MP05-15 8 YEARS PROSTHETIC VAGINAL PELVIC ORGAN PROLAPSE REPAIR IN ULTRA-HIGH-VOLUME CENTER: 4487 PATIENTS, 250 CASES PER SURGEON ANNUALLY AND NO EVIDENCE FOR MESH BAN

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-15 8 YEARS PROSTHETIC VAGINAL PELVIC ORGAN PROLAPSE REPAIR IN ULTRA-HIGH-VOLUME CENTER: 4487 PATIENTS, 250 CASES PER SURGEON ANNUALLY AND NO EVIDENCE FOR MESH BAN Shkarupa Dmitry*, Shkarupa Andrey, Kubin Nikita, Shulgin Andrey, Staroseltseva Olga, Vostrikova Evgenia, and Ustinova Anna Shkarupa Dmitry*Shkarupa Dmitry* More articles by this author , Shkarupa AndreyShkarupa Andrey More articles by this author , Kubin NikitaKubin Nikita More articles by this author , Shulgin AndreyShulgin Andrey More articles by this author , Staroseltseva OlgaStaroseltseva Olga More articles by this author , Vostrikova EvgeniaVostrikova Evgenia More articles by this author , and Ustinova AnnaUstinova Anna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: At the moment, there is no universal approach to the treatment of patients with pelvic organ prolapse (POP). Native tissue repair is characterized with the lack of effectiveness in advanced cases however the use of synthetic materials can lead to a number of specific complications. The objective was to assess the evolution in POP-mesh surgery based on tertiary center experience. METHODS: The database of 4487 patients operated for POP with the use of mesh implants during 2012-2019 was analysed retrospectively. The type of performed surgery and indicators characterizing its safety and effectiveness were evaluated. RESULTS: According to the results, it was possible to retrace distinctly how the techniques for pelvic floor reconstruction have been changed basing on clinical experience and global trends. First, there were two “big” meshes: one for each compartment. Then, there was a total exclusion of mesh implantation in posterior compartment in favor of native tissue repair. Further, the fixation of implant to arcus tendinius was replaced for sacrospinous. Meanwhile, the transition from trocar technique to anchor fixation took place. Subsequently, the anchor fixation was changed again for trocar and a “big” implant was replaced by apical sling which was put bilaterally in sacrospinous ligaments and the anterior compartment was repaired via original subfascial colporrhaphy. Then the bilateral fixation was replaced by the unilateral apical sling. Finally, the technique described above was combined with posterior colpoperineoplasty for the hybrid three-level reconstruction of the pelvic floor. The results of all listed techniques are presented in the table. It is important that with the decrease of the implanted mesh material amount and decrease of fixation points, the technique’s safety rises while retaining its high effectiveness. CONCLUSIONS: The keystone of the improvement of technologies in vaginal reconstruction of the pelvic floor for 8 years was to reduce the amount of synthetic material and the number of fixation points of mesh implant together with pathogenetically substantiated native tissue repair. In high-volume center where every doctor performs at least 250 surgeries annually, the number of complications is more than acceptable. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e47-e47 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shkarupa Dmitry* More articles by this author Shkarupa Andrey More articles by this author Kubin Nikita More articles by this author Shulgin Andrey More articles by this author Staroseltseva Olga More articles by this author Vostrikova Evgenia More articles by this author Ustinova Anna More articles by this author Expand All Advertisement PDF downloadLoading ...