MEDIUM-TERM COMPARISON OF UTERINESPARING VERSUS HYSTERECTOMY IN PELVIC RECONSTRUCTION TREATED WITHELEVATED SYSTEM MESH
K. HUANG1, F. CHUANG2;
1Kaohsiung Chang Gung Mem. Hosp.,Kaohsiung, Taiwan, 2Dept. of Obs and Gyn, Kaohsiung ChangGung Me, Kaohsiung, Taiwan.
Introduction: Previously,hysterectomy was considered standard procedure for pelvic organprolapse. Recently, uterine preservation had become a choice in theprolapse surgery, and there were studies discussing the efficacy ofdifferent type of surgical kit with uterine preservation. In ourinstitution, Elevate mesh system was widely used during the past fewyears. We are interested in that whether there were differences inthe midterm outcome using the Elevated mesh with or without uterinepreservation.
Objective: This study aims to compare thesurgical outcomes and complications between hysterectomy and uterinesparing in treatment of severe prolapsed uterine with single incisiontransvaginal mesh of Elevate system.
Methods: 256 patientsdiagnosed with POP-Q stage 3/4 uterine prolapse who have undergonereconstructive repair with trans-vaginal Elevate system mesh fromNovember 2010 to November 2014 were identified by chart reviews. Allpatients were divided into two groups: hysterectomy (n=183) anduterine sparing (n=73) table 1. Pre-operative and post-operativesubjective assessments urine and prolapsed symptoms, objective POP-Qscore, urodynamic examination, and complications were comparesbetween the groups.
Results: The mean follow-up periodswere 36 months (range 24-70 months). There were no between-groupdifferences in anatomy and functional outcomes after surgery. Nostatistically significant differences were found in postoperativeadverse events between the groups table2,3.
Pelvic reconstruction using Transvaginal mesh (Elevatesystem) with hysterectomy or uterine sparing results in similaranatomic, functional outcomes and complications at 3 years follow up.Thus, in selected patients undergoinguterine prolapsed repair, weconsider uterine sparing a viable alternative to hysterectomy. Whendiscussing TVM repair, the possible adverse events should bediscussed with the patients in details, and the possibility ofuterine preservation.
Conclusions: Pelvic reconstructiverepair using Elevate mesh system with hysterectomy and uterinesparing surgery has similar anatomic and functional results at 3years. Therefore, we consider uterine sparing surgery to be analternative to hysterectomy in prolapsed uterine repair.
References:1. Polypropylene mesh as an alternative option for uterinepreservation in pelvic reconstruction in patients with uterineprolapse. J Obstet Gynaecol Res 2012 Jan;38(1):97-101. 2.Medium termcomparison of uterus preservation versus hysterectomy in pelvic organprolapse treatment with Prolift™ mesh.Int Urogynecol J. 2015Jul;26(7):1013-20 3.Comparison of short-term outcomes followingpelvic reconstruction with Perigee and Apogee systems: hysterectomyor not? Int Urogynecol J. 2012 Jan;23(1):79-84. 4. Evaluation of thesingle-incision Elevate system to treat pelvic organ prolapse:follow-up from 15 to 45 months. Int Urogynecol J. 2015Sep;26(9):1341-6.