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

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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Quo Vadis Urogynecology 2020 – Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1302-7803 ◽

2021 ◽

Vol 81 (02) ◽

pp. 183-190

Author(s):

Gert Naumann

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Professional Training ◽

Pelvic Floor Dysfunction ◽

Estrogen Therapy ◽

Pelvic Organ ◽

Alloplastic Materials ◽

Wide Range ◽

Quo Vadis

AbstractThe current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patientʼs state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.

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Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods

Medicina ◽

10.3390/medicina57040387 ◽

2021 ◽

Vol 57 (4) ◽

pp. 387

Author(s):

Karolina Eva Romeikienė ◽

Daiva Bartkevičienė

Keyword(s):

Clinical Trials ◽

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Randomized Clinical Trials ◽

Pelvic Floor Muscle Training ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

Cochrane Library ◽

Muscle Training

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed.

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Sexual function in women with pelvic floor disorders

Canadian Urological Association Journal ◽

10.5489/cuaj.1625 ◽

2013 ◽

Vol 7 (9-10) ◽

pp. 199 ◽

Cited By ~ 11

Author(s):

Rebecca G. Rogers

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Sexual Function ◽

Pelvic Floor ◽

Pelvic Floor Disorders ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

The Impact

Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction.

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bFGF Activates Integrin β1 and Subsequently Upregulates Collagens via the p-MEK1/2/p-ERK1/2 Signaling Pathway in L929 Cells

10.21203/rs.3.rs-296400/v1 ◽

2021 ◽

Author(s):

Lian Yang ◽

Shasha Hong ◽

Yang Li ◽

Tingting Wang ◽

Li Hong

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Signaling Pathway ◽

Pelvic Floor Dysfunction ◽

Underlying Mechanism ◽

Pelvic Organ ◽

Integrin Β1 ◽

L929 Cells ◽

Signal Transduction Protein ◽

Special Project

Abstract The substantial loss of collagen in the supporting tissues of the pelvic floor is characteristic of pelvic organ prolapse (POP). A bFGF-induced collagen increase has been widely recognized by scholars, but the role of bFGF in pelvic floor dysfunction and the mechanism by which bFGF promotes collagen have not been reported. Here, we elucidated this mechanism. After bFGF stimulation, L929 cells showed significantly increased expression of collagen, integrin β1, and MEK1/2 signaling proteins. Our previous studies showed that integrin β1 plays an important role in electric stimulation-induced collagen expression, which suggests an underlying mechanism. By overexpressing and silencing integrin β1, we proved that integrin β1 is also an important signal transduction protein of bFGF that promotes collagen through the MEK1/2 pathway, which is a classic collagen-promoting pathway. In summary, these findings suggest that bFGF can stimulate the expression of collagen through the integrin β1/p-MEK1/2/p-ERK/1/2 signaling pathway in L929 cells. Keyword Pelvic organ prolapse; bFGF; integrinβ1; ERK1/2; Collagen Special project for Chinese women's pelvic floor dysfunction prevention and treatment (no. 201817092) and the Natural Science Foundation of Hubei Province（no.2019CFB149）.

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Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse

Gynecologic and Obstetric Investigation ◽

10.1159/000520979 ◽

2021 ◽

Author(s):

Junfang Yang ◽

Kun Zhang ◽

Jinsong Han ◽

Yiting Wang ◽

Ying Yao ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Protective Factor ◽

Pelvic Organ ◽

Vaginal Mesh ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Surgery ◽

Post Menopause

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

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Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors

International Urogynecology Journal ◽

10.1007/s00192-005-0003-8 ◽

2005 ◽

Vol 17 (4) ◽

pp. 315-320 ◽

Cited By ~ 183

Author(s):

Pierre Collinet ◽

Franck Belot ◽

Philippe Debodinance ◽

Edouard Ha Duc ◽

Jean-Philippe Lucot ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Prolapse Repair ◽

Pelvic Organ Prolapse Repair ◽

Mesh Technique

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Role of Magnetic Resonance defecography in assessment of pelvic floor dysfunction

QJM ◽

10.1093/qjmed/hcaa068.015a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M S Moussa ◽

Y I Abdelkhaleq ◽

S M Botros ◽

A A Montasser

Keyword(s):

Pelvic Organ Prolapse ◽

Physical Examination ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

Magnetic Resonance Defecography ◽

Facial Defect ◽

Floor Failure ◽

Muscle Tear

Abstract Purpose to assess the role of the role of MR defecography in assessment of pelvic floor failure . Methods and Material Thirty-six patients (twenty-seven female and nine male) with female and male patients, complaining of stress urinary incontinence, constipation, fecal incontinence or pelvic organ prolapse. Results MRI revealed 18 cystocele (50%), compared to physical examination 2 cases(5.6%),MRI revealed 28 rectocele ( 77.8%) compared to physical examination that showed 13 (36.1%) , MRI revealed 10 uterine descent (40.7%), compared to physical examination 6 (22.2%) I, MRI revealed 7 enterocele (19.4%) compared to physical examination that was negative. MRI revealed level I/II facial defect in and level III facial defect in, 19 cases of Intussusception (52.8%), urethral hypermobility in 14 (38.9%), sphincteric defect 7 (19.4%), levator angle weakness in 30 cases (83.3%), iliococcygeaus muscle tear in 5 cases (13.9%), puborectalis tear in 3 cases (8.3%),anorectal decent in 26 cases (72.2%), genital hiatus width in 23 (63.9%) Conclusion Dynamic MR imaging is a necessary tool in the diagnosis of multicompartment pelvic organ prolapse and it provides good concordance with clinical examination

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Pelvic Organ Prolapse and Pelvic Floor Dysfunction

General Gynecology ◽

10.1016/b978-032303247-6.10023-1 ◽

2007 ◽

pp. 543-581

Author(s):

Andrew I. Sokol ◽

Mark D. Walters

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ

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Correlation of Pelvic Organ Prolapse Quantification Technique with Pelvic Floor Dysfunction Symptoms

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i3.22169 ◽

2019 ◽

Vol 3 (3) ◽

pp. 528-531

Author(s):

Tarun Pradhan ◽

Pappu Rijal ◽

Baburam Dixit Thapa ◽

Rabindra Dev Bhatta ◽

Mohsina Hakkim ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

Observer Variation ◽

Anatomical Site ◽

Significant Relation ◽

Site Specific ◽

Genital Hiatus ◽

A Prospective Study

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders. Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5. Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation. Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

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