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Long-term outcomes of synthetic transobturator nonabsorbable anterior mesh versus anterior colporrhaphy in symptomatic, advanced pelvic organ prolapse surgery

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Abstract

Introduction and hypothesis

Anterior vaginal mesh (AVM) combined with sacrospinous ligament fixation (SSF) yields better long-term success rates over anterior colporrhaphy (AC) in advanced pelvic organ prolapse (POP) surgery, with a low rate of mesh-related complications.

Methods

Medical records of 198 patients who underwent surgery for POP between January 2006 and March 2010 were reviewed retrospectively. Patients’ assessment at baseline and third-year postoperative follow-up were analyzed. SSF plus AC or AVM was performed for apical and anterior compartment repair. Primary outcome was objective cure [Pelvic Organ Prolapse Quantification (POP-Q) stage ≤ 1)], and subjective cure defined as negative response to questions 2 and 3 on the POPDI-6. Secondary outcomes were complications, symptoms severity and quality of life as measured with validated questionnaires.

Results

Post-operative data were available for 186 patients, 72 in AC group and 114 in AVM group were analyzed. The mean age, parity and operating time in AVM group were significantly higher as compared to AC group. The overall objective and subjective cure rate in AVM group was significantly higher than AC group (90.3 % and 88.6 % versus 73.6 % and 70.8 %, with P value = 0.003 and 0.002 respectively). Mesh exposure rate was 3.5 %. Improvement in both POPDI-6 and PISQ-12 in AVM group was statistically significant compared to AC group.

Conclusion

Transobturator synthetic nonabsorbable AVM combined with SSF yielded a favorable and sustainable result over 5 years as compared to traditional AC, both in anatomical and subjective success rate. Mesh related morbidities were low and acceptable.

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Abbreviations

AVM:

Anterior vaginal mesh

AC:

Anterior colporrhaphy

SSF:

Sacrospinous ligament fixation

POP:

Pelvic organ prolapse

POP-Q:

Pelvic Organ Prolapse Quantification system

POPDI-6:

Pelvic Organ Prolapse Distress Inventory 6

PISQ-12:

Pelvic Organ Prolapse/Urinary Incontinence Sexual Function 12 questionnaire

FDA:

Food and Drug Administration

RCT:

Randomized controlled trial

IIQ-7:

Incontinence Impact Questionnaire 7

UDI-6:

Urogenital Distress Inventory 6

USI:

Urodynamic stress incontinence

CISC:

Clean intermittent self-catheterization

SPSS:

Statistical Product and Service Solutions

References

  1. Moore RD, Miklos JR (2009) Vaginal repair of cystocele with anterior wall mesh via transobturator route: efficacy and complications with up to 3-year follow-up. Adv Urol: 743831. doi:10.1155/2009/743831

  2. Keys T, Campeau L, Badlani G (2012) Synthetic mesh in the surgical repair of pelvic organ prolapse: current status and future directions. Urol J 80(2):237–243. doi:10.1016/j.urology.2012.04.008

    Article  Google Scholar 

  3. Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG (2011) Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J 22(7):789–798. doi:10.1007/s00192-011-1384-5

    Article  PubMed  Google Scholar 

  4. Maher CM, Feiner B, Baessler K, Glazener CMA (2011) Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22:1445–1457. doi:10.1007/s00192-011-1542-910.1002/14651858.CD004014.pub4)[1

    Article  PubMed  Google Scholar 

  5. Urogynecologic Surgical Mesh: Update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse (2011). http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM262760.pdf

  6. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Sachaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26

    Article  PubMed  Google Scholar 

  7. 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(2):131–139

    Article  CAS  PubMed  Google Scholar 

  8. Shumaker SA, Wyman JF, Uebersax JS, McClish DK, 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. Quality of life research : Int J Qual Life Rehabil Res 3(5):291–306

    Article  CAS  Google Scholar 

  9. Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193:103–113

    Article  CAS  PubMed  Google Scholar 

  10. 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 Pelvic Floor Dysfunct 14(3):164–168

    Article  PubMed  Google Scholar 

  11. Su TH, Lau HH (2010) Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire. J Sex Med 7(12):3940–3945

    Article  PubMed  Google Scholar 

  12. Miyazaki FS (1987) Miya Hook ligature carrier for sacrospinous ligament suspension. Obstet Gynecol 70(2):286–288

    CAS  PubMed  Google Scholar 

  13. Rane A, Kannan K, Barry C, Balakrishnan S, Corstiaans LY (2008) A prospective study of the Perigee system for the management of cystocoeles: medium-term follow-up. Aust N Z J Obstet Gynaecol 48:427–432

    Article  PubMed  Google Scholar 

  14. Lo TS, Ashok K (2011) Combined anterior trans-obturator mesh and sacrospinous ligament fixation in women with severe prolapse–a case series of 30 months follow-up. Int Urogynecol J 22(3):299–306. doi:10.1007/s00192-010-1266-2

