Intravaginal Slingplasty Research Articles

Posterior intra-vaginal slingplasty for the treatment of vaginal apex prolapse: Medium-term results of 140 operations with a novel procedure

Objectives Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex prolapse. A novel surgical technique, posterior intra-vaginal slingplasty (PIVS), was reported recently to include both a high therapeutic rate and a low complication rate. The present study was aimed at evaluating the preliminary data of a series of PIVS-treated patients. Study design A total of 140 patients with vaginal apex prolapse underwent the PIVS operation in a daycare setting. Pre-operative demographics, operative details and post-operative follow-up data were prospectively collected for all patients. Results The PIVS procedure dose requires neither laparotomy nor deep transvaginal dissection as previously required for operative intervention. No intra-operative complications were recorded. The hospitalization period was relatively short. Three patients (2.1%) presented with surgical failure, whereas 137 (97.8%) of the operated patients reported satisfaction with the therapeutic results. One patient had post-operative unilateral gluteal skin infection. She was treated by surgical removal of the infected hemi-tape. Twelve (8.6%) patients had vaginal tape protrusion, of which 11 underwent segmental tape resection at the outpatient clinic. Two patients had spontaneous rejection of the tape while the vaginal apex remained well suspended. One patient suffered from post-operative fever of unknown origin, which was effectively treated with oral antibiotics. Conclusions The novel PIVS operation reduces the complication rate and shortens the rehabilitation period previously reported for the types of operation designed in the past to cure vaginal apex prolapse. The current list of results supports the previously reported efficacy, safety and simplicity of this procedure. However, more long-term data are required to be able to draw solid conclusions concerning the superiority of the discussed operative technique.

Mid-term Results and Complications of Posterior Intravaginal Slingplasty for Patients with Uterine and Vaginal Vault Prolapse

Purpose: Only a few reports have been published describing the mid-term results of posterior intravaginal slingplasty (IVS). We analyzed the efficacy and complications of this procedure. Materials and Methods: We analyzed the treatment outcomes of 95 patients who underwent posterior IVS due to uterine (n=59) and vaginal vault (n=36) prolapse. The degrees of prolapse were classified according to pelvic organ prolapse quantification (POPQ) of the International Continence Society (ICS), and posterior IVS was conducted for cases above stage 2. Polypropylene tape was used for all 95 patients. On the postoperative evaluation, stage 0 was regarded as a complete remission, stage 1 as an improvement and above stage 2 as a failure. Results: Among the patients operated on for uterine and vaginal vault prolapse, 48 (81.4%) and 30 (83.3%) patients were cured, and 8 (13.6%) and 6 (16.7%) patientsshowed improvement, and 3 (5.1%) and 0 (0%) patients showed failure, respectively. The mean hospitalization was 3.3 and 3.8 days, the mean operative time was 37.4 and 36.7 minutes, and the mean bleeding volume was 91 and 102ml in the uterine prolapse group and the vaginal vault prolapse group, respectively. The mean follow-up time was 27.3 months (2-40). Identified complications were tape erosion in 9 cases (9.5%), hemorrhage that needed transfusion in 3 cases (3.2%), and recurrent prolapse in 3 cases (3.2%). Conclusions: Posterior IVS proved to be a highly effective therapeutic method for uterine and vaginal vault prolapse, with a low surgical risk and less discomfort to the patients. Tape erosion was a relative frequent complication of this operation. (Korean J Urol 2007;48:971-975)

Vaginal Erosion and Pelvic Abscess after Anterior Intravaginal Slingplasty (IVS) in Patient with Stress Urinary Incontinence

Vaginal Erosion and Pelvic Abscess after Anterior Intravaginal Slingplasty (IVS) in Patient with Stress Urinary Incontinence

The surgical results of the pubovaginal sling procedure using Intravaginal Slingplasty (IVS) for stress urinary incontinence

