Correction Of Pelvic Organ Prolapse Research Articles

Porcine Small Intestinal Submucosa Mesh for Treatment of Pelvic Organ Prolapsed.

Background:Pelvic organ prolapse (POP) is a major health concern that affects women. Surgeons have increasingly used prosthetic meshes to correct POP. However, the most common used is synthetic mesh, and absorbable mesh is less reported. This research aimed to evaluate the clinical effectiveness of porcine small intestinal submucosa (SIS).Methods:Consecutive forty POP patients who met the inclusion criteria underwent pelvic reconstruction surgery with SIS between March 2012 and December 2013. The patients’ clinical characteristics were recorded preoperatively. Surgical outcomes, measured by objective and subjective success rates, were investigated. We evaluated the quality of life (QOL) using the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Sexual QOL was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12).Results:At postoperative 12 months, the subjective recurrence rate (7.5%) was much lower than the objective recurrence rate (40.0%). Postoperatively, no erosion was identified. One underwent a graft release procedure because of urinary retention, and one had anus sphincter reconstruction surgery due to defecation urgency. Another experienced posterior vaginal wall infection where the mesh was implanted, accompanied by severe vaginal pain. Estrogen cream relieved the pain. One patient with recurrence underwent a secondary surgery with Bard Mesh because of stage 3 anterior vaginal wall prolapse. Scoring system of PFDI-20 was from 59.150 ± 13.143 preoperatively to 8.400 ± 4.749 postoperatively and PFIQ-7 was from 73.350 ± 32.281 to 7.150 ± 3.110, while PISQ-12 was from 15.825 ± 4.050 to 12.725 ± 3.471.Conclusions:QOL and the degree of subjective satisfaction were significantly improved postoperatively. Anterior repair deserves more attention because of the higher recurrence rate. The long-term follow-up of the patient is warranted to draw firm conclusion.

Análisis de costes del tratamiento del prolapso de órganos pélvicos mediante colposacropexia laparoscópica o malla transvaginal

ObjectivesThe objective of this study is to compare direct costs of repairing pelvic organ prolapse by laparoscopic sacrocolpopexy (LS) against vaginal mesh (VM). Our hypothesis is the correction of pelvic organ prolapse by LS has a similar cost per procedure compared to VM. Material and methodsWe made a retrospective comparative analysis of medium cost per procedure of first 69 consecutive LS versus first 69 consecutive VM surgeries. We calculate direct cost for each procedure: structural outlays, personal, operating room occupation, hospital stay, perishable or inventory material and prosthetic material. Medium cost per procedure were calculated for each group, with a 95% confidence interval. ResultsLS group has a higher cost related to a longer length of surgery, higher operating room occupation and anesthesia; VM group has a higher cost due to longer hospital stay and more expensive prosthetic material. Globally, LS has a lower medium cost per procedure in comparison to VM (5,985.7 €±1,550.8 € vs. 6,534.3 €±1,015.5 €), although it did not achieve statistical signification. ConclusionsIn our midst, pelvic organ prolapse surgical correction by LS has at least similar cost per procedure compared to VM.

Combined reconstructive surgery involving uterosacral colpopexy and anterior vaginal mesh implantation for pelvic organ prolapse.

The optimal treatment for pelvic organ prolapse has been the subject of much discussion. The aim of this study was to assess the utility of a combination of uterosacral colpopexy and anterior vaginal mesh implantation. A single-center prospective cohort study was conducted. Twenty-eight patients with stage III-IV cystocele and uterine prolapse underwent reconstructive surgery. A combination of vaginal hysterectomy, McCall culdeplasty, and trocar-guided anterior vaginal mesh implantation was performed, and the patients' postoperative outcomes were analyzed. Patient satisfaction was investigated using the modified Short Form 12 version 2 (SF-12v2) questionnaire, and interviews regarding sexual behavior were conducted at 1 postoperative year. A bladder injury occurred during the dissection in one case (3.6%). Recurrent vaginal vault prolapse beyond the hymen was observed in one patient (cure rate: 96.4%), and further mesh augmentation was required in this case. Another patient developed mild cystocele (Ba = 0), but was simply observed because she did not complain of any symptoms caused by vaginal descent. We did not experience any other mesh-related complications, such as protrusion, chronic pain, or chronic inflammation, during the follow-up period. The patients' modified SF-12 scores at 12 months were significantly better than their preoperative scores in all eight domains. The satisfactory correction of pelvic organ prolapse was achieved using a combination of vaginal hysterectomy and uterosacral ligament colpopexy augmented by anterior vaginal mesh implantation. © 2016 Japan Society of Obstetrics and Gynecology.

