Long term Follow-up of Transvaginal Anatomical Implant of Mesh in Pelvic organ prolapse

De-Yi Luo,Hong Shen,Tong-Xin Yang

doi:10.1038/s41598-018-21090-w

De-Yi Luo, Hong Shen + Show 1 more

Open Access

https://doi.org/10.1038/s41598-018-21090-w

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Abstract

Transvaginal mesh (TVM) is a minimally invasive but effective treatment for pelvic organ prolapse (POP). However, mesh exposure is a common and problematic complication after TVM. This study assessed the safety and long-term outcomes of TVM. A retrospective review was performed on the medical records of 175 consecutive patients who underwent TVM with the anatomical implant technique for pelvic organ prolapse at our center from April 2007 to December 2012. All operations were performed using TVM with the anatomical implant technique. Intraoperative variables, postoperative complications, and TVM outcomes were assessed. In average of 8 years (ranging from 4 to 10 years), the objective cure ratio reached 99.4%; and the subjective success rate of the TVM operation was 91.4%. Only 2 cases (1.1%) were identified as having mesh exposure. The reoperation rate was 4.0% (95% CI, 1.1–6.9%). No patients abstained from sex due to the operation or postoperative discomfort. Our anatomical implant technique for correcting POP is feasible in TVM procedures, which lead to favourable subjective and objective outcomes with the lowest rates of mesh exposure (1.1%) in published data. Therefore, performing TVM operations with the appropriate technique could consider to be permitted.

Highlights

In an era that promotes minimally invasive surgery to decrease morbidity and hospitalisation costs, Transvaginal mesh (TVM) remains an attractive option
The anatomical implant technique was applied in all patient operations. 36 cases of Prolift A, 114 cases of Prolift T, 4 cases of Prolift P, 3 cases of Prosima A and 18 cases of Prosima C were performed; 25 cases of Tension-free Vaginal Tape Obturator (TVT-O) and 4 cases of Tension-free Vaginal Tape (TVT) were performed at the same period of surgery
After TVM, patients’ subjective symptoms were improved (Table 1), and the subjective success rate of the TVM operation performed in 175 patients was 91.4%. 17 patients reported chronic pain and discomfort on the perineum, operative incision or puncture area (9.7%; 95% CI, 5.3–14.1%) (Table 3). 24 patients with an average age of 50.0 ± 7.2 years were sexually active, in which 22 patients reported an improved quality of postoperative sex, and no patients abstained from sex due to postoperative discomfort (Table 3)

Summary

Introduction

In an era that promotes minimally invasive surgery to decrease morbidity and hospitalisation costs, TVM remains an attractive option. To improve the efficacy and minimize the surgical complications of TVM, we proposed a modified vaginal dissection technique (anatomical implant technique) for pelvic reconstruction. This study evaluated the feasibility of the anatomical implant technique and reported the long-term outcomes. The data from the study should be considered when choosing an appropriate POP therapy, especially among medical decision support systems

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