Vaginal reconstruction for the remedy of pelvic organ prolapse: the effect, influence on urinary and sexual function and quality of life in two-years follow-up
Part I. Vaginal status and complications


Authors: I. Čadková;  I. Huvar
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice Milosrdných bratří p. o., Brno, primář MUDr. I. Huvar, CSc.
Published in: Ceska Gynekol 2017; 82(6): 430-435

Overview

Objective:
To evaluate the effect, risks and benefits of vaginal reconstruction surgery for pelvic organ prolapse (POP). This article (part I of the study) focuses on the vagina – POP-Q status, complications, re-operations.

Design:
Clinical prospective non-randomized trial, two years follow-up.

Setting:
Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.

Materials and methods:
The cohort consisted of 410 women who underwent anterior and/or posterior vaginal repair (with or without hysterectomy or anti-incontinence procedure) in our hospital in the two years period (1. 3. 2012 – 28. 2. 2014). From among the total, 297 women received transvaginal mesh (TVM group), 113 women underwent „native tissue reconstruction“ – NT group. Vaginal status was evaluated pre-operative, in the early postoperative period and 2 – 6 – 12 and 24 month after the surgery.

Results:
The number of women that had come to the vaginal investigation at 2 – 6 – 12 – 24 month in NT group: 96 – 49 – 58 – 65, in TVM group: 277 – 218 – 228 – 222. All percentage relates then to the number of vaginally checked cases in the appropriate time. The most distal point of vagina: NT group – preoperative mean 1,12 (median +1), after two years mean -1,30 (median -1). Vaginal wall reaching hymen or 1 cm under it found in 24 women (36.9%), POP stage III, IV, i.e. decrease ≥ 2 cm, was in two women (3.1%). TVM group: preoperative mean 2.93 (median +2), after two years mean -1.73 (median -2). Prolapse 0–1 cm under hymen developed in 39 women (17.6%), POP stage III, IV found in five women (2.3%). Clinically significant complications (symptomatic and/or dehiscence >1 cm) in the hospital period and after 2 – 6 – 12 – 24 month in NT group: 3.5% – 12.5% – 2% – 0 – 0 of the checked women, in TVM group these numbers were 3.5% – 12.3% – 8.7% – 6.1% – 3.2%. Reoperation for recurrent POP: in NT group once (0.9%), in TVM group three times (1.0%). Reoperation for vaginal complication after NT operation: six times (5.3%), after TVM procedure 15 times (5.1%). Protrusion resection from the above done in nine cases (three times resection itself, six times in combination with another indication).

Conclusion:
The vaginal reconstruction of POP has a good effect with acceptable rate of complications. The NT procedure had the higher percentage of POP recurrence (40% vs 19.9%), the TVM surgery had more late vaginal complications (6...3% vs 0 after NT). Number of re-operations for vaginal complications was similar in both groups (about 5%).

Keywords:
POP, pelvic organ prolapse, transvaginal mesh, colporrhaphy, complications, long-term follow-up


Sources

1. Al-Nazer, MA., Gomaa, IA., Ismail, WA., El-Etriby, MA. Anterior colporrhaphy versus repair with mesh for anterior vaginal wall prolapse: a comparative clinical study. Arch Gynecol Obstet, 2012, 286(4), p. 965–972.

2. Araco, F., Gravante, G., Sorge, R., et al. The influence of BMI, smoking and age on vaginal erosions after synthetic mesh repair for pelvic organ prolapses. A multicenter study. Acta Obstet Gynecol, 2009, 88, p. 772–780.

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

4. Cintra, CC., Oliviera, CEB. Opinion: Yes. Int Braz J Urol, 2016, 42(4): p. 637–639.

5. Čadková, I., Huvar, I. Protruse vaginální síťky – role metody a materiálu. Prakt Gyn, 2015, 19(3), Suppl. 1, 1S3–1S33 s. 29.

6. Dietz, HP., Hankins, KJ., Wrong, V. The natural history of cystocele recurrence. Int Urogynecol J, 2014, 25(8), p. 1053–1057.

7. Dwyer, PL., Riss, P. Synthetic mesh in pelvic reconstructive surgery: an ongoing saga. Int Urogynecol J, 2016, 27(9), p. 1287–1288.

8. Fialkow, MF., Newton, KM., Lentz, GM., Weiss, NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19, p. 437–440.

9. Fialkow, MF., Newton, KM., Weiss, NS. Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19(11), p. 1483–1487.

10. Halaška, M., a kol. Urogynekologie. Praha: Galén, 2004, s. 110–118, 132–133, 137–148.

11. Haylen, BT., Freeman, RM., Swift, SE., et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of protheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J, 2011, 22(1), p. 3–5.

