V2-02 TOTAL AUTOLOGOUS FASCIA LATA ANTERIOR REPAIR AND APICAL SUSPENSION: A NEW TECHNIQUE

Abstract

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2017V2-02 TOTAL AUTOLOGOUS FASCIA LATA ANTERIOR REPAIR AND APICAL SUSPENSION: A NEW TECHNIQUE Christian Twiss, Miguel Craig, Frank Lin, and Joel Funk Christian TwissChristian Twiss More articles by this author , Miguel CraigMiguel Craig More articles by this author , Frank LinFrank Lin More articles by this author , and Joel FunkJoel Funk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The reclassification of vaginal mesh to a high risk device for treatment of pelvic organ prolapse prompted our group to consider alternative graft materials. Based on the similar success rates and durability of mesh and autologous fascia in the treatment of female stress urinary incontinence (SUI), our objective was to develop a transvaginal repair for anterior and apical vaginal prolapse with the use of only autologous fascia lata graft thereby avoiding synthetic mesh, allograft and xenograft. METHODS The video demonstrates our technique for Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair. Autologous fascia lata of suitable size (4 X 12 cm up to 5 X 14 cm) is harvested through a minimally invasive, lateral upper thigh incision. The graft is then cut into 3 strips (1cm X 12cm up to 1.3 cm X 14cm) and reassembled with one strip affixed to the bladder neck and sutured to the obturator internus fascia with 0-vicryl. The other 2 strips are sutured to the strip at the bladder neck with CV-2 Gore-Tex suture, crossed at the level of the vaginal apex, and sutured to the sacrospinous ligaments with 0-PDS. Patients were followed with subjective SEAPI scores, visual analog pain (VAP) scores (range 0-10), pelvic examination (Baden-Walker grading), and examination of the thigh harvest site. RESULTS The AAA-POP procedure has been performed on 5 patients with a mean age of 61 and a mean follow-up of 2 months. Apical uterine suspension was performed in 3/5 patients and the other 2/5 patients were status post hysterectomy. Symptoms of pelvic organ prolapse resolved in all 5 patients, but 1 patient had an asymptomatic grade 1 cystocele without apical prolapse at 3 months follow-up. No patients complained of SUI or urge incontinence on SEAPI scoring. 1 patient required lysis of a concurrent pubovaginal sling 2 weeks postoperatively with resolution of urinary retention, and 1 patient had mild obstructive symptoms on SEAPI scoring. 2 patients developed thigh hernias postoperatively, and the mean VAP score at the harvest site was 1.8 for all patients. CONCLUSIONS Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair with fascia lata is a feasible option in the post-mesh era and appears to be safe and efficacious with short-term follow-up. Longer follow-up is needed to determine long term success and possible complications of the procedure. Although self-reported pain scores were low, patients should be aware of the risk of residual pain at the harvest site and possible development of a thigh hernia. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e133 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christian Twiss More articles by this author Miguel Craig More articles by this author Frank Lin More articles by this author Joel Funk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...