Two‐years results of native tissue versus vaginal mesh repair in the treatment of anterior prolapse according to different success criteria: A randomized controlled trial
“…It was found that 7.7% (72/933) of women who underwent a mesh repair also had surgery for mesh exposure. This evidence is further supported by recent studies [26, 27]. …”
Section: Resultssupporting
confidence: 89%
“…At 3 years follow-up, the objective anatomic cure rate was 91.4% for the mesh group and 41.2% for the colporrhaphy group. A more recent randomized study also showed a significant difference of efficacy between the trocar-guided Nazca TC ® kit and anterior colporrhaphy groups [27]. The trial reported on 86 patients with an anterior compartment prolapse stage 2 or more, according to the POP-Q system.…”
Section: Resultsmentioning
confidence: 99%
“…Using different outcomes may have considerable impact on the results even of a single study. As an example, in a recent randomized controlled trial comparing vaginal mesh repair to anterior colporrhaphy, anatomic cure rates were 74.4% and 51.1%, respectively at 2 years, but dropped to 40% for each group when the definition of a successful outcome was changed from postoperative prolapse POP-Q stage 2 or less to stage 1 or less [27]. …”
Awareness and reporting of mesh-related complications of pelvic organ prolapse repairs have increased in recent years. As a result, deciding whether to use a mesh or not has become a difficult task for urogynecologists. Our aim was to summarize reasons for and against the use of mesh in prolapse repair based on a review of relevant literature. Scopus and PubMed databases were searched for papers reporting on the efficacy and safety of native tissue versus non-absorbable, synthetic mesh prolapse repairs. Randomized controlled trials, systematic reviews, and meta-analyses were included. Evidence is presented for each vaginal compartment separately. In the anterior compartment, mesh repairs seem to offer clearly superior efficacy and durability of results compared to native tissue repairs, but with an equally clear increase in complication rates. In the isolated posterior compartment prolapse, high-quality evidence is sparse. As far as the apical compartment is concerned, sacrocolpopexy is the most efficacious, yet the most invasive procedure. Data on the comparison of transvaginal mesh versus native tissue repairs of the apical compartment are somewhat ambiguous. Given the inevitable coexistence of advantages and disadvantages of mesh use in each of the prolapsed vaginal compartments, an individualized treatment decision, based on weighing risks against benefits for each patient, seems to be the most rational approach.
“…It was found that 7.7% (72/933) of women who underwent a mesh repair also had surgery for mesh exposure. This evidence is further supported by recent studies [26, 27]. …”
Section: Resultssupporting
confidence: 89%
“…At 3 years follow-up, the objective anatomic cure rate was 91.4% for the mesh group and 41.2% for the colporrhaphy group. A more recent randomized study also showed a significant difference of efficacy between the trocar-guided Nazca TC ® kit and anterior colporrhaphy groups [27]. The trial reported on 86 patients with an anterior compartment prolapse stage 2 or more, according to the POP-Q system.…”
Section: Resultsmentioning
confidence: 99%
“…Using different outcomes may have considerable impact on the results even of a single study. As an example, in a recent randomized controlled trial comparing vaginal mesh repair to anterior colporrhaphy, anatomic cure rates were 74.4% and 51.1%, respectively at 2 years, but dropped to 40% for each group when the definition of a successful outcome was changed from postoperative prolapse POP-Q stage 2 or less to stage 1 or less [27]. …”
Awareness and reporting of mesh-related complications of pelvic organ prolapse repairs have increased in recent years. As a result, deciding whether to use a mesh or not has become a difficult task for urogynecologists. Our aim was to summarize reasons for and against the use of mesh in prolapse repair based on a review of relevant literature. Scopus and PubMed databases were searched for papers reporting on the efficacy and safety of native tissue versus non-absorbable, synthetic mesh prolapse repairs. Randomized controlled trials, systematic reviews, and meta-analyses were included. Evidence is presented for each vaginal compartment separately. In the anterior compartment, mesh repairs seem to offer clearly superior efficacy and durability of results compared to native tissue repairs, but with an equally clear increase in complication rates. In the isolated posterior compartment prolapse, high-quality evidence is sparse. As far as the apical compartment is concerned, sacrocolpopexy is the most efficacious, yet the most invasive procedure. Data on the comparison of transvaginal mesh versus native tissue repairs of the apical compartment are somewhat ambiguous. Given the inevitable coexistence of advantages and disadvantages of mesh use in each of the prolapsed vaginal compartments, an individualized treatment decision, based on weighing risks against benefits for each patient, seems to be the most rational approach.
IntroductionWe assessed outcome and outcome-measure reporting in randomised controlled trials evaluating surgical interventions for anterior-compartment vaginal prolapse and explored the relationships between outcome reporting quality with journal impact factor, year of publication, and methodological quality.MethodsWe searched the bibliographical databases from inception to October 2017. Two researchers independently selected studies and assessed study characteristics, methodological quality (Jadad criteria; range 1–5), and outcome reporting quality Management of Otitis Media with Effusion in Cleft Palate (MOMENT) criteria; range 1–6], and extracted relevant data. We used a multivariate linear regression to assess associations between outcome reporting quality and other variables.ResultsEighty publications reporting data from 10,924 participants were included. Seventeen different surgical interventions were evaluated. One hundred different outcomes and 112 outcome measures were reported. Outcomes were inconsistently reported across trials; for example, 43 trials reported anatomical treatment success rates (12 outcome measures), 25 trials reported quality of life (15 outcome measures) and eight trials reported postoperative pain (seven outcome measures). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.412; P = 0.018). No relationship was demonstrated between outcome reporting quality with impact factor (β = 0.078; P = 0.306), year of publication (β = 0.149; P = 0.295), study size (β = 0.008; P = 0.961) and commercial funding (β = −0.013; P = 0.918).ConclusionsAnterior-compartment vaginal prolapse trials report many different outcomes and outcome measures and often neglect to report important safety outcomes. Developing, disseminating and implementing a core outcome set will help address these issues.
“…While the use of a transvaginal mesh has been shown to be both subjectively and objectively more effective than anterior colporrhaphy [ 4 ], many complications related both to the mesh and to the transobturator approach have been described [ 1 , 7 , 8 ]. The transobturator procedure involves inserting two needles in both obturator areas without visual control.…”
PurposeTo map the vascular anatomy of the obturator foramen using fixed anatomic landmarks.MethodTwenty obturator regions were dissected in 10 fresh female cadavers after vascular blue dye injection in five cadavers (50%). Furthermore, 104 obturator regions were reconstructed by angiotomodensitometry from 52 women under investigation for suspected arterial disease. The anatomy of the obturator region was mapped by measuring the distance of vascular structures from the middle of the two branches of the ischiopubic bone, which were used as fixed landmarks.ResultsThe bifurcation of the obturator artery was at a mean (SD) distance of 30.0 mm (4.5) from the middle of the ischiopubic branch (MISP). The anterior branch of the obturator vessels was 15.2 mm (10.1) from the MISP. The posterior branch of the obturator vessels was 5.5 mm (4.0) and 23.6 mm (8.7) from the middle of the outer edge of the obturator foramen (MOE) and the MISP, respectively. Using 5° and 95° percentiles of these measurements we defined a central avascular triangle.ConclusionsOur data show that, beyond inter-individual variations, a central triangular avascular area can be identified in the obturator foramen between the posterior and anterior obturator artery using fixed landmarks.
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