New Surgical Procedures for Pelvic Organ Prolapse: Tension-free Vaginal Mesh

Abstract

Pelvic organ prolapse (POP) is characterized by a lack of pelvic floor support, which causes the pelvic organs and vaginal wall to protrude. For many decades, suture repair techniques have been the primary choice of surgical treatment when indicated. Traditional surgical techniques are, however, associated with a high recurrence rate. Since 1996, vaginal mesh surgery for treatment of POP has been performed with several types of procedure. Among these procedures, the tension-free vaginal mesh (TVM) procedure is expected to be effective for reconstruction of the pelvic floor and to be applicable to almost all types of POP. Gynemesh (Gynecare Ethicon, Somerville, NJ, USA), a thin, high-porosity synthetic polypropylene prosthesis, is inserted as a hammock under the bladder, applied laterally on the arcus tendineus fasciae pelvis, and retained by two unsecured bilateral transobturator arms. A posterior interrectovaginal prosthesis is inserted in front of the rectum and applied laterally on the levatores ani, retained by a bilateral lateral arm secured to the median part of the sacrospinous ligament. We used TVM to treat 40 cases of POP from May 1, 2007, to June 30, 2008. We have applied both anterior and posterior meshes in 29 cases and an isolated anterior mesh only in 10 cases. The TVM was quite effective for all types of POP, including recurrent cases. However, bladder injury (3 cases) and rectal injury (1 case) occurred during this period. We believe that TVM is a decisive innovation in the treatment of POP, but surgeons must be familiar with its technical details before practice.