We investigated the surgical results and complications of the Intravaginal Slingplasty (IVS) procedure in women with stress urinary incontinence. A total of 72 women with urethral hypermobility underwent the pubovaginal sling procedure using IVS with a mean age of 50.35+/-9.07 years. Average Body Mass Index, mean parity and daily mean pad usage was 29.2+/-3.5, 3.7+/-1.74 and 2.9+/-1.76, respectively. Preoperative urge incontinence was observed in 61.12% of the patients. The mean follow-up was 13.87+/-2.4 months. The operative time, postoperative urge symptoms, de novo detrusor instability and complications were all documented. The mean operating time was 25 min (18-40 min). Though postoperative first monthly controls proved 95.8% total dryness, the cure and improvement rates declined to 45.4% and 24.2% in 66 patients who completed 1 year of follow-up. The overall success and patient satisfaction rates were 69.6% and 87.5% respectively. De novo detrusor instability was observed in five patients (6.9%) whereas detrusor instability persisted in 25% of the patients. Bladder perforation and prolonged urinary retention developed in 11.1% of the patients. No signs of hematoma, infection and erosion were detected. IVS is an easy procedure with low complication rates and it takes about 25 min. In spite of lower cure rates than the alternative surgical techniques, patient satisfaction rates seemed to be similar. Low cure rates may be due to either from inappropriate patient selection or from the biochemical and biomechanical properties of the polypropylene mesh. For this reason, randomized controlled trials and animal experiments should be evaluated for a further decision on the success rates.

Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingoplasty operation

It has been reported that, by the age of 80, the risk of women to undergo surgery for the treatment of pelvic organ prolapse (POP) exceeds 10%, a percentage expected to increase with the rise in life expectancy. The vaginal approach for POP reconstructive operations is associated with fewer complications and results in a shorter rehabilitation period than the abdominal route, whereas hysterectomy is widely performed concomitantly whenever the uterus is significantly prolapsed. However, there is no clear evidence supporting the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure--the posterior intravaginal slingplasty (PIVS) for correction of advanced uterine prolapse--at the same time, comparing additive vaginal hysterectomy to uterine preservation, to evaluate the therapeutic significance of hysterectomy when vaginal apical prolapse is reconstructed with PIVS. Seventy-nine women presenting with moderate to severe uterine prolapse were enrolled into the current PIVS study. Vaginal hysterectomy was concomitantly performed upon patient's request (44 patients), whereas those wishing to preserve their uterus underwent reconstructive surgery only (35 patients). No intraoperative or postoperative major complications were recorded during an average follow-up of 29.8 months: One patient (1.3%) presented with surgical failure, whereas 71 (89.9%) of the operated patients reported satisfaction with the therapeutic results. Bladder overactivity symptoms declined from three thirds of the patients preoperatively to below 10% postoperatively. Ten (12.7%) patients had vaginal tape protrusion; all underwent segmental tape resection at the out-patient clinic. Because the PIVS procedure does not require either laparotomy or deep transvaginal dissection, as previously required for operative intervention, the hospitalization period was relatively short: 4.2 days for the hysterectomy group and 1.5 for the non-hysterectomy group. Other statistically significant differences between the hysterectomy and non-hysterectomy groups were the average ages (63.5 vs 51.0 years, respectively) and concomitant surgery (87% vs 69%, respectively, the higher percentage due to additive amputation of elongated uterine cervices). No other significant differences were recorded. The current results support the previously reported efficacy, safety, and simplicity of the PIVS procedure as well as the legitimacy of uterine preservation. Moreover, unstable bladder symptoms were found to be improved after this operation. However, long-term data are required to be able to draw solid conclusions concerning the superiority of the discussed operation.

Polypropylene Midurethral Tapes Do Not Have Similar Biologic and Biomechanical Performance in the Rat

ObjectivesTo evaluate the biomechanical properties and histologic changes of different commercially available polypropylene midurethral tapes (MUTs) after implantation in the rat. MethodsPieces of Advantage®, intravaginal slingplasty (IVS), suprapubic arch sling (SPARC™), and tension-free vaginal tape (TVT) were implanted over the rectus fascia of rats, with six rats serving as controls. On retrieval 24 wk later, the degree of adherence and sample measurements were recorded. Biomechanical testing of the retrieved samples was performed using the uniaxial loading method. Histologic evaluation of the samples under light microscopy included the following parameters: inflammatory infiltrate, fibrosis, mast cell presence, muscular infiltration, and collagen filling of the mesh. ResultsNo mesh extrusion or infection was encountered. The biomechanical and histologic results were consistent within each group. TVT displayed peculiar adherence characteristics not found among the other brands. No statistically significant difference were found in mean peak load and extension at peak load among the four tested brands. Stiffness of TVT was significantly lower than that of each of the other three brands. Stiffness of Advantage was significantly higher than that of SPARC. The histologic findings differed from one MUT brand to another. By grading certain histologic parameters, an untested model to assign a score for biocompatibility potential in the rat, to different MUTs, was developed. ConclusionsCommercially available polypropylene MUTs display different biologic and biomechanical properties in the rat.

