Comparison of Postoperative Short-Term Outcomes between Tension-Free Vaginal Mesh Surgery Using the Capio™ SLIM Suture Capturing Device and Conventional TVM Surgery for Pelvic Organ Prolapse

Abstract

Aim We compared the short-term effectiveness of tension-free vaginal mesh (TVM) surgery using the Capio SLIM suture capturing device and conventional TVM surgery for treatment of pelvic organ prolapse. Methods We retrospectively compared postoperative pain, urinary function, and length of hospital stay between 7 patients who underwent TVM surgery using the Capio device and 9 patients who underwent conventional TVM surgery. Results There was no significant between-group difference in mean age between the Capio TVM group and the conventional TVM group (76.0 ± 5.6 years and 72.5 ± 11.5 years) or in mean operating time (86.56 ± 23.33 min and 95.28 ± 23.88 min). Four of the 7 patients in the Capio TVM group could not sense the urge to urinate after removal of the urethral catheter, but all patients in the conventional TVM group did so. The volume of the first voluntary urination was significantly smaller in the Capio TVM group than that in the conventional TVM group (102.14 ± 80.57 mL versus 472.22 ± 459.43 mL). The mean residual urine volume after the first voluntary urination was greater in the Capio TVM group than that in the conventional TVM group (285.70 ± 233.82 mL versus 34.56 ± 73.31 mL). The number of catheter days and mean maximal volume of residual urine were significantly greater in the Capio TVM group. The mean postoperative hospital stay was 6.57 ± 1.83 days in the Capio TVM group and 3.2 ± 0.42 days in the conventional TVM group. Six patients who underwent Capio TVM surgery complained of deep-seated pain in the hip region. Conclusion Urinary function may worsen postoperatively when the Capio TVM device is used in patients with pelvic organ prolapse.

Transvaginal mesh surgery for pelvic organ prolapse without blind maneuver

“…These maneuvers occasionally cause unexpected blood loss, visceral injury, voiding dysfunction, pain, and dyspareunia. 2,3,[7][8][9][10] Uphold Lite Vaginal Support System (Boston Scientific) was a unique method that can help avoid puncture, but requires vigorous dissection on using the Capio Suture Capturing Device (Boston Scientific) which connects the mesh to the sacrospinous ligaments; therefore, it might have similar possibilities. 7,18,19 Although our technique involves the following procedures: (1) incising the posterior vaginal wall, (2) performing medial traction of rectum, and (3) rupturing the rectovaginal fascia, all procedures could be performed with direct vision.…”

“…In addition, no patients complained of pain on sitting because there were no skin incisions for trocar or needle puncture. 7 Dyspareunia was not investigated in this study because most patients were very elderly, more than half had lost their husband, and/or most had no sex life. When patients are younger and sexually active, we believe that they would be suitable for LSC.…”

“…In most facilities, therefore, surgeons created a mesh insert by cutting polypropylene mesh (Gynemesh PS; Ethicon, Somerville, NJ, USA or Polyform synthetic mesh; Boston Scientific, Natick, MA, USA) to match the pattern of the Prolift System (Ethicon, Somerville, NJ, USA), other kits, or the original pattern. 7,8 TVM surgery reportedly involved the risk of complications during or after surgery, such as injury of the bladder, rectum, and ureter, accidental massive bleeding/hematoma, urinary dysfunction, infection, dyspareunia, chronic pain, mesh erosion/exposure, and vaginal scarring. [9][10][11][12][13] In 2019, The US Food and Drug Administration ordered the manufacturers of all surgical mesh products indicated for the transvaginal repair of POP to stop selling and distributing their products.…”

“…In Japan, commercial ready‐made kits were not made available because the Ministry of Health, Labour and Welfare did not license them. In most facilities, therefore, surgeons created a mesh insert by cutting polypropylene mesh (Gynemesh PS; Ethicon, Somerville, NJ, USA or Polyform synthetic mesh; Boston Scientific, Natick, MA, USA) to match the pattern of the Prolift System (Ethicon, Somerville, NJ, USA), other kits, or the original pattern 7,8 …”

Presurgical bladder wall thickness is a useful marker to predict the postsurgical improvement of symptoms in patients with pelvic organ prolapse‐related overactive bladder

“…Furthermore, patients without a uterus underwent total TVM (T‐TVM), wherein one piece of a prosthetic mesh, consisting of two connected parts, is inserted into the anterior and posterior walls. 22 , 23 , 24 All patients underwent the same surgical procedure using TVM by an expert surgeon (T.M.). Finally, 41 patients treated with TVM (anterior 24, posterior 0, anterior and posterior 12, and total 5) were enrolled in this study.…”