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Rotem R, Galvin D, Daykan Y, Al-Shukaili S, O'Reilly BA, O'Sullivan OE. Precision in Practice: The Critical Role of Mesh and Procedure Type Specification in Urogynecological Surgeries and Research. Int Urogynecol J 2024:10.1007/s00192-024-05820-5. [PMID: 38811409 DOI: 10.1007/s00192-024-05820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/24/2024] [Indexed: 05/31/2024]
Abstract
Recently, the debate surrounding the use of mesh in urogynecological procedures has intensified, leading to FDA warnings and heightened safety concerns. This clinical opinion emphasizes the vital need to specify mesh types in these procedures, drawing attention to the risk profiles and clinical outcomes associated with various meshes and the procedures that utilize them. A significant issue identified in contemporary literature is the tendency to group diverse mesh types under the same umbrella, disregarding their unique characteristics and applications. We describe the range of mesh types, their application routes, and associated complications, highlighting the risks of this nonspecific approach to patient safety and informed decision making. We critically examine the generalization of mesh terminology in clinical and research dialogues. Concluding with specific recommendations for health care providers and researchers, the paper advocates for a more nuanced understanding and communication in the field, ultimately aiming to improve patient care and safety in urogynecological practice.
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Affiliation(s)
- Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Wilton Road, Wilton, Cork, Ireland
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Daniel Galvin
- Department of Urogynaecology, Cork University Maternity Hospital, Wilton Road, Wilton, Cork, Ireland.
| | - Yair Daykan
- Department of Obstetrics and Gynaecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sumaiya Al-Shukaili
- Department of Urogynaecology, Cork University Maternity Hospital, Wilton Road, Wilton, Cork, Ireland
- Obstetrics and Gynaecology Department, Urogynaecology, Royal Hospital, Muscat, Oman
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Wilton Road, Wilton, Cork, Ireland
| | - Orfhlaith E O'Sullivan
- Department of Urogynaecology, Cork University Maternity Hospital, Wilton Road, Wilton, Cork, Ireland
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Pecorella G, Morciano A, Sparic R, Tinelli A. Literature review, surgical decision making algorithm, and AGREE II-S comparison of national and international recommendations and guidelines in pelvic organ prolapse surgery. Int J Gynaecol Obstet 2024. [PMID: 38760975 DOI: 10.1002/ijgo.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II-S (AGREE II-S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German-speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous-hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
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Restriction of Surgical Options for Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:467-475. [PMID: 38683201 DOI: 10.1097/spv.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
ABSTRACT The purpose of this document is to update the 2013 AUGS Position Statement based on subsequent decisions made by the U.S. Food and Drug Administration, published clinical data, and relevant society and national guidelines related to the use of surgical mesh. Urogynecologists specialize in treating pelvic floor disorders, such as pelvic organ prolapse (POP) and urinary incontinence, and have been actively involved and engaged in the national and international discussions and research on the use of surgical mesh in the treatment of POP and stress urinary incontinence. In 2019, the U.S. Food and Drug Administration ordered manufacturers of transvaginally placed mesh kits for prolapse to stop selling and distributing their devices, stating that the data submitted did not provide a reasonable assurance of safety and effectiveness. Evidence supports the use of mesh in synthetic midurethral sling and abdominal sacrocolpopexy. The American Urogynecologic Society (AUGS) remains opposed to any restrictions that ban currently available surgical options performed by qualified and credentialed surgeons on appropriately informed patients with pelvic floor disorders. The AUGS supports the U.S. Food and Drug Administration's recommendations that surgeons thoroughly inform patients seeking treatment for POP about the risks and benefits of all potential treatment options, including nonsurgical options, native tissue vaginal repairs, or abdominally placed mesh. There are certain clinical situations where surgeons may assert that the use and potential benefit of transvaginal mesh for prolapse outweighs the risk of other routes/types of surgery or of not using mesh. The AUGS recommends that surgeons utilize a shared decision-making model in the decision-making process regarding surgical options, including use of transvaginally placed mesh.
