International Urogynecology Journal

, Volume 23, Issue 12, pp 1753–1761

Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes

  • Manhan K. Vu
  • Juraj Letko
  • Kelly Jirschele
  • Adam Gafni-Kane
  • Aimee Nguyen
  • Honyan Du
  • Roger P. Goldberg
Original Article

DOI: 10.1007/s00192-012-1780-5

Cite this article as:
Vu, M.K., Letko, J., Jirschele, K. et al. Int Urogynecol J (2012) 23: 1753. doi:10.1007/s00192-012-1780-5

Abstract

Introduction and hypothesis

Here we describe anatomic and quality of life (QOL) outcomes of an anterior and apical compartment prolapse repair involving a reduced mesh implant size and apex-only fixation.

Methods

One hundred and fifteen patients undergoing the repair at a single urogynecology center were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) and inpatient chart reviews. A horizontal incision eliminated overlap with the mesh, and each sacrospinous ligament was approached anteriorly by blunt dissection. Recurrence was defined as apical (C), or anterior (Aa or Ba) ≥0, and secondary analyses were performed using POP-Q ≥ −1 as the anatomic threshold. Pelvic Floor Distress Inventory (PFDI), Surgical Satisfaction Questionnaires (SSQ) and a dyspareunia symptom scale were analyzed pre- and postoperatively.

Results

Fifty-three women with uterus in situ demonstrated a combined anterior–apical recurrence rate of 1.89 %, including no anterior (Ba ≥ −1) and one apical (C ≥ −1) recurrence. Forty-seven women undergoing repair for vault prolapse had recurrence rates ranging from 0 % in those with prior hysterectomy to 4.2 % in those undergoing concurrent hysterectomy. The rate of mesh exposure was 3/115 (2.6 %), including two in women with concurrent hysterectomy. Self-reported dyspareunia was more common preoperatively (13.4 %) than postoperatively (9.3 %). PFDI scores improved in all domains, and 93 % completing the SSQ reported they were satisfied and would choose the surgery again.

Conclusions

This technique resulted in successful outcomes within both anterior and apical compartments with a low rate of mesh complication, and no cases required mesh removal or hospital readmission. High rates of satisfaction and improved condition-specific QOL were observed.

Keywords

CystoceleUterine prolapseMeshPelvic organ prolapseUpholdQuality of life

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Manhan K. Vu
    • 1
    • 3
  • Juraj Letko
    • 1
  • Kelly Jirschele
    • 1
  • Adam Gafni-Kane
    • 1
  • Aimee Nguyen
    • 1
  • Honyan Du
    • 2
  • Roger P. Goldberg
    • 1
  1. 1.University of Chicago Pritzker School of MedicineNorthShore University HealthSystem Division of UrogynecologyEvanstonUSA
  2. 2.Center for Clinical and Research InformaticsNorthShore University HealthSystemEvanstonUSA
  3. 3.Fort WorthUSA