Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes

Vu, Manhan; Letko, Juraj; Jirschele, Kelly; Gafni-Kane, Adam; Nguyen, Aimee; Du, H.; Goldberg, Roger P.

doi:10.1007/s00192-012-1780-5

Cited by 58 publications

(40 citation statements)

References 23 publications

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“…To the best of our knowledge, no previous studies on the mesh kit used in the present study have assessed quality of life aspects; yet again, other vaginal mesh operations have resulted in improvements in quality of life comparable with those in our study [7,28]. Preoperatively, the most distressing symptoms were related to lower urinary tract dysfunction and pelvic organ prolapse, which both to a large extent were relieved after surgery.…”

Section: Discussionsupporting

confidence: 72%

“…It is designed to provide level I support at the vaginal apex, while also providing level II support where a concomitant cystocele is likely to occur. The procedural technique was standardized before initiation of the study and was based on a previously described surgical technique [7]. In brief, the Uphold procedure is designed to use a small incision at the vaginal apex, to introduce a Capio® Suture Capturing Device, which helps to connect the mesh to the sacrospinous ligaments and suspend the apex.…”

Section: Methodsmentioning

confidence: 99%

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Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

et al. 2016

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Introduction and hypothesis The objective was to assess safety and clinical outcomes in women operated on using the Uphold™ Lite Vaginal Support System. Methods We carried out a 1-year, multicenter, prospective, single cohort study of 207 women with symptomatic Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 apical pelvic organ prolapse, with or without concomitant anterior vaginal wall prolapse. Safety data were collected using a standardized questionnaire. Anatomical outcome was assessed by the POP-Q and subjective outcomes by the Pelvic Floor Distress Inventory after 2 months and 1 year using a one-way repeated measures analysis of variance. Pain was evaluated using a visual analog scale. Results The overall rate of serious complications was 4.3 % (9 out of 207 patients), including 3 patients with bladder perforations, 1 with bleeding >1,000 ml, 2 who had undergone reoperations with complete mesh removal because of pain, and 3 surgical interventions during follow-up because of mesh exposure. POP-Q stage ≤1 after 1 year was 94 % and subjective symptom relief was reported by 91 % of patients (p < 0.001). Pain after 2 months and 1 year was 60 % lower compared with the preoperative mean (p < 0.001). Minor complications occurred in 20 women (9.7 %) and were dominated by lower urinary tract dysfunction. No predisposing risk factors for complications were found. Conclusions The Uphold™ Lite procedure in women with apical pelvic organ prolapse provided satisfactory restoration of vaginal topography and symptom relief. However, serious complication rates were largely comparable with those of other transvaginal mesh kits.

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Section: Discussionsupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

et al. 2016

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“…All patients underwent a pre-trial standardized surgical procedure using the Uphold TM Lite system and all gynecologic surgeons participating in the trial had supervised hands-on operating room training before initiation of the study. The surgical procedure has been described elsewhere [17]. Briefly a small incision was used, leaving approximately 2 cm undisturbed at the vaginal apex.…”

Section: Methodsmentioning

confidence: 99%

Quality of life after Uphold™ Vaginal Support System surgery for apical pelvic organ prolapse—A prospective multicenter study

Rahkola-Soisalo

Altman

Falconer

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To study the effects on quality of life in women operated for apical pelvic organ prolapse using the Vaginal Uphold TM System. Study design: In this prospective cohort study, women (n = 207) with symptomatic apical prolapse, with or without cystocele, were operated using the Uphold TM Vaginal Support System. Follow-up for quality of life was performed at 12 months after surgery, and assessed by the PFDI-20, and PFIQ-7, and sexual function by the PISQ-12. We used odds ratios (ORs) with 95% confidence intervals (CIs) for outcome association analyses using logistic regression.Results: At one-year follow-up majority of women experienced an overall postoperative improvement in quality of life (p < 0.001). One year after surgery Uphold TM operation alone increased the risk for prolapse related bother as compared to Uphold TM combined with anterior colporraphy (POP-IQ-7; OR 2.1; 95% CI 1.01-4.3). The frequency of dyspareunia decreased postoperatively (p = 0.004), however, after one-year, overall sexual function deteriorated significantly (p < 0.001). The worsening in sexual function scores was mainly attributed to the partner related domain, whereas the behavioral-emotive and physical domains showed no significant changes. Conclusion: Apical prolapse repair using Uphold TM improved quality of life among our patients but worsened overall sexual function postoperatively. 2016 Elsevier Ireland Ltd. All rights reserved. IntroductionAlthough the restoration of vaginal topography often results in improvements in pelvic organ prolapse symptoms the incongruence between objective and subjective outcomes in pelvic organ prolapse surgery is well established [1][2][3]. As a consequence, the focus of pelvic organ prolapse surgery has pivoted towards patients centered outcomes and quality of life measures, [4-6] rather than simply measuring pelvic anatomy outcomes of surgery.In women after pelvic organ prolapse surgery quality of life measures may entail a variety of domains of which the effects on sexual function has received perhaps the most attention [7]. Nonetheless, it remains unclear how, and to what extent, sexual dysfunction relates to pelvic reconstructive surgery. Some studies suggest that sexual dysfunction is a common sequela after mesh augmented reconstructive surgery [8,9], others suggest that surgery has no effect [10][11][12], or even improve sexual function domains [13,14]. Ambiguous results have also been shown for other quality of life domains in relation pelvic organ prolapse surgery.We have previously reported on the safety and efficacy outcomes and subjective relief of condition specific symptoms after using the Uphold TM Vaginal Support System [15]. In the present study we assessed quality of life and sexual function outcomes following Uphold TM surgery in a prospective cohort of women with apical prolapse and with or without concurrent cystocele.

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“…Reports of these complications led the Federal Drug Administration to issue a safety notification regarding the use of vaginally placed mesh in the treatment of pelvic organ prolapse [14]. It is noteworthy, however, that mesh exposure rates appear to be decreasing [15][16][17][18]. The first procedures using vaginal mesh followed the same surgical principles used in previous surgeries involving fascial grafts.…”

Section: Discussionmentioning

confidence: 99%

“…However, as techniques have evolved, the exposure rates are declining and are approaching those of ASCs. In a recent study by Goldberg's group, the mesh exposure rate was as low as 2.6 % [18].…”

Section: Discussionmentioning

confidence: 99%

Comparison of location of mesh placed transvaginally vs mesh placed abdominally at the time of sacrocolpopexy

et al. 2014

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ASC and full-thickness vaginal dissection result in histologically similar locations. Dissection for ASC may only result in the correct plane between the bladder and vagina in approximately 60 % of cases. We achieved full-thickness dissection for the transvaginal approach in 50 % of the cases, with one small penetration into the bladder serosa. Using a full-thickness dissection technique for TVM may be one way of reducing mesh exposure rates in those seen with ASC.

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Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes

Abstract: This technique resulted in successful outcomes within both anterior and apical compartments with a low rate of mesh complication, and no cases required mesh removal or hospital readmission. High rates of satisfaction and improved condition-specific QOL were observed.

Cited by 58 publications

References 23 publications

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

Quality of life after Uphold™ Vaginal Support System surgery for apical pelvic organ prolapse—A prospective multicenter study

Comparison of location of mesh placed transvaginally vs mesh placed abdominally at the time of sacrocolpopexy

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