The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse.

ObjectiveThe purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms.MethodsA total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65).ResultsOAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms.ConclusionWomen with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage.

What to Do With Recurrent Prolapse After Vaginal Mesh Failure?

Study ObjectiveTo show that in selected cases laparoscopic sacrocolpopexy can be used for the treatment of recurrent pelvic organ prolapse after vaginal mesh surgery. MethodsStep-by-step examination of the technique using an educative video. Institutional review board approval was obtained. SettingThe authors describe two clinical cases of treatment of recurrent pelvic organ prolapse, after a vaginal mesh surgery, using laparoscopic sacrocolpopexy. PatientsA 56-year old patient (para 3, gravida 2) presented with the sentation of bulging in the vagina. On physical examination, the patient had a grade 2-3 vaginal apical prolapse and a stage 4 rectocele. She had a slight mesh contraction but no vaginal extrusion and no pain were reported. Eleven years before, she had a vaginal total hysterectomy for pelvic organ prolapse correction and one year before she had a vaginal prolapse repair using a synthetic mesh. A laparoscopic sacrocolpopexy with bilateral ooforectomy was performed. The second case is of a 54-year old patient (para 2, gravida 2) that presented stress urinary incontinence. On physical examination, the patient had a grade 3 uterine prolapse and grade 2 cystocele. Eleven years before she had a vaginal prolapse repair using a synthetic mesh and a miduretral sling for stress urinary incontinence. Two years before, she had the miduretal sling removed for recurrent urinary infections and dysuria. A laparoscopic sub-total hysterectomy with salpingectomy and ovarian conservation, sacrocolpopexy and a Burch colposuspension was performed. Measurements and Main ResultsThe procedures and postoperative recovery were uneventful. No minor or major complications occurred. The patients were discharged three days after surgery. ConclusionLaparoscopic sacrocolpopexy is a promising approach for the treatment of recurrent pelvic organ prolapse after vaginal mesh surgery. It appears to be feasible, safe, and effective.

The Feasibility of Clean Intermittent Self-Catheterization Teaching in an Outpatient Setting.

The aim of this study was to evaluate the feasibility of teaching clean intermittent self-catheterization (CISC) in an outpatient setting to women planning surgery for pelvic organ prolapse (POP) and/or urinary incontinence (UI). This was a prospective observational study of 55 women who planned surgical correction of POP and/or UI. All women were taught CISC as part of their preoperative education. The ability to learn CISC and the amount of time needed to teach CISC were recorded. Multivariate modeling, χ2 test, Fisher exact test, and Kruskal-Wallis analysis of variance were used for statistical analysis. Of the 55 subjects consecutively enrolled, 51 subjects (93%) were able to learn CISC and demonstrate competency (P < 0.00001). Four subjects (7%) were unable to learn CISC. The median time to teach CISC with demonstrated proficiency was 3.7 minutes (range, 1.8-7.4 minutes). Of the subjects who learned CISC and had surgery, the mean (SD) time in days from preoperative teaching to the postoperative voiding trial was 16 (11) days (range, 2-39 days). Of the 41 subjects who completed the postoperative voiding trial and had data recorded, 33 (80%) were able to self-catheterize without nurse assistance or with minimal verbal coaching, whereas 8 (20%) subjects required hands-on nursing assistance or were unable to perform CISC (P < 0.001). Clean intermittent self-catheterization can be taught to most patients undergoing POP/UI surgery in a short time (median, 3.7 minutes). The overwhelming majority of patients are able to retain the CISC skill weeks after being taught in the clinic.