MP-18.05: Efficacy and complications of posterior IVS for patients with uterine and vaginal vault prolapse

The recent development of posterior intravaginal slingplasty (IVS) has led to significant change for the treatment of uterine and vaginal vault prolapse. We analyzed the efficacy and complications of posterior IVS for the patients with uterine and vaginal vault prolapse.

Tension-free vaginal tape (TVT) and intravaginal slingplasty (IVS) for stress urinary incontinence: A multicenter randomized trial

This study was undertaken to compare the efficacy and morbidity of 2 minimally invasive procedures for stress urinary incontinence. This was a prospective randomized multicenter trial; 190 women with primary urodynamic stress incontinence were randomly assigned to tension-free vaginal tape (TVT) (n = 95) or intravaginal slingplasty (IVS) (n = 95). The primary and secondary outcome measures were rates of success and complications. SPSS software was used for data analysis. At 2 years 92 and 87 patients were available in the TVT and IVS group for outcomes analysis. Subjectively, 80 (87%) and 68 (78%) women were cured, respectively. Objectively, a 1-hour pad test was negative in 78 (85%) and 63 (72%) patients. Eight of the patients assigned to IVS (9%) had vaginal erosion/infection, compared with none in the TVT group (P < .01). Both procedures were effective for stress incontinence, but 9% of women treated with the IVS required removal of the tape for erosions.

Posterior intravaginal slingplasty (infracoccygeal sacropexy) in the treatment of vaginal vault prolapse

Posterior intravaginal slingplasty (infracoccygeal sacropexy) in the treatment of vaginal vault prolapse

Posterior intravaginal slingplasty for vault and uterovaginal prolapse: an initial experience

Genital prolapse surgeries are traditionally time-consuming and can be complex with significant morbidity. Most of the techniques described have incorporated removal of the prolapsed uterus prior to the repair, thus increasing morbidity and hospital stay. Recently, interest has been focused on minimally invasive day-case techniques, which have similar success rates but relatively lower morbidity than the conventional surgeries. We report an initial experience of 14 cases of vault and uterovaginal prolapse treated with the intravaginal slingplasty procedure. This study involved retrospective analyses of the case notes as well as evaluation by contemporary patient questionnaire. In our series we used a modified technique to correct uterovaginal prolapse without performing a hysterectomy. The cure rates in vault and uterovaginal prolapses were statistically significant, and the complication rates were minimal, facilitating a short hospital stay. Hence, the procedure was equally successful in women who had undergone hysterectomy and women with an intact uterus. We conclude that intravaginal slingplasty is minimally invasive and safe, with a high cure rate and high patient satisfaction.

Severe Mesh Complications Following Intravaginal Slingplasty

Severe Mesh Complications Following Intravaginal Slingplasty

Severe Mesh Complications Following Intravaginal Slingplasty

Severe Mesh Complications Following Intravaginal Slingplasty

Severe Mesh Complications Following Intravaginal Slingplasty

Sydney, NSW, Australia Editor’s Note: Obstetrics & Gynecology welcomes letters as written or e-mail correspondence. Send e-mail addressed to [email protected]

Severe Mesh Complications Following Intravaginal Slingplasty

Severe Mesh Complications Following Intravaginal Slingplasty

Efficacy of Posterior IVS for the Patients with Vaginal Vault and Uterine Prolapse

