LONG-TERM FOLLOW-UP OF ANTERIORVAGINAL REPAIR: A COMPARISON AMONG COLPORRHAPHY, COLPORRHAPHY WITHREINFORCEMENT BY XENOGRAFT, AND MESH FOLLOW-UP OF ANTERIOR VAGINALREPAIR: A COMPARISON AMONG COLPORRHAPHY, COLPORRHAPHY WITHREINFORCEMENT BY XENOGRAFT, AND MESH
M. BALZARRO, E. RUBILOTTA, A.PORCARO, N. TRABACCHIN, A. SARTI, M. CERRUTO, W. ARTIBANI;
Urology,AOUI Verona, Verona, Italy.
Introduction: Pelvic OrganProlapse (POP) is a common pathological condition and its incidenceis likely to increase further because of aging populations.Concerning the anterior compartment and its surgical treatment, ithas been seen the use of numerous new materials.
Objective:The aim of our study was to assess the long-term efficacy, thesubjective and objective outcomes, and the complications in patientstreated for POP with transvaginal anterior colporrhaphy alone, withreinforcement by using porcine Xenograft (Pelvisoft® Biomesh), andtransvaginal anterior repair with polypropylene mesh.
Methods:A retrospective study of a prospectively maintained database wasperformed at a single center. Between 2000 and 2015, 123 womenunderwent cystocele repair. Follow-up was completed in 109 patientsaged 46-80 years: 42 patients underwent a transvaginal anteriorcolporrhaphy alone (AC), 19 patients underwent a transvaginalanterior colporrhaphy with associated reinforcement by usingPelvisoft® Xenograft (AC-P), and 48 patients underwentanterior colporrhaphy repair with polypropylene mesh (AC-M)reinforcement. The characteristics of patients are listed in Table 1.The mean follow-up was 94.80 + 51.72 months (range 19-192months). Subjectives outcomes were evaluated by validatedquestionnaires: Patient Global Impression of Improvement (PGI-I) andPatient Perception of Bladder Condition (PPBC). Personal patientsatisfaction rate was also measured by the question “are yousatisfied with the surgical procedure?” and asking if they wouldconfirm to undergo the same surgical choice during counseling beforesurgery. Objective outcomes have been evaluated for each patient bytwo different surgeons, considering a failure, anterior vaginal wallrecurrence > 2, POP-Q, and Baden-Walker Halfway System.Statistical analysis was performed using the chi-square or Fisherexact test.
Results: In all surgical techniques used, thePGI-I questionnaire results showed a general perceived treatmentbenefit, and the PPBC questionnaire results indicated improvementfrom the previous bladder condition. The personal patient’ssatisfaction rate was higher in the AC-P group. Most of theinterviewed women in all groups would confirm the same surgicalchoice during counseling before surgery. The best anatomical outcomeshave been achieved with AC-P, followed by AC-M, and finally by AC(p>0.05). Data showed a higher rate of complications in the AC-Mgroup (p<0.05). All the results and complications are reported intable 1. Our study is based on a long-term follow-up, which is longerthan 5 years in all the groups. All groups had similarcharacteristics, except for the higher rate of associated surgery inthe AC group, and a lower number of patients in the AC-P group. Thelower population in the AC-P group could explain the bettersubjective and objective results (p >0.05). The higherassociated procedures for apical support in the AC group could haveimproved the results in anterior vaginal wall repair. The highernumber of complications in the AC-M group (p <0.05) couldexplain the lower subjective satisfaction of patients.
Conclusions:Considering the last Food and Drug Administration reclassification ofsurgical mesh to class III (1), and the last Scientific Committee onEmerging and Newly Identified Health Risks document on “Safety ofsurgical meshes used in urogynecological surgery” (2), our datashow that it is possible to revalue transvaginal anteriorcolporrhaphy technique alone or associated with a Xenograft. Ourpatients, treated without using mesh, have objective and subjectiveoutcomes non-inferior with respect to those treated by mesh.Moreover, the complication rate is lower in patients who underwentsurgery without mesh.