Long-term outcomes of pelvic organ prolapse repair using a mesh-capturing device when comparing single- versus multicenter use

Christian Falconer,Daniel Altman,Päivi Rahkola-Soisalo,Edward Morcos,Tomi Mikkola,Georgios Poutakidis

doi:10.1007/s00404-020-05764-3

Abstract

PurposeThe aim of this study was to compare long-term effects of high-volume surgery at a single-center to multicenter use when using a mesh-capturing device for pelvic organ prolapse (POP) repair.MethodsFive years after surgery 101 (88%) at the single center were compared with 164 (81.2%) in the multicenter trial. Outcome measurements included clinical examination, prolapse-specific symptom questionnaires [Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire—short form (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] and pain estimation by VAS (0–10).ResultsOptimal apical segment outcome was 95% in the single- compared to 83.3% in the multicenter study (p < 0.001). POP recurrence in the anterior and posterior walls (POP-Q, Ba and Bp ≥ 0) was more common at the multicenter as compared to the single center [(19.8% vs 5.4%) and (26% vs 2.7%), (p < 0.001)]. Reoperations for POP and mesh-related complications were more frequent in the multicenter study [31/202 (15.3%) vs 7/116 (6.1%), p < 0.001]. Total PFDI-20, PFIQ-7 and PISQ-12 scores were comparable between the cohorts. There were no significant differences in overall pain scores in-between the cohorts during follow-up. At the single center, 1/81 patients (1.2%) had VAS 7/10, i.e. severe pain, as compared to 3/131 (2.3%) in the multicenter study (p = 0.277).ConclusionsDespite the high objective and subjective long-term effectiveness of the procedure in both regular use, and at a high-volume center, centralizing the use of a standardized capturing-device guided transvaginal mesh for POP repair reduced secondary interventions by more than half.

Highlights

Pelvic reconstructive surgery using the transvaginal UpholdTM Lite mesh kit to suspend the apical vaginal segment has been shown to effectively ameliorate pelvic organ prolapse (POP) symptoms and restore anatomical outcomes at short term [1,2,3,4,5,6,7,8]
In this 5-years analysis which combined data from two separate cohort studies using the U pholdLite mesh device for POP reconstructive surgery, we found that singlecenter high-surgery volumes resulted in less reoperations for POP recurrence and fewer mesh-related complications requiring surgical intervention
A number of studies have shown that the UpholdLite procedure for apical prolapse provide satisfactory subjective and objective outcomes and that high surgical volumes result in short-term decreased complication rates following apical mesh augmented surgery [1,2,3,4,5,6,7,8]

Summary

Introduction

Pelvic reconstructive surgery using the transvaginal UpholdTM Lite mesh kit to suspend the apical vaginal segment has been shown to effectively ameliorate pelvic organ prolapse (POP) symptoms and restore anatomical outcomes at short term [1,2,3,4,5,6,7,8]. There is a continued need for investigating safety and effectiveness of transvaginal mesh devices since many patients who have already undergone the procedures are facing unknown long-term outcomes. In the field of pelvic reconstructive surgery, there is, scarce evidence to support this claim. As a consequence, it is not known how long-term outcomes and morbidity may differ between the settings [2, 4, 8]. The aim of this study was to evaluate if high-volume center outcomes are superior to the results of regular use of Uphold mesh kit for apical prolapse at long term and how this relates to long-term morbidity of the procedure

Objectives

Methods

Results

Conclusion