Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study

Abstract

The aim of this study was to evaluate the anatomical and functional results of a low-weight polypropylene mesh coated with an absorbable film in prolapse surgery by vaginal route. We have conducted a prospective multicentre study in 13 gynaecological and urological units. There were 230 patients requiring repair for anterior or posterior vaginal prolapse included. The present report is based on the analysis of the first 143 patients evaluated after at least 10 months follow-up. All patients were operated by the vaginal route using a specially designed mesh (Ugytex, Sofradim, France). Prolapse severity were evaluated using the Pelvic Organ Prolapse staging system. Symptoms and quality of life were evaluated preoperatively and during follow-up using the validated Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) self-questionnaires. Mean age was 63 years (37-91). Anterior, posterior and anterior-posterior repair with the mesh were performed in 67 (46.9%), 11 (7.7%) and 65 (45.4%) patients, respectively. With a mean follow-up of 13 months (10-19), 132 patients were considered anatomically cured (92.3%) with a recurrence rate of 9 of 132 for cystocele (6.8%) and 2 of 76 for rectocele (2.6%). Nine vaginal erosions occurred (6.3%), six of them necessitated another procedure by simple excision. The rate of de novo dyspareunia was 12.8%. At follow-up, improvement of PFDI and PFIQ scores were highly significant (p<0.0001). The use of low-weight polypropylene mesh coated with a hydrophilic absorbable film for vaginal repair of genital prolapse seems to decrease local morbidity while maintaining low recurrence rates.

Trocar-guided polypropylene mesh for pelvic organ prolapse surgery—perioperative morbidity and short-term outcome of the first 100 patients

“…In our study, no validated method was used in pre-and postoperative examination but the follow-up was 1 year, which is considered as a minimum adequate period of time to assess the efficacy of prolapse repair [22]. There have been reports of anatomically high success rates when meshes are used [10][11][12]16] and also significant improvements in the patients' quality of life have been reported [9]. Anatomical cure is naturally a remarkable indicator for outcome, especially when evaluating new surgical techniques for treating POP.…”

“…The serious perioperative complication rates related to procedures using meshes in vaginal surgery have been low [11,12]. However, postoperative mesh-related adverse events, e.g., mesh erosion, may affect the quality of life in the long-term follow-up.…”

Efficacy and Safety of "Tension-free" Placement of Gynemesh PS for the Treatment of Anterior Vaginal Wall Prolapse

“…These include a poor healing environment, which is influenced by blood flow, infections, foreign body reactions, patient age, concomitant hysterectomy, and mesh characteristics. de Tayrac et al [19] reported that vaginal erosion occurred three times more often when a concomitant hysterectomy was performed. The authors explained that this difference was most likely due to vessel injury associated with uterine cervix dissection.…”

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

“…In studies with apical fixation or concomitant apical surgery [71][72][73][74][75][76][77][78][79], anterior repair using a synthetic mesh (excluding Prolift ® and Perigee ® ) had a cumulative success rate of 93 %; the cumulative success rate of studies without apical fixation or without standard apical surgery [80][81][82][83][84][85][86][87][88][89] was 83 %. The cumulative rate of mesh erosion was 8 % (137/1740); the cumulative rate for chronic pain and de novo dyspareunia was 7% (59/846).…”