Abstract
Pelvic organ prolapse can significantly reduce quality of life of affected women, with many cases requiring corrective surgery. The rate of recurrence is relatively high after conventional prolapse surgery. In recent years, alloplastic meshes have increasingly been implanted to stabilize the pelvic floor, which has led to considerable improvement of anatomical results. But the potential for mesh-induced risks has led to a controversial discussion on the use of surgical meshes in urogynecology. The impact of cystocele correction and implantation of an alloplastic mesh on patients' quality of life/sexuality and the long-term stability of this approach were investigated. In a large prospective multicenter study, 289 patients with symptomatic cystocele underwent surgery with implantation of a titanized polypropylene mesh (TiLOOP ® Total 6, pfm medical ag) and followed up for 36 months. Both primary procedures and procedures for recurrence were included in the study. Anatomical outcomes were quantified using the POP-Q system. Quality of life including sexuality were assessed using the German version of the validated P-QoL questionnaire. All adverse events were assessed by an independent clinical event committee. Mean patient age was 67 ± 8 years. Quality of life improved significantly over the course of the study in all investigated areas, including sexuality and personal relationships (p < 0.001, Wilcoxon test). The number of adverse events which occurred in the period between 12 and 36 months after surgery was low, with just 22 events reported. The recurrence rate for the anterior compartment was 4.5%. Previous or concomitant hysterectomy increased the risk of recurrence in the posterior compartment 2.8-fold and increased the risk of erosion 2.25-fold. Cystocele correction using a 2nd generation alloplastic mesh achieved good anatomical and functional results in cases requiring stabilization of the pelvic floor and in patients with recurrence. The rate of recurrence was low, the patients' quality of life improved significantly, and the risks were acceptable.
Highlights
Pelvic organ prolapse can significantly reduce quality of life of affected women, with many cases requiring corrective surgery
Pelvic organ prolapse can significantly reduce the quality of life of affected women [1]
The multicenter study was only started after the study had been publicly registered in the registry of the National Institutes of Health (NIH) and the ethical votes required by the professional code were available for every participating center
Summary
Pelvic organ prolapse can significantly reduce quality of life of affected women, with many cases requiring corrective surgery. With 1st generation implants, a number of new adverse events occurred following the implantation of alloplastic meshes and included vaginal erosion, pain and dyspareunia [15] These mesh-induced risks [16] have led to the benefits of alloplastic materials for patients in prolapse surgery still being controversially discussed, despite the positive data on the long-term stability reported in the Cochrane analysis. Improvements to the procedure such as lighter meshes, the improvement of dissection techniques, better apical fixation and the increased experience of surgeons has succeeded in significantly reducing the rate of complications [1] This has been confirmed by previously published results of the study reported on here [5, 6]. The final results for quality of life, sexuality, and anatomical outcomes are available
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