Single incision anterior apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery at 36 months follow-up

Lo, Tsia‐Shu; Al-Kharabsheh, Ahlam Mahmoud; Tan, Yiap Loong; Pue, Leng Boi; Hsieh, Wu‐Chiao; Uy-Patrimonio, Ma. Clarissa

doi:10.1016/j.tjog.2017.10.016

Cited by 20 publications

(13 citation statements)

References 22 publications

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“…To the best of our knowledge, our study is the first focusing on surgical management of patients with symptomatic advanced POP with the modified Surelift system, and has demonstrated good 1-year objective and subjective outcomes. Anatomic correction of anterior and apical prolapse was 100%, which compares favorably with results from previous similarly conducted studies using Elevate-A and Uphold [4,5]. The subjective cure rate at 1 year was 92.8%.…”

Section: Discussionsupporting

confidence: 82%

“…A previous study with 52-month follow-up showed an objective cure rate of 94.4% for a transvaginal mesh (TVM) used for advanced vaginal cuff eversion [3]. The Elevate-A system (Elevate Anterior and Apical Prolapse Repair System, American Medical Systems, Minnetonka, MN), a single-incision mesh system for anterior and apical prolapse repair, had showed 3-year objective cure rates of 96.6% and 98.3% in the anterior and apical compartments, respectively [4]. Similarly, the Uphold Lite vaginal mesh system (Boston Scientific, Marlborough, MA) with proximal mesh placement on the bilateral sacrospinous ligaments had promising 1-year 95.5% and 94.3% objective and subjective cure rates, respectively, for patients with symptomatic anterior or apical prolapse stage III or IV [5].…”

mentioning

confidence: 99%

“…De novo stress urinary incontinence (SUI) is a known occurrence after correction of POP (particularly anterioapical) owing to unkinking of the vesicourethral angle [6]. There is emerging evidence suggesting increased incidence after the use of a single-incision mesh system for the management of advanced POP, ostensibly owing to tissue damage and denervation during dissection of the paravesical fossa space to reach the bilateral sacrospinous ligaments [4]. However, in 2019 the Food and Drug Administration (FDA) halted US sales of pelvic mesh owing to serious concerns over lack of long-term follow-up data on their effectiveness compared with native tissue repair and safety outcomes (particularly with regard to mesh-related complications), as well as insufficient evidence that the probable benefits of TVM outweigh their risks.…”

mentioning

confidence: 99%

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Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

Huang

et al. 2021

Journal of Minimally Invasive Gynecology

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To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. Design: Retrospective cohort study. Setting: Tertiary-care university hospital. Patients: Patients with symptomatic anterior or apical POP stage III and above. Interventions: All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. Measurements and Main Results: Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre-and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. Conclusion:A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery. (2021) 28, 107−116.

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Section: Discussionsupporting

confidence: 82%

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confidence: 99%

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confidence: 99%

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Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

Huang

et al. 2021

Journal of Minimally Invasive Gynecology

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“…An 11-year population-based nationwide descriptive study showed a trend of uterine suspension with uterine preservation during the latter years, [19] and the uterus preservation is always considered when there is no pathological finding of uterus. [20] In 2014, this minimally invasive procedure of UPHOLD LITE Vaginal Support System with the Capio SLIM Suture Capturing Device (Boston Scientific, Marlborough, MA, USA) has been used in our hospital. More than 500 patients have been treated with this procedure so far.…”

Section: Discussionmentioning

confidence: 99%

Uterine-preserving pelvic organ prolapse surgery using the UPHOLD LITE vaginal support system

