Trans-Obturator Approach and the Native Tissue in the Treatment of High Stage Prolapse of the Anterior Vaginal Wall: Midterm Results of a New Surgical Technique.

Abstract

Pelvic organ prolapse is a common condition as a consequence of the pelvic floor support weakness. This study evaluated the clinical results of treating the high stage prolapse of the anterior vaginal wall using a trans-obturator approach and the native vaginal wall tissue. This was a prospective analysis of 94 patients with anterior vaginal wall prolapse stage ≥ Ⅲ. They underwent surgery with the trans-obturator approach using the native vaginal wall tissue. The objective primary outcome was evaluated according to the pelvic organ prolapse staging system (POP-Q). The subjective primary outcome was evaluated with pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) questionnaires. The secondary outcomes were post-surgery complications. Totally, 85 of 94 patients were followed up for a mean of 38.2 ± 4 months. The objective anatomical success rate was 90.58%. PDFI-20 and PFIQ-7 scores had improved (P = 0.001). The complications were minor (G1) according to the Clavien-Dindo classification (8.2 %). At one year follow up 3 out of 8 patients with clinical SUI underwent transvaginal repair with the Poly propylene mini sling mesh. The midterm results of the surgical repair of the high stage anterior vaginal wall prolapse are promising with a new surgical technique by trans-obturator approach and native vaginal wall as the supportive layer.