The use of synthetics in the treatment of pelvic organ prolapse

Abstract

Despite an improved understanding of pelvic anatomy and organ function and advances in surgical techniques, long-term success rates in pelvic surgery are still variable (3-59%), but can reach up to 92% in the case of associated procedures. The major causes of recurrent pelvic prolapse after corrective surgery are related to patient factors, such as poor tissues, impaired healing processes and chronic pathological increases in intra-abdominal pressure. Other causes of failure are, however, probably related to surgical techniques: the use of weak or insufficient sutures, or suboptimal performance of the surgery. In line with progress in the surgical correction of abdominal hernias, the use of synthetic mesh in pelvic reconstructive surgery also seems to guarantee its reliability, especially when autologous tissue is of poor quality or insufficient quantity. Moreover, the use of artificial mesh may simplify a surgical procedure, reducing operative time and the need for additional techniques. This review evaluates the main properties of synthetic biomaterials, their complications and the most common procedures involved in the use of synthetic mesh: the abdominal sacral colpopexy and transvaginal cystocele repair.

Estudo randômico da correção cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando histerectomia versus preservação uterina

“…Tal reação pode ser desejada ou inconveniente, quando causa efeitos compressivos ou obstrutivos. Portanto, tal fenômeno deve sempre ser lembrado e a tela implantada sem tensão 13 . A utilização de tela monofilamentar e macroporosa (tipo I) é a mais apropriada, porém na literatura são descritas taxas de extrusão dessa tela entre 6 e 25% 15 .…”

“…Vários procedimentos cirúrgicos foram propostos para a correção do prolapso genital; no entretanto, apesar do crescente desenvolvimento das técnicas cirúrgicas e do conhecimento da anatomia pélvica, os resultados não são completamente satisfatórios. As taxas de recidivas do prolapso de órgãos pélvicos após correção cirúrgica variam de 22% a 92% 13,14 . O uso de telas na cirurgia reconstrutora pélvica se baseia na premissa de que as distopias são consequentes ao enfraquecimento dos tecidos naturais.…”

The incidence of mesh extrusion after vaginal incontinence and pelvic floor prolapse surgery

“…Similarly, other authors have observed tears or breaks in the endopelvic fascia of women with pelvic floor prolapse during reconstructive surgery [9] . Regardless of the etiology of the laxity, many reconstructive surgeons have argued that prolapsed vaginal tissue is weak and, alone, cannot provide support for adequate repair, creating a need for further tissue reinforcement [10] . The current available options for graft materials applicable to pelvic floor support include autologous fascia, cadaveric fascia, porcine dermis, porcine small intestine submucosa, and synthetic mesh [11] .…”

Improvement of postoperative care in women with genital prolapse

“…За цих умов пологи і травми розглядаються як про-вокуючі фактори [6,8,29]. І що яскравіші прояви дисплазії на поліорганному рівні, то частішими є швидкі та стрімкі пологи, і так само частіше виникає пролапс геніталій, який більш виражено маніфестує, важче піддається хірургічній корекції та зумовлює високу частоту рецидивів [5].…”