SHORT TERM OUTCOMES OF THE MINIMALMESH TVM FOR THE TREATMENT OF PELVIC ORGAN PROLAPSE
N. TAKAZAWA1, M.SHIMOINABA 2, S. HONDA 2, A. FUJISAKI 3,Y. YOSHIMURA 3, S. HORIE 1;
1Urology,Juntendo Univ., Tokyo, Japan, 2Urology, Yotsuya Med. Cube,Tokyo, Japan, 3Yotsuya Med. Cube, Tokyo, Japan.
Introduction: Despite of the bigargument about the urogynecological surgical mesh implants for pelvicorgan prolapse (POP) surgery, there are still many surgeons in favourof transvaginal mesh (TVM). In fact, the worse is the connectivetissue, the less an autologous tissue repair is likely to beeffective. Thus, in the patients with weak connective tissue, itseems that the vaginal mesh POP reconstruction is still an adequateindication for the long standing therapeutic results. On the otherhand, since commercially available mesh kits for POP repair is notavailable in Japan, self-cut mesh from square mesh and originallydeveloped needle are utilized for TVM. To develop the TVM operationfor operations with few mesh-related complications, we devised anoperation not to let obturator foramen penetrate using small mesh.The mesh used in this method is smaller in area by 56 %, as comparedwith the previous mesh used for cystocele. Another distinct point isthat mesh has two arms and one of arm pass through each SSL. There isno arm in obturator muscle or foramen.
Objective: Theobjective of this study is to evaluate the clinical outcomes andcomplications of the minimal mesh TVM without using commerciallyavailable kits for the treatment of pelvic organ prolapse(POP).
Methods: This retrospective cohort study involved 91women who underwent surgical management of prolapse with originallydesigned small mesh in the period between July 2014 and August 2015.Polyform TM (Boston Scientific 15×20cm) was cut in theshape semicircle (5×7cm) with 2 arms. This original mesh is smallerin size by 56 % as compared with the mesh widely used in Japan and ithas only two arms delivered into each right and left sacrospinousligament (SSL). In cases of concomitant mid-urethral sling procedure,it was performed through a separate incision.
Main outcomemeasures included pelvic organ prolapse quantification (POP-Q)measurement, perioperative and postoperative complications, thepresence of stress urinary incontinence (SUI), overactive bladdersymptom score (OABSS) and Prolapse Quality of Life Questionnaire(P-QOL). The definition for prolapse recurrence is POP-Q stage 2 ormore (leading edge of the prolapse ≧-1cm from the hymen). Statistical analyses were performed with JMPver.1 (1 SAS Institute, Cary, NC, USA). A risk analysis of recurrenceand de novo SUI was performed using a Wilcoxson rank sum test orFisher’s exact tests. We compared the preoperative score with postoperative score of questionnaire scores using Wilcoxson rank sumtest. A difference was considered statistically significant when Pwas <0.05.
Results: Prolapse recurrence of stage II wasseen in 10 cases (10.9%) and there was no severe recurrence of stageIII or more. Mesh erosion was seen in 2 cases (2.1%). PostoperativeSUI was seen in 9 patients (20.9%) and two of them had additionalincontinence surgeries. Body mass index (BMI) was significantlyassociated with the prolapse recurrence. Preoperative POP-Q stage didnot significantly affect the recurrence rate. P-QOL parameters weresignificantly improved in all domains.
Conclusions: Thetrans-vaginal minimal mesh repair without using commerciallyavailable kits had successful outcomes with low anatomic recurrenceat one year. Mesh related complications are rare and significant QOLimprovement is offered. It is assumed that our minimal mesh techniquemight work as an alternative, in-expensive and effective treatmentoption for the management of POP.
References: Basicprocedures in tension-free vaginal mesh operation for pelvic organprolapse. Int. J. Urol. 2011; 18(8): 555-6. Minimal mesh repair forapical and anterior prolapse: Initial anatomical and subjectiveoutcomes. Int. Urogynecol. J. 2012; 23(12): 1753-61.