TRANSVAGINAL MESH REPAIR OF PELVICORGAN PROLAPSE
M. BRAVERMAN, A. TAL, R. MOLNAR;
O&G, Haemek Hosp., afula, Israel.
Introduction: There ishigh-quality evidence that the use of synthetic nonabsorbable meshimproves anatomic outcomes and subjective bulge symptoms for theanterior compartment compared with native tissue repair, however,there is poor quality data in regards to the use of mesh for theposterior and apical compartments (1). Rates of re operation forprolapse recurrence reported to be lower in the mesh group comparedto native tissue repair, however, overall re operation rate for thecombined outcome of prolapse, stress incontinence, or mesh exposurewas higher in the mesh group (2).
Objective: The aim ofthis study was to report objective outcomes, complications rate andre operation rate after transvaginal mesh (TVM) repairs.
Methods:This was a retrospective evaluation of all TVM procedures performedin our institution between the years 2010 and 2013 for pelvic organprolapse. The procedures were performed using ProliftTM mesh.Objective outcome was evaluated using the Pelvic Organ ProlapseQuantification (POP-Q) system, using the definition of POP-Q ≤stage 1 and absence of prolapse symptoms reported by the patient.Perioperative complications including blood loss, adjacent organsdamage and voiding difficulties were reported. Mesh complicationsincluding mesh exposure, dyspareunia, de-novo urinary stressincontinence (USI), and chronic pelvic pain were reported. Overallre-operation rates for mesh complications, USI or voidingdifficulties were evaluated.
Results: 154 patientsparticipated in this analysis and completed follow-up. Of them, 126anterior repair with mesh and 65 apical and posterior repair withmesh. The mean follow up was 29 months. Bladder injury occurred in 3(1.8%) patients. The mean hemoglobin decline was 1.5 gr. 107)69%)patients had anatomical cure using the composite outcome of overallPOP-Q ≤ stage 1 and absence of prolapse symptom. Of the 47 (30.5%)patients who did not meet the cure criteria, only 28(18.1%) patientshad failure in the treated compartment and 19(12.3%) had failure indifferent compartment. Overall 82% success rate in treatedcompartment. 12 (7.7%) of patients had mesh exposure, of them 9 weretreated conservatively. 14 (9%) patients had re-operation in thefollow up period for recurrence of prolapse, mesh exposure ofUSI.
Conclusions: outcome of mesh usage in our institutionwas satisfactory and overall complications rate were lower thanreported before.
References: 1. Obstet Gynecol. 2016Jul;128(1):81-91. doi: 10.1097/AOG.0000000000001451.2. CochraneDatabase Syst Rev. 2016 Feb 9;2:CD012079. doi:10.1002/14651858.CD012079.