Vaginal Mesh for Prolapse: A Randomized Controlled Trial

Iglesia, Cheryl B.; Sokol, Andrew I.; Gutman, Robert E.; Sokol, Eric R.; Kudish, Bela; Shott, Susan

doi:10.1097/aog.0b013e3181ff78e1

Cited by 29 publications

(49 citation statements)

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“…25 However, existing synthetic and natural materials for POP treatment in clinics cannot fully meet these requirements, as shown by 1) the high dyspareunia, infection, and erosion or extrusion rate resulting from the synthesis scaffolds and 2) the rapid degradation of natural scaffolds. [9][10][11][12][13][14][15][16] To overcome these problems, we constructed a composite nanofibrous membrane by electrospinning nanofibers with a PS core embedded in a gelatin sheath as a potential POP. Electrospinning provides a facile approach to fabricate nanofibrous scaffolds similar to natural extracellular matrix, in that they have large surface volume ratio for three-dimensional cell ingrowth and controlled release of bioactive molecules.…”

Section: Resultsmentioning

confidence: 99%

“…9,10 For example, a high vaginal mesh erosion rate (15.6%) at 3 months after surgery was reported. 11,12 On the other hand, naturally derived materials such as porcine dermis and SIS have many ideal characteristics for POP replacement, including cell compatibility and degradable properties. Their structural and functional proteins are similar to the native mammalian extracellular…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction

Ge¹,

Jiang

et al. 2015

IJN

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Pelvic organ prolapse (POP) is a serious health issue affecting many adult women. Complications of POP include pelvic pressure, pelvic pain, and problems in emptying their bowels or bladder. Sometimes, POP may even cause urinary outflow obstruction and lead to bladder or kidney infections. Currently, synthetic and naturally derived materials have been chosen for treatment of POP to reduce the high recurrence rates after surgical interventions. However, existing materials for POP treatment cannot meet the clinical requirements in terms of biocompatibility, mechanics, and minimal risk of rejection. Especially, erosion in synthetic polymers and rapid degradation in natural polymers limit their further applications in clinics. To address these concerns, we report a novel POP replacement using core–sheath polystyrene/gelatin electrospun nanofiber mesh. The outside gelatin sheath provides a hydrophilic surface and implantable integrity between host and guest, while the inner PS core offers the necessary mechanical support. The composite mesh shows graft accommodation in pelvic submucosa after implantation in vivo, as shown in hematoxylin–eosin staining and T helper cell phenotype and macrophage phenotype stainings. Qualitative analysis of inducible nitric oxide synthase, arginase, interferon-γ, and interleukin-10 gene expressions also indicates that the implanted composite mesh switches to accommodation mode 2 weeks postimplantation. Thus, these novel core–sheath polystyrene/gelatin nanofibrous membranes are promising in pelvic reconstruction.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction

Ge¹,

Jiang

et al. 2015

IJN

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“…[6][7][8][9][10] So, although the use of vaginal mesh reduces the risk of recurrent POP surgery, mesh-specific complications might negatively affect quality of life. Whether patients would accept mesh-specific complications to benefit from a lower risk of recurrence, or if they prefer to accept a higher risk of recurrence to avoid mesh-related complications is not known yet.…”

