Are anterior mesh arms necessary in Japanese‐style transvaginal mesh surgery for cystocele?

Abstract

Aim In this study, we retrospectively analyzed the medium‐term efficacy and safety of surgery with transobturator two‐arm transvaginal mesh for cystocele and to verify whether the anterior arms are necessary for Japanese‐style transvaginal mesh surgery. Methods The study included 203 patients with cystocele who underwent transobturator two‐arm transvaginal mesh at our hospital between August 2015 and June 2017 and received appropriate follow‐up care for at least 48 months after surgery. Results The Pelvic Organ Prolapse Quantification stage was III in all the patients. Intraoperative complications included two cases of bladder injury and one case of more than 200 mL of blood loss. The mean observation period was 51.9 months, and prolapse recurred in the operated compartment in nine patients (4.4%). No cases of mesh exposure were observed. In comparing the preoperative characteristics of the 9 patients with prolapse recurrence at the surgical site with those of the other 194 patients, we found that the recurrence rate was significantly higher among patients in whom point Ba being 3.5 cm or more and among patients younger than 66 years. Conclusions Transobturator two‐arm transvaginal mesh for cystocele was as good and safe as the procedure previously reported with four‐arm mesh; thus, it was possible to omit the anterior mesh arms in Japanese‐style transvaginal mesh surgery. Patients should be informed preoperatively that prolapse recurs at a significantly higher rate among younger patients and in those whose point Ba being 3.5 cm or more.

Investigation of predictive factors for the presence of voiding dysfunction after transvaginal mesh surgery—Can the flow curve shape on uroflowmetry be a predictor?

“…The surgical technique was used according to previous reports, [14][15][16] and the mesh was made by self-cutting. For TVM-A, TVM-AP, and TVM-C, we used the mesh shapes reported by Takeyama et al 14 and Watanabe et al 15 similar to Prolift™ mesh (Johnson & Johnson, New Brunswick, NJ, USA), but smaller.…”

“…The surgical technique was used according to previous reports, [14][15][16] and the mesh was made by self-cutting. For TVM-A, TVM-AP, and TVM-C, we used the mesh shapes reported by Takeyama et al 14 and Watanabe et al 15 similar to Prolift™ mesh (Johnson & Johnson, New Brunswick, NJ, USA), but smaller. For TVM-Uphold, we used the mesh shape reported by Takazawa et al 16 similar to, but smaller than, Uphold™ mesh (Boston Scientific, Natick, MA, USA).…”