Transvaginal surgery using self‐cut mesh for pelvic organ prolapse: 3‐year clinical outcomes

Abstract

Objectives To evaluate subjective and objective outcomes, complication, recurrence, and reoperation rates after transvaginal mesh surgery for the management of pelvic organ prolapse. Methods This was a retrospective analysis of transvaginal mesh surgery carried out using self‐cut mesh measuring subjective outcomes using validated questionnaires, and objective outcomes using Pelvic Organ Prolapse Quantification. Patients diagnosed with stage ≥2 pelvic organ prolapse were counseled about all possible surgical options. After thorough explanation about the benefits and risks during transvaginal mesh surgery, patients who gave signed consent were scheduled for surgery and evaluated at 1 and 3 years postoperatively. Results We included 101 patients who completed a minimum of 3‐year follow up. One year and 3‐year follow up showed significant improvement both on subjective and objective outcomes. Recurrences were observed in three patients (3%), with one (1%) patient undergoing reoperation. One case (1%) of intraoperative complication (bladder injury) and four cases (4%) of postoperative complications (two mesh exposure, one hematoma and one significant increase in post‐voiding residual) were recorded. Overall patients’ satisfaction was positive. Conclusions Transvaginal mesh surgery using self‐cut mesh is associated with significant improvement in both subjective and objective outcomes, offering low recurrence and complication rates, and high patient satisfaction rates. It can be a safe, effective and cost‐efficient option not only for recurrence cases, but also as primary management of pelvic organ prolapse using a standardized technique and proper patient selection.

Mesh exposure after transvaginal mesh prolapse surgery: Out of permissible range?

“…To give a brief overview, the present study presented much lower rates of mesh exposure (1.25%) and chronic pain (0.49%) after TVM compared with Western studies 15–18 . These results are consistent with studies from Asian countries, including Japan, Korea and Taiwan 4–9,19–21 . Furthermore, use of modified TVM (Uphold‐type TVM) without transobturator arms and posterior mesh could help avoid mesh exposure in the urinary tract and the rectum.…”

“…The biggest difference between Western and Japanese studies can be seen in the reported rates of vaginal mesh exposure. Systematic reviews showed that the rate of vaginal exposure often reached ≥10% in Western countries, 15,16 whereas Japanese studies reported the rate was 2.0–3.2% 5–7 . In the first 300 patients of the present study, the rate of vaginal exposure was 2.3%, 4 and the final overall rate was 0.7%.…”

“…A macroporous monofilament polypropylene mesh, Gynemesh PS (Ethicon Women’s Health and Urology, Somerville, NJ, USA) was used until May 2014, and Polyform (Boston Scientific, Marlborough, MA, USA) was used thereafter. The mesh was cut into a shape similar to Prolift (Ethicon Women’s Health and Urology) or Uphold (Boston Scientific) with paper patterns, as described in previous studies 4–10 . After water dissection with epinephrine solution, a minimum‐sized central incision (3–4 cm) was made on the vaginal wall.…”

“…In the conventional TVM group, custom‐made eyed needles were used to pass nylon loops through the obturator foramen (from the anterior vaginal incision) and the sacrospinous ligament (from the posterior vaginal incision) 4–7 . Then, the mesh arms (four in the anterior mesh, and two in the posterior mesh) were placed using the nylon loops.…”

“…In 2011, the FDA released a safety communication about mesh‐related complications, causing the number of TVM to decrease in the USA and Europe thereafter 2,3 . However, in Japan, where self‐cut mesh is used, medical societies have continued to accept the procedure while having extensive discussions about the prevention and management of TVM complications, thus keeping complication rates relatively low 4–9 . In addition, recent shifts from conventional TVM to modified TVM without transobturator arms and posterior mesh also helped to further decrease complications 8,10 .…”