Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction

Abstract

Aims: A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point ¢xation is also reviewed. Methods: After proper vaginal dissection, a specially fashioned ''H'' shaped polypropylene mesh is positioned and ¢xed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior ¢xation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat 1 . Results: Seventy-six patients (79%) were available with a mean follow-up time of 30.7 AE 1.7 months and mean age of 69.3 AE 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, de¢ned as an occasional leak. For those with preoperative incontinence (n ¼ 36), average pad use per day decreased signi¢cantly from 2.1 AE 0.4 to 0.8 AE 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 AE 0.3 on a scale of 1 (least satis¢ed) to 10 (most satis¢ed). Conclusions: Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and e⁄cacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable. Neurourol. Urodynam. 26:53^58, 2007. ß 2006

Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh

“…The score for any type of urinary incontinence at follow-up was statistically significantly lower in both groups, this implying an improvement in overall urinary incontinence. Similar results have been reported elsewhere [5,8,17].…”

“…The differences between the study groups are not statistically significant mesh and recommended abandoning this mesh. Other uncontrolled trials have reported dyspareunia rates from 10% to 36% after using polypropylene mesh [5,6,8,14,15]. On the other hand, improvement of dyspareunia rates after repair with mesh has been reported [15][16][17].…”

“…Polypropylene mesh has been used to reinforce anterior repair with comparatively good anatomical results in uncontrolled trials [5][6][7][8]. There are, however, only a few randomized studies comparing traditional repair with the use of mesh, fewer have used polypropylene, and data on symptom resolution are even scantier [9][10][11][12].…”

Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

“…The diagnosis was both problematic as different authors used different definitions (mesh erosion, vaginal mesh extrusion, and minor mesh exposure) and its clinical impact controversial as some gynaecologists operated on erosions 15,18,33,34,[40][41][42][43][44][45][46][47][48][49]54,61 , whereas others treated erosions with debridement, vaginal estrogens, antiseptics, or antibiotics. 36,41,48,57,60 One of the anecdotally cited contraindications for the use of mesh is the likelihood of dyspareunia.…”

Suburethral Slingplasty Using a Self-Fashioned Mesh for Treating Urinary Incontinence and Anterior Vaginal Wall Prolapse

“…There are three similar articles using self-fashioned mesh for treating stress urinary incontinence and anterior vaginal wall prolapse have been found in recent five years (Mustafa and Wadie, 2006;Amrute et al, 2007;Eboue et al, 2010 ). Character of mesh, patient number, mean follow-up period, success rates, and complications of these articles and ours are as tabled below (Table 1).…”