of well conducted clinical trials, make the choice of repair more difficult. Gynemesh (Ethicon, Inc.), a wide-pore polypropelene mesh, seems to be an excellent graft material with low risk for graft infection (1.4%) or erosion [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] .Elliott DS, Krambeck AE, Chow GK found, with robotically assisted laparoscopy: a decreased hospital stay, low complication rates and high patient satisfaction [11][12] . This surgical technique described by Elliott DS, Frank I, Dimarco DS, Chow GK on the other side can involve placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant.…”

Outcome and medium-term functional results of anterior rectopexy for rectocele repair

“…Pelvic organ prolapse is a common condition in female adults [5,6]. Clinical symptoms include constipation, dyspareunia and pelvic discomfort (e.g.…”