Similar anatomical and quality of life outcomes were observed with polypropylene mesh and sacrospinous ligament fixation for the treatment of uterine prolapse. Complication rate was higher in the mesh group.
Both techniques were effective. Anatomical efficacy was superior in the mesh group regarding the anterior compartment; quality of life changes were also greater in the mesh group. Complications were significantly higher in the mesh group.
Introduction
The aim of this study was to compare long‐term outcomes in patients who underwent either native tissue repair or monofilament macroporous polypropylene mesh.
Methods
This multicenter, randomized trial included—at the end of 5 years follow‐up—122 women with severe pelvic organ prolapse, who were randomly assigned to undergo surgical treatment using native tissue repair (native tissue group, n = 59) or synthetic mesh repair (mesh group, n = 63). Cure criterion was when pelvic organ prolapse‐quantification (POP‐Q) point was ≤0. Quality of life was assessed using the prolapse quality‐of‐life questionnaire and sexual function with the quality of sexual function.
Results
Groups were homogeneous preoperatively with the exception of the previous pelvic surgery variable, which was higher in mesh (P = .019). Cure rate was significantly better for mesh group in the anterior compartment (P = .002) and in the combination of all compartments (P = .001). Native tissue group was significantly better when there was prolapse in the posterior and apical compartment (P = .031). In the quality of life analysis, mesh group showed a significant improvement compared with native tissue group (P = .004). Complications were significantly higher in mesh and recurrence in native tissue. Regarding the reoperation rate, there was no difference between groups, but native tissue had a higher reoperation rate due to recurrence (P = .031).
Conclusions
Outcomes in women with severe POP were better with mesh use than native tissue repair, both in the anterior compartment and in the multicompartmental prolapse after 5‐year follow‐up. Complications were more common in the mesh group and recurrences were more frequent in the native tissue group.
Estudo randômico da correção cirúrgica do prolapso uterino Estudo randômico da correção cirúrgica do prolapso uterino Estudo randômico da correção cirúrgica do prolapso uterino Estudo randômico da correção cirúrgica do prolapso uterino Estudo randômico da correção cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando através de tela sintética de polipropileno tipo I comparando através de tela sintética de polipropileno tipo I comparando através de tela sintética de polipropileno tipo I comparando através de tela sintética de polipropileno tipo I comparando histerectomia versus preservação uterina histerectomia versus preservação uterina histerectomia versus preservação uterina histerectomia versus preservação uterina histerectomia versus preservação uterina A randomized comparison of two vaginal procedures for the treatment of A randomized comparison of two vaginal procedures for the treatment of A randomized comparison of two vaginal procedures for the treatment of A randomized comparison of two vaginal procedures for the treatment of A randomized comparison of two vaginal procedures for the treatment of uterine prolapse using polypropylene mesh: histeropexy versus histerectomy uterine prolapse using polypropylene mesh: histeropexy versus histerectomy uterine prolapse using polypropylene mesh: histeropexy versus histerectomy uterine prolapse using polypropylene mesh: histeropexy versus histerectomy uterine prolapse using polypropylene mesh: histeropexy versus histerectomy SILVIA Comparar os resultados anatômicos pós-operatórios de pacientes portadoras de prolapso uterino tratadas utilizando tela de polipropileno para correção dos defeitos do assoalho pélvico, comparando histerectomia vaginal com a preservação do útero. Método Método Método Método Método: Estudo randomizado com 31 mulheres portadoras de prolapso uterino estádio III ou IV (POP-Q) divididas em dois grupos: Grupo HV-15 mulheres submetidas à histerectomia vaginal e reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) e Grupo HP-16 mulheres mulheres submetidas à reconstrução da anatomia do assoalho pélvico com tela de polipropileno tipo I (Nazca R-Promedon) preservando o útero. Raça, urgência miccional, constipação intestinal, dor sacral, sangramento e tempo de operação foram os parâmetros analisados. ResultadosResultados Resultados Resultados Resultados: O tempo de seguimento médio foi de nove meses. Não se observou diferença entre os grupos nas complicações funcionais. O tempo cirúrgico foi 120 minutos para grupo HV versus 58.9 minutos para grupo HP ( p < 0.001 ) e o volume de perda sanguínea intraoperatória foi 120 mL no grupo HV versus 20 mL para grupo HP ( p < 0.001*). A taxa de sucesso objetivo foi 86.67% para grupo HV e 75% para grupo HP (p = 0,667). A taxa de erosão de tela foi 20% (3/15) de extrusão no grupo HV versus 18,75% (3/16) no grupo HP (p = 1,000). Conclusão Conclusão Conclusão Conclusão Conclusão: A correção cirúrgica do assoalho pélvico com telas nas...
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