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Short-term outcome after transvaginal mesh repair of pelvic organ prolapse

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Abstract

The objective of this study is to report on short-term outcomes after pelvic organ prolapse repair using Prolift® transvaginal mesh. A 3-year multicenter prospective cohort study was performed in 28 centers. Assessment preoperatively and at 2 months postoperatively included the condition-specific pelvic organ prolapse quantification system (POP-Q) and a macroscopic inflammatory scale. Subjective outcome was measured using the urogenital distress inventory (UDI) and the incontinence impact questionnaire (IIQ-7). Surgical characteristics and adverse events during follow-up were registered in a separate protocol. The evaluation is based on the interim safety analysis and includes 2-month evaluations of 123 cases. Pelvic organ perforation occurred in four cases (3.2%), three bladder injuries and one case of rectal perforation. At the 2-month follow-up, there were two cases of mesh exposure, an increase of mild–moderate granuloma formation in the operated areas (P < 0.003) but no cases of serious adverse tissue reactions related to the polypropylene mesh. Postoperative anatomical cure (defined as POP-Q stage 0–1) was 87% after anterior repair, 91% after posterior repair and 88% after total repair. All quality of life aspects measured by the IIQ-7 improved 2 months after surgery. Pelvic heaviness, vaginal bulging, and vaginal protrusion all decreased considerably (P < 0.001). There was also a significant improvement in several lower urinary tract symptoms and a decreased need for manually assisted defecation. This first report from an ongoing multicenter study suggests that transvaginal mesh surgery with the Prolift® system is associated with satisfactory outcomes 2 months after surgery. There were no severe adverse events attributed to the polypropylene mesh.

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References

  1. Baessler K, Maher CF (2006) Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits. Curr Opin Obstet Gynecol 18:560–566

    Article  PubMed  Google Scholar 

  2. Walters MD (2003) The use and misuse of prosthetic materials in reconstructive pelvic surgery: does the evidence support our surgical practice? Int Urogynecol J 14:365–366

    Article  Google Scholar 

  3. Nygaard I (2007) Marketed vaginal mesh kits: rampant experimentation or improved quality of care? Thoughts following the 2006 AUGS meeting by AUGS president Ingrid Nygaard, M.D. Int Urogynecol J 18:483–4

    Article  Google Scholar 

  4. Dwyer PL, O'Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG 111:831–836

    Article  PubMed  Google Scholar 

  5. Achtari C, Hiscock R, O'Reilly BA, Schierlitz L, Dwyer PL (2005) Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J 16:389–394

    Article  Google Scholar 

  6. Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B (2007) Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift™ technique)—a case series multicentric study. Int Urogynecol J 18:743–752

    Article  CAS  Google Scholar 

  7. Parker MC, Phillips RK (1993) Repair of rectocoele using Marlex mesh. Ann R Coll Surg Engl 75:193–194

    PubMed  CAS  Google Scholar 

  8. Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Phillips RK (1996) Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg 183:257–261

    PubMed  CAS  Google Scholar 

  9. Flood CG, Drutz HP, Waja L (1998) Anterior colporrhaphy reinforced with Marlex mesh for the treatment of cystoceles. Int Urogynecol J 9:200–204

    Article  CAS  Google Scholar 

  10. Beets GL, Go PM, van Mameren H (1996) Foreign body reactions to monofilament and braided polypropylene mesh used as preperitoneal implants in pigs. Eur J Surg 162:823–825

    PubMed  CAS  Google Scholar 

  11. Dietz HP, Vancaillie P, Svehla M, Walsh W, Steensma AB, Vancaillie TG (2003) Mechanical properties of urogynecologic implant materials. Int Urogynecol J 14:239–243

    Article  CAS  Google Scholar 

  12. Debodinance P, Berrocal J, Clave H, Cosson M, Garbin O, Jacquetin B, Rosenthal C, Salet-Lizee D, Villet R (2004) Changing attitudes on the surgical treatment of urogenital prolapse: birth of the tension-free vaginal mesh [article in French]. J Gynecol Obstet Biol Reprod 33:577–588

    CAS  Google Scholar 

  13. de Tayrac R, Picone O, Chauveaud-Lambling A, Fernandez H (2006) A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh. Int Urogynecol J 17:100–105

    Article  Google Scholar 

  14. Falconer C, Soderberg M, Blomgren B, Ulmsten U (2001) Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J 12:S19–23

    Article  Google Scholar 

  15. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  PubMed  CAS  Google Scholar 

  16. Zdichavsky M, Jones JW, Ustuner ET, Ren X, Edelstein J, Maldonado C, Breidenbach W, Gruber SA, Ray M, Barker JH (1999) Scoring of skin rejection in a swine composite tissue allograft model. J Surg Res 85:1–8

    Article  PubMed  CAS  Google Scholar 

  17. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res 3:291–306

    Article  PubMed  CAS  Google Scholar 

  18. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14:131–139

    Article  PubMed  CAS  Google Scholar 

  19. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J 14:164–168

    Article  Google Scholar 

  20. Hiltunen R, Nieminen K, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2007) Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 110:455–462

    PubMed  Google Scholar 

  21. Mellgren A, Anzen B, Nilsson BY, Johansson C, Dolk A, Gillgren P, Bremmer S, Holmstrom B (1995) Results of rectocele repair. A prospective study. Dis Colon Rectum 38:7–13

    Article  Google Scholar 

  22. Kenton K, Shott S, Brubaker L (1999) Outcome after rectovaginal fascia reattachment for rectocele repair. Am J Obstet Gynecol 181:1360–1364

    Article  PubMed  CAS  Google Scholar 

  23. Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U (2001) Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J 12(Suppl 2):S5–S8

