Abstract
ABSTRACTObjective:The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus.Materials and Methods:This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse < than stage 2. A telephone survey questionnaire was used to evaluate patient's satisfaction.Results:Sixty-six patients with pelvic organ prolapse stage 3, including uterine pro-lapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at −6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus.Conclusions:Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse.
Highlights
The prevalence of symptomatic pelvic organ prolapse (POP) is difficult to estimate because of lack of standardized methods to evaluate symptomatic prolapse, and lack of data concerning the proportion of women with POP who do not seek medical aid [1]
Advances in vaginal mesh surgery have resulted in new techniques for preserving the uterus [7, 8]
There are several medical reasons for preserving the uterus: (a) avoiding early and late complications of hysterectomy; (b) decreasing the rate of mesh erosion if a mesh is used at the time of hysterectomy [8]; (c) reducing the cost of surgery with a shorter operation and hospitalization time [15]; and (d) risk of vault prolapse, which is greater in women who had previous hysterectomy, especially after vaginal hysterectomy due to prolapse, as shown in several studies [16, 17]
Summary
The prevalence of symptomatic pelvic organ prolapse (POP) is difficult to estimate because of lack of standardized methods to evaluate symptomatic prolapse, and lack of data concerning the proportion of women with POP who do not seek medical aid [1]. It is possible to estimate the prevalence of symptomatic POP by the number of patients who choose to undergo surgical repair. Treatment of POP with synthetic mesh has become common [9]. Some safety concerns for the use of grafts in POP repair have led the US Food and Drug Administration (FDA) to publish a safety notification in 2011, and subsequently guidelines for the use of vaginal meshes [10, 11]
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Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
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