The role of synthetic and biological prostheses in reconstructive pelvic floor surgery

Birch, Colin; Fynes, Michelle

doi:10.1097/00001703-200210000-00015

Cited by 138 publications

(97 citation statements)

References 60 publications

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“…In the same mentioned Julian's study, the healing was achieved in 100% patients with mesh, but 25% of related morbidity was added due to the features of the prosthetic material used. To prevent these complications, we should consider the pore sizes, which along with material and filament knit provide the level of flexibility to the mesh (14), decreasing the chance of erosion as it is larger.…”

Section: Discussionmentioning

confidence: 99%

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

et al. 2006

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Objectives: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. Materials and Methods: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. Results: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. Discussion: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.

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Section: Discussionmentioning

confidence: 99%

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

et al. 2006

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“…Therefore, the discrepancy in age was not explained by a larger proportion of women who were having further surgery among the non-recruited women. (12). e, Randomised in error: one woman had baseline comorbidities that made her ineligible for PROSPECT; one woman had prolapse surgery privately after declining to participate but prior to randomisation.…”

Section: Non-recruited Womenmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of surgical options for the management of anterior and/or posterior vaginal wall prolapse: two randomised controlled trials within a comprehensive cohort study – results from the PROSPECT Study

Glazener

Breeman

Elders

et al. 2016

Health Technol Assess

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BackgroundThe use of mesh in prolapse surgery is controversial, leading to a number of enquiries into its safety and efficacy.ObjectiveTo compare synthetic non-absorbable mesh inlay, biological graft and mesh kit with a standard repair in terms of clinical effectiveness, adverse effects, quality of life (QoL), costs and cost-effectiveness.DesignTwo randomised controlled trials within a comprehensive cohort (CC) study. Allocation was by a remote web-based randomisation system in a 1 :1 : 1 ratio (Primary trial) or 1 : 1 : 2 ratio (Secondary trial), and was minimised on age, type of prolapse repair planned, need for a concomitant continence procedure, need for a concomitant upper vaginal prolapse procedure and surgeon. Participants and outcome assessors were blinded to randomisation; participants were unblinded if they requested the information. Surgeons were not blinded to allocated procedure.SettingThirty-five UK hospitals.ParticipantsPrimary study: 2474 women in the analysis (including 1348 randomised) having primary anterior or posterior prolapse surgery.Secondary study: 398 in the analysis (including 154 randomised) having repeat anterior or posterior prolapse surgery.CC3: 215 women having either uterine or vault prolapse repair.InterventionsAnterior or posterior repair alone, or with mesh inlay, biological graft or mesh kit.Main outcome measuresProlapse symptoms [Pelvic Organ Prolapse Symptom Score (POP-SS)]; prolapse-specific QoL; cost-effectiveness [incremental cost per quality-adjusted life-year (QALY)].ResultsPrimary trials: adjusting for baseline and minimisation covariates, mean POP-SS was similar for each comparison {standard 5.4 [standard deviation (SD) 5.5] vs. mesh 5.5 (SD 5.1), mean difference (MD) 0.00, 95% confidence interval (CI) –0.70 to 0.71; standard 5.5 (SD 5.6) vs. graft 5.6 (SD 5.6), MD –0.15, 95% CI –0.93 to 0.63}. Serious non-mesh adverse effects rates were similar between the groups in year 1 [standard 7.2% vs. mesh 7.8%, risk ratio (RR) 1.08, 95% CI 0.68 to 1.72; standard 6.3% vs. graft 9.8%, RR 1.57, 95% CI 0.95 to 2.59]. There were no statistically significant differences between groups in any other outcome measure. The cumulative mesh complication rates over 2 years were 2 of 430 (0.5%) for standard repair (trial 1), 46 of 435 (10.6%) for mesh inlay and 2 of 368 (0.5%) for biological graft. The CC findings were comparable. Incremental costs were £363 (95% CI –£32 to £758) and £565 (95% CI £180 to £950) for mesh and graft vs. standard, respectively. Incremental QALYs were 0.071 (95% CI –0.004 to 0.145) and 0.039 (95% CI –0.041 to 0.120) for mesh and graft vs. standard, respectively. A Markov decision model extrapolating trial results over 5 years showed standard repair had the highest probability of cost-effectiveness, but results were surrounded by considerable uncertainty.Secondary trials: there were no statistically significant differences between the randomised groups in any outcome measure, but the sample size was too small to be conclusive. The cumulative mesh complication rates over 2 years were 7 of 52 (13.5%) for mesh inlay and 4 of 46 (8.7%) for mesh kit, with no mesh exposures for standard repair.ConclusionsIn women who were having primary repairs, there was evidence of no benefit from the use of mesh inlay or biological graft compared with standard repair in terms of efficacy, QoL or adverse effects (other than mesh complications) in the short term. The Secondary trials were too small to provide conclusive results.LimitationsWomen in the Primary trials included some with a previous repair in another compartment. Follow-up is vital to identify any long-term potential benefits and serious adverse effects.Future workLong-term follow-up to at least 6 years after surgery is ongoing to identify recurrence rates, need for further prolapse surgery, adverse effects and cost-effectiveness.TriaI registrationCurrent Controlled Trials ISRCTN60695184.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 95. See the NIHR Journals Library website for further project information.

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“…The polypropylene mesh used in our patients has the ideal sling material characteristics of not being absorbable, and being easy to access and apply. There is information that especially mesh of Type I material with macroporous and monofilament characteristics reduces the risk of erosion and infection [22,23]. In our patient group, we used monofilament polypropylene mesh with Type I characteristics, and only encountered vaginal erosion in 2 patients.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Vaginal Tape Surgery at Stress Urinary Incontinence: Our Medium-Term Results

İrkılata¹

2016

Ann Clin Anal Med

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Anahtar KelimelerGerilimsiz Vajinal Tape; Subüretral Sling; Stres Üriner İnkontinans; Ürodinami Abstract Aim: Percutaneous vaginal tape surgery is a cheap and effective choice among stress urinary incontinence surgeries. It is aimed to evaluate the characteristics and the treatment results of patients who underwent percutaneous vaginal tape surgery in this study. Material and Method: The clinical characteristics of 48 patients who underwent percutaneous vaginal tape surgery were retrospectively investigated. The patients were asked about ability to hold urine and quality of life during clinical check-ups and by telephone. Results: The average age of the 48 patients was 51.17±9.96 years. The average cystometric capacity was 445±107.08 ml and average Q max values before and after the operation were 31.10±11.38 ml/s and 23.20±14.27 ml/s (p=0.23). The general patient results after an average of over six months were 79.2% cure, 18.75% improvement and 2.05% unsuccessful. Of the 19 patients who remained for monitoring, after an average 58.4 month followup 16 (84.2%) patients fully cure, and 3 (15.8%) reported renewal of complaints after initial improvement. Discussion: Currently, application simplicity, short and medium-term successful results, and acceptable low complication rates make percutaneous vaginal tape surgery is a good treatment alternative that can be chosen for stress urinary incontinence cases.

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The role of synthetic and biological prostheses in reconstructive pelvic floor surgery

Cited by 138 publications

References 60 publications

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

Clinical effectiveness and cost-effectiveness of surgical options for the management of anterior and/or posterior vaginal wall prolapse: two randomised controlled trials within a comprehensive cohort study – results from the PROSPECT Study

Percutaneous Vaginal Tape Surgery at Stress Urinary Incontinence: Our Medium-Term Results

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