Tags

Type your tag names separated by a space and hit enter

One-year outcome of concurrent anterior and posterior transvaginal mesh surgery for treatment of advanced urogenital prolapse: case series.
J Minim Invasive Gynecol. 2010 Jul-Aug; 17(4):473-9.JM

Abstract

STUDY OBJECTIVE

To estimate the safety and efficacy of performing concurrent anterior and posterior transvaginal mesh surgery using a commercially available kit (Gynecare PROLIFT Pelvic Floor Repair System; Ethicon, Inc., Somerville, NJ) for treatment of advanced urogenital prolapse (stage III or higher, Pelvic Organ Prolapse Quantification [POP-Q] system staging).

DESIGN

Case control series study (Canadian Task Force classification II-2).

SETTING

Medical school-affiliated hospital.

PATIENTS

Forty-three patients with severe prolapse, POP-Q stage III (n=23) or IV (n=20), underwent surgery and were followed up for more than 1 year. In patients with any prolapse greater than stage I, surgery were considered to have functional failure. The Surgical Satisfaction Questionnaire was used for subjective evaluation at 1 year postoperatively.

INTERVENTIONS

Extensive pelvic reconstructive procedures were primarily performed using a combination of the PROLIFT anterior and posterior pelvic systems (i.e., similar to sparing the intermediate section of the PROLIFT total pelvic system). The concurrent pelvic surgery included sequential vaginal total hysterectomy, perineorrhaphy, and suburethra sling, if indicated. Additional subjective and objective evaluations included POP-Q staging, urodynamic assessment, and preoperative and 12-month postoperative questionnaires.

MEASUREMENTS AND MAIN RESULTS

Objective and subjective data were available for 42 patients. The subjective cure rate and objective success rate for prolapse at 12-month follow-up was 95.2% and 97.6%, respectively. Mean follow-up was 15.7 months, operation time was 79.2 minutes, operative blood loss was 109.1 mL, and postoperative hospital stay was 4.1 days. Intraoperative and postoperative complications were minor. All patients voided spontaneously before discharge. One mesh extrusion, no wound defective healing, and no rejection were observed. Two patients developed asymptomatic recurrent rectocele (stage II, POP-Q staging) that required no surgical intervention. Urodynamic parameters related to voiding dysfunction improved after surgery. Significant improvements were found using the Incontinence Impact Questionnaire and the Urogenital Distress Inventory.

CONCLUSION

Using concurrent anterior and posterior transvaginal mesh for pelvic reconstructive surgery is a safe and an effective method for treating advanced pelvic prolapse. Mesh-related complications are likely minimal, and mesh protrusion at the apex is likely to not occur. Further studies with longer follow-up are required to evaluate long-term effectiveness.

Authors+Show Affiliations

Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan. 2378@cgmh.com.tw

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20547113

Citation

Lo, Tsia-Shu. "One-year Outcome of Concurrent Anterior and Posterior Transvaginal Mesh Surgery for Treatment of Advanced Urogenital Prolapse: Case Series." Journal of Minimally Invasive Gynecology, vol. 17, no. 4, 2010, pp. 473-9.
Lo TS. One-year outcome of concurrent anterior and posterior transvaginal mesh surgery for treatment of advanced urogenital prolapse: case series. J Minim Invasive Gynecol. 2010;17(4):473-9.
Lo, T. S. (2010). One-year outcome of concurrent anterior and posterior transvaginal mesh surgery for treatment of advanced urogenital prolapse: case series. Journal of Minimally Invasive Gynecology, 17(4), 473-9. https://doi.org/10.1016/j.jmig.2010.03.003
Lo TS. One-year Outcome of Concurrent Anterior and Posterior Transvaginal Mesh Surgery for Treatment of Advanced Urogenital Prolapse: Case Series. J Minim Invasive Gynecol. 2010 Jul-Aug;17(4):473-9. PubMed PMID: 20547113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-year outcome of concurrent anterior and posterior transvaginal mesh surgery for treatment of advanced urogenital prolapse: case series. A1 - Lo,Tsia-Shu, Y1 - 2010/05/23/ PY - 2009/11/16/received PY - 2010/02/26/revised PY - 2010/03/06/accepted PY - 2010/6/16/entrez PY - 2010/6/16/pubmed PY - 2010/9/30/medline SP - 473 EP - 9 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 17 IS - 4 N2 - STUDY OBJECTIVE: To estimate the safety and efficacy of performing concurrent anterior and posterior transvaginal mesh surgery using a commercially available kit (Gynecare PROLIFT Pelvic Floor Repair System; Ethicon, Inc., Somerville, NJ) for treatment of advanced urogenital prolapse (stage III or higher, Pelvic Organ Prolapse Quantification [POP-Q] system staging). DESIGN: Case control series study (Canadian Task Force classification II-2). SETTING: Medical school-affiliated hospital. PATIENTS: Forty-three patients with severe prolapse, POP-Q stage III (n=23) or IV (n=20), underwent surgery and were followed up for more than 1 year. In patients with any prolapse greater than stage I, surgery were considered to have functional failure. The Surgical Satisfaction Questionnaire was used for subjective evaluation at 1 year postoperatively. INTERVENTIONS: Extensive pelvic reconstructive procedures were primarily performed using a combination of the PROLIFT anterior and posterior pelvic systems (i.e., similar to sparing the intermediate section of the PROLIFT total pelvic system). The concurrent pelvic surgery included sequential vaginal total hysterectomy, perineorrhaphy, and suburethra sling, if indicated. Additional subjective and objective evaluations included POP-Q staging, urodynamic assessment, and preoperative and 12-month postoperative questionnaires. MEASUREMENTS AND MAIN RESULTS: Objective and subjective data were available for 42 patients. The subjective cure rate and objective success rate for prolapse at 12-month follow-up was 95.2% and 97.6%, respectively. Mean follow-up was 15.7 months, operation time was 79.2 minutes, operative blood loss was 109.1 mL, and postoperative hospital stay was 4.1 days. Intraoperative and postoperative complications were minor. All patients voided spontaneously before discharge. One mesh extrusion, no wound defective healing, and no rejection were observed. Two patients developed asymptomatic recurrent rectocele (stage II, POP-Q staging) that required no surgical intervention. Urodynamic parameters related to voiding dysfunction improved after surgery. Significant improvements were found using the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. CONCLUSION: Using concurrent anterior and posterior transvaginal mesh for pelvic reconstructive surgery is a safe and an effective method for treating advanced pelvic prolapse. Mesh-related complications are likely minimal, and mesh protrusion at the apex is likely to not occur. Further studies with longer follow-up are required to evaluate long-term effectiveness. SN - 1553-4650 UR - https://www.unboundmedicine.com/medline/citation/20547113/One_year_outcome_of_concurrent_anterior_and_posterior_transvaginal_mesh_surgery_for_treatment_of_advanced_urogenital_prolapse:_case_series_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(10)00115-9 DB - PRIME DP - Unbound Medicine ER -