Outcome of repeat surgery for genital prolapse using prolift-mesh

Abstract

IntroductionUrogenital prolapse can have a significant impact on quality of life. The life time risk of requiring surgery for urogenital prolapse is 11%. Prolift mesh has recently been introduced to reduce repeat operation rate and for long-term benefit.ObjectiveTo evaluate the outcome of the treatment of urogenital prolapse with synthetic mesh.MethodsA retrospective review of case notes of all women who underwent prolift mesh insertion for prolapse between July 2004 and June 2005, at Royal Alexandra Hospital Paisley UK. We looked at the presenting complaints, previous operation, intraoperative complications and complications at six weeks and six months follow-up.ResultsTwenty-two procedures were carried out in the twelve months period. Age of the patients ranged from 55 to 82 years (median 64 yrs). Eleven had anterior Prolift (50%), Seven had posterior Prolift 31.8% and four total Prolift 18%. There were no intraoperative complications. All the patients had previous surgery for prolapse. Eight patients had anterior repair, six patients had posterior repair, and three patients had abdominal hysterectomy. Vaginal hysterectomy was carried out with mesh insertion as a concomitant procedure in seven cases (31.25%). All patients were seen at six weeks and six months after the surgery. Complications rate included mesh erosion one patient and suture material protruding in the vagina one patient, one patient had failed prolift operation. All the twenty-one patients were cured giving 95.4% success rate.ConclusionThe use of prolene mesh in pelvic reconstructive surgery was associated with good outcome and minimal complications in this study.

Multidisciplinary management of women with pelvic organ prolapse, urinary incontinence and lower urinary tract symptoms. A clinical and psychological overview

“…Surgical treatment of prolapse is contraindicated in women with local vaginal diseases, with early-stage asymptomatic prolapse, or who are unfit to undergo sur-gery [34]. Synthetic mesh has been widely used in the surgical treatment of pelvic organ prolapse but exposes women to the risk of specific complications which may require mesh removal [36][37][38][39][40]. In this regard, the US Food and Drug Administration (FDA) warned about serious complications associated with the transvaginal placement of mesh for POP [41,42].…”

“…In the same way, the International Urogynecological Association's (IUGA) Grafts Roundtable [37] advises against the use of vaginal meshes to correct POP in the presence of stage I-II, local/systemic pain syndromes, or possible pregnancy; in addition, the use of meshes does not seem to be highly effective in the case of prolapse of the posterior compartment or in women aged below 50 years; conversely, the best results seem to be achieved in women aged above 50 years, with stage II prolapse of the anterior compartment, deficient fascia, chronic increase in intra-abdominal pressure, or both, and in the case of relapses [37]. Finally, possible complications with the use of meshes have been reported either during or after prolapse correction, or intraoperatively, i.e., bleeding; injury involving the bladder, ureter or urethra, nerve or bowel; anesthesia-related complications, and deep venous thrombosis (DVT), with the subsequent risk of pulmonary embolism (PE) [34,36]. Postoperative complications include infections, mesh contraction or erosion through the vagina, chronic pain, recurrent voiding symptoms and sexual dysfunctions [34,43,44].…”