Stress incontinence surgery at the time of prolapse surgery: mandatory or forbidden?

Concomitant anti-incontinence surgery at the time of prolapse repair has been a long-debated topic. Still today, there remains no clear answer to this question, although in recent years the literature has become more robust with the addition of more randomized controlled trials. The lifetime risk for women of undergoing surgical correction of pelvic organ prolapse is significant, and concomitant anti-incontinence surgery is an important question during surgical planning. This review delves further into the current literature to discuss a possible algorithm for managing the risk of stress incontinence after pelvic organ prolapse repair and examines the support in the literature for the following treatment methods: (1) anti-incontinence surgery for all women undergoing pelvic organ prolapse repair, (2) anti-incontinence surgery for no women undergoing pelvic organ prolapse repair, and (3) anti-incontinence surgery in select women undergoing pelvic organ prolapse repair. While there are data both for and against each of these approaches, after a review of the literature, we recommend anti-incontinence surgery for select women undergoing pelvic organ prolapse repair, including women with a history of symptomatic and occult stress incontinence diagnosed preoperatively.

Should Prophylactic Anti-Incontinence Procedures Be Performed at the Time of Prolapse Repair? Systematic Review

Urodynamic studies performed prior to prolapse repair in women with high-grade pelvic organ prolapse (POP) have revealed asymptomatic stress urinary incontinence (SUI) in 36% to 80% of these women. The probable explanation for maintenance of continence prior to surgery in these patients may be urethral kinking or compression of the urethra by the genital prolapse. Once the genital prolapse has been repaired, these women are at high risk of postoperative SUI. Although occult SUI and prolapse repair can be corrected during a single surgery, combining both procedures is highly controversial. Some surgeons question the effectiveness of a single surgery to make both repairs and recommend a second surgical procedure after prolapse repair to correct occult incontinence. However, there are risks associated with a new hospitalization and a second surgery. This systematic literature review was conducted to determine whether performing prophylactic anti-incontinence procedures during surgical POP correction in women with severe genital prolapse and no symptoms of incontinence could prevent postoperative SUI. PubMed, EMBASE, Cochrane Library, and Lilacs databases were searched to identify articles published up to January 12, 2014. The search was limited to randomized trials. All participants had severe POP and no symptoms of SUI prior to prolapse surgery. The primary study outcome was the incidence of SUI or the need of treatment for this condition after the surgical procedure. The initial search identified 5618 studies; 66% of these were selected for full text analysis. Only 7 of these trials met the study inclusion and exclusion criteria. Following the systematic review, a meta-analysis was performed with common variables of studies and the same scale of quantification. Performance of any prophylactic anti-incontinence procedure during prolapse repair reduced the incidence of SUI postoperatively; the relative risk was 0.51, with a 95% confidence interval of 0.38 to 0.68. However, the results were different when the types of anti-incontinence procedure used were analyzed separately. The only anti-incontinence procedure that led to a significant reduction in the incidence of UI was retropubic midurethral sling surgery (relative risk, 0.09; 95% confidence interval, 0.02–0.36). These data show that use of the retropubic midurethral sling concomitantly with prolapse repair in women with severe POP is the only prophylactic anti-incontinence procedure that reduces risk of SUI.

Improvement of overactive bladder symptoms after tension-free vaginal mesh operation in women with pelvic organ prolapse: Correlation with preoperative urodynamic findings.

