Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors

Collinet, Pierre; Belot, F.; Debodinance, P.; Duc, E. Ha; Lucot, Jean-Philippe; Cosson, Michel

doi:10.1007/s00192-005-0003-8

Cited by 225 publications

(140 citation statements)

References 8 publications

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“…The diagnosis was both problematic as different authors used different definitions (mesh erosion, vaginal mesh extrusion, and minor mesh exposure) and its clinical impact controversial as some gynaecologists operated on erosions 15,18,33,34,[40][41][42][43][44][45][46][47][48][49]54,61 , whereas others treated erosions with debridement, vaginal estrogens, antiseptics, or antibiotics. 36,41,48,57,60 One of the anecdotally cited contraindications for the use of mesh is the likelihood of dyspareunia. This outcome is more problematic to measure because some women are not sexually active, but not all studies take this factor into account when reporting their sexual function data.…”

Section: Safetymentioning

confidence: 99%

Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

Jia

Glazener

Mowatt

et al. 2008

BJOG

192

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Background The efficacy and safety of mesh/graft in surgery for anterior or posterior pelvic organ prolapse is uncertain.Objectives To systematically review the efficacy and safety of mesh/graft for anterior or posterior vaginal wall prolapse surgery.Search strategy Electronic databases and conference proceedings were searched, experts and manufacturers contacted, and reference lists of retrieved papers scanned.Selection criteria Randomised controlled trials (RCTs), nonrandomised comparative studies, registries, case series involving at least 50 women, and RCTs published as conference abstracts from 2005 onwards.Data collection and analysis One reviewer screened titles/ abstracts, undertook data extraction, and assessed study quality. Data analysis was conducted for three subgroups: anterior, posterior, and anterior and/or posterior repair (not reported separately).Results Forty-nine studies involving 4569 women treated with mesh/graft were included. Study quality was generally high. Median follow up was 13 months (range 1-51 months). In anterior repair, there was short-term evidence that mesh/graft (any type) significantly reduced objective prolapse recurrence rates compared with no mesh/graft (relative risk 0.48, 95% CI 0.32-0.72). Nonabsorbable synthetic mesh had a significantly lower objective prolapse recurrence rate (8.8%, 48/548) than absorbable synthetic mesh (23.1%, 63/273) and biological graft (17.9%, 186/1041), but a higher erosion rate (10.2%, 68/666) than absorbable synthetic mesh (0.7%, 1/147) and biological graft (6.0%, 35/581). There was insufficient information to compare any of the other outcomes regardless of prolapse type.Conclusions Evidence for most outcomes was too sparse to provide meaningful conclusions. Rigorous long-term RCTs are required to determine the comparative efficacy of using mesh/graft.

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Section: Safetymentioning

confidence: 99%

Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

Jia

Glazener

Mowatt

et al. 2008

BJOG

192

View full text Add to dashboard Cite

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“…Vaginal erosions are well known and may affect more than 10% of patients [1]. They usually require local excision.…”

Section: Introductionmentioning

confidence: 99%

Correlation between shrinkage and infection of implanted synthetic meshes using an animal model of mesh infection

et al. 2010

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Introduction and hypothesis The aim of this study was to evaluate a link between mesh infection and shrinkage. Methods Twenty-eight Wistar rats were implanted with synthetic meshes that were either non-absorbable (polypropylene (PP), n=14) or absorbable (poly (D,L-lactic acid) (PLA94), n=14). A validated animal incisionnal abdominal hernia model of mesh infection was used. Fourteen meshes (n=7 PLA94 and n=7 PP meshes) were infected intraoperatively with 10e6 CFU Escherichia coli, and compared with 14 non-infected meshes (n=7 PLA94 and n=7 PP meshes) (control groups). Explantations were performed on day 30. Shrinkage was evaluated by a reproducible numerical analysis of mesh area. Infection and histological study were evaluated on day 30.Results Non-infected meshes were less shrunk than infected meshes for both non-absorbable (5.0±1.7% versus 21.6±6.1%, p<0.05) and absorbable meshes (2.4±0.9% versus 11.0±2.5%, p<0.05). Conclusion This study highlights a link between infection and shrinkage in the model used.

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“…Transvaginal repair of anterior compartment defects and apical vaginal prolapse with mesh has been evaluated [Collinet et al, 2005;de Tayrac et al, 2005]. Our technique incorporates the use of a mono¢lament polypropylene mesh for the repair of Baden^Walker Grade 3^4 cystoceles, enteroceles, or vaginal vault prolapse.…”

Section: Introductionmentioning

confidence: 99%

Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction

Amrute

Eisenberg

Rastinehad

et al. 2006

Neurourology and Urodynamics

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Aims: A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point ¢xation is also reviewed. Methods: After proper vaginal dissection, a specially fashioned ''H'' shaped polypropylene mesh is positioned and ¢xed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior ¢xation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat 1 . Results: Seventy-six patients (79%) were available with a mean follow-up time of 30.7 AE 1.7 months and mean age of 69.3 AE 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, de¢ned as an occasional leak. For those with preoperative incontinence (n ¼ 36), average pad use per day decreased signi¢cantly from 2.1 AE 0.4 to 0.8 AE 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 AE 0.3 on a scale of 1 (least satis¢ed) to 10 (most satis¢ed). Conclusions: Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and e⁄cacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable. Neurourol. Urodynam. 26:53^58, 2007. ß 2006

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Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors

Cited by 225 publications

References 8 publications

Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

Correlation between shrinkage and infection of implanted synthetic meshes using an animal model of mesh infection

Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction

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