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[Implants for genital prolapse : Pro mesh surgery].
Urologe A 2017; 56(12):1576-1582U

Abstract

There has been an overall increase in pelvic organ prolapse due to demographic changes (increased life expectancy). Increasing sociocultural demands of women require treatments that are more effective with methods that are more successful. In the treatment of pelvic floor insufficiency and uterovaginal prolapse, pelvic floor reconstructions with mesh implants have proven to be superior to conventional methods such as the classic colporrhaphy, reconstructions with biomaterial, and native tissue repair in appropriately selected patients and when applying exact operation techniques, especially because of good long-term results and low recurrence rates. When making a systematic therapy plan, one should adhere to certain steps, for example, a pelvic floor reconstruction should be undertaken before performing the corrective procedure for incontinence. The approach, if vaginal, laparoscopic, or abdominal should be chosen wisely, taking into consideration the required space of action, in such a way that none or only minimal collateral damage related to the operation occurs. The use of instrumental suturing techniques and operation robots are advantageous in the case of difficult approaches and limited anatomical spaces. In principle, the surgeon who implants meshes should be able to explant them! The surgical concept of mesh-related interventions in the pelvis must meet established rules. "Implant as little mesh as possible and only as much suitable (!) mesh as absolutely necessary!" In the case of apical direct fixations, a therapeutically relevant target variable is the elevation angle of vagina (EAV). Established anatomical fixation points are preferable. A safe distance between implants and vulnerable tissue is to be maintained. Mesh-based prolapse repairs are indicated in recurrences, in primary situations, in combined defects of the anterior compartment, in central defects of multimorbid and elderly patients, and above all, when organ preservation is wanted. Native connective tissue structures are to be preserved, strengthened and reconstructed to restore altered functions. Practical skills for highly specialized mesh-based operations as well as effective techniques for complication management should be taught in interdisciplinary specialist courses.

Authors+Show Affiliations

Charité - Universitätsmedizin Berlin, Berlin, Deutschland. joerg.neymeyer@charite.de. Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland. joerg.neymeyer@charite.de.Charité - Universitätsmedizin Berlin, Berlin, Deutschland.Charité - Universitätsmedizin Berlin, Berlin, Deutschland.Charité - Universitätsmedizin Berlin, Berlin, Deutschland.Charité - Universitätsmedizin Berlin, Berlin, Deutschland.

Pub Type(s)

Journal Article
Review

Language

ger

PubMed ID

29134243

Citation

Neymeyer, J, et al. "[Implants for Genital Prolapse : Pro Mesh Surgery]." Der Urologe. Ausg. A, vol. 56, no. 12, 2017, pp. 1576-1582.
Neymeyer J, Moldovan DE, Kornienko K, et al. [Implants for genital prolapse : Pro mesh surgery]. Urologe A. 2017;56(12):1576-1582.
Neymeyer, J., Moldovan, D. E., Kornienko, K., Miller, K., & Weichert, A. (2017). [Implants for genital prolapse : Pro mesh surgery]. Der Urologe. Ausg. A, 56(12), pp. 1576-1582. doi:10.1007/s00120-017-0540-z.
Neymeyer J, et al. [Implants for Genital Prolapse : Pro Mesh Surgery]. Urologe A. 2017;56(12):1576-1582. PubMed PMID: 29134243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Implants for genital prolapse : Pro mesh surgery]. AU - Neymeyer,J, AU - Moldovan,D-E, AU - Kornienko,K, AU - Miller,K, AU - Weichert,A, PY - 2017/11/15/pubmed PY - 2019/3/21/medline PY - 2017/11/15/entrez KW - Descensus KW - Elevation angle of vagina (EAV) KW - Mesh KW - Sacropexy KW - Triplefixation SP - 1576 EP - 1582 JF - Der Urologe. Ausg. A JO - Urologe A VL - 56 IS - 12 N2 - There has been an overall increase in pelvic organ prolapse due to demographic changes (increased life expectancy). Increasing sociocultural demands of women require treatments that are more effective with methods that are more successful. In the treatment of pelvic floor insufficiency and uterovaginal prolapse, pelvic floor reconstructions with mesh implants have proven to be superior to conventional methods such as the classic colporrhaphy, reconstructions with biomaterial, and native tissue repair in appropriately selected patients and when applying exact operation techniques, especially because of good long-term results and low recurrence rates. When making a systematic therapy plan, one should adhere to certain steps, for example, a pelvic floor reconstruction should be undertaken before performing the corrective procedure for incontinence. The approach, if vaginal, laparoscopic, or abdominal should be chosen wisely, taking into consideration the required space of action, in such a way that none or only minimal collateral damage related to the operation occurs. The use of instrumental suturing techniques and operation robots are advantageous in the case of difficult approaches and limited anatomical spaces. In principle, the surgeon who implants meshes should be able to explant them! The surgical concept of mesh-related interventions in the pelvis must meet established rules. "Implant as little mesh as possible and only as much suitable (!) mesh as absolutely necessary!" In the case of apical direct fixations, a therapeutically relevant target variable is the elevation angle of vagina (EAV). Established anatomical fixation points are preferable. A safe distance between implants and vulnerable tissue is to be maintained. Mesh-based prolapse repairs are indicated in recurrences, in primary situations, in combined defects of the anterior compartment, in central defects of multimorbid and elderly patients, and above all, when organ preservation is wanted. Native connective tissue structures are to be preserved, strengthened and reconstructed to restore altered functions. Practical skills for highly specialized mesh-based operations as well as effective techniques for complication management should be taught in interdisciplinary specialist courses. SN - 1433-0563 UR - https://www.unboundmedicine.com/medline/citation/29134243/[Implants_for_genital_prolapse_:_Pro_mesh_surgery] L2 - https://dx.doi.org/10.1007/s00120-017-0540-z DB - PRIME DP - Unbound Medicine ER -