To further elucidate the mechanisms of overactive bladder coexisting with pelvic organ prolapse. A total of 100 consecutive women with stage 2 or greater pelvic organ prolapse associated with cystocele were enrolled in the present prospective study. They underwent urodynamic studies and then received tension-free vaginal mesh operation. Urodynamic studies were carried out before and after the correction of pelvic organ prolapse using a single gauze pack in the vagina in the sitting position. The overactive bladder symptom score and International Prostate Symptom Score were collected before and 3 months after surgery. In 53 of 100 cases, pelvic organ prolapse was accompanied with overactive bladder, and detrusor overactivity was observed in 28 out of 53 pelvic organ prolapse with overactive bladder cases (52.8%). Detrusor overactivity was resolved in 18 and reduced in four out of 28 cases after the correction of pelvic organ prolapse by the gauze packing method. Of 53 patients who had overactive bladder preoperatively, overactive bladder symptoms disappeared in 35 cases (66.0%) and improved in six additional cases (11.3%) after tension-free vaginal mesh operation. A total of 20 of 25 cases whose overactive bladder symptoms disappeared or improved after surgery coincided with those who had shown either disappearance (n = 16) or improvement (n = 4) of detrusor overactivity after intravaginal gauze pack insertion in preoperative urodynamic studies. All scores in the overactive bladder symptom score decreased significantly after tension-free vaginal mesh, as well as the International Prostate Symptom Score, except for night-time frequency. Pelvic organ prolapse-associated overactive bladder or detrusor overactivity conditions can be reversed in most cases within a short period of time after surgical correction of pelvic organ prolapse.

General and method-specific complications of sacrocolpopexy

Sacrocolpopexy has remained standard procedure for correction of pelvic organ prolapse regardless of the affected compartment. Assuming the appropriate indication, it is characterized by an excellent long-term cure rate. Asymptomatic pelvic organ prolapse is no indication for surgery and should not be corrected in view of possible complications. This article summarizes general and method-specific complications of sacrocolpopexy, identifies causes, and allows error management to be tailored to each individual patient to increase treatment and outcome quality.

VOLUNTARY SURGICAL CONTRACEPTION OF WOMEN OF LATE REPRODUCTIVE AGE SUFFERING FROM PELVIC ORGAN PROLAPSE – FEATURES AND BENEFITS

In recent years there has been a noticeable "rejuvenation" of pelvic organ prolapse. Inconsistency of the pelvic floor muscles, including the omission of sexual organs, is extremely common pathology, observed almost a third of women of reproductive age. The search for effective, convenient methods of contraception for this category of patients is an important problem of modern gynecology.We proposed a method of transvaginal voluntary surgical contraception, produced in conjunction with surgical treatment of descent and prolapse of the vaginal walls. Studied the nearest and long-term results of surgery in 50 women to which, during the surgical treatment of genital prolapse at the same time was performed transvaginal occlusion of the fallopian tubes. Control groups consisted of 30 women to which in the first step before surgical correction of pelvic organ prolapse have been performed minilaparotomy and voluntary surgical sterilization (VSS). Our method consists in penetrating into the abdominal cavity through the anterior vaginal vault, downgrading the fallopian tubes with a hook of Ramathibodi and tubal sterilization by Pomeroy method. Intra - and postoperative complications were not observed. In the late postoperative periods - the effectiveness of the method was 100%. Marked tendency to improve the quality of sexual life tells about the positive impact of elimination of genital prolapse with simultaneous DCA on the quality of life of women.

Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic review.

Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired. The probable explanation for patients remaining subjectively continent is that POP can cause urethral kinking or compression. We hypothesized that performing prophylactic anti-incontinence procedures during surgical POP correction in women with no symptoms for urinary incontinence (UI) may prevent SUI postoperatively. A systematic review of randomized trials was performed. Participants were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. Results are presented as relative risk (RR), with 95% confidence interval (95% ). Initially, 5,618 studies were identified by the search strategy, but only seven trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR 0.51; 95% CI 0.38-0.68). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent retropubic midurethral sling surgery was the only group that benefited from the anti-incontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95% 0.02-0.36). Prophylactic treatment of women with severe POP using retropubic midurethral sling was the only procedure that reduced the risk of UI.

A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function.

