Tension‐free vaginal mesh procedure for pelvic organ prolapse: A single‐center experience of 310 cases with 1‐year follow up

Abstract

Objective: To prospectively evaluate the efficacy of a tension-free vaginal mesh (TVM) procedure for pelvic organ prolapse (POP). Methods: Between December 2005 and April 2008, 310 female patients (mean age 67.2 years, range 42-84) with POP underwent TVM procedures at our institute. Fifty-six individuals were qualified as stage 2 according to the POP quantification system and 162 and 92 were stage 3 and 4, respectively. One hundred ninety-one patients underwent anterior TVM, and seven underwent posterior TVM. One hundred twelve cases underwent both anterior and posterior TVM procedures. Each patient was systematically assessed at 1, 3, 6 and 12 months after surgery. Quality of life (QOL) was also assessed by using the Short Form-36 and the prolapse-QOL questionnaires. Results: Perioperative complications were the following: five bladder injuries (1.6%), no rectal injuries and three hemorrhages greater than 400 mL (1.0%). The anatomical cure rate (% stage 0 cases) at 3, 6 and 12 months after surgery were 94.1%, 93.5%, and 92.3%, respectively. Short Form-36 and prolapse-QOL parameters were significantly improved , and maintained during the follow-up period. Postoperative complications were the following: five pelvic hematomas (1.6%), one wound infection (0.3%), 10 vaginal mesh extrusions (3.2%), and three cases of pelvic pain (1.0%). Complications concerning lower urinary tract function were: eight cases of postoperative stress urinary incontinence (2.6%), three cases of transient urinary retention (1.0%), and two cases of de novo overactive bladder (0.6%). Conclusions:The TVM procedure provides a good outcome at 1 year with a low incidence of surgical complications and recurrence. Further evaluation with a longer follow up is needed.

Retrospective study of tension‐free vaginal mesh operation outcomes for prognosis improvement

“…7 Takahashi et al reported that the anatomical cure rate was 100% after 3 months and 92.3% after 1 year by using a similar (non-mesh-kit) procedure as ours. 8 Our data was as low as their data. Diez-Itza et al reported that preoperative severe prolapse (POP-Q stage III and IV) of any part was associated with anatomical failure but not with functional recurrence.…”

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

“…The cumulative continence rate following transobturator mesh was 61 % (81/132) [124][125][126]. However, after the additional insertion of a suburethral tape, 235 out of 237 women (99 %) were continent postoperatively [87,[127][128][129]. One randomized study investigated the question whether treatment should be carried out as a one-stage or a two-stage procedure; it was found that the treatment of stress incontinence was equally successful, irrespective of whether the suburethral TVT was inserted at the same time as the anterior vaginal wall repair (83/87, 95%) or three months later (47/53, 89%; based on an ontreatment analysis) [130].…”

Urogynäkologie, „overactive bladder“ und Neurourologie

“…Bei vernünftiger Indikation und entsprechender operativer Erfahrung bieten die Netze objektiv und auch subjektiv dauerhaft gute Langzeitergebnisse [3] und zeigen randomisiert gegen die klassische vordere Kolporrhaphie bessere Langzeitergebnisse, wenngleich die Kurz-und Langzeitkomplikationsraten der Kunststoffimplantate höher lag [4]. Die oft sehr unkritische Verwendung dieser Netze und von der Industrie getriebene weite Verbreitung, auch bei nicht sehr erfahrenen Operateuren, führte zumindest in den USA 2008 zur Empfehlung seitens der FDA, dass diese Netze aufgrund hoher Komplikationsraten nur bei Rezidiveingriffen indiziert seien.…”