Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis

Abstract

Keywords► anterior pelvic organ prolapse ► cystocele ► surgery ► mesh ► colporrhaphy ► meta-analysis AbstractPurpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6-8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] ¼ 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] ¼ 45,98 [9,[72][73][74][75][76][77][78][79][80][81][82]25]), longer surgery time (MD ¼ 15,08 [0,67]), but less prolapse recurrence (OR ¼ 0,22 [01,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different.

Pelvic Organ Prolapse Repair with Mesh: Description of Surgical Technique Using the Surelift^® Anterior Repair System

“…Regarding the complication rate after this surgery, we would stress that the only complications detected during follow-up were small vaginal mesh exposures, with a rate similar to that reported by other authors (3.2–19%) [14]; these cases could be treated using a minimally invasive approach. However, mesh exposure has been reported up to 7 years after surgery [14], and the results of long-term series have shown an exposure rate as high as 42% [15]. Thus, longer follow-up would be needed to confirm that the exposure rate does not increase over time.…”

Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America

“…Guideline sections covering genital prolapse and stress urinary incontinence have been published in the Brazilian Journal of Gynecology and Obstetrics. 47,48 The guidelines for recurrent UTI have yet to be published in a peer-reviewed journal, but are available online as a guide for members of FEBRASGO; they recommend behavioral modification, followed by immunomodulatory prophylaxis (in particular OM-89), and, finally, by either continuous or postcoital antimicrobial prophylaxis.…”

“…Guideline sections covering genital prolapse and stress urinary incontinence have been published in the Brazilian Journal of Gynecology and Obstetrics. 47,48 The guidelines for recurrent UTI have yet to be published in a peer-reviewed journal, but are available online as a guide for members of FEBRASGO; they recommend behavioral modification, followed by immunomodulatory prophylaxis (in particular Although local guidelines from individual countries or regions exist, there is a need for an overarching Latin American consensus. 42,43 The founding of the Brazilian Society of Urogynecology and the Pelvic Floor (Associação Brasileira de Uroginecologia e Assoalho Pélvico) in 2017, and the experience of its president, Jorge M. Haddad, as representative to the International Urogynological Association (IUGA) precipitated the formation of the Latin American Board of Urogynecology, in the same year.…”

Mesh-augmented transvaginal repair of recurrent or complex anterior pelvic organ prolapse in accordance with the SCENIHR opinion

“…Since none of our patients required further surgery up to the follow-up, all exposures could be managed conservatively. The reported exposure rates in the literature range between 3.2 and 14% [2,[13][14][15][16][17][20][21][22][23][24][25]. Exposure rates have decreased successively in the last decade because of stricter patient selection, advancements in mesh compounds and design and improvement of surgical techniques.…”