The aim of this review was to investigate the impact of native tissue repair for pelvic organ prolapse (POP) on overall sexual function and dyspareunia. Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and Embase were searched for trials of prolapse surgery assessing sexual function and dyspareunia before and after surgery. We assessed observational studies and randomized controlled trials investigating the impact of surgical correction of POP on sexual function. Surgical interventions assessed were anterior and/or posterior repair with or without a vaginal hysterectomy. Studies including patients undergoing concurrent incontinence surgery or vaginal mesh insertion were excluded from the analysis. Dyspareunia was analyzed separately. We identified 674 potential citations, of which 14 articles assessed sexual function and/or dyspareunia before and after traditional prolapse surgery. The results suggest evidence for significant improvement in sexual function postsurgery, with a standardized mean difference of -0.55, 95 % confidence interval (CI) -0.68 to -0.43 in favor of surgical correction. Dyspareunia rates were also significantly improved postoperatively, with overall odds ratio of at least 2.5 times as likely as the chances of deterioration. Sexual function is significantly improved and dyspareunia significantly reduced following native tissue prolapse surgery. There were several methodological problems with the quality of the primary research, particularly related to study heterogeneity, use of different outcome measures, and absence of well-designed randomized controlled trials.

Optimization of diagnostics and treatment of mixed and stress urinary incontinence in women

Save or occurrence «de novo» of the bladder and urethra dysfunction in surgical correction of urinary incontinence (UI) among women is impotant problem of Urogynecology. Purpose: To evaluate the role of complex diagnostics in determination of the pathogenetically based tactics with mixed and stress incontinence among women. Materials and Methods: The study included 633 patients 22-88 years old with complaints of mixed (n = 356) and stress (n = 277) UI before treatment (medical, physiotherapy, sling surgery): 119 - clinically, 514 - complexly (clinical examination and complex urodynamic testing). Surgical correction of pelvic organ prolapse is performed to 270 patients. Complex examination was repeated to all of them in 1-3 and 12-36 months after treatment. Results: detrusor overactivity - DO (32.9 %) and urethral instability (23.1 %) before surgery is more common among patients with complaints of mixed incontinence, but among patients with stress complaints this pathology is also found in 5 %, and 8.3 % of cases, respectively. 55.9 % patients with complaints of mixed incontinence and 47.2 % - with stressful complaints were not operated in connection with full or significant reduction of complaints on the background of pathogenic conservative therapy. The efficacy of sling operations for stress and mixed incontinence is high but not statistically different and generally amounts to 97.1 % in 3-36 months after surgery. The frequency of postoperative dysfunction among clinically examined patients with complaints of mixed incontinence was in general 46 %, the frequency among complexely examined patients - 9.7 %. (OR 7,7, 95 % CI 2,9-20,3). Conclusion: Complex examination with the use of urodynamic testing, the therapy of bladder and urethra neuro-muscular dysfunction, the selection of patients for surgical treatment leads to a significant reduction of dysfunction number in early and late postoperative period and improve patients’ satisfaction with the treatment.

The use of mesh implants in vaginal prolapse surgery: Position statement and recommendations of the South African Urogynaecology Association

This is the 2014 updated guideline and position statement from the South African Urogynaecology Association on the use of transvaginal mesh for the surgical correction of pelvic organ prolapse.

Discrete choice experiments: helping to understand how patients make decisions and promoting non-paternalistic care.

