Surgical management of pelvic organ prolapse in women

Abstract

Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinous colpopexy, uterosacral colpopexy and transvaginal mesh. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living, and increased cost of the abdominal approach.The use of mesh or graft inlays at the time of anterior vaginal wall repair reduces the risk of recurrent anterior wall prolapse on examination. Anterior vaginal polypropylene mesh also reduces awareness of prolapse, however these benefits must be weighted against increased operating time, blood loss, rate of apical or posterior compartment prolapse, de novo stress urinary incontinence, and reoperation rate for mesh exposures associated with the use of polypropylene mesh.Posterior vaginal wall repair may be better than transanal repair in the management of rectocele in terms of recurrence of prolapse. The evidence is not supportive of any grafts at the time of posterior vaginal repair. Adequately powered randomised, controlled clinical trials with blinding of assessors are urgently needed on a wide variety of issues, and they particularly need to include women's perceptions of prolapse symptoms. Following the withdrawal of some commercial transvaginal mesh kits from the market, the generalisability of the findings, especially relating to anterior compartment transvaginal mesh, should be interpreted with caution.

Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months

“…Sexual function of patients with dyspareunia was severely affected preoperatively. The average rate for dyspareunia reported in the literature is 12 % [31]. In our study, 15.6 % of women had dyspareunia before undergoing surgery.…”

“…At 12 and 36 months after the procedure, the quality of life of the surveyed study participants had improved even more, and the difference to the preoperative figures remained significant. Further studies have also confirmed that mesh-based correction of pelvic organ prolapse can significantly improve patientsʼ quality of life, despite mesh-associated side-effects [26][27][28][29][30][31].…”

Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

“…Evidence supporting the value of combination surgery is still limited in these women and two reviews recognised the need for further research. 3,4 Nevertheless, many physicians combine incontinence surgery during POP repair and there are probably large regional differences in treatment. 5,6 The clinical dilemma as whether to perform combination surgery or not was the subject of two randomised trials in women with overt SUI.…”

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

“…The most commonly used material is a surgical mesh made of polypropylene (PPL) which has long been used successfully to treat hernias. Although mesh augmented POP repair procedures have higher anatomical success rates compared to no-mesh, the functional and quality of life outcomes are not as good [6] and severe complications with life changing consequences can occur in up to 10-30% of cases [7]. Complications associated with the use of vaginal mesh are now reported widely in the media together with many litigations against physicians and manufacturers leading to the withdrawal of several mesh products from the USA market [8].…”