Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Abstract

Objectives: Analysis of feasibility, efficacy and short-term results after six-arm transvaginal mesh OPUR implantation in women with apical prolapse. Material and methods:The same surgeon operated all of 39 women using mesh OPUR. Preoperatively patients had a standardized interview and clinical examination. Intraoperative and postoperative complications were analyzed. Postoperative evaluation included standardized interview, clinical examination and standardized pelvic floor ultrasound performed with 2D transvaginal probe and 4D abdominal probe.Results: There was no complication that needed operative intervention. Hematomas in 3 patients resolved spontaneously. Transient voiding difficulties which lasted less than 7 days were observed in 5 patients. No erosion was observed. Comparison of pre-and postoperative results in 34 women revealed that in all 3 compartments improvement in POP-Q scale was statistically significant (p < 0.0000). One patient with malposition and rolled up mesh needed re-operation. During PFS-TV in 94.1% of patients urethra was normobile or hypermobile. In all of the patients urethral end of the mesh was positioned far enough from the middle part of the urethra (ultrasound) to implant suburethral sling without risk of collision. Sexually active women did not inform of any important discomfort or pain during intercourse. Conclusions:It seems that six-arm OPUR mesh, if implanted under strict surgical rules, gives low risk of complications and high chance to successfully reduce POP symptoms in short term after the operation. It seems that OPUR mesh should not have negative influence on the results after anti-incontinence suburethral sling.

Urethral funneling visualized during pelvic floor sonography — analysis of occurrence among urogynecological patients

“…Also, there are studies showing that a suburethral tape implantation that effectively treated SUI in patients have also often eliminated the funneling. If the funneling persisted after the suburethral tape implantation, it was found to be a risk factor for failure of SUI surgical treatment [13,[18][19][20]. Some experts managed to visualize urethral funneling also in cases after a successful treatment with suburethral tape [18][19][20].…”

The Urogynecology Section of the Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment of pelvic organ prolapse

“…Pelvic floor testing may be the source of useful information in patients after unsuccessful urogynecologic surgeries [3,14,40].…”

Urogynecology Section of the Polish Society of Gynecologists and Obstetricians guidelines on the management of stress urinary incontinence in women

“…The scope of preoperative diagnostics depends on the symptoms, findings of the clinical examination and the additional tests, the experience of the physician and common practice in a given medical center. It is necessary to evaluate pelvic organ prolapse and the possible treatment methods before or during SUI surgery [32,33]. These issues have been discussed elsewhere, in the guideline for the surgical management of POP.…”