Discrete choice experiments are a technique used primarily by health economists to inform healthcare policy decisions in settings of limited resources. They are most commonly used to elucidate which attributes of policies are important to patients (for example do patients prefer longer weekday clinic opening times or more capacity within the normal working day). The technique can also be used to explore, in depth, patient preferences for individual (as opposed to policy) treatment decisions. Patient preferences, joint care decisions, and a non-paternalistic ethos are key to patient-centred care. So, understanding what is important to patients when making healthcare choices should be encouraged and is probably an under-researched area. Here, Notten et al. have used this technique to investigate what is important to patients when choosing between mesh surgery and anterior colporrhaphy for the primary correction of pelvic organ prolapse (POP). The high risk of dyspareunia under mesh surgery was found to be important to patients, and a reason why many of the patients preferred anterior colporrhaphy over mesh surgery. Whether these decisions varied by age was not considered here (appropriately so, as the study sample was not large), but presumably this may become less important with increasing age. Risk of infection, although relatively low in comparison with the other risks (realistic risk in the region of 2–5%), was also found to be important for women; whereas risk of recurrence, although deemed important a priori, and found to be statistically significant here (realistic risk in the region of 30%), was found to be relatively less important than risk of infection. In this study, all of the women in the sample had made a treatment choice for anterior colporrhaphy, so it is perhaps little surprising that the majority preferred this treatment option. Being very sceptical, we might even interpret these findings as telling us that 26% changed their minds after full consideration of the risks and benefits. Ideally, for results to be generalisable, patients should not have made their treatment decision before participation in a discrete choice experiment. What's more, participation in a study like this, before a treatment decision is made, could also benefit the individual, allowing them to make a treatment decision informed by up-to-date evidence and a full explanation and consideration of the risks and benefits. Of course, this is simply how all treatment decisions should be made, with a full explanation of the uncertainty of the evidence base and a treatment decision made by the patient dependent on what is important to them. Ensuring that we promote the patient-centred ethos in decision-making, however, we must take care that although a large majority of the women in this study preferred anterior colporrhaphy, not all did, and it therefore remains important to elicit the preferences of all women at the time of decision-making. The author has no conflicts of interest to disclose. ■

Surgical treatment for pelvic organs prolapse

Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.

378 High bilateral cervicosacropexy in “W-Technique” with an MRI visible textile implant for the correction of pelvic organ prolapse in single incision technique

378 High bilateral cervicosacropexy in “W-Technique” with an MRI visible textile implant for the correction of pelvic organ prolapse in single incision technique

377 Follow up for urinary continence after pelvic organ prolapse repair

CONCLUSIONS It’s well-know that the risk for woman of being the operated for 80 years about the pelvic organ prolapse (POP) or stress urinary incontinence (SUI) is about 11% [1]. It should be noted that approximately 22-30% of patients who were continent before surgery noted SUI postoperatively [2], [3], which has a strong impact on the quality of life of patients. Objective of our study was to evaluate the incidence of SUI and anti-incontinence surgery for 6 months in patients after surgical correction of pelvic organ prolapse (POP) by the vaginal approach. This study included 82 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients. All patients were submitted to standard protocol of preoperative examination including a history taking and gynecological examination with cough tests with or without prolapse repositioning by speculum, pessary or manually. All patients were operated by vaginal approach. The results of surgical treatment of POP were evaluated for the presence SUI within 1, 3 and 6 months after the operation during office visits and using the UDI-6 questionnaire.

Trans-Vaginal Mesh Revision: A Comprehensive Review on Etiologies and Management Strategies with Emphasis on Postoperative Pain Outcomes.

The use of polypropylene mesh to augment surgery aimed to correct pelvic organ prolapse and stress urinary incontinence stems largely from the high recurrence rates of native tissue repairs. While objective outcomes were improved, mesh related complications began to emerge that included mesh exposures, extrusions, dyspareunia and other pain issues. However, the indication for and benefit of surgical intervention(s) to address these complications are lacking. We aim to review to current literature regarding postoperative pain outcomes following vaginal mesh revision. Evidence based literature indicates that mesh complications are not rare and surgery that aims to address them generally have an overall benefit. However, studies available are generally small case series of a retrospective nature with short follow up. Some themes are evident: there is a long lag period from mesh insertion to removal; there is a lack of a true denominator of total mesh insertions making it hard to gauge the real scope of the problem; mesh material found not along the expected trocar path or coursing close to neurovascular structures thus raises the possibility of technical errors during insertion. Transvaginal mesh revision(s) for mesh complications generally have a positive effect on pain outcomes, but better controlled studies are needed. Additionally, since technical issues may be a factor in the development of mesh complications, rigorous training and sufficient surgical case volume should be emphasized.