    Article  Google Scholar 

  24. Altman D, Falconer C (2007) Perioperative morbidity using transvaginal mesh in pelvic organ prolapse repair. Obstet Gynecol 109:303–308

    PubMed  Google Scholar 

  25. Popovic I, Debodinance P, Cosson M, Boukerrou M (2007) Prosthetic reinforcements: how to manage bladder injuries? Int Urogynecol J 18:1215–1217 DOI 10.1007/s00192-007-0310-3

    Article  CAS  Google Scholar 

  26. LaSala CA, Schimpf MO (2007) Occurrence of postoperative hematomas after prolapse repair using a mesh augmentation system. Obstet Gynecol 109:569–572

    PubMed  Google Scholar 

  27. Kenton KS, Woods MP, Brubaker L (2002) Uncomplicated erosion of polytetrafluoroethylene grafts into the rectum. Am J Obstet Gynecol 187:233–234

    Article  PubMed  Google Scholar 

  28. Yamada BS, Govier FE, Stefanovic KB, Kobashi KC (2006) Vesicovaginal fistula and mesh erosion after Perigee (transobturator polypropylene mesh anterior repair). Urology 68:1121–1127

    Article  PubMed  Google Scholar 

  29. Deffieux X, de Tayrac R, Huel C, Bottero J, Gervaise A, Bonnet K, Frydman R, Fernandez H (2007) Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J 18:73–79

    Article  CAS  Google Scholar 

  30. Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164:965–969

    Article  PubMed  CAS  Google Scholar 

  31. Altman D, Mellgren A, Blomgren B, Lopez A, Zetterstrom J, Nordenstam J, Falconer C (2004) Clinical and histological safety assessment of rectocele repair using collagen mesh. Acta Obstet Gynecol Scand 83:995–1000

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was made possible through the cooperation and collective efforts of the Nordic transvaginal mesh group, listed in alphabetical order: (Denmark) Susanne Axelsen, Karl Möller Bek, Skejby Hospital, Skejby, Jens Prien Larsen, Nyköbing Hospital, Nyköbing; (Finland) Pentti Kiilholma, Riikka Aaltonen, Turku University Hospital, Turku, Teuvo Takala, Tiina Vaari, Päisät-Hämes Central Hospital Lahti, Tapio Väyrynen, Jorvi Hospital, Espoo, Hans-Anders Unnérus, Helsinski University Central Hospital, Lohja Hospital, Lohja; (Norway) Marie Elström Engh, Akershus University Hospital, Ahus, Anja Holstad, Gjøvik Hospital, Gjøvik, Kolbjörn Kasin, Kongsberg Hospital, Kongsberg, Rolf Kirschner, Rikshospitalet, Oslo, Anne-Grethe Paulsen, Haukeland Hospital, Bergen, Sigurd Kulseng Hansen, Asker & Bærum Hospital, Bærum, Margareta Verelst, Regional Hospital in Tromsø, Tromsø; (Sweden) Daniel Altman, Danderyd Hospital, Stockholm, Bo Anzén, Danderyd Hospital, Stockholm, Lena Clementsson, Kristiansstad Hospital, Kristiansstad, Christian Falconer, Danderyd Hospital, Stockholm, Folke Flam, St. Göran Hospital, Stockholm, Eva Fornell, Linköping University Hospital, Linköping, Jonas Gunnarsson, Sahlgrenska University Hospital, Göteborg, Björn Holm, Örebro University Hospital, Örebro, Kenneth Krohn, Vrinnevi Hospital, Norrköping, Nina Kyrklund, Danderyd Hospital, Stockholm, Gregor Larson, Västerås Hospital, Västerås, P-G Larsson, Skaraborg Hospital Skövde, Skövde, Paula Löwenadler, Ystad Hospital, Ystad, Mazoumeh Rezapour, Uppsala University Hospital, Uppsala, Gunilla Tegerstedt, South Hospital, Stockholm, Vasiliki Tsaknakis, Halmstad Hospital, Halmstad, Jan Zetterström, Danderyd Hospital, Stockholm.

Competing interests and financial disclosure

D.A. has an educational advisory position for Gynecare Scandinavia. C.F. has an advisory board position for Gynecare Scandinavia. None of the researchers in the Nordic transvaginal mesh group own stock or hold stock options in the mesh manufacturing company. The study was instigated by the responsible researchers and entirely funded by university-administered research funds including grants from the Swedish Society of Medicine. Investigator meetings in relation to the study have been sponsored by Gynecare Scandinavia.

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Authors and Affiliations

  1. Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 182 88, Stockholm, Sweden

    Daniel Altman & Christian Falconer

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Daniel Altman

  3. Helsinki University Central Hospital, Department of Obstetrics and Gynecology, Jorvi Hospital, Espoo, Finland

    Tapio Väyrynen

  4. Department of Obstetrics and Gynaecology, Akershus University Hospital, University of Oslo, Lørenskog, Norway

    Marie Ellström Engh

  5. Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark

    Susanne Axelsen

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  1. Daniel Altman
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  2. Tapio Väyrynen
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  3. Marie Ellström Engh
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  4. Susanne Axelsen
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  5. Christian Falconer
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For the Nordic Transvaginal Mesh Group

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Correspondence to Daniel Altman.

Additional information

Clinical trial registration available at www.clinicaltrials.gov, identifier NCT00402844.

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Altman, D., Väyrynen, T., Engh, M.E. et al. Short-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J 19, 787–793 (2008). https://doi.org/10.1007/s00192-007-0526-2

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  • DOI: https://doi.org/10.1007/s00192-007-0526-2

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