Effectiveness and Safety of Posterior Vaginal Repair with Single-Incision, Ultralightweight, Monofilament Propylene Mesh: First Evidence from a Case Series with Short-Term Results.

Francesco Deltetto,Giovanni Buzzaccarini,Alessandro Favilli,Amerigo Vitagliano,Gail Mahady

doi:10.1155/2021/3204145

Abstract

Objective The use of transvaginal mesh is controversial, and over time, multiple surgical methods for the treatment of posterior vaginal prolapse (PVP) have been proposed including different surgical approaches and techniques. To date, no clear conclusion has been reached about the use of mesh for reinforcing transvaginal posterior repair. The aim of this study was to evaluate the feasibility, safety, and effectiveness of a novel, ultralightweight mesh for the treatment of PVP. Methods We performed a single-center, prospective observational study on consecutive patients referred for primary or recurrent, symptomatic stage II PVP (according to the international Pelvic Organ Prolapse Quantification System) from April 2017 to September 2018. In all patients, transvaginal posterior repair was augmented with a single-incision, isoelastic polypropylene mesh. Data about the postoperative outcomes were collected until December 2019. Results A total number of 15 patients were included. The median follow-up after surgery was 18 months (IQR = 14). Surgery was completed in all cases without complications. Regarding the anatomical outcomes (as measured according to POP-q classification), a significant improvement was observed in terms of Bp, D, and C (p < 0.05). The functional outcomes were significantly ameliorated after surgery, with a reduction of bulge symptom, stypsis, incomplete evacuation, and excessive staining (p < 0.05). The quality of life was significantly improved in the majority of patients (p < 0.05). Median patients' satisfaction rate was 100% (IQR = 22.5%). Neither early nor late postoperative complications occurred. Conclusions Single-incision, ultralightweight polypropylene meshes were safe and highly effective in the treatment of PVP. As our study has some limitations, further large, controlled studies are needed.

Highlights

Pelvic organ prolapse (POP) refers to the descent or herniation of one or more pelvic organs from their normal attachment sites or their normal position in the pelvis [1]
posterior vaginal prolapse (PVP) can be associated with rectal pain and defecatory dysfunctions, potentially causing a serious deterioration of patients’ quality of life [8, 9]
The study was exempted from institutional review board (IRB) approval because its design was observational and all data was anonymized before analysis

Summary

Introduction

Pelvic organ prolapse (POP) refers to the descent or herniation of one or more pelvic organs from their normal attachment sites or their normal position in the pelvis [1]. POP is a common condition, affecting up to 50% of parous women and being associated with high healthcare costs [3]. The lifetime risk for women undergoing POP surgery is estimated between 6.3% and 19% and is expected to further increase in the near future [4, 5]. For these reasons, the development of effective strategies for treating POP has gained high social priority. The second most common type of POP is posterior vaginal prolapse (PVP), whose incidence is estimated in 5.7 new BioMed Research International cases per 100 women-year [6, 7]. PVP can be associated with rectal pain and defecatory dysfunctions (such as constipation, tenesmus, splinting, and fecal incontinence), potentially causing a serious deterioration of patients’ quality of life [8, 9]

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Discussion

Conclusion