Abstract
ABSTRACTIntroduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable.Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses.Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis.Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion.Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.
Highlights
In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure
The use of mesh in POP surgery has been discussed extenibju | Anterior six arms mesh for high stage vaginal prolapse sively lately, but the benefit is likely when there is a combination of risk factors such as recurrent POP, deficient fascia, chronic increased abdominal pressure, advanced stage and apical-anterior defect [4].Surgery using mesh, in this situation, presents better results in correcting high grades anterior and apical vaginal prolapses [2, 5]
We propose a mesh shape to correct both anterior and apical prolapses, associated or not with stress urinary incontinence (SUI), with a single anterior vaginal incision, showing long-term results
Summary
In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. Objective: To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Intervention: Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Conclusions: The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed. American women have an estimated 20% lifetime risk of undergoing a surgery for urinary incontinence or pelvic organ prolapse (POP) [1]. According to Whiteside et al [3], 58% of the women who had undergone surgery for genital prolapse, presented recurrence at 1-year follow-up evaluation. The use of mesh in POP surgery has been discussed extenibju | Anterior six arms mesh for high stage vaginal prolapse sively lately, but the benefit is likely when there is a combination of risk factors such as recurrent POP, deficient fascia, chronic increased abdominal pressure, advanced stage and apical-anterior defect [4].Surgery using mesh, in this situation, presents better results in correcting high grades anterior and apical vaginal prolapses [2, 5]
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