et al. 2019

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This article aims to evaluate the safety and outcome of women with pelvic organ prolapse (POP) treated by a minimally invasive bilateral sacrospinous hysteropexy (UPHOLD LITE Vaginal Support System, Boston Scientific) without concomittent anti-incontinence surgery. This retrospective study was conducted between 2014 and 2016. Evaluated items included surgical parameter and postoperative outcome. Three hundred thirteen women with POP were eligible and 22 were excluded because of history of either or more following situations, such as hysterectomy, mesh augmentation, previous anti-incontinence procedures, and radical pelvic surgery before. With a median follow-up of 26 months, surgery-related morbidity rate was 23.7% (69/291), including 1 with bladder injury (0.3%), 2 with hematoma (0.7%), 8 with urinary tract infection (2.8%), 48 with voiding dysfunction (16.5%) and 10 with mesh problems (3.4%). Among these morbidities, 12 patients (4.1%) needed surgical intervention, including 6 for mesh problems, 1 for bladder injury, 2 for hematoma, and 3 for anti-incontinence surgery. The difference of pelvic organ prolapse quantification (POP-Q) stage before and after surgery showed a statistical significance (anterior portion from 1.36 ± 2.60 to −2.69 ± 0.26, posterior portion from −1.29 ± 2.08 to −2.46 ± 0.62, and cervix portion from 2.03 ± 4.80 to −6.98 ± 2.26, all P < .001). At the end of August 2018, re-intervention rate for POP recurrence was 2.1% (n = 6), including abdominal sacrocolpopexy (n = 1), anterior repair (n = 1), vaginal total hysterectomy and uterine-sacral ligament suspension (n = 1), vaginal total hysterectomy and LeFort (n = 1), LeFort (n = 1), and pessary support (n = 1). Because some women developed postoperative lower urinary tract symptom, preoperative evaluation, including careful and detailed history taking, and urodynamic evaluation is suggested. After adequate counseling, uterine-preserving sacrospinal ligament suspension by UPHOLD LITE Vaginal Support System surgery could be considered in the management of women with POP, because of its high successful rate (97.9%) and low morbidity rate.

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“…SSF was fixed on the right unilateral side via the posterior approach 12 . No additional support was done for TVM that provided anterior and apical support such as Prolift anterior and posterior (Prolift T) 13 , Elevate Anterior/Apical (Elevate A) 14 , and Uphold. Concomitant MUS (Transobturator tape) was offered to patients with higher score in question #3 (Urine leak related to physical activity, coughing or sneezing) than #2 (Urine leakage related to the feeling of urgency) on UDI-6.…”

Section: Methodsmentioning

confidence: 99%

Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes

Uy-Patrimonio²,

Kao

et al. 2020

Sci Rep

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patients with pelvic organ prolapse (pop) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUi-UD) and detrusor overactivty(Do) would co-exist in a number of patients. Management entails relieving the obstructive element. to determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUi-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-UD. Main outcome measures: Objective cure-absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure-assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. improvement of SUi UD and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. ergo, vaginal pRS cures symptoms of MUi-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI. Mixed urinary incontinence (MUI) alone has been the leading cause of urinary incontinence in women above 65 years old. The ten-year cumulative incidence of urinary incontinence rates MUI as the first reported symptom in 37.2% of elderly patients 1. The International Urogynecological Association (IUGA) and International Continence Society (ICS) define MUI as the complaint of involuntary leakage of urine associated with exertion, sneezing, or coughing, as well as leakage associated with urgency 2. The cause of which is due to striated muscle atrophy, estrogen deficiency, abnormalities in histomorphology, and microstructural changes 3. Diagnosis of MUI through urodynamic studies pose a great challenge, since results fail to correlate with patient's symptoms, which lead to under diagnosis. Management of these group patients has generally been based on the predominant symptom that the patients report as the most bothersome 4. On the other hand, patients with pelvic organ prolapse (POP) often have lower urinary tract symptoms (LUTS). The use of urodynamic study for pre-operative evaluation of patients with POP becomes mandatory per recommendation by International Consultation on Incontinence 5. Urodynamic studies unmask occult stress urinary incontinence (SUI-UD) and identify women with concomitant detrusor overactivity (DO) and overt SUI-UD. Women with DO and SUI-UD are considered to have mixed type urinary incontinence (MUI-U). The incidence of MUI in patients with POP is 34.3% 6. Relieving the obstructive element becomes the main focus of management

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Single incision anterior apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery at 36 months follow-up

Abstract: SIM A has better 3 years objective and subjective cure rate than SSF in the anterior and/or apical compartment prolapse.

Cited by 20 publications

References 22 publications

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

Uterine-preserving pelvic organ prolapse surgery using the UPHOLD LITE vaginal support system

Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes

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