5-YEAR OUTCOME FOLLOWING POSTERIORPROLAPSE REPAIR WITH A MONOFILAMENT POLYPROPYLENE IMPLANT
O. GOJIS, I. URBANKOVA, M.KRCMAR, L. KROFTA, J. FEYEREISL;
Inst. for the care of mother andchild, Prague, Czech Republic.
Introduction: In last decadethere is an ongoing discussion on the suitability of synthetic graftsduring primary and also during repeated prolapse reconstructivesurgery. It has been shown that anatomical yet not subjectiveoutcomes in the anterior compartment are better with implants, butfor the posterior compartment, sufficient information is lacking. Thesuccess rate for primary native tissue is high, however, up therecurrence may affect up to one-third of operated women.
Objective:Mid-term follow-up of a prospectively followed cohort of womenundergoing posterior or posterior-central compartment prolapsereconstruction using a Prolift Posterior implant®.
Methods:A cohort of patients was prospectively followed over a 5 year period(1.2006 - 12.2011). This included women who presented strictly withthe posterior or central-posterior prolapse stage 2 and worse thatwas corrected using a monofilament polypropylene implant (ProliftPosterior®, Gynecare Prolift, Ethicon, Inc., Piscataway, NJ, USA).The cohort included primary as well as repeated cases, yet women withconcomitant procedures were excluded. Patients were checked at 6weeks, 3, 6 and 12 months and then yearly, including theurogynecological examination and subjective outcome ( Visual AnalogueScale, Pelvic organ prolapse, Incontinence, Sexual functionquestioner, and International Consultation on Incontinencequestioner). Prolapse recurrence was defined as stage 2 and more inany compartment of the vagina.
Results: Out of one hundredtwenty-four patients, who were included, only 14 (11.3%) had nohistory of prolapse surgery. The average age, BMI, and parity were60.0 years, 27.6 and 2.3, respective. The average operation time andthe blood loss were 64.25 min and 115mL, respective. There was noperioperative perforation of the urinary bladder, intestine or therectum. The 5-year recurrence rate was 3.3.% in the operatedcompartment and 25% de novo prolapse in the anterior compartment withthe average time to the manifestation of 19.5 and 23 months,respective. De novo prolapse was more often observed in women withrepeated surgery compared to primary corrections (22.2% vs 7.1%).Erosion rate, de novo dyspareunia, and stress urinary incontinencewere 3.3%, 5.7% and 13.1%, respective. Normal sexual activity wasreported by 34% women who were not active before thesurgery.
Conclusions: In this single-center study, wedocumented, that the implant-augmented reconstruction of theposterior prolapse improved anatomical conditions with minimaladverse events during a mid-term period. Recurrence rates in operatedand unoperated compartments, as well as, erosion rate correspond todata published in the current literature (1). The risk of de novoprolapse in unoperated compartment seems to be higher in women withrepeated prolapse surgery.
References: 1. DOI:10.1007/s00192-011-1384-5