Purpose: The recent development of posterior intravaginal slingplasty (IVS) has led to significant changes for the treatment of vaginal vault or uterine prolapse. We analyzed the efficacy of performing posterior IVS for the patients with vaginal vault and uterine prolapse. Materials and Methods: This study analyzed the treatment outcomes of 56 patients with vaginal vault or uterine prolapse and these patients were seen at our hospital from March 2004 to August 2005. The degree of prolapse was classified according to the POP-Q system. The grades were 17 cases of stage 2, 8 cases of stage 3 and 5 cases of stage 4 in the vaginal vault prolapse group, and 14 cases of stage 2, 6 cases of stage 3 and 6 cases of stage 4 in the uterine prolapse group. Results: Fifteen cases in the vaginal vault prolapse group and 9 cases in the uterine prolapse group received combined tension-free vaginal tape (TVT) or the tension-free vaginal tape obturator system (TVT-O). The patients who received combined rectocele repair were 17 cases in the vaginal vault prolapse group and 17 cases in the uterine prolapse group. The mean operation time was 37 minutes and the mean bleeding volume was 94ml. The mean admission period was 3.5 days and the mean follow-up time was 9.5 months (1-17). Polypropylene tape was used for 56 patients without any rejection reactions or rectal perforation. Among the 30 patients operated on for vaginal vault prolapse, 24 patients were cured and 6 patients showed improvement. Among the 26 patients operated on for uterine prolapse, 23 patients were cured and 3 patients showed improvement. Conclusions: Posterior IVS proved to be a highly effective therapeutic procedure for vaginal vault and uterine prolapse. (Korean J Urol 2006; 47:263-267) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Long-term Follow-up Comparison between Intravaginal Slingplasty(IVS) and Tension-free Vaginal Tape(TVT) Procedure for Female Stress Urinary Incontinence

Long-term Follow-up Comparison between Intravaginal Slingplasty(IVS) and Tension-free Vaginal Tape(TVT) Procedure for Female Stress Urinary Incontinence

TISSUE REACTIONS OF 5 SLING MATERIALS AND TISSUE MATERIAL DETACHMENT STRENGTH OF 4 SYNTHETIC MESH MATERIALS IN A RABBIT MODEL

We evaluated tissue reactions to 5 sling materials used in tension-free vaginal tape (TVT), intravaginal slingplasty (IVS), polypropylene mesh hernia repair, the suprapubic approach to suburethral polypropylene tape (SPARC) and cadaveric fascia lata procedures. We also compared the mesh-to-tissue attachment strength of 4 sling mesh materials (TVT, IVS, surgical polypropylene mesh and SPARC) at on days 2, 7, 15 and 30 after implantation. A total of 20 female New Zealand White rabbits were randomized to group 1-2 days, group 2-7 days, group 3-15 days and group 4-30 days. After the rabbits were anesthetized an 8 cm midline incision was made for rectus muscle access, and 0.5 x 1 cm pieces of TVT, IVS, SPARC, surgical polypropylene mesh and cadaveric fascia lata were sewn to the rectus muscle with direct contact. At the same time 4 subfascial tunnels in the medial surface of the upper extremities were prepared, and 1.0 x 0.5 cm strips of TVT, IVS, SPARC and polypropylene mesh were implanted in each tunnel. On days 2, 7, 15 and 30 after implantation mechanical testing was performed to define tissue detachment strength. The strips of 5 sling materials were then harvested with the surrounding tissue. Specimens were studied by light microscopy. Mean detachment strength, that is the minimum weight needed to move the mesh, of the synthetic meshes from days 2 to 30 were 291.6 to 2,390.0 gm for TVT, 178.4 to 2,160.0 gm for SPARC, 188.4 to 1,850.0 gm for hernia mesh and 92.8 to 1,510.0 gm for IVS (at all data points TVT vs IVS p < 0.05). Light microscopy revealed a quite uniform tissue reaction with a sign of marked acute inflammation in and around the mesh fibers on days 2 and 7 after implantation. All meshes showed stable fibrosis and muscle infiltration on day 30. All 5 synthetic sling materials produce similar tissue reactions beginning soon after implantation. Cadaveric fascia lata persisted in tissue with remarkable perifascial fibrosis at day 30. When comparing the 4 polypropylene mesh materials; the attachment capacity of TVT was superior and that of IVS was the least of the 4. TVT was statistically better than IVS at all data points. SPARC and hernia mesh provided results similar to those of TVT.

