The clinical and urodynamic outcomes of single-incision mesh surgery using the Uphold system for the treatment of pelvic organ prolapse

Abstract

this retrospective cohort study aims to assess the clinical and urodynamic outcomes of single-incision mesh surgery with the Uphold system. The medical records of 140 women with anterior and/or apical compartment prolapse stage 2 or greater who underwent Uphold mesh surgeries were reviewed. the clinical evaluation included a pelvic examination, a urodynamic study (UDS), and a personal interview to evaluate lower urinary tract symptoms (LUTS). After a follow-up time of 12-30 months, the anatomical reduction rates were 100% and 96.4% for the apical and anterior compartments, respectively, and these rates were similar across women with or without hysterectomy. All of the LUTS and several UDS parameters improved significantly. The continence rate in women with stress urinary incontinence (SUi) was improved if they also underwent a mid-urethral sling (MUS) operation. However, the continence rate did not differ between women with and without occult urodynamic stress incontinence who did not undergo a concomitant MUS operation. the rate of vaginal mesh extrusion was 2.8%, and this complication rarely occurred beyond the learning curve. In conclusion, the anatomic correction of the Uphold system was satisfactory with a low rate of mesh extrusion. Women with SUI would benefit from a concomitant MUS operation. Apical prolapse is an important issue among pelvic organ prolapse (POP) 1 , and level 1 support (according to DeLancey's description) should be provided during repair 2. In native tissue reconstruction, the sacrospinous ligament is an important attachment point of apical compartment repair. With direct visualization, sacrospinous ligament perforation and retrieval can be aided with specific devices, such as Deschamps ligature carrier 3 , but it is not always easy to approach the ligament from the vagina. The anatomic outcomes of sacrospinous ligament fixation, which is usually performed unilaterally, are heterogenous 4. Additionally, a higher rate of apical compartment recurrence was reported in sacrospinous hysteropexy than in hysterectomy 5. Therefore, a more durable procedure suitable for either uterine preservation or hysterectomy is needed 6 , and various transvaginal mesh (TVM) kits have been developed in recent decades. TVM was once considered a breakthrough innovation in treating POP. Regardless of fair anatomic outcomes, reports about mesh extrusion raised concerns about its safety 7. Due to the lack of long-term evidence in safety, the US Food and Drug Administration (FDA) ordered all manufacturers to stop selling synthetic mesh intended for transvaginal repair of anterior compartment prolapse on April 16th, 2019 8. Although TVM surgery is performed less often since the order, a continuous follow-up of women who underwent TVM surgeries is necessary and can provide abundant information. Although numerous procedures regarding level 1 support have been described, fixation with grafts is still one of the options in the flowchart 9. It appears that TVM still plays a role in

Transperineal pelvic floor ultrasound for analyzing the outcomes of pelvic floor surgery for the treatment of anterior compartment prolapse: A comparative study of transvaginal mesh and native‐tissue repair

“…First, this was a retrospective study, and the follow‐up durations for the patients were inconsistent and limited. Although a 1‐year follow‐up is unlikely to fully reveal all complications of transvaginal mesh surgery, a low risk of serious side effects during long‐term follow‐up can be expected given the relatively lightweight mesh body 38 . Second, this study was performed at one hospital, and it involved two urogynecology subspecialist surgeons.…”

Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

“…visceral injury as well as dislocation and failure at long term subjective cure rates ranging from 43 to 92% 4 . In this context, it is important to discuss advantages and risks of concurrent sling procedures with patients [5][6][7][8] . The question whether patients with POP combined with SUI preoperatively or developing de novo SUI postoperatively would benefit from simultaneous sling procedures or not has not been scientifically answered yet 9 .…”