Abstract
Objective: To report the safety and efficacy of single incision anchored anterior vaginal mesh repair for women with recurrent anterior vaginal prolapse.Methods: Retrospective study of women with recurrent anterior vaginal prolapse, Stage 2 or beyond, who underwent single incision anchored vaginal mesh repair with Anterior Elevate (American Medical Systems, Minnetonka, USA) between June 2012 and October 2016. Pre-operatively, the Prolapse Quality-of-Life questionnaire (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were completed. Post-operatively, women completed the P-QOL, PISQ-12 and the global impression of improvement questionnaire (PGI-I). Preoperative POP-Q and post operative POP-Q examination at up to 24 months follow up were recorded. At average follow up of 36 months, participants were interviewed via telephone using questions from the P-QOL, PISQ and PGI-I.Results: 45 women had single incision anterior vaginal mesh kit repair for recurrent prolapse. Postoperatively, 85% of women reported cure of their prolapse symptoms. At 24 months, 80.0% had POP-Q stage 0 or 1 in the anterior compartment, and 93.8% achieved anatomical cure of apical prolapse (point C above 0). During structured telephone interview at mean follow up of 36 months, on PGI-I, 70% reported feeling ‘much better’ or ‘very much better’.Conclusion: Vaginal surgery using single incision lightweight mesh kits can be an effective approach for women with recurrent anterior vaginal prolapse, resulting in subjective and objective cure rates of over 80% with reasonable safety profile up to 60 months postoperatively.
Highlights
The introduction of vaginal meshes for pelvic floor reconstruction has generated considerable debate regarding safety and efficacy [1,2,3]
The recent PROSPECT trial showed that using vaginal mesh for primary prolapse repair does not add additional benefit, with increased complication rates such as vaginal mesh extrusion [6]
We report the safety, medium term efficacy and complications of single incision anchored anterior vaginal mesh repair kit, Elevate PC, in the surgical treatment of women with recurrent anterior vaginal wall prolapse
Summary
The introduction of vaginal meshes for pelvic floor reconstruction has generated considerable debate regarding safety and efficacy [1,2,3]. The initial rationale for the use of vaginal mesh for prolapse repair relates to the reported high recurrence following traditional native tissue repair. Anterior vaginal repair could be common, only a minority of women appear to need repeat surgical intervention after non mesh anterior colporrhaphy [4,6,7]. Vaginal meshes were initially introduced to treat primary uterovaginal prolapse. The recent PROSPECT trial showed that using vaginal mesh for primary prolapse repair does not add additional benefit, with increased complication rates such as vaginal mesh extrusion [6]. The role and safety of vaginal meshes in the treatment of recurrent prolapse, seems less clear
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