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International Urogynecology Journal

Published in:

01-07-2014 | Original Article

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study

Authors: Tsung-Hsien Su, Hui-Hsuan Lau, Wen-Chu Huang, Ching-Hung Hsieh, Rhu-Chu Chang, Chin-Hui Su

Published in: International Urogynecology Journal | Issue 7/2014

Abstract

Introduction and hypothesis

To compare the efficacy and safety of the Elevate™ anterior and posterior prolapse repair system and traditional vaginal native tissue repair in the treatment of stage 2 or higher pelvic organ prolapse.

Methods

A cohort study was conducted between January 2010 and July 2012. Patients who underwent transvaginal pelvic reconstruction surgery for prolapse were recruited. The primary outcome was anatomical success 1 year after surgery. The secondary outcome included changes in the quality of life and surgical complications. Recurrence of prolapse was defined as stage 2 or higher prolapse based upon the pelvic organ prolapse qQuantification system.

Results

Two hundred and one patients (100 in the Elevate™ repair group and 101 in the traditional repair group) were recruited and analyzed. The anatomical success rate of the anterior compartment was significantly higher in the Elevate™ repair group than in the traditional repair group (98 % vs 87 %, p = 0.006), but not for the apical (99 % vs. 6 %, p = 0.317) or posterior (100 % vs 97 %, p = 0.367) compartments after a median 12 months of follow-up. Both groups showed significant improvements in the quality of life after surgery with no statistical difference. Mesh-related complications included extrusion (3 %) and the need for revision of the vaginal wound (1 %). Those in the mesh repair group had a longer hospital stay (p = 0.04), operative time (p < 0.001), and greater estimated blood loss (p = 0.05). Other complications were comparable with no statistical difference.

Conclusions

The Elevate™ prolapse repair system had a better 1-year anatomical cure rate of the anterior compartment than traditional repair, with slightly increased morbidity.

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRef

Kenton K, Mueller ER (2006) The global burden of female pelvic floor disorders. BJU Int 98 [Suppl 1]:1–5PubMedCrossRef

Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidence based literature review. Int Urogynecol J Pelvic Floor Dysfunct 17:195–201PubMedCrossRef

Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 14:CD004014

Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG 111:831–836PubMedCrossRef

Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C; Nordic Transvaginal Mesh Group (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364:1826–1836CrossRef

Su TH, Liu PE, Lau HH, Huang WC, Lin TY, Hsieh CH (2011) Impact of Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 22:585–590CrossRef

FDA (2011) FDA Safety Communications: UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. http://www.fda.gov/MedicalDevices/ Safety/AlertandNotices/ucm262435.htm. Accessed 13 July 2011

Haylen BT, Sand PK, Swift SE, Maher C, Moran PA, Freeman RM (2012) Transvaginal placement of surgical mesh for pelvic organ prolapse: more FDA concerns—positive reactions are possible. Int Urogynecol J 23:11–13PubMedCrossRef

10.

Murphy M, Holzberg A, van Raalte H, Kohli N, Goldman HB, Lucente V, Network PS (2012) Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication: “UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse”. Int Urogynecol J 23:5–9PubMedCrossRef

11.

Moore RD, Mitchell GK, Miklos JR (2012) Single-incision vaginal approach to treat cystocele and vault prolapse with an anterior wall mesh anchored apically to the sacrospinous ligaments. Int Urogynecol J 23:85–91PubMedCentralPubMedCrossRef

12.

Lukban JC, Roovers JP, Vandrie DM et al (2012) Single-incision apical and posterior mesh repair: 1-year prospective outcomes. Int Urogynecol J 23:1413–1419PubMedCrossRef

13.

Stanford EJ, Moore RD, Roovers JP et al (2013) Elevate anterior/apical: 12-month data showing safety and efficacy in surgical treatment of pelvic organ prolapse. Female Pelvic Med Reconstr Surg 19:79–83PubMedCrossRef

14.

Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRef

15.

Uebersax JS, Wyman JF, Shumaker SA et al (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn 14:131–139PubMedCrossRef

16.

Su TH, Lau HH (2010) Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire. J Sex Med 7:3940–3945PubMedCrossRef

17.

Su TH, Lau HH, Huang WC et al (2009) Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure. J Sex Med 6:3201–3207PubMedCrossRef

18.

Dietz V, Huisman M, Joyce M et al (2008) Functional outcome after sacrospinous hysteropexy for uterine descensus. Int Urogynecol J Pelvic Floor Dysfunct 19:747–752PubMedCentralPubMedCrossRef

Title: Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study
Authors: Tsung-Hsien Su
Hui-Hsuan Lau
Wen-Chu Huang
Ching-Hung Hsieh
Rhu-Chu Chang
Chin-Hui Su
Publication date: 01-07-2014
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 7/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2294-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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