OP08.07: Pelvic floor ultrasound assessment of anterior pelvic organ prolapse recurrence after transvaginal mesh pelvic reconstruction

Stress incontinence (SUI) and pelvic organ prolapse (POP) are common conditions. There is high-level evidence that midurethral mesh slings for stress incontinence are effective and safe; however, the rare but serious potential risks of this surgery must be discussed with the patient. The use of transvaginal mesh for prolapse repair does not appear to be supported by the current evidence, and its use should be restricted to specialized pelvic floor surgeons and specific clinical situations.

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Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Ginekologia Polska ◽

10.5603/gp.a2017.0057 ◽

2017 ◽

Vol 88 (6) ◽

pp. 302-306

Author(s):

Tomasz Kluz ◽

Edyta Wlaźlak ◽

Grzegorz Surkont

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Pelvic Organ ◽

Short Term ◽

Pelvic Floor Ultrasound ◽

Ultrasound Evaluation

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Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry

10.22541/au.161735639.95965660/v1 ◽

2021 ◽

Author(s):

Xavier Fritel ◽

Renaud de Tayrac ◽

Joe de Keizer ◽

Sandrine Campagne-Loiseau ◽

Michel Cosson ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Vaginal Repair ◽

Mesh Placement ◽

Native Tissue ◽

Prolapse Recurrence ◽

Pop Surgery ◽

Laparoscopic Sacropexy ◽

One Year

Objective: To assess the incidence of serious complications and reoperations for recurrence after pelvic organ prolapse (POP) surgery and compare the three most common types of repair. Design: Prospective cohort study using a registry. Setting: 19 surgical centres in France. Population: 2309 women participated between 2017 and 2019. Methods: a multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures: Serious complications and subsequent reoperations for POP recurrence Results: Mean follow-up was 16.6 months. Surgeries included in the analysis were native tissue vaginal repair (N=504), transvaginal mesh placement (692), and laparoscopic sacropexy with mesh (1113). Serious complications occurred among 52 women (2.3%), and reoperation for recurrence was required for 32 (1.4%). At one year, the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair (95% confidence interval 0-3.9), 3.9% for transvaginal mesh (2.0-5.9), and 2.2% for sacropexy (1.1-2.6). Compared with the native tissue vaginal repair group, the risk of serious complications was higher in the transvaginal mesh group (weighted-HR 3.84, 2.43-6.08), and the sacropexy group (2.48, 1.45-4.23), while the risk of reoperation for prolapse recurrence was reduced in both groups (transvaginal mesh [0.22, 0.13-0.39] and sacropexy [0.29, 0.18-0.47]). Conclusions: Laparoscopic sacropexy with mesh appears to have a better risk profile (few serious complications and few reoperations for recurrence) than transvaginal mesh placement (more serious complications) and native tissue vaginal repair (more reoperations for recurrence). These results are useful for informing women and for shared decision making.

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Safety and Effectiveness of Transvaginal Mesh Placement in Treating Pelvic Organ Prolapse

10.21203/rs.2.17251/v1 ◽

2019 ◽

Author(s):

Zeyu Chen ◽

Wensheng Du ◽

Haitao Zhu

Keyword(s):

Pelvic Organ Prolapse ◽

Blood Loss ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Operation Time ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Intraoperative Blood Loss ◽

Postoperative Fever

Abstract To observe the clinical effect and complications of transvaginal mesh (TVM) placement on treating pelvic organ prolapse (POP).Methods From May 2014 to June 2017, 89 patients with moderate to severe pelvic organ prolapse and pelvic floor defect (PFD) had received TVM pelvic reconstruction at our hospital. The operation time, intraoperative blood loss and intraoperative complications of all patients were recorded, and the incidence of postoperative complications was also observed. In addition, the POP-Q was utilized to evaluate the severity of POP in patients before surgery, as well as at 6 weeks, 6 months, 12 months and 24 months after surgery, respectively; besides, the Pelvic Floor Influence Questionnaire-7 (PFIQ-7), Pelvic Floor Dysfunction Inventory 20 (PFDI-20), and Patient Global Impression of Improvement (PGI-I) were adopted to evaluate the quality of life of patients.Results All the 89 cases had successfully completed the surgery, with the operation time of 60.0±13.0 min and the intraoperative blood loss of 57.2±21.9 mL. All patients had no bladder or rectal injury during the surgery. 2 patients displayed asymptomatic recurrence ,10 cases had postoperative fever, while 3 had mesh exposure, and all of them were improved after symptomatic treatment. Upon discharge, the lumbosacral and pubic discomfort, as well as pelvic organ dragging sensation had disappeared in all patients. In the final follow-up, the PFIQ-7 and PFDI-20 scores in the 89 cases were reduced compared with those before surgery (Ps<0.05).Conclusions TVM placement is effective on treating moderate to severe POP, which is associated with a lower complication rate and higher postoperative satisfaction.

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Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-0941-3485 ◽

2019 ◽

Vol 79 (09) ◽

pp. 983-992 ◽

Cited By ~ 2

Author(s):

Murat Yassa ◽

Niyazi Tug

Keyword(s):

Patient Satisfaction ◽

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Pelvic Organ ◽

Stage Ii ◽

Pelvic Floor Ultrasound ◽

Anterior Compartment ◽

Tertiary Center ◽

Laparoscopic Lateral Suspension ◽

Subjective Cure

Abstract Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than − 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.

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Endoscopic management of transvaginal mesh kit bladder extrusion: A case report and literature review

Journal of Clinical Urology ◽

10.1177/2051415820937193 ◽

2020 ◽

pp. 205141582093719

Author(s):

Ariel J. Dunn ◽

Katherine L. Dengler ◽

Daniel D. Gruber ◽

David J. Osborn

Keyword(s):

Pelvic Organ Prolapse ◽

Rare Complication ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Endoscopic Management ◽

Invasive Technique ◽

Level Of Evidence ◽

Acute Cystitis ◽

Prolapse Recurrence ◽

Mesh Excision

Objective: A rare complication of transvaginal synthetic mesh kits is bladder mesh extrusion. Treatment options include abdominal or vaginal surgical mesh excision or endoscopic mesh vaporization. There are very few published studies detailing endoscopic management. This unique case describes how repeated endoscopic mesh vaporization may be required as mesh extrusion may progress. Methods: A 71-year old female with a history of pelvic organ prolapse managed with an anterior transvaginal mesh kit presented years later with persistent urgency incontinence and recurrent acute cystitis. Cystoscopy eventually revealed bladder calculi adherent to extruded mesh. The stones and extruded mesh were vaporized using the Holmium laser on three occasions over 3 years. Results: Our approach offered a minimally invasive technique with short recovery, no use of a catheter post-operatively and maintained original prolapse repair; however, these patients may be at risk of mesh extrusion recurrence. Conclusion: Bladder extrusion of transvaginal pelvic organ prolapse kit mesh is thankfully a rare complication. With no current consensus for treatment of bladder mesh extrusion, the decision to perform complete mesh excision versus endoscopic treatment should be based on the degree and location of the extrusion, the risk of major complications, mesh extrusion recurrence and the patient’s desired outcomes, including recovery time and risk for prolapse recurrence. Endoscopic vaporization of extruded pelvic organ prolapse mesh likely has a higher recurrence rate than vaginal or abdominal excision. The risks and benefits are important to discuss during counseling and informed consent in these difficult cases. Level of evidence: 4

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