Short-Term Outcome Analysis of Total Pelvic Reconstruction With Mesh:: The Vaginal Approach

Shah, Darshan K.; Paul, Elliot M.; Rastinehad, Ardeshir R.; Eisenberg, Evan R.; Badlani, Gopal H.

doi:10.1097/01.ju.0000100141.38862.38

Cited by 45 publications

(27 citation statements)

References 11 publications

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“…The literature reports that 73-79% of prolapse and stress incontinence patients are dry after transvaginal prosthetic pelvic fl oor surgery [16][17][18] . Our data confi rm 75% post-operative continence rate (3 of 4 patients).…”

Section: Discussionmentioning

confidence: 99%

Uterus-Sparing Vaginal Surgery of Genitourinary Prolapse Employing Biocompatible Material

Nicita

Marzi²,

Filocamo³

et al. 2005

Urol Int

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Objective: The study presents an original uterus sparing technique for transvaginal repair of total genitourinary prolapse. The technique employs a synthetic mesh of mixed polypropylene and 910 polyglactin fibers. Methods: The prosthesis creates a support for the cystocele, the cervix and the enterocele. It has four anchoring sites: two at the rear in the sacrospinous ligaments and two at the front in the arcus tendineous of the levator ani muscle. Between February 2001 and December 2004, 24 patients (mean age 66.9 years), presenting symptoms of uterine prolapse, cystocele and enterocele (POP-Q stage III-IV Aa associated to II-III-IV C), were treated with our procedure. Pre- and postoperative parameters were evaluated statistically. Results: No patient had any serious complications. The mean follow-up was 31.1 months (range 6–52). 19 patients (79.1%) have shown excellent results and have been completely cured. In 5 other cases (20.8%), the cystocele was completely cured and there was a significant improvement in the hysterocele and the enterocele. One patient required surgical treatment for postoperative stress incontinence. Statistical analysis of data regarding the pre- and postoperative prolapse stage demonstrated a high degree of objective cure rates (p < 0.0001). Conclusions: While hysterectomy remains the habitual treatment for severe uterine prolapse, our technique provides a promising alternative solution. It is also significant that there were no complications of erosion or infection associated with the prosthesis.

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Section: Discussionmentioning

confidence: 99%

Uterus-Sparing Vaginal Surgery of Genitourinary Prolapse Employing Biocompatible Material

Nicita

Marzi²,

Filocamo³

et al. 2005

Urol Int

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“…Overt or occult stress urinary incontinence is also addressed as mid-urethral and bladder neck support is included. An analysis of short-term outcomes of this procedure was published previously [Shah et al, 2004]. We describe our current surgical technique of 4-point ¢xation, with modi¢cation of anterior arm being tension-free, using a single polypropylene mesh for anterior compartment repair, vaginal vault suspension, and mid-urethral support, with a subjective evaluation of outcomes and complications.…”

Section: Introductionmentioning

confidence: 99%

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

Amrute

Eisenberg

Rastinehad

et al. 2006

Neurourology and Urodynamics

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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

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“…Lechaux et al, achieved similar results in patients who had their prosthetic material implanted transperineally [4]. Other authors rate the risk of postoperative dyspareunia between 1 to 21% of patients [10,11,14,15]. A very high rate of satisfied or very satisfied patients seems highly promising.…”

Section: Discussionmentioning

confidence: 97%

“…Nevertheless, implantation of a non-absorbable polypropylene mesh may lead to its erosion, invoke a feeling of foreign mass in the space between the vagina and the rectum, as well as become the site of inflammation. Various authors have estimated the occurrence of prosthetic material erosion, mainly through the vaginal wall, at 0-20% of the operated patients [4,6,[9][10][11][12]. Its surgical repair is seldom necessary.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic materials for treating posterior vaginal wall prolapse and rectocele — own experience

Stadnik

Kościński

2016

Ginekol Pol

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Objectives: This report describes results of posterior vaginal wall prolapse and rectocele treatment performing tension free reconstruction method with polypropylene mesh implantation. Material and methods:In years 2001 to 20015, 71 female patients in age of 42-82 years were surgically treated. Besides difficult emptying they complained of feeling of heaviness in the pelvis (38%) and dyspareunia (16.9%). Defecography and magnetic resonance proved the presence of rectocele in 84.5%, enterocele in 38%, descending perineum in 28.2%, genital organ prolapse in 23.9%, and rectal prolapse in 22.5% cases. 37 patients with defects of low location have undergone implantation of prosthetic material from vaginal approach. In cases of high location and genital organ prolapse abdominal approach was done.Results: Permanent reconstruction of the rectovaginal septum has been achieved in 70 patients (98%). Symptoms of dyschesia, pelvic plain, heavy straining were persisted in 4 patients (10.3%). 3 cases of mash erosions were diagnosed. One patient was reoperated. Among 6 other patients who needed futher surgical treatment only one was reoperated because of vaginal prolapse. 81.7% of patients was satisfied with their treatment. Conclusion:Using prosthetic materials in pelvic floor defects treatment is characterized by high efficacy and low complication percentage.

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Short-Term Outcome Analysis of Total Pelvic Reconstruction With Mesh:: The Vaginal Approach

Abstract: Transvaginal technique of 4-point vaginal vault fixation using mesh is a safe and effective procedure at 2 years.

Cited by 45 publications

References 11 publications

Uterus-Sparing Vaginal Surgery of Genitourinary Prolapse Employing Biocompatible Material

Uterus-Sparing Vaginal Surgery of Genitourinary Prolapse Employing Biocompatible Material

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

Prosthetic materials for treating posterior vaginal wall prolapse and rectocele — own experience

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