Mesh repair of vaginal wall prolapse

Kapur, Kanika; Dalal, Vinod

doi:10.1016/j.mjafi.2013.09.011

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…In a single TVM series using the Perigee technique, the average blood loss was found to be 180 ml [5], which was much higher than in our TVM data series (83 ml), and the mean procedure duration was also shorter in the TVM group (39 min vs. 60.9 min) [54]. In our retrospective study, we found no significant alterations between the prosthesis and natural tissue reconstructive operations in length of operation and blood loss.…”

Section: Discussioncontrasting

confidence: 56%

Slings and meshes in the therapy of prolapse and urinary incontinence

Fekete

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Pelvic organ prolapse (POP) is an important health issue for women, with up to 20% of women undergoing one or more operations to correct prolapse over their lifetime [1]. The reported rate or stress urinary incontinence (SUI) coexisting with POP is as high as 63–80% [2]. The classical anterior colporrhaphy has a high relapse rate for anterior compartment descent (26–58%), and anti-SUI effectiveness of this non-prosthesis method is only negligible (42%–62%) [3,4], so according to the current guidelines anterior colporrhaphy is not indicated in case of SUI . It is also known that the postoperative complication rate for very effective prosthesis operations is high. Permanent implants have been associated with higher rates for de novo stress incontinence (relative risk 1.39), bladder perforation (relative risk 3.92) and postoperative dyspareunia [5]. Synthetic transvaginal mesh has been employed in the treatment of POP with increasing popularity and is usually highly effective in controlling the principal symptoms of prolapse. Based on the US Food and Drug Administration (FDA) warnings of 2008 and 2011, specialists should arrive at a more precise balance between the low success rate for non-mesh techniques and the higher number of postoperative complications of prosthesis methods [6]. Therefore, in a retrospective study, we aimed to evaluate and compare anti-POP efficacy, anti-stress incontinence (anti-SUI) efficacy, and the early (six weeks) and late (36 months) postoperative complication rates for anterior vaginoplasty and the most commonly used transvaginal mesh (TVM) operations. In our series, we found that the TVM operations were significantly better in the reconstruction of POP (91.3% vs. 66.3%; p<0.001) and SUI (90% vs. 55%, p<0.001) after three years of follow-up. Hence, in our study, de novo urge incontinence (DNUS) was significantly more frequently observed (11.86% vs. 0%). Extrusion of the implanted mesh was found in 8.3% of cases involving a prosthesis. In our cases, the implanted mesh was fixed to the peri-urethral tissue with two anchoring stitches, as we had hypothesised; this is superior to the original TVM for anti-incontinence. Previous studies have reported that mesh operations provide unfavourable SUI cure rates. Therefore, the anchoring used as additional anti-incontinence surgical strategies is increasingly being scrutinized to achieve better postoperative continence without any significant side-effects for patients with both POP and SUI. A randomized prospective study was designed to evaluate the anti-SUI effectiveness of that anchoring technique. Mesh contraction and bunching may cause nerve entrapment as well as excessive tension on the fixed mesh arms, which both lead to pain. It is documented that mesh folding and contraction are among the reasons for chronic pelvic pain, dyspareunia and mesh extrusion. A new concept involving an anchorless implant was developed to reduce the side-effects of prosthesis operations. The assumption was that an anchorless neo-pubocervical fascia would accurately mimic the physiological support system, therefore providing adequate support. A new type of mesh was designed with a flexible frame. In our multi-centre study, seventeen patients (84.2%) had Stage 0 prolapse and three patients (15.8%) had Pelvic Organ Prolapse Quantification system (POP–Q) (International Continence Society (ICS)) Stage 1 prolapse after two years of follow-up. No cases of mesh erosion or chronic pelvic pain were documented at follow-up. There has been a drop in the rates for intra-operative bladder perforations and vesicovaginal fistulas (VVF) after the introduction of infra-pubic operative techniques, but the suitable reconstructive technique is still questionable. We reintroduced an “oldy but goody” operative technique of Lehoczky’s island flap implantation for prosthesis-induced VVF. In our short series, all the operated cases were free of fistulas after three months of follow-up. Although the rate for concomitant SUI in patients with POP is as high as 63–80% [2], the effective treatment for coexisting SUI and POP is still debated. The anti-SUI efficacy of the prosthetic placement is barely 72–83% [34-36]. Therefore, the research group developed a modification to the transobturator four-arm TVM to increase its anti-incontinence effect. The proposed modification to the original surgical procedure includes the suture of the anterior part of the mesh to the mid-urethra to prevent the mesh sliding. We think that the appropriate elevation of the mid-urethra would thus occur with the anterior arms and that would achieve a more effective anti-incontinence. We designed a single-centre, prospective, double-blind (participant, investigator/surgeon, outcome assessor), randomized, controlled trial to evaluate the anti-SUI success rate for the modified TVM.

