Pelvic Organ Prolapse Stage Research Articles

Cystocele repair by vaginal route: comparison of three different surgical techniques of mesh placement

Different techniques of mesh placement for cystocele repair are known. Our goal was to compare anatomical and functional outcomes of three different techniques of mesh placement over a 3-year follow-up. Between March 2003 and June 2004, 230 patients (stage 2-4 pelvic organ prolapse (POP)) were included in a prospective study. For cystocele repair, mesh was implanted either with two arms into the retropubic space (RP) or with two to four arms into the obturator foramen (TO), or fixed to the arcus tendineous fascia pelvis (FG). Patients' distribution is as follows: 142 TO, 32 RP, and 31 FG. Anatomical success (cystocele < stage 2 in the POP staging system) was clearly poorer after the retropubic free technique, with success rates of 69% (RP), 90.1% (TO), and 96.6% (FG) (p = 0.004). POP distress inventory (p < 0.005) and POP impact questionnaire scores were both significantly poorer after RP. RP technique is less effective than TO and FG techniques.

Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial

To compare the de novo prolapse rate in the untreated vaginal compartments following conventional vaginal prolapse repair and tension-free vaginal mesh repair. Secondary analysis of a randomised controlled trial. Thirteen centres in the Netherlands. Women with recurrent pelvic organ prolapse stage II or higher. Random assignment to either conventional vaginal native tissue repair or vaginal mesh insertion. de novo pelvic organ prolapse stage II or higher in the untreated vaginal compartments at 12 months after surgery. de novo pelvic organ prolapse at and beyond the hymen, de novo prolapse beyond the hymen and prolapse domain scores of the Urogenital Distress Inventory. At 12 months ten of 59 women (17%) in the conventional group versus 29 of 62 women (47%) in the mesh group were diagnosed with a de novo pelvic organ prolapse stage II or higher in the untreated compartment (P < 0.001, odds ratio 4.3, 95% confidence interval 1.9-10.0). Additional apical support to a mesh-augmented anterior repair significantly reduced the de novo prolapse rate. Women with a de novo prolapse in the mesh-treated group demonstrated significantly higher mean bother scores on the domain genital prolapse of the Urogenital Distress Inventory score (13.1 ± 24.2) compared with those without de novo prolapse (2.9 ± 13.9) (P = 0.03). Mesh-augmented prolapse repair in only one vaginal compartment is associated with a higher de novo prolapse rate in the untreated compartments compared with conventional vaginal native tissue repair in women with recurrent pelvic organ prolapse.

Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse

To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP). One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire. We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P<0.001) except for total vaginal length (P=0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P<0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P<0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low. TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.

Impact on quality of life after ring pessary use for pelvic organ prolapse

The purpose of this study was to evaluate symptoms associated with pelvic organ prolapse (POP) and quality of life (QOL) improvement in patients who continue ring pessary use at 1 year. Seventy-seven symptomatic POP patients had successful fitting, and 64 patients (83.1%) continued use at 1 year. The Thai version of Prolapse Quality of Life (P-QOL) questionnaire was used to evaluate symptoms associated with POP and impact on QOL. A higher score represents a greater impairment on the QOL, whereas a lower score represents a better QOL. Mean age was 66.7 ± 8.6 years, median parity was 4 (range 0-10), 59 patients (92.2%) were menopausal, and none had received hormone treatment. Only nine patients (14.1%) were sexually active. Most patients were in the advanced stage of POP - 32.8% stage 3 and 29.7% stage 4. Improvement of prolapse symptoms and voiding difficulty were reported in 100% and 85.7% of the patients, respectively. Among patients who had lower urinary tract symptoms at pre-treatment, about half of patients improvement in frequency, urgency, and urgency urinary incontinence. Only 9.1% of the patients had improvement in stress urinary incontinence (SUI), and 23.8% of the patients reported new onset of SUI (de novo SUI). The median score from all P-QOL domains except personal relationships were significantly decreased after 1 year of ring pessary use. The median total scores at baseline and at 1 year were 40 and 8, respectively (P < 0.001). Ring pessary is an effective non-surgical treatment to alleviate symptoms associated with POP. It can improve QOL in symptomatic POP patients.

