Abstract
Pelvic organ prolapse is a frequent female pathology, often causing a negative impact on the patient’s quality of life. The purpose of this paper is to present the results that we have achieved in 32 patients with anterior vaginal compartment prolapse, managed using the transvaginal mesh approach.Over a period of twelve months, we have performed 32 transvaginal reconstructive procedures using a four arms polypropylene mesh. The superior arms of the mesh have been passed through the obturator foramen while the inferior arms have been passed through the sacrospinous ligament.The surgery has lead to a significant improvement in the quality of life in this group of patients, this being assessed using self-administered questionnaires that evaluated the quality of life, the sexual function, and urinary continence. Anatomical success was achieved in 96.87% of the cases. In terms of postoperative complications, we mention one case of vaginal erosion, one case of de novo dyspareunia and three cases of pelvic discomfort. So far we have not encountered any mesh exposure cases nor prolapse recurrence.Considering the results that we have achieved in our study, we can conclude that the transvaginal polypropylene mesh approach can prove itself to be a viable solution for the management of genital prolapse, especially if we consider the high postoperative rates of anatomical success and low rates of postoperative complications, as well as improving the patient’s quality of life. In spite of these encouraging results, the fact that in recent years FDA has emitted several warnings in terms of postoperative complications following such procedures, as well as the fact that our study was conducted on a small group of patients, limits the strength of our research, its only purpose being to present our experience for this surgical approach over a limited period of time.
Highlights
Pelvic organ prolapse (POP) is one of the most frequent female pathologies, and it is the result of several factors that lead to the weakening of the pelvic supporting structures
Considering the results that we have achieved in our study, we can conclude that the transvaginal polypropylene mesh approach can prove itself to be a viable solution for the management of genital prolapse, especially if we consider the high postoperative rates of anatomical success and low rates of postoperative complications, as well as improving the patient’s quality of life
In spite of these encouraging results, the fact that in recent years Food and Drug Administration (FDA) has emitted several warnings in terms of postoperative complications following such procedures, as well as the fact that our study was conducted on a small group of patients, limits the strength of our research, its only purpose being to present our experience for this surgical approach over a limited period of time
Summary
Pelvic organ prolapse (POP) is one of the most frequent female pathologies, and it is the result of several factors that lead to the weakening of the pelvic supporting structures (pelvic floor fascias, ligaments, and muscles). Other factors that increase the risk of POP are: obesity, structural changes related to aging and to hormonal imbalances as a result of menopause, history of hysterectomy, surgery for genital prolapse or other pelvic surgeries, pelvic radiotherapy for different malignancies, collagen disorders, constipation and other pathologies or situations that associate with a chronic intra-abdominal increased pressure (heavy manual labor, chronic cough) [6,7,8,9,10,11,12,13,14,15,16] All of these factors weaken the Journal of Medicine and Life Vol 12, Issue 1, January-March 2019 pelvic floor muscles and ligaments and favor the prolapse of the pelvic organs (bladder along with the urethra, uterus, rectum) resulting in a vaginal bulge. Depending on the dimensions of the vaginal bulge, the patients can present with urinary tract symptoms (urinary urgency, urinary stress incontinence, urinary frequency, incomplete bladder emptying or difficulty in urinating, recurrent urinary tract infections), constipation or fecal incontinence, pain or discomfort during sexual intercourse, pelvic pressure or heaviness, sensation of vaginal protrusion [6, 17, 18]
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