    Article  PubMed  Google Scholar 

  15. Lo TS, Tan YL, Khanuengkitkong S, Dass AK (2013) Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women. Int Urogynecol J 24(5):809–816

    Article  PubMed  Google Scholar 

  16. Funk MJ, Visco AG, Weidner AC, Pate V, Wu JM (2013) Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Int Urogynecol J. doi:10.1007/s00192-013-2043-9

    PubMed Central  Google Scholar 

  17. Kaufman Y, Singh SS, Alturki H, Lam A (2011) Age and sexual activity are risk factors for mesh exposure following transvaginal mesh repair. Int Urogynecol J 22(3):307–313. doi:10.1007/s00192-010-1270-6

    Article  PubMed  Google Scholar 

  18. Letouzey V, Deffieux X, Gervaise A, Mercier G, Fernandez H, de Tayrac R (2010) Trans-vaginal cystocele repair using a tension-free polypropylene mesh: more than 5 years of follow-up. Eur J Obstet Gynecol Reprod Biol 151:101–105

    Article  PubMed  Google Scholar 

  19. Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364:1826–1836

    Article  CAS  PubMed  Google Scholar 

  20. Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203(3):e231–e238. doi:10.1016/j.ajog.2010.03.030

    Google Scholar 

  21. Miller D, Lucente V, Babin E, Beach P, Jones P, Robinson D (2011) Prospective clinical assessment of the transvaginal mesh technique for treatment of pelvic organ prolapse-5-year results. Female Pelvic Med Reconst Surg 17(3):139–143. doi:10.1097/SPV.0b013e3182175da6

    Article  Google Scholar 

  22. Long CY, Hsu CS, Wu CH, Liu CM, Wang CL, Tsai EM (2012) Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 161(1):105–108

    Article  PubMed  Google Scholar 

  23. Cao Q, Chen YS, Ding JX, Hu CD, Feng WW, Hu WG, Hua KQ (2013) Long-term treatment outcomes of transvaginal mesh surgery versus anterior-posterior colporrhaphy for pelvic organ prolapse. Aust N Z J Obstet Gynaecol 53(1):79–85. doi:10.1111/ajo.12040

    Article  PubMed  Google Scholar 

  24. Stanford EJ, Cassidenti A, Moen MD (2012) Traditional native tissue versus mesh-augmented pelvic organ prolapse repairs: providing an accurate interpretation of current literature. Int Urogynecol J 23:19–28

    Article  CAS  PubMed  Google Scholar 

  25. Chen L, Miller JAA, Hsu Y, DeLancey JOL (2006) Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol 108:324–332

    Article  PubMed Central  PubMed  Google Scholar 

  26. Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L (2006) Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 195:1837–1840

    Article  PubMed  Google Scholar 

  27. Withagen MI, Milani AL, de Leeuw JW, Vierhout ME (2012) Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. Br J Obstet Gynecol 119(3):354–360. doi:10.1111/j.1471-0528.2011.03231.x

    Article  CAS  Google Scholar 

  28. Nieminen K, Hiltunen R, Heiskanen E, Takala T, Niemi K, Merikari M, Heinonen PK (2008) Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1611–1616. doi:10.1007/s00192-008-0707-7

    Article  PubMed  Google Scholar 

  29. Lo TS (2009) Combined Pelvic Reconstructive Surgery and Transobturator Tape (Monarc) in women with advanced prolapse and urodynamic stress incontinence: a case control series. J Minim Invasive Gynecol 16(2):163–168

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China

    Tsia-Shu Lo & Pei-Ying Wu

  2. Department of Obstetrics and Gynecology, Serdang Hospital, Selangor, Malaysia

    Leng Boi Pue

  3. Fellow of the Division of Urogynecology, Department of Obstetrics & Gynecology, Chang Gung Memorial Hospital (Linkou branch), Taoyuan, Taiwan

    Leng Boi Pue, Yiap Loong Tan & Pei-Ying Wu

  4. Department of Obstetrics and Gynecology, Kuching General Hospital, Sarawak, Malaysia

    Yiap Loong Tan

  5. Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou branch), 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan Hsien, Taiwan, 333, Republic of China

    Tsia-Shu Lo

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  1. Tsia-Shu Lo
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Correspondence to Tsia-Shu Lo.

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Lo, TS., Pue, L.B., Tan, Y.L. et al. Long-term outcomes of synthetic transobturator nonabsorbable anterior mesh versus anterior colporrhaphy in symptomatic, advanced pelvic organ prolapse surgery. Int Urogynecol J 25, 257–264 (2014). https://doi.org/10.1007/s00192-013-2200-1

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  • DOI: https://doi.org/10.1007/s00192-013-2200-1

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