Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh

Abstract

Objective To determine the efficacy and safety of a new technique using Atrium polypropylene mesh (Atrium, Hudson, New Hampshire, USA) as an overlay graft for repair of large or recurrent anterior and posterior compartment prolapse. Design A retrospective review of women who had vaginal prolapse surgery with Atrium mesh reinforcement.Setting Tertiary referral urogynaecology unit in Australia.Population Forty-seven women where mesh was placed under the bladder base with lateral extensions onto the pelvic sidewall, 33 women where a Y-shaped mesh was placed from the sacrospinous ligaments to the perineal body and 17 women who had mesh placement in both compartments. Methods Women were assessed by site-specific vaginal examination pre-operatively and post-operatively at six weeks, six months and two years. Main outcome measures All complications. Rate of recurrent prolapse assessed by the Baden -Walker halfway classification system. Results Mean follow up was 29 months (range 6 to 52). Four of 64 women with anterior mesh placement (6%) developed a grade 2 asymptomatic cystocele. Five women (5%) required further surgery for recurrent prolapse at a non-mesh site. Erosion occurred in nine women (9%). Three healed after intravaginal oestrogen cream, five after excision of exposed mesh and vaginal closure and one woman also had surgical closure of a rectovaginal fistula. The risk of mesh erosion decreased over the study period. Urinary, coital and bowel symptoms were significantly improved following surgery. Conclusions This technique shows promise in correcting pelvic organ prolapse. Vaginal mesh erosion is the most common complication and is related to surgical experience.

Pelvic organ prolapse transvaginal repair by the Prolift system: Evaluation of efficacy and complications after a 4.5 years follow up

“…17,27,[30][31][32] In the present study, the rate of de novo dyspareunia was 13.3%, similar to those observed in larger series. Dyspareunia after POP surgery might be as a result of mesh exposure or mesh shrinkage.…”

Outcome of Repeat Surgery for Genital Prolapse using Prolift-Mesh

“…Most cases of prolapse in the Caucasian population is due to age factors that weaken the ligaments supporting the pelvic structures [14]. In this study the failure of the total mesh prolift was in the 82 year old lady.…”

The mesh debate

“…In a prospective randomised study by Julian in 1996 of 24 patients with mesh versus non-mesh for surgical treatment of recurrent cystocele [5], there was a better anatomical result with no recurrence in the mesh group but 3 of the 12 patients had mesh exposure. When we reported our 2-year results in 2004, our mesh exposure rate was 9% [6]. It was interesting that the results of a meta-analysis of recent studies published this year by Abed et al [7] showed an incidence of 10.3%.…”