Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

Zoltán Fekete,Zoltán Bajory,Zoltan Kozinszky,Szilvia Kőrösi,László Pajor,Gábor Németh

doi:10.1186/s12894-018-0363-2

Abstract

BackgroundThis study aims to explore the feasibility of anchoring a four-arm transvaginal mesh (TVM) to the mid-urethra to correct an anterior compartment POP–Quantification stage II–III (Q II–III) and concomitant genuine SUI.MethodsWe analysed clinical data from 248 patients with stage II–III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2008 and June 2010. One hundred and twenty-four women treated with anterior colporrhaphy and 62 patients implanted with a conventional permanent TVM were selected as historical matched controls. Sixty-two patients received a modified permanent TVM, where the mesh was fixed to the mid-urethra with two stitches for the purpose of potentially correcting SUI. Surgical complications were classified using the Clavien–Dindo (CD) classification system.ResultsThe anti-SUI efficacy was minimally higher in the mTVM group than in the original TVM group (p = 0.44, 96.8% vs 91.9%, respectively), while prosthesis surgery was more effective than anterior colporrhaphy in improving the anterior compartment POP–Q status (96.8, 90.3% vs 64.5%, respectively). Anchoring the mesh did not increase the extrusion rate (p = 0.11). The de novo urge symptoms were not more prevalent among those who had received additional periurethral stitches (p = 1.00, 11.3% vs 12.9%). The incidence of reoperation observed in the mTVM group was non-significantly lower than that in the TVM group (p = 0.15, 6.5% vs 16.1%); however, the difference did not reach the level of significance. The early postoperative complication profile was more favourable among the mTVM patients (classified as CD I: 8.1%; CD II: 1.6%; and CD IIIb: 1.6%) as compared to the TVM group (p = 0.013).ConclusionsThe new, modified mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications.

Highlights

This study aims to explore the feasibility of anchoring a four-arm transvaginal mesh (TVM) to the midurethra to correct an anterior compartment POP–Quantification stage Pelvic organ prolapse quantification system stage II (II)–III (Q II–III) and concomitant genuine stress urinary incontinence (SUI)
We demonstrate an alternative operative method for POP–Q II–III repair and anti-incontinence with the TVM fixed to the mid-urethra
The operation took a similar amount of time in the modified transvaginal mesh (mTVM) group as compared with the anterior colporrhaphy (Adjusted odds rate (AOR): 1.03) or TVM (AOR: 0.97) control group

Summary

Introduction

This study aims to explore the feasibility of anchoring a four-arm transvaginal mesh (TVM) to the midurethra to correct an anterior compartment POP–Quantification stage II–III (Q II–III) and concomitant genuine SUI. Vaginal prosthetic surgery has been proposed for anterior compartment POP– Quantification (Q) stage II–III (International Continence Society/International Urogynecological Association) [4] in Fekete et al BMC Urology (2018) 18:53 techniques represent an increased complication rate and elevated financial burden. The TVT-O sling is located under the mid-urethra, whereas the TVM elevates the whole anterior and middle compartment [14]. TVM produces a significantly weaker anti-SUI effect compared to that of the TVT-O since TVM elevates the urinary bladder neck [7]. We hypothesise that the original TVM operation can be followed by residual SUI as the strengthening of the back arms may result in a backward sliding of the entire mesh, leading to a lack of suspension of the urethra

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