12. Heinonen, P., Aaltonen, R., Joronen, K., et al. Long-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J, 2016, 27(7), p. 1069–1074.

13. Chen, CC., Collins, SA., Rodgers, AK., et al. Perioperative complications in obese women vs. normal-weight women who undergo vaginal surgery. Am J Obstet Gynecol, 2007, 197(1), p. 98.

14. Illiano, E., Giannitsas, K., Zucchi, A., et al. Sacrocolpopexy for posthysterectomy vaginal vault prolaps: long-term follow-up. Int Urogynecol J, 2016, 27(10), p. 563–1569.

15. Ismail, S., Duckett, J., Rizk, D., et al. Recurrent pelvic organ prolapse: International Urogynecologial Association Research and Development Committee opinion. Int Urogynecol J, 2016, 27(11), p. 1619–1632.

16. Jírová, J., Pán, M. Současné postavení vaginálních implantátů při řešení sestupu pánevních orgánů. Čes Gynek, 2017, 82(1), s. 72–78.

17. Lee, D., Dillon, B., Lemack, G., et al. Transvaginal mesh kits – how „serious“ are the complications and are they reversible? J Urol, 2013, 81(1), p. 43–48.

18. Lo, TS., Pue, LB., Tan, YL., et al. Long-term outcomes of synthetic transobturator nonabsorbable anterior mesh versus colporrhaphy in symptomatic, advanced pelvic organ prolapse surgery. Int Urogynecol J, 2014, 25(2), p. 257–264.

19. Madsen, LD., Nüssler, E., Kesmodel, US., et al. Native tissue repair of isolated primary rectocele compared with nonabsorbable mesh: patient-reported outcomes. Int Urogynecol J, 2017, 28(1), p. 49–57.

20. Maher, C., Feiner, B., Baessler, K., et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev, 2016 Feb 9;2.

21. Maher, C., Feiner, B., Baessler, K., Schmid, C. Surgical mana­gement of pelvic organ prolapse in women. Cochrane Database Syst Rev, 2010 Apr 14; (4).

22. Maher, C., Feiner, B., Baessler, K., et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev, 2016 Oct 1, (10).

23. Martan, A. Nové operační a léčebné postupy v urogynekologii. Praha: Maxdorf Jesenius, 2013.

24. Murphy, M., Holzberg, A., van Raalte, H., et al. Time to rethink: 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, 2012, 23(1), p. 5–9.

25. Ow, LL., Lim, YN., Dwyer, PL., et al. Native tissue repair or transvaginal mesh for recurrent vaginal prolapse: what are the long-term outcomes? Int Urogynecol J, 2016, 27(9), p. 1313–1320.

26. Pastorčáková, M., Huser, M., Belkov, AI., Ventruba, P. Využití syntetických síťových implantátů v operační léčbě sestupu pánevních orgánů. Čes Gynek, 2014, 79(2), s. 140–146.

27. Rudnicki, M., Laurikainen, E., Pogosean, R., et al. A 3-year follow-up after anterior colporrhaphy compared with collagen-coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial. BJOG, 2016, 123(1), p. 136–142.

28. Švabík, K., Martan, M., Mašata, J. Prolaps a avulzní poranění levatoru. Čes Gynek, 2012, 77(4), s. 304–307.

29. US Food and Drug Administration. FDA safety communication: update on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. July 13, 2011. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm

30. US Food and Drug Administration. FDA strengthens requirements for surgical mesh for the transvaginal repair of pelvic organ prolapse to address safety risks. January 4, 2016. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm479732.htm

31. Turner, LC., Lavelle, ES., Shepherd, JP. Comparison of complications and prolapse reccurence between laparoscopic and vaginal uterosacral ligament suspension for the treatment of vaginal prolapse. Int Urogynecol J, 2016, 27(5), p. 797–803.

32. Wong, V., Shek, KL., Goh, J., et al. Cystocele recurrence after anterior colporrhaphy with and without mesh use. Eur J Obstet Gynecol Reprod Biol, 2014, 172, p. 131–135.

33. Wu, PY., Chang, CH., Shen, MR., et al. Seeking new surgical predictors of mesh exposure after transvaginal mesh repair. Int Urogynecol J, 2016, 27(10), p. 1547–1555.

34. Zoorob, D., Karram, M., Stecher, A., et al. Analysis of surgical outcomes and determinants of litigation among women with transvaginal mesh complications. Female Pelvic Med Reconstr Surg, 2016, 22(6), p. 404–409.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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