CLINICAL OUTCOME OF RECONSTRUCTIVESURGERY WITH ANTERIOR VAGINAL MESH AND UTEROSACRAL LIGAMENT COLPOPEXYFOR ADVANCED PELVIC ORGAN PROLAPSE
A. TAKASE, A. HAMURO, D.TACHIBANA, T. MISUGI, H. KATAYAMA, N. YOKOI, M. HAYASHI, R. UEMURA,M. KOYAMA;
Osaka City Univ. Graduate Sch. of Med., Osaka, Japan.
Introduction: The suitablesurgical procedure for pelvic organ prolapse (POP) has been confusingsince FDA's alert against vaginal mesh implant. Reconstructivevaginal native tissue repair is still useful, especially forrestoring the apical part of the vagina. Tension-free vaginal mesh(TVM) surgery can work well for severe anterior vaginal wall descent,not for the posterior vaginal mesh. We used uterosacral ligamentsuspension to provide apical vaginal support and anterior TVMimplantation to provide anterior vaginal support (level II), and thiscombined approach compensated for the disadvantages of the twooperations.
Objective: Objective: The main aim of the studywas to evaluate the clinical outcome including postoperativecomplications and patients’ satisfaction after combination ofuterosacral colpopexy (modified McCall suture) and anterior TVMoperation. The optimal treatment for pelvic organ prolapse has beenthe subject of much discussion.
Methods: This study wasconducted as a single-center prospective cohort. Reconstructivesurgery was performed in fifty-eight POP patients with stage III toIV cystocele and uterine prolapse (Ba: +4.9±1.6, C: +3.9±3.0).Uterosacral colpopexy (modified McCall culdeplasty by Nichols DH) andtrocar-guided anterior vaginal mesh implantation through theobturator foramen followed after conventional vaginal hysterectomy.Postoperative outcomes and patients' satisfaction were analyzed byconsecutive POP-Q assessments and the modified Short Form 12 version2 (SF-12v2) questionnaire including quality of life (QOL) assessmentand sexual behaviors, respectively. Recurrence was defined when themost distal point was beyond the hymen.
Results: Meanoperation time and blood loss were 124.8±15.9 min, 68.5±54.5 mlrespectively. Intraoperative tissue injury (bladder perforation)occurred in one case. Recurrence of vaginal descent observed in twocases (Ba: +4 and +1, cure rate: 96.5%). Reoperation was carried outin only one case. In two patients, asymptomatic mild cystocele wasobserved (Ba: 0) but additional treatments were not required. Anyother mesh-related complications, such as mesh protrusion, chronicpelvic pain, or chronic inflammation did not occur through follow-upperiod (1-6 years). Postoperative modified SF-12 scores at 12 monthswere significantly improved in all 8 domains.
Conclusions:The combined operation of vaginal hysterectomy and uterosacralligament colpopexy augmented by anterior vaginal mesh implantationwas safe and durable surgical treatment with satisfactory maintenanceof QOL. The subjective satisfactory correction of pelvic organprolapse was achieved.
References: J. Obstet. Gynaecol.Res. Vol. 42, No. 6: 707-715, June 2016