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Section: Discussioncontrasting

confidence: 56%

Slings and meshes in the therapy of prolapse and urinary incontinence

Fekete

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“…A műtét elvégzéséhez szükséges idő érthető módon szignifikánsan hosszabbnak mutatkozott a TVM-csoportban, mint a háló nélküli csoportban (39,01 ± 5,95 min vs. 35,55 ± 6,92 min), viszont az általunk mért műtéti idő a TVM-csoportban a nemzetközi irodalomban szereplőnél jobb volt (60,9 min) [30]. A becsült vérveszteség tekintetében a két csoport között nem találtunk jelentős eltérést, és az általunk becsült vérzés az A nemzetközi tanulmányokkal megegyezően saját vizsgálatunk során is azt az eredményt kaptuk, hogy az alkalmazott hálóműtét rekonstruktív képességben mind a süllyedést helyreállító, mind a genuin stresszincontinentiára kifejtett hatás tekintetében szignifikánsan jobb, mint a háló nélküli Kelly-Stoeckel-plastica.…”

Section: Megbeszélésunclassified

Hüvelyi hálóműtétek gyakorlata az amerikai korlátozó figyelmeztetés után. Merjem, vagy ne merjem?

2018

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“…Benson et al [ 5 ] show that the surgical technique concerning the use of meshes has better outcomes within apical vaginal prolapse compared to vaginal surgery with a sacrospinous fixation. A large amount of papers support the use of mesh in surgery; in particular, the guidelines for vaginal prolapse surgery show that meshes are better performing with respect to other traditional techniques [ 6 ]. In comparison to old techniques the innovative surgical procedure for transvaginal prolapse (Apogee, Perigee, and Prolift) has shown good results in short term, despite having significant complications such as buttock pain, vaginal erosion, erosion of the bladder, and infection and therefore should be used carefully.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical, Topological and Chemical Features That Influence the Implant Success of an Urogynecological Mesh: A Review

Maria

Santoro

Vozzi

2016

BioMed Research International

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Synthetic meshes are normally used to treat several diseases in the field of urogynecological surgery. Not-optimal selection of mesh and/or its not-correct implant may increase patient's pain and discomfort. The knowledge of mechanical behaviour and topological and chemical properties of a mesh plays a fundamental role to minimize patient's suffering and maximize the implant success. We analysed several papers reporting the meshes application for urogynecological pathologies, to extrapolate the principal parameters that normally are used to characterise the biomechanical, topological, and chemical properties, and to verify their influence on implant success. In this way we want demonstrate that, knowing these features, it is possible to foresee the success of a mesh implant. This review shows that the application of a mesh strictly depends on elastic modulus, failure load, porosity and pore size, filament diameter, polymer weight, and crystallinity. To increase the success of the implant and to help choice of optimal mesh for a clinical need, two indexes have been proposed for comparing, in an easier way, the mechanical performance of different commercially available meshes.

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Mesh repair of vaginal wall prolapse

Cited by 6 publications

References 12 publications

Slings and meshes in the therapy of prolapse and urinary incontinence

Slings and meshes in the therapy of prolapse and urinary incontinence

Hüvelyi hálóműtétek gyakorlata az amerikai korlátozó figyelmeztetés után. Merjem, vagy ne merjem?

Biomechanical, Topological and Chemical Features That Influence the Implant Success of an Urogynecological Mesh: A Review

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