Prospective analysis of transvaginal mesh hysteropexy in the treatment of uterine prolapse

Abstract

Introduction and hypothesisThe aim of this study was to assess the efficacy of using transvaginal mesh to correct uterine prolapse by hysteropexy. Methods This was a single-center, prospective study of 40 subjects with bothersome uterine prolapse. Inclusion criteria were bothersome perception of a vaginal bulge on Pelvic Floor Distress Inventory short form (PFDI-20) and having a Pelvic Organ Prolapse Quantification System (POP-Q) point C of −2 or worse. Exclusionary criteria included inability to consent, history of pelvic malignancies, or any prior prolapse repair. Eligible subjects were treated with transvaginal mesh hysteropexy between March 2016 and July 2018 for a primary outcome of composite success, which was defined by a POP-Q point C value of −2 or higher, PFDI−20 question 3 indicating no bothersome perception of prolapse, and no retreatment. Secondary outcomes included responses to condition-specific and quality-of-life questionnaires, satisfaction/regret, and complications. Results Transvaginal mesh hysteropexy was performed in 40 subjects. The majority (68%) had advanced stage (III/IV) uterine prolapse. At a median follow-up of 12 months, there was an 84% composite success, and considering only anatomic criteria (POP-Q point C < -1), there was a 92% success. No subject required reintervention for recurrent or persistent uterine prolapse. There were no cases of mesh exposures. In terms of safety, one subject required a blood transfusion for symptomatic anemia (Clavien-Dindo grade II), and one subject reported de novo dyspareunia from a perineal band that was released in office at 6 months (grade IIIa), but otherwise there were no serious immediate or late complications. There were significant improvements in both condition-specific and quality-oflife assessments from baseline. Subject satisfaction and acceptance for the procedure were high. Conclusions In this single-center case series of 40 women with bothersome uterovaginal prolapse, transvaginal mesh hysteropexy appears safe and effective for correcting advanced stage uterine prolapse at the short term. A future multicenter controlled trial would be needed to determine efficacy against native tissue repair.

Experiencia de la histeropexia vaginal, usando prótesis de polipropileno

“…Resultados que se encuentran dentro de los reportados por Fatton et al 15 , quienes, en un estudio multicéntrico que incluyó 110 pacientes, publicaron una tasa de fracaso del 4,7%. No obstante, Khandwala et al reportaron en la histeropexia transvaginal con prótesis un 84% de éxito combinado, en una población de 40 participantes 29 , porcentaje discretamente inferior al 90,47%, de nuestros resultados.…”

Vaginal mesh hysteropexy: a review

“…Case series further supported the use of vaginal mesh hysteropexy to treat POP. Reports with as many as 291 patients demonstrated high success with low complication rates with vaginal mesh hysteropexy [35 ▪ –37 ▪ ,38,39 ▪ ,40,41]. Follow-up periods ranged from 12 to 26 months, but success rates were 83–98% for both anatomic and composite success.…”

Letter to “Prospective analysis of transvaginal mesh hysteropexy in the treatment of uterine prolapse”

“…Dear Editor, I read with great interest the recently published article on the efficiency of transvaginal mesh hysteropexy operation for uterine prolapse [1]. There are, however, several potential issues with the article, with implications for the reliability of the findings.…”