Pregnancy after laparoscopic sacral colpopexy: a case report

We report a case of a pregnancy and follow the delivery of a young woman who previously underwent a laparoscopic sacral colpopexy (LSC) for pelvic organ prolapse (POP). A 38-year-old woman with POP desires pregnancy who after unsuccessful medical treatment with pessary underwent a laparoscopic uterine ventrosuspension (LUV). However, this procedure also failed and there was an immediate relapse. Thus, LSC was then performed. After which, she became pregnant culminating in elective caesarean delivery. The LUV failure was documented by a POP-Q classification and dynamic pelvic magnetic resonance (PMR) which was carried out 1 month after the surgery. When the same assessment was conducted after the LSC, it showed an optimal POP correction. The short-term post-delivery follow-up exhibited a small prolapse relapse, which remained stable 48 months after surgery as confirmed by a new PMR. Surgical correction of POP is possible in women with pregnancy desires. The result is variable and links to the POP stage and other surgical interventions.

Résultats de la promontofixation par voie laparoscopique robot-assistée pour la prise en charge des prolapsus urogénitaux : analyse de la littérature

Laparoscopic sacral colpopexy (LSCP) is one of the gold standard surgical treatment for the management of urogenital prolapse. Robot-assisted laparoscopic sacrocolpopexy (RALSCP) is an alternative surgical access which has been recently proposed. The aim of the current study was to report the functional results obtained after RALSCP. [corrected] A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: robotic; robot; sacrocolpopexy; sacralcolpopexy. Clinical cases and series of less than five cases were spontaneously not selected herein. Overall, 12 series in published between September 2004 and September 2011 which included 350 female patients were selected. The mean age was 63 years old with a pelvic organ prolapse of stage 3 to 4 in the Baden Walker classification. The mean operative time of the RALSCP was 207 minutes with a conversion rate of 3,4% and an intraoperative complication rate of 4,6%. The mean length of hospital stay was 3 days and the perioperative complication rate of 7,1%. The success rate of the RALSCP was 97% and the vaginal erosion rate was 2,5% with a median follow-up of 13,5 months. The mid-term functional results obtained after RALSCP were equivalent to those obtained with the LSCP approach. However, there is no prospective randomized comparison available between the two access so far. In addition, the experience with RALSCP remains limited due to the important cost that the robotic access generates.

Levator ani subtended volume: a novel parameter to evaluate levator ani muscle laxity in pelvic organ prolapse

We describe a new parameter based on magnetic resonance 3-dimensional (3D) reconstructions proposed to evaluate levator ani muscle (LAM) laxity in women with pelvic organ prolapse (POP). This is an institutional review board-approved, retrospective chart review of 35 women with POP, stages I-IV. The 3D Slicer software package was used to perform 2-dimensional and 3D measurements and the levator ani subtended volume (LASV) was described. Basically, the LASV represents the volume contained by LAM between 2 planes, which coincides with pubococcygeal line and H line. Correlations among measurements, ordinal POP stages, POP Quantification (POPQ) individual measurements, and validated questionnaires were performed. The LASV differentiated major (III and IV) from minor (I and II) POPQ stages, which positively correlated to POP stages and POPQ individual measurements. The LASV is a promising parameter to evaluate the LAM laxity.

Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction

The objectives of the present review was to present and discuss evidence for pelvic floor muscle (PFM) training on female stress urinary incontinence (SUI), pelvic organ prolapse (POP) and sexual dysfunction. This manuscript is based on conclusions and data presented in systematic reviews on PFM training for SUI, POP and sexual dysfunction. Cochrane reviews, the 4th International Consultation on Incontinence, the NICE guidelines and the Health Technology Assessment were used as data sources. In addition, a new search on Pubmed was done from 2008 to 2011. Only data from randomized controlled trials (RCTs) published in English language is presented and discussed. There is Level 1, Grade A evidence that PFM training is effective in treatment of SUI. Short-term cure rates assessed as <2g of leakage on pad testing vary between 35 and 80%. To date there are 5 RCTs showing significant effect of PFM training on either POP stage, symptoms or PFM morphology. Supervised and more intensive training is more effective than unsupervised training. There are no adverse effects. There is a lack of RCTs addressing the effect of PFM training on sexual dysfunction. PFM training should be first line treatment for SUI and POP, but the training needs proper instruction and close follow-up to be effective. More high quality RCTs are warranted on PFM training to treat sexual dysfunction.

Contribution of Primary Pelvic Organ Prolapse to Micturition and Defecation Symptoms

Objective. To investigate the contribution of Pelvic Organ Prolapse (POP) to micturition and defecation symptoms. Method. Cross-sectional study including 64 women presenting with POP symptoms and 50 controls without POP complaints. Subjects were evaluated using POP-Quantification system, Urinary Distress Inventory, and Defecation Distress Inventory. The MOS SF-36 health survey and the Center for Epidemiological Studies Depression scale were used to measure self-perceived health status and depressive symptoms, respectively. Results. POP in terms of POP-Q had a moderate impact on the symptom observing vaginal protrusion (explained variance 0.31). It contributed modestly to obstructive voiding and overactive bladder symptoms (explained variance 0.09, resp., 0.14) but not to urinary incontinence. Constipation was more likely explained by clinical depression than by pelvic floor defects (explained variance 0.13, resp., 0.05). Conclusion. Stage of POP and specific prolapse symptoms are associated but such a strong association does not exist between POP and micturition or defecation symptoms.

Effect of Colpexin Sphere on pelvic floor muscle strength and quality of life in women with pelvic organ prolapse stage I/II: a randomized controlled trial

Colpexin Sphere was effective for advanced pelvic organ prolapse. The aim of this study was to assess the effect of Colpexin Sphere in women with pelvic organ prolapse (POP) stage I or II on pelvic floor muscle strength, quality of life, and POP stage. Women were randomly divided into Colpexin Sphere with pelvic floor muscle exercise group and exercise only group for a 16-week period. They had Colpexin pull test and digital test every 4 weeks. Quality of life and POP stage were re-evaluated at the end of treatment. Ninety-one women were recruited and 85 completed. Colpexin Sphere plus pelvic floor exercise improved pelvic floor muscle strength. There was no significant difference between both groups. Vaginal symptom score decreased in both groups while the stages of prolapse did not change. Colpexin Sphere plus pelvic floor exercise and exercise alone improved pelvic floor muscle strength.

Sexual Function and Quality of Life for Women with Mild‐to‐Moderate Stress Urinary Incontinence

Sexual function is affected by stress urinary incontinence with or without pelvic organ prolapse. The aim of the study was to describe the sexual function of women with mild-to-moderate stress urinary incontinence, with or without pelvic organ prolapse (up to stage 2) and examine correlations with symptoms and quality of life. This investigation was part of a large, randomized, clinical trial of women with stress urinary incontinence who participated in an exercise intervention. Women included in the study suffered from stress urinary incontinence as measured by a pad test and were interested in an exercise intervention. All participants underwent assessment for prolapse staging. Instruments included: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Incontinence Quality of Life Questionnaire (I-QOL), and a health and urinary leakage questionnaire. One hundred and eighty-seven ambulatory women, aged 20 to 65 years, had a mean sexual function score of 36.9 (standard deviation [SD] 5.9). No significant correlation was found between the sexual function scores and quantity of urinary leakage. A significant correlation existed between the sexual function and I-QOL scores (P < .001). An additional finding was that women with urgency symptoms were older (P= .04) and had significantly lower sexual function scores (mean 35.7; SD 6.4) than those who did not report urgency (mean 38.7; SD 4.6; P < .001). Women with mild-to-moderate stress urinary incontinence, without or with lower stages of pelvic organ prolapse, demonstrated good sexual function, which correlated with physical and psychosocial factors. Health professionals need to perform multifaceted intake assessments on women with urinary leakage to customize their health promotion regimen.

Do patient goals vary with stage of prolapse?

To assess the relationship between stage of pelvic organ prolapse and self-expressed patient goals at initial urogynecologic evaluation. From February to December of 2010, women presenting for evaluation of pelvic floor disorders were asked to identify up to 5 goals for treatment. Charts were reviewed for demographics. Patients were grouped according to stage of prolapse and goals were grouped into 9 categories. Two hundred twenty-six women completed the questionnaire. Relief of urinary symptoms were the most commonly stated goal regardless of prolapse stage, pelvic organ prolapse quantitative-0 (59%), pelvic organ prolapse quantitative-I (78%), pelvic organ prolapse quantitative-II (55%), and pelvic organ prolapse quantitative-III (58%). Lifestyle, daily activity, and sexual function goals were the second, third, and fourth most common goals in all stages, respectively. Resolution of urinary symptoms, ability to perform daily activities, and sexual function goals are at least as important as resolution of prolapse symptoms and may be the reason for seeking care.

Comparison of the Changes in Sexual Function of Premenopausal and Postmenopausal Women Following Transvaginal Mesh Surgery

The effect of transvaginal mesh (TVM) surgery on sexual function between premenopausal and postmenopausal women remains controversial. To compare the changes in sexual function of premenopausal and postmenopausal women following TVM repair. One hundred and fifty-two consecutive women with symptomatic pelvic organ prolapse (POP) stages II to IV were referred for TVM procedures at our hospitals. Sixty-eight women were included because they were sexually active and had complete follow-up. All subjects were divided into the premenopausal (N = 36) and postmenopausal (N = 32) groups. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system and a personal interview with the Female Sexual Function Index (FSFI), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). The FSFI, UDI-6, and IIQ-7 questionnaires. The mean age, rates of hypertension, and previous hysterectomy were significantly higher in the postmenopausal group (P < 0.05) compared with the premenopausal group. As for the POP-Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) in both groups except for total vaginal length (P > 0.05). Similarly, the UDI-6 and IIQ-7 scores significantly decreased postoperatively (P < 0.01). After POP surgery, the score of the dyspareunia domain decreased significantly in the premenopausal group (P < 0.01) but was not the case for the postmenopausal group (P > 0.05). There were no significant changes in other domains and total scores in both groups (P > 0.05). However, higher rates of worsening dyspareunia and total scores were noted in the premenopausal group (P = 0.03 vs. 0.033). TVM procedure is effective for the anatomical restoration of POP. However, individual domain of FSFI such as dyspareunia may worsen in the premenopausal women. Additionally, our results revealed that over one third of premenopausal women could have a worsening sexuality domain postoperatively, with significantly higher rate of deteriorated dyspareunia and total FSFI scores than postmenopausal women.

Factors affecting the feasibility of bilateral salpingo-oophorectomy during vaginal hysterectomy for uterine prolapse

About 15% of all hysterectomies are performed for pelvic organ prolapse, generally through the transvaginal approach. However, concomitant bilateral salpingo-oophorectomy (BSO) is not always feasible through this approach, because the adnexae are sometimes inaccessible. To identify factors affecting the feasibility of performing BSO during transvaginal hysterectomy for uterine prolapse. We reviewed charts of all women undergoing vaginal hysterectomy for uterine prolapse in our institution between December 2005 and November 2009, at which time BSO was uniformly attempted in all patients. One hundred and seventy-two women who underwent vaginal hysterectomy were identified, of whom 134 (78%) underwent concomitant BSO. Women in whom BSO was feasible were younger (60.6±10.1 vs 65.6±8.6 years, P<0.02) and had a higher prevalence of advanced prolapse, including stage IV cystocele (68% vs 38%, P=0.01), stage III-IV rectocele (40% vs 11%, P=0.003) and stage IV uterine prolapse (64% vs 25%, P=0.0005). The feasibility of BSO was primarily dependent on the stage of pelvic organ prolapse and patients' age. Relaxation of the adnexae because of weakness of the infundibulo-pelvic ligaments may accompany severe pelvic organ prolapse and may potentially explain the feasibility of BSO in these women.

Trocar-Guided Mesh Compared With Conventional Vaginal Repair in Recurrent Prolapse: A Randomized Controlled Trial

OBJECTIVE: To compare efficacy and safety of trocar-guided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse. METHODS: Patients with recurrent pelvic organ prolapse stage II or higher were randomly assigned to either conventional vaginal prolapse surgery or polypropylene mesh insertion. Primary outcome was anatomic failure (pelvic organ prolapse stage II or higher) in the treated vaginal compartments. Secondary outcomes were subjective improvement, effects on bother, quality of life, and adverse events. Questionnaires such as the Incontinence Impact Questionnaire and Urogenital Distress Inventory were administered at baseline, 6 months, and 12 months. Anatomic outcomes were assessed by an unblinded surgeon. Power calculation with alpha=0.05 and beta=0.80 indicated that 194 patients were needed. RESULTS: Ninety-seven women underwent conventional repair and 93 mesh repair. The follow-up rate after 12 months was 186 of 190 patients (98%). Twelve months postsurgery, anatomic failure in the treated compartment was observed in 38 of 84 patients (45.2%) in the conventional group and in eight of 83 patients (9.6%) in the mesh group (P<.001; odds ratio, 7.7; 95% confidence interval, 3.3-18). Patients in either group reported less bulge and overactive bladder symptoms. Subjective improvement was reported by 64 of 80 patients (80%) in the conventional group compared with 63 of 78 patients (81%) in the mesh group. Mesh exposure was detected in 14 of 83 patients (16.9%). CONCLUSION: At 12 months, the number of anatomic failures observed after tension-free vaginal mesh insertion was less than after conventional vaginal prolapse repair. Symptom decrease and improvement of quality of life were equal in both groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00372190. LEVEL OF EVIDENCE: I.

Factores de riesgo en el fracaso de la reparación quirúrgica del prolapso de suelo pelviano

Introduction Pelvic organ prolapse (POP) surgery has variable results of recurrence and complications. We have aimed to analyze our outcomes in order to know the factors associated with anatomical and functional failure in POP surgery. Material and methods A retrospective study of 69 patients who underwent POP surgery at our hospital was performed. Registered variables were: Age, BMI, number of deliveries, previous pelvic surgery, menopause, quality of life, urinary incontinence, associated frequency-urgency symptoms, high POP stage, vaginal compartments repaired, type of mesh, urethro-suspension and vaginal hysterectomy during POP surgery and its complications. Patients were evaluated at 1, 6 and 12 months post-surgery. The technique was considered as failed when relapse or mesh erosion occurred and when the patient is not satisfied or there was relapse. The sample is described, analyzing the relationship of the variables studied by univariate analysis (Chi square and Mann-Whitney U test) and a study was made of which variables may have predictive value in the failure of the repair (multiple logistic regression). Results Surgery failed in 17 patients during the follow-up at one year. BMI (29.6 ± 2.03 vs 27.1 ± 3.32), delivery number (3.4 ± 0.71 vs. 2.8 ± 1.88), menopause, frequency- urgency symptoms and number of vaginal compartments repaired were associated with treatment failure although only BMI, delivery number and frequency-urgency symptoms were defined as independent predictive variables when the logistic regression was carried out. Conclusions Overweightness-obesity, previous delivery number and frequency-urgency symptoms before surgery are factors associated to anatomical and functional failure after POP repair.

Definition of recurrence of pelvic organ prolapse: is it really important?

Pelvic organ prolapse (POP) is becoming an important women's health priority worldwide because the cumulative lifetime risk for undergoing surgical intervention is estimated to be greater than 11% [1, 2]. Almost one third of these women will develop postoperative recurrence requiring further surgery, thus representing a significant public health problem [3]. Causes of recurrence of POP are poorly understood but include younger or older age, obesity, genetic predisposition for weakness of the pelvic floor, advanced prolapse, and performing an inappropriate primary procedure [4–6]. Although the etiology of recurrence of POP is frequently discussed in the literature, very few studies report on the outcome of surgical treatment in women with recurrent disease. In the published case series to date, data on the long-term outcome are often lacking or difficult to compare and therefore the cumulative surgical cure rate and/or independent efficacy of each surgical technique remain uncertain [3, 7]. This is usually attributed to the use of various and non-validated tools to measure the outcome of a large number of operative techniques, particularly the novel disposable surgical kits, in a small subset of patient cohorts. The lack of a uniformly accepted definition of recurrence including a detailed description of the anatomical location of the defect and whether this is in the same or different vaginal compartment may also be responsible [3, 6, 7]. It might therefore be helpful to have a standard definition and/or classification of recurrent POP as a separate clinicopathological entity from primary disease and are urgently needed by the urogynecologic community, similar to recent standardization reports [8]. This endeavor will increase the scientific validity of outcome measures of surgical intervention for recurrent POP with a potential for selecting the most effective procedures and will contribute to our understanding of the pathogenesis of recurrence. A standardized terminology of POP recurrence will also allow comparison of the results of surgical treatment between different surgeons and centers and will provide robust clinical evidence to assist in counseling women about the expected treatment outcome [9]. Hence, the ambiguous postoperative outcome measures that are currently used in the biomedical literature such as “surgical failure,” “persistent,” “recurrence,” “relapse,” or “de novo” should now be replaced by the appropriate medical terminology that facilitates interpretation of data obtained by different researchers in this field. There is also mounting evidence at present that anatomical evaluation, per se, does not often reflect patient perception of their condition and women with the same preoperative POP stage may have completely different expectations [9]. Moreover, the concept of restoring normal vaginal anatomy in women with POP using reconstructive pelvic surgery is S. Salvatore (*) Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy e-mail: stefanosalvatore@hotmail.com

Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals

To evaluate the prevalence of prolapse and related bladder, bowel, and sexual problems in transsexual patients (TS) after sex reassignment surgery. A cross-sectional study. A tertiary referral center. 55 transsexuals, comprising 52 male-to-female and 3 female-to-male patients. Gynecologic examination with pelvic floor testing, measurements for pelvic organ prolapse applying International Continence Society pelvic organ prolapse (ICS-POP) staging, and the Sheffield prolapse questionnaire to assess prolapse symptoms, and bladder, bowel, and sexual function. ICS-POP score and Sheffield prolapse questionnaire. Of the 55 transsexuals who participated in this study (52 male-to-female and 3 female to male), 7.5% showed a prolapse greater than or similar to ICS-POP stage 2, and 3.8% required surgical intervention. For bladder symptoms, 47% reported voiding difficulties, 24.6% urgency, 17% urge incontinence, and 23% stress incontinence. Fecal urgency and incomplete emptying of the bowel occurred in 9.4% and 7.6% of patients, respectively. In addition, 23% reported that they were never satisfied with their sexual function. Pelvic floor symptoms may occur in transsexuals involving the bladder, bowel, and sexual function. Surgical corrective options should be determined on an individual basis as with other patients who have prolapse symptoms.

2075 EVALUATING THE QUALITY OF URINARY INCONTINENCE AND PROLAPSE TREATMENT (EQUIPT) STUDY: QUALITY INDICATOR DEVELOPMENT FOR PELVIC ORGAN PROLAPSE

2075 EVALUATING THE QUALITY OF URINARY INCONTINENCE AND PROLAPSE TREATMENT (EQUIPT) STUDY: QUALITY INDICATOR DEVELOPMENT FOR PELVIC ORGAN PROLAPSE

Collagen-coated polypropylene mesh in vaginal prolapse surgery: an observational study

Objective We evaluated the efficacy and safety of a collagen-coated polypropylene mesh with a trans-obturator approach for cystocele repair. Study design We considered as eligible for our study 97 patients with a stage ≥2 cystocele according to the Pelvic Organ Prolapse Staging System (POP-Q), with or without associated apical or posterior vaginal wall prolapse. They were also evaluated pre- and post-operatively using validated questionnaires (P-QoL, Wexner and PISQ-12). Patients underwent cystocele repair using Avaulta ® Biosynthetic Anterior Support System (CR Bard Inc., Billerica, USA). Objective anatomical cure was defined when points Ba, C and Bp were at stage 0 (good outcome) or stage 1 (satisfactory outcome). The McNemar chi-square test was used to compare categorical variables, the paired t-test for continuous parametric variables, and the Mann–Whitney test for continuous non-parametric variables. Results All patients completed the 1-year follow-up. We observed an anatomical cure rate of 64.9% for anterior vaginal wall prolapse (point Ba < −1), and a statistically significant improvement in storage, voiding, post-micturition and prolapse-related symptoms. Quality of Life and sexuality were also statistically improved, while we found no impact on anorectal function. We also observed the development of vaginal mesh exposure in 21 patients (21.6%). Conclusion Our data suggest that the collagen-coated polypropylene mesh, as we used it, gives a high recurrence rate (35.1%) and a high exposure rate (21.6%) at one-year follow-up, and is consequently unsatisfactory for the treatment of anterior vaginal wall prolapse.