HIGH INCIDENCE OF VAGINAL MESH EXTRUSION USING THE INTRAVAGINAL SLINGPLASTY SLING

The intravaginal slingplasty (IVS) is a tension-free vaginal tape variant that uses a multi-filament polypropylene tape to support the mid urethra for the treatment of female stress urinary incontinence. Numerous cases of defective vaginal wound healing have been described in the international urogynecological literature. We describe our experience of vaginal mesh extrusion using the IVS sling. A total of 35 patients underwent suburethral sling procedures for anatomical stress urinary incontinence using the IVS system from November 2002 to September 2003. A retrospective chart review was performed to retrieve data on safety and efficacy, complications and outcomes using this product. Six patients (17%) to date have presented with defective vaginal healing manifested by extrusion of the sling material. Mean time to presenting symptoms was 9 months (range 2 to 15). All patients required surgical removal of the sling material. No urethral erosions were noted. Our experience suggests that the IVS sling system, which uses a multi-filament polypropylene suburethral mesh, incurs an unacceptably high rate of defective vaginal wound healing and mesh extrusion.

Severe Mesh Complications Following Intravaginal Slingplasty

Synthetic meshes are increasingly used in the management of stress urinary incontinence and pelvic organ prolapse. This report describes severe complications following anterior and/or posterior intravaginal slingplasties employing a multifilament polypropylene mesh. We describe the symptoms, findings, subsequent management, and outcome of 19 consecutive women who have been referred with complications following anterior (n = 11) and/or posterior intravaginal slingplasty (n = 13) employing the multifilament polypropylene tape. The main indications for removal of the 11 anterior intravaginal slings were intractable mesh infection in 6 women, retropubic abscess with cutaneous sinus in one, and vesico-vaginal fistula in one, intravesical mesh and pain syndrome in one, and voiding difficulties and pain syndrome in two. The main indications for removal of the 13 posterior intravaginal slings were intractable mesh infection in three and pain syndrome and dyspareunia in 10 women. Removal of the slings was performed after a median time of 24 months post-slingplasty. At follow-up between 6 weeks and 6 months, in all women genital pain, chronic vaginal discharge and bleeding, voiding, and defecation difficulties had been markedly alleviated (5) or they had ceased (14). Twelve of 17 sexually active women (71%) resumed sexual intercourse without difficulties. Ten women required subsequent surgery for stress incontinence and pelvic organ prolapse. Surgeons should be aware of the potential complications of synthetic meshes. Until data on the safety and efficacy of the intravaginal slingplasties are available, these procedures cannot be recommended.

Posterior intravaginal slingplasty for vaginal prolapse

To evaluate the results of the posterior intravaginal slingplasty (IVS). From a urogynecology database, 42 patients who had undergone posterior IVS procedures were analyzed. All the selected patients had also had a posterior colporrhaphy (88% with mesh inserted into the rectovaginal space). Intraoperatively, there was one complication, a rectum perforation. All patients were followed-up, with a median of 13 months. Recurrent prolapse, grade 3 or 4, developed in 12 patients (29%) which included ten cystoenteroceles (24%), four rectoenteroceles (10%), and three cases of utero/vault prolapse (7%). Repeat surgery was performed in six patients (14%). For utero/vault prolapse, eight patients presented preoperatively with grades 3 and 4 prolapse. On follow-up, three patients had utero/vault prolapse, one of whom did not have utero/vault prolapse on presentation. Therefore, of the eight patients presenting with utero/vault prolapse, only two had repeat prolapse on follow-up, which reflected an improvement of 75%. The posterior IVS delivered satisfactory results for vault and posterior compartment prolapse, with a 75% improvement in vault prolapse. It was not possible, however, to separate the effect of posterior IVS and posterior colporrhaphy on the prevention of recurrent prolapse nor on the improvement of difficulty in defecation. Due to the utilization of the now-abandoned vaginal anterior colposuspension procedure for the treatment of anterior compartment prolapse, no conclusions regarding the impact of the posterior IVS on the anterior compartment can be made.