Outcomes of Single Incision Anchored Anterior Vaginal Mesh Repair for Recurrent Vaginal Prolapse

Objective: To report the safety and efficacy of single incision anchored anterior vaginal mesh repair for women with recurrent anterior vaginal prolapse.Methods: Retrospective study of women with recurrent anterior vaginal prolapse, Stage 2 or beyond, who underwent single incision anchored vaginal mesh repair with Anterior Elevate (American Medical Systems, Minnetonka, USA) between June 2012 and October 2016. Pre-operatively, the Prolapse Quality-of-Life questionnaire (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were completed. Post-operatively, women completed the P-QOL, PISQ-12 and the global impression of improvement questionnaire (PGI-I). Preoperative POP-Q and post operative POP-Q examination at up to 24 months follow up were recorded. At average follow up of 36 months, participants were interviewed via telephone using questions from the P-QOL, PISQ and PGI-I.Results: 45 women had single incision anterior vaginal mesh kit repair for recurrent prolapse. Postoperatively, 85% of women reported cure of their prolapse symptoms. At 24 months, 80.0% had POP-Q stage 0 or 1 in the anterior compartment, and 93.8% achieved anatomical cure of apical prolapse (point C above 0). During structured telephone interview at mean follow up of 36 months, on PGI-I, 70% reported feeling ‘much better’ or ‘very much better’.Conclusion: Vaginal surgery using single incision lightweight mesh kits can be an effective approach for women with recurrent anterior vaginal prolapse, resulting in subjective and objective cure rates of over 80% with reasonable safety profile up to 60 months postoperatively.

A 9-year audit of the efficacy of diathermy for cystitis cystica

The aim of this study was to assess whether cystoscopy with diathermy for cystitis cystica in patients with recurrent urinary tract infection (UTI) is associated with decreased incidence of UTI. A retrospective 9-year audit was performed in a single urogynaecology centre. Patients with proven recurrent UTI and failed conservative therapy underwent cystoscopy with diathermy to cystitis cystica. The number of UTI’s 12- months pre and post cystoscopy was evaluated using women as their own controls with multivariant analysis of cofounding factors. Of 82 patients with recurrent UTI, 47 patients underwent cystoscopy with diathermy to cystitis cystica (median follow up 2 months [interquartile range, IQR6-31, one patient lost to follow up]). Pre-cystoscopy median UTI per annum was 3 per patient (IQR1-4). Post cystoscopy, median UTI for each woman was significantly reduced (median reduction -2[IQR-5-1], mean -2.14[95%CI -2.94, -1.34], P=<0.001). In the subgroup of patients who had previous vaginal mesh repair for prolapse (n=8) there was no significant benefit from diathermy (median reduction - 1.5[95%CI -0.988, 3.988], P=0.197). In conclusion, cystoscopy and diathermy of cystitis cystica was generally associated with significant reductions in UTI’s in the 12 months following diathermy.