Section: Introductionmentioning

confidence: 99%

Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment

Notten

Essers

Weemhoff

et al. 2014

BJOG

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Objective We investigated patients' preferences for anterior colporrhaphy or mesh surgery as surgical correction of anterior vaginal wall prolapse.Design Labelled discrete choice experiment.Setting Three Dutch teaching hospitals.Population Women with anterior vaginal wall prolapse Pelvic Organ Prolapse Quantification stage 2 or more, indicated for anterior colporrhaphy (n = 100).Methods Discrete choice experiments are an attribute-based survey method for measuring preferences. In this experiment, women were asked to choose between two treatment scenarios, mesh surgery or anterior colporrhaphy. These surgical treatments differed in four treatment attributes: (i) recurrence rate, (ii) exposure rate, (iii) infection rate, (iv) dyspareunia. Data were analysed using a multinomial logit model.Main outcome measures Women's preferences for anterior colporrhaphy or mesh surgery for the repair of vaginal wall prolapse.Results All treatment attributes, i.e. recurrence, exposure, infection and dyspareunia, proved to be significant in the woman's decision to choose mesh surgery (P < 0.001), while only two attributes out of three, recurrence and infection, were significant for anterior colporrhaphy (P < 0.001). The relative importance data showed that with regards to the four statistically significant attributes for mesh, dyspareunia was the most important attribute, and of the two significant attributes for anterior colporrhaphy, the risk of infection. Based on the attributes and levels in our discrete choice experiment, anterior colporrhaphy was preferred in 74% as a primary correction of anterior vaginal wall prolapse, followed by a preference for mesh in 26% of all choices.Conclusion This study showed that next to the risk of recurrence, other aspects like risk of infection, dyspareunia and exposure play a role in the woman's preference for a surgical treatment. In addition, our results indicate that anterior colporrhaphy is preferred in the majority of the choices, followed by a preference for mesh surgery in a quarter of all choice sets. However, these results represent the average preference of a sample of women and cannot be taken as the preference of each individual. In the medical decision-making context, information from the current study should be personalised to fit patient's unique circumstances. For patients to construct their own, individual preferences, they should be well informed about the existence and magnitude of the potential benefits and risks related to either anterior colporrhaphy or mesh surgery.

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“…[13] Complications related to placement of mesh or passage of needle entrance such as visceral or vascular injury, also pelvic pain or mesh extrusion were reported. [14] This study aims to evaluate safety and efficacy of four arms polypropylene mesh in management of SUI associated with cystocele during the long term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Transobturator four arms mesh in the surgical management of stress urinary incontinence with cystocele

Sherif

Othman

Eldkhakhany

et al. 2017

Turkish Journal of Urology

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Objective: This study aims to evaluate safety and efficacy of four arms polypropylene mesh in the longterm follow-up in the management of stress urinary incontinence (SUI) associated with cystocele. Material and methods:This prospective study was conducted on 50 female patients with SUI associated with cystocele. Patients underwent placement of transobturator four-arms mesh implants. Stress incontinence was evaluated using cough stress test with and without prolapse reduction, Stamey's grading of SUI, the validated Arabic version of the International Consultation on Incontinence Questionnaire-Short Form and King Health Questionnaire forms. Perioperative parameters evaluated included age, body mass index, grade of SUI, time of procedure, hospital stay after surgery, difference between pre-, and postoperative serum hemoglobin values, and need for blood transfusion. Follow-up visits were planned at 3, 9 and 18 months after surgery. Results:The mean operative time was 37.4±10.2 (25-60) minutes. Blood transfusion was not required. The mean hospital stay was 30.5±10 (24-48) hrs. Five (10%) patients had fever and urinary tract infections were noticed in five (10%) patients. Two (4%) women had urine retention after catheter removal and vaginal mesh erosion was present in one (2%) patient. Forty (80%) patients were cured from SUI, 8 (16%) patients were improved and 2 (4%) patients failed to respond. Conclusion:Cystocele associated with SUI can be repaired with transobturator four-arms mesh with promising results, improved quality of life, and tolerable side effects.

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Vaginal Mesh for Prolapse: A Randomized Controlled Trial

Cited by 29 publications

References 1 publication

Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction

Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction

Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment

Transobturator four arms mesh in the surgical management of stress urinary incontinence with cystocele

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Vaginal Mesh for Prolapse: A Randomized Controlled Trial

Cited by 29 publications

References 1 publication

Integration of nondegradable polystyrene and degradable gelatin in a core&ndash;sheath nanofibrous patch for pelvic reconstruction

Integration of nondegradable polystyrene and degradable gelatin in a core&ndash;sheath nanofibrous patch for pelvic reconstruction

Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment

Transobturator four arms mesh in the surgical management of stress urinary incontinence with cystocele

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Resources

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Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction

Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction