Total Pelvic Floor Reconstruction Research Articles

Subjective and Objective Evaluation of Total Pelvic Floor Reconstruction with Six-Arm Mesh in Patients with Severe Pelvic Organ Prolapse: A 1-Year Retrospective Study.

PurposeTo investigate the effect of total pelvic floor reconstruction with a six-arm mesh in the treatment of pelvic organ prolapse.Patients and MethodsThis is a retrospective observational cohort study. A total of 368 patients with pelvic organ prolapse underwent pelvic floor reconstruction surgery. Patients were categorized by the type of surgical mesh: 176 patients received a six-arm mesh and 192 patients received an anteroposterior approach mesh. The 1-year effect of the two groups was compared. The Pelvic Floor Distress Inventory Questionnaire (PFDI-20), Colorectal-Anal Distress Inventory (CRADI-8) and the Pelvic Organ Prolapse Quantitation (POP-Q) staging were used for evaluation. The incidence of complications was recorded. A cure standard was registered by a POP-Q score of grade I or below. A P value <0.05 indicates the difference is statistically significant.ResultsThere was no recurrence documented in the patients; the cure rate was 100% in both groups. After surgery, the length of the vagina in the six-arm mesh group was longer than that of the control group at 6 months and 12 months, respectively (P < 0.05). The six-arm mesh group had lower PFDI-20 and CRADI-8 scores after surgery than those of the control group at 6 and 12 months, respectively (P < 0.05). Pelvic floor and rectal dysfunction symptom improvement were superior in the six-arm mesh group compared with the control group. After surgery, the Female Sexual Function Inventory (FSFI) score of the six-arm mesh group was superior to that of the control group at 6 and 12 months, respectively (P < 0.05). The incidence of complications in the six-arm mesh group was lower than that of the control group (P < 0.05).ConclusionThe total pelvic floor reconstruction using six-arm mesh has the same healing rate as anteroposterior approach mesh surgery, and it is better than traditional surgery in improving subjective symptoms and reducing postoperative complications.

Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh.

To investigate the impact of enhanced recovery after surgery (ERAS) on perioperative outcomes after total pelvic floor reconstruction surgery with transvaginal mesh. A single-center, retrospective observational cohort study involved 177 patients who underwent total pelvic floor reconstruction surgery with transvaginal mesh between August 2015 and November 2017. Eighty-five patients treated according to a traditional protocol formed the control group and 92 patients treated using the ERAS pathway were assigned to the ERAS group. Registered outcomes included demographic characteristics, intraoperative and postoperative data (first assisted walking time, first intestinal exhaust time, length of stay, hospital costs), and complications. The first assisted walking time (40.6±1.48 vs 23.56±3.26hours, P<0.001) and the first intestinal exhaust time (27.65±11.63 vs 18.65±10.68hours, P<0.001) were earlier in the ERAS group. The implementation of the ERAS pathway was associated with shorter length of stay (121.35 vs 70.25hours, P<0.001) and lower hospital costs (46 838.65±2584.08 vs 42 793.57±2560.3 RMB, P<0.001). There was no difference in surgical outcomes or postoperative complications between the two groups. ERAS is safe, economical, and reliable after total pelvic floor reconstruction surgery and promotes perioperative recovery without increasing complication rates.

Modified posterior intravaginal slingplasty: does the additional bilateral tape attachment to the sacrospinous ligament improve the results?

IntroductionHigh failure and recurrent prolapse remains an important issue for pelvic organ prolapse (POP) surgery. The posterior intravaginal slingplasty (PIVS) is a minimally invasive, transperineal technique providing level I support, by creating neo-sacrouterine ligaments using a mesh. In order to reduce the POP recurrence rate, achieve a safer apical support and thereby better functional outcomes, we attached PIVS tape to the sacrospinous ligament bilaterally and compared the anatomical and functional outcomes for our modified technique versus the original PIVS.Material and methodsWe evaluated 368 patients, with a symptomatic pelvic organ prolapse in various grades, who had undergone a total pelvic floor reconstruction. Seventy-seven of 368 (21%) patients underwent the original PIVS, 291 (79%) patients were treated by the modified PIVS. When necessary, the following procedures were added: anterior transobturator mesh, posterior wall repair, perineal body repair and suburethral transobturator sling. All had follow-up checks for at least one year. The primary outcome was an objective cure, defined as grade 0 or grade 1 according to Baden-Walker. Secondary outcomes were prolapse recurrence, symptoms, visual analogue scales for satisfaction, quality of life, recommendation, reoperation rates and presence of complications.ResultsThe total reconstructions we made, using each technique, were successful. We achieved an apical success rate of 97 to 96%, on average, with the modified and original IVS respectively. We found a statistically significant improvement in urge incontinence and frequency symptoms than the original PIVS with our modified technique.ConclusionsModified PIVS in combination with concomitant procedures generates high anatomical and functional cure rates with low complications and recurrences.

The efficacy and feasibility of total reconstruction versus nontotal reconstruction of the pelvic floor on short-term and long-term urinary continence rates after radical prostatectomy: a meta-analysis

BackgroundRecently, total pelvic floor reconstruction (TR) has been the treatment of choice for improving urinary incontinence (UI) after radical prostatectomy (RP). However, the superiority of TR with respect to urinary continence recovery following RP remains controversial. This study identified the effect of TR versus nonTR of the pelvic floor on short-term and long-term continence rates after RP.MethodsA literature search was performed in November 2017 using the PubMed, Embase, and Web of Science databases. Only comparative research or clinical studies reporting urinary continence outcomes was included in the meta-analysis, and the quality of evidence was evaluated using the 2011 Level of Evidence for therapy research.ResultsWe analyzed ten studies reporting urinary continence rates after RP at one or more postoperative time points (1, 2, 4, 12, 24, and 52 weeks). TR was associated with significantly better urinary continence outcomes at 1 week (OR 2.76, 95% CI 1.58–4.84, P < 0.001), 2 weeks (OR 2.57, 95% CI 1.74–3.80, P < 0.001), 4 weeks (OR 2.61, 95% CI 1.56–4.38, P < 0.001), 12 weeks (OR 4.33, 95% CI 2.01–9.33, P < 0.001), 24 weeks (OR 3.83, 95% CI 1.54–9.55, P = 0.004), 52 weeks (OR 4.10, 95% CI 1.80–9.38, P < 0.001) after RP. There was no difference in the rate of complications between the two arms (OR 0.54, 95% CI 0.19–1.54, P = 0.25).ConclusionsCompared with nonTR, TR is significantly and positively associated with a return to continence but not with complication rate in men following RP, suggesting that TR may be useful for decreasing the urinary incontinence rate after surgery.

Observation about postoperative complication of pelvic floor reconstruction and nursing progress

Total pelvic floor reconstruction is a minimally invasive and effective method for the treatment of pelvic organ prolapsed. It is a minimally invasive and effective method for the treatment of pelvic organ prolapsed, and it significantly improves the quality of life of patients. However, due to the complex anatomy of the pelvic floor, the requirements of clinical physicians and nursing is high, and related complications are easy to occur. This article introduces the observation and nursing care of the complications such as the bladder/rectum and nerve injury, the erosion of the mesh, the symptoms of the pelvic floor reconstruction, the pain or discomfort of the intercourse. Summary of the recent 10 years research results, to provide reference and guidance for clinical nursing work. Key words: Nursing care; Postoperative complications; Pelvic organ prolapse; Pelvic floor reconstruction

Manometric comparison of anorectal function after posterior vaginal compartment repair with and without mesh.

Background:Although repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction, the data about posterior compartment are scarce. The aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse (POP).Methods:This was a prospective, double-blind, clinical pilot study of 22 postmenopausal women with symptomatic POP (overall POP-quantification [POP-Q] Stage III-IV) who underwent total pelvic floor reconstruction. Patients were grouped according to the use of mesh for posterior vaginal compartment repair: A mesh group and a nonmesh group. POP-Q stage, the pelvic floor impact questionnaire short form-7 (PFIQ-7) and anorectal manometry were evaluated before and 3 months after surgery. Anatomical success was defined as POP-Q Stage II or less. A t-test was used to compare preoperative with postoperative data in the two groups.Results:Totally, 17 (71%) were available for the follow-up. POP-Q measurements improved significantly compared to baseline (P < 0.05) in both groups. No recurrence was observed. Subjects in both groups reported improvement in pelvic floor symptoms, and there was no significant difference in the PFIQ-7 score between groups at follow-up (P > 0.05). Compared with baseline, the nonmesh group exhibited a statistically significant decrease in anal residual pressure, a significant increase in the anorectal pressure difference during bowel movement, and a reduced rate of dyssynergia defecation pattern (P < 0.05).Conclusions:Provided there is sufficient support for the anterior wall and apex of vagina with mesh, posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.

Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: impact on early recovery of urinary continence.

To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes. A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction. There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P < 0.05). The mean interval to achieve continence was significantly shorter in the total pelvic floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003). The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical reinforcement of the pelvic floor. Therefore, this technique is likely to improve urinary continence outcomes after laparoscopic radical prostatectomy.

Total pelvic floor reconstruction versus transvaginal hysterectomy for pelvic organ prolapse: a retrospective cohort

Aims: To evaluate the surgical outcomes following total pelvic floor reconstruction (TPFR) and transvaginal hysterectomy (TVH). Materials and Methods: This was a retrospective cohort study of all patients who underwent TPFR or TVH repair for pelvic organ prolapse (POP) between January 2005 and January 2011. A total of 251 consecutive women were evaluated prior to, and at two, six, and 12 months after surgery. Anatomy, symptoms, and quality of life were measured using the Pelvic Organ Prolapse Quantification system (POP-Q) and pelvic floor distress inventory (PFDI). The surgical outcomes were compared between groups using Student’s t-test and ANCOVA tests (p Results: Of the 251 patients, 129 had a total pelvic floor reconstruction (TPFR group), and concomitant modified transobturator inside-out tension-free urethral suspension (TVT-O) was used in pelvic floor dysfunction patients with stress urinary incontinence. The patients that underwent vaginal hysterectomy surgery (TVH group) were 122. At two, six, and 12 months, respectively, 12.40% (TPFR group) and 18.85% (TVH group) of the patients were lost to follow-up. There were no significant differences between TPFR group and TVH group for all preoperative variables (p > 0.05). The TPFR patients had significantly lower operation time, blood loss, anus exhaust time, remaining catheter time, and the length of stay in hospital (p 0.05). Postoperatively, the recurrence rate in TVH group was higher than that of TPFR group after surgery at six and 12 months (p 0.05). The PFDI score was significantly different between the groups. Conclusions: The short-term clinical results suggest that the two surgeries are safe and effective in treating female POP. The patients’ quality life was improved, but TPFR technique was more conspicuous for treating POP.

Conventional repair, Prolift system and Gynemesh system in total pelvic floor reconstruction: a comparison

Objective To compare the conventional repair,Prolift system and Gynemesh system in total pelvic floor reconstruction.Methods Forty patients with pelvic organ prolapse(POP),who were treated in our department from March 2009 to March 2011,were included in the present study.Fifteen cases were in the conventional repair group,10 in the Prolift system surgery,and the other 15 in the Tongshi group(revised total pelvic floor construction with Gynemesh).The pre-,peri-operative data and follow-up results were compared between the 3 groups.Results The body mass index,menopause age,pregnant times and the degrees of prolapses were comparable in the 3 groups(P0.05).The degrees of anterior and posterior vaginal proplase and uterus proplase were not significantly different between the 3 group(P0.05).The intro-operative blood loss,highest body temperature,residual urine,operation time,and hospital stay were not significantly different between the 3 groups(P0.05).The follow-up rate was 100% for the Prolift group,with a mean time of(5.8±2.0) months;one case developed erosion in the anterior vagina1 wall and one had Ⅰ stress urinary incontinence.The follow-up rate was 93.3% in the Gyenmesh group,with a mean time of(9.1±2.0) months;one case had chylous ascites after whole pelvis suspension and one had recurrent anterior vaginal proplase POP-Q Ⅱ.The follow-up rate was 100% in the classical group,with a mean time of(9.1±5.0) months;anterior and posterior vaginal proplase POP-Q Ⅱ were each found in one case.Conclusion Conventional repair,Prolift system and Gynemesh system are all safe and suitable for total pelvic floor reconstruction,and they have no difference concerning the short-term clinical outcomes and complications.

Operation nursing with the materials application of surgimesh system and T-sling system in total reform pelvic floor reconstruction

Objective To summarize up the operation nursing and health education of reforming pelvic floor reconstruction.Methods Totals of 61 women who underwent the surgery for reforming pelvic floor reconstruction were selected and used the materials of surgimesh system and T-sling system during their operation.And the nursing and the health education for the operation were summarized,and the nursing key was proposed.Results All surgeries were successfully completed.Among 61 cases,no case had a relapse,erosion,net exposure,hematom,vaginaled fistel,and hospital infection occurred.Conclusions Health education such as learning knowledge of anatomy before operating,right operative positions,positive and rigorous care cooperation,kegle function exercise and so on,is an efficient path to improve the success of operation and reduce the relapse. Key words: Nursing; Health education; Surgimesh system; T-sling system; Reform pelvic floor reconstruction

Total Pelvic Floor Reconstruction with Uterine Conservation

Total Pelvic Floor Reconstruction with Uterine Conservation

Prospective multi-center study in "Xiehe" pelvic floor reconstruction surgery for severe pelvic organ prolapse

To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery. From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage III to IV from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. With a median follow-up of 14.0 months (6 - 28 months), twenty-three patients showed recurrent prolapse (8.3%, 23/277), and anatomical success (< stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6.9% (19/277). The postoperative de novo stress incontinence rate was 6.5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P < 0.01). And there was no significant difference in the average score of PISQ before and after the surgery (76.6 ± 15.4 versus 75.5 ± 14.5 versus 73.6 ± 12.6, P > 0.05), but the rate of de novo dyspareunia was 11% (9/80). "Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

Total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse.

To evaluate clinical effectiveness of total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse. We retrospectively analyzed the clinical data of 21 patients with severe pelvic organ prolapse. The anatomical outcomes were evaluated by Pelvic Organ Prolapse Quantitation, functional effectiveness by Prolapse Quality of Life method, and sexual function and operation-related complications were also analyzed. All surgical operations were accomplished successfully by the same surgeon. No impairment of bladder, urethra, rectum, or great vessels was noted, and no patient required blood transfusion. The mean operation duration was (63±19) minutes, and the mean intra-operative blood loss was (143±72) ml. One patients experienced post-operative urinary retention for 7 days, and the remaining 20 patients were able to micturate spontaneously 1-2 day after surgery. The post-operative morbidity rate was 14.3%. Three patients (14.3%) experienced mesh erosion. Of 12 patients who were sexually active, two patients suffered from algopareunia from dyspareunia, one from de novo overactive bladder, and one from stress urinary incontinence Questionnaire scores showed that the overall post operative quality of life was improved significantly (P=0.000), while quality of sexual life significantly degraded (P=0.044) The anatomic cure rate was 95.2% (20/21), and the patient subjective satisfaction rate was 85.7% (18/21) The total pelvic floor reconstruction is a safe and effective approach for the repair of severe pelvic organ prolapse, although its functional effectiveness is not as notable as anatomical outcomes However, the complications such as mesh erosion, low urinary tract symptoms, algopareunia, and dyspareunia should be carefully managed.

Total Prolift(TM) system surgery for the repair of recurrent severe pelvic organ prolapse

To evaluate the clinical outcomes of total Prolift(TM) system surgery for the repair of recurrent severe pelvic organ prolapse. The clinical records of 13 cases of recurrent severe pelvic organ prolapse were retrospectively analyzed. The characteristic was vaginal vault prolapse in combination with anterior and posterior wall prolapse. Anatomic effect (according to POP-Q score), functional effect (according to prolapse quality of life) and sexual life (according to sexual life score) of each patient were assessed. All subjects were post-menopausal with a mean age (60 ± 9) years and a mean BMI of (25.6 ± 2.9) kg/m(2). All operations were accomplished successfully without any impairment of bladder, urethra, rectum, great vessels or nerves or blood transfusion. The mean operation time was (61 ± 18) minutes and the mean blood loss (155 ± 84) ml. All patients were followed up for a medium of 19 (15 - 30) months. Except for one post-operative urinary retention for a period of 7 days, 12 patients were able to micturate spontaneously 1 - 2 d post-operatively with a residual urine volume of less than 100 ml. During follow-up, mesh erosion (n = 1), de novo overactive bladder (n = 1), one algopareunia (n = 1) and dyspareunia (n = 1) occurred. Postoperative Quality of Life Scores improved significantly (P < 0.01). However, sexual life scores was impaired (P < 0.05). The anatomic cure rate was 92.3% and the patient subjective satisfactory rate 84.6%. The total Prolift(TM) system surgery represents a safe, simple and useful treatment for recurrent severe pelvic organ prolapse with satisfactory objective clinical outcomes. However, the level of patient subjective satisfaction is lower than objective cure rate. Meanwhile, harmful effects on sexual life remain a main concern.

Short-term therapeutic effect of modified total pelvic floor reconstruction in treatment of severe pelvic organ prolapse

To evaluate short-term clinical effects of modified total pelvic floor reconstruction surgery in treatment of severe pelvic organ prolapse. Thirty-nine cases with severe pelvic organ prolapse including vault prolapse diagnosed by pelvic organ prolapse quantification (POP-Q) system received modified total pelvic floor reconstruction surgery. Clinical parameters associated peri-operative period and 12 months after surgery and complications were analyzed. Median operation time was 70 minutes (30-240 minutes), median blood loss was 100 ml (10-200 ml). Seventy-seven percent (30/39) patients were able to micturate spontaneously in the next morning after surgery with postvoid residual volume less than 100 ml (0-650 ml). No severe intra-operative complications were recorded and the rate of postoperative morbidity was 20% (8/39). Median post-operative hospital stay was 4 days (1-11 days). The patients were followed up at median 24 months (13-29 months). According to POP-Q system evaluation, the successful rate of operation reached 100%. Two cases (5%, 2/39) were recorded as symptomatic recurrence which manifested as posterior wall prolapse within 24 months after operation. During follow-up, 8% (3/39) patients were found to have erosion within 7 months after surgery, and urgent urinary incontinence was observed in 5% (2/39) cases, while constipation occurred in 8% (3/39) cases. The most remarkable complication was dyspareunia (36%, 5/14); while 50% (7/14) experienced better sexual life after surgery. Modified total pelvic reconstruction is a safe, efficient and micro-invasive surgery in treatment of severe pelvic organ prolapse. However, its influence on post-operative sexual life should be concerned.

Clinical observation on quality of life of two different operative methods of total pelvic floor reconstruction.

To compare patients' quality of life followed by Prolift operation and the revised total pelvic floor reconstruction with Gynemesh. Thirty one patients underwent total pelvic floor reconstruction surgery were divided into two groups, including 14 cases treated by Prolift surgery and 17 cases treated by the revised total pelvic floor construction with Gynemesh. The body weight index (BWI), menopausal age and gravidity history did not show significant difference between two groups (P > 0.05). The patients' age with 63 +/- 9 in Prolift group was significantly lower than 69 +/- 5 in Gynemesh group (P < 0.05). Questionnair score of quality of life were collected and evaluated pre- and post-operation. (1) Preoperative scores: there was no significantly different scores of the following index between two groups (P > 0.05), which were 91 +/- 42 in pelvic floor impact query, 100 +/- 59 in pelvic floor distress query and 77 +/- 26 in sexual life query in Prolift group, 65 +/- 56 in pelvic floor impact query, 89 +/- 73 in pelvic floor distress query and 75 +/- 18 in sexual life query in Gynemesh group. (2) Postoperative scores: similarly, there was also no significantly different scores in the following index between two groups (P > 0.05), which were 7 +/- 15 in pelvic floor impact query, 27 +/- 24 in pelvic floor distress query and 79 +/- 43 in sexual life query in Prolift group, 13 +/- 24 in pelvic floor impact query, 24 +/- 21 in pelvic floor distress query and 74 +/- 15 in sexual life query in Gynemesh group. The patients' quality of life were improved after Prolift operation and the revised total pelvic floor construction with Gynemesh. However, about quality of sexual life, Prolift operation did much better than revised pelvic surgery with Gynemesh.

Augmented repairs and use of interposition grafts in pelvic reconstructive surgery: Part II

Part I of this review on graft interposition for pelvic organ prolapse focused on the properties of biologic and synthetic materials used in vaginal reconstructive surgery and on the widespread use of these materials in the treatment of anterior vaginal wall prolapse. Part II focuses on prosthetic reinforcement during reconstructive surgical procedures involving the middle compartment (vaginal vault and apex) and posterior compartment (rectocele). The new “minimally invasive” kits directed at total pelvic floor reconstruction are discussed in this context. We conclude with a review of the unique complications associated with graft interposition and their management, as well as a discussion of areas to direct future research with the intent of promoting a greater understanding of the role and use of prosthetic grafts during pelvic reconstructive surgical procedures.

Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction

A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat(R). Seventy-six patients (79%) were available with a mean follow-up time of 30.7 +/- 1.7 months and mean age of 69.3 +/- 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n = 36), average pad use per day decreased significantly from 2.1 +/- 0.4 to 0.8 +/- 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 +/- 0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable.

909: Analysis of Long-Term Outcomes of Single Polypropylene Mesh in Total Pelvic Floor Reconstruction

909: Analysis of Long-Term Outcomes of Single Polypropylene Mesh in Total Pelvic Floor Reconstruction

The management of ureteric colic

The management of ureteric colic has changed significantly over the past three decades,. Factors such as stone size, location, composition as well as patient and surgeon preference influence the management decision. Recent work has looked at the expansion of the role of medical therapy beyond symptomatic control to attempt to target some of the reversible factors in stone retention and thereby improve the likelihood of spontaneous stone expulsion. Changes in shock wave lithotripsy and ureteroscopy offer patients highly effective, minimally invasive options for stone clearance that can often be performed on an outpatient basis. This paper reviews the options available to the urologist in the treatment of ureteric colic as well as the advantages and disadvantages of each therapy.