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Zwierzchowska A, Tomasik P, Horosz E, Barcz E. Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review. J Clin Med 2024; 13:2336. [PMID: 38673609 PMCID: PMC11051119 DOI: 10.3390/jcm13082336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.
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Affiliation(s)
| | | | | | - Ewa Barcz
- Department of Gynaecology and Obstetrics, Medical Faculty Collegium Medicum, University of Cardinal Stefan Wyszynski, 01-938 Warsaw, Poland; (A.Z.); (P.T.); (E.H.)
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Martins SB, Castro RDA, Takano CC, Marquini GV, Oliveira LMD, Martins Junior PCF, Dias MM, Girão MJBC, Sartori MGF. Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e584-e593. [PMID: 37944925 PMCID: PMC10635794 DOI: 10.1055/s-0043-1772592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/13/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C < -1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). MATERIALS AND METHODS After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. RESULTS There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p < 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p = 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. CONCLUSION High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.
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Affiliation(s)
- Sérgio Brasileiro Martins
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo de Aquino Castro
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Claudia Cristina Takano
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gisele Vissoci Marquini
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leticia Maria de Oliveira
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Márcia Maria Dias
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Padoa A, Braga A, Fligelman T, Athanasiou S, Phillips C, Salvatore S, Serati M. European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:703-716. [PMID: 37490710 DOI: 10.1097/spv.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
| | | | | | - Stavros Athanasiou
- Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Urogynaecology, Basingstoke, Hampshire, United Kingdom
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Milan, Italy
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Furuie I, Quevedo A, Tovar P, Santos F, Zomer M, Castro G, Kondo W. Laparoscopic repair of an anterior perineal hernia: a video presentation. Facts Views Vis Obgyn 2023; 15:153-155. [PMID: 37436052 PMCID: PMC10410649 DOI: 10.52054/fvvo.15.2.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The perineal hernia is a condition that occurs as a result of a defect in the pelvic diaphragm. It is classified as anterior or posterior, and as either a primary or secondary hernia. The best management of this condition remains controversial. OBJECTIVES To demonstrate the surgical steps of a laparoscopic repair with mesh of a perineal hernia. MATERIALS AND METHODS A video presentation showing the laparoscopic repair of a recurrent perineal hernia. MAIN OUTCOME MEASURES A 46-year-old woman with a prior history of a primary perineal hernia repair had complaints of a symptomatic vulvar bulge. Pelvic magnetic resonance imaging showed a 5 cm hernia sac at the right anterior pelvic wall containing adipose tissue. A laparoscopic perineal hernia repair was performed by dissection of the space of Retzius, reduction of the hernial sac, closure of the defect and mesh fixation. RESULTS The laparoscopic repair with mesh of a recurrent perineal hernia is demonstrated. CONCLUSION We showed that the laparoscopic approach can be an effective and reproducible treatment for perineal hernia. LEARNING OBJECTIVE Understanding of the surgical steps involved in the laparoscopic repair with mesh of a recurrent perineal hernia.
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Nowakowski Ł, Gałczyński K, Dybowski M, Typek R, Dawidowicz A, Miotła P, Olcha P, Rechberger T. Effects of topical dehydroepiandrosterone therapy in women after pelvic organ prolapse surgery. Menopause 2023; 30:629-634. [PMID: 37130371 DOI: 10.1097/gme.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) occurs predominantly in postmenopausal women. Restoration of the proper estrogenization of vaginal mucosa is important in preoperative and postoperative treatment, increasing the effectiveness of this approach. The objective of this study was the development of intravaginal vaginal suppositories containing DHEA and comparison of the clinical effects of vaginal topical therapy with DHEA, estradiol, or antibiotic after POP surgery. METHOD Nine types of vaginal suppositories containing 6.5 mg DHEA in different bases were prepared to find optimal formulation for the vaginal conditions. Ninety women referred for POP surgery were randomly assigned to one of three groups receiving topical treatment in the postoperative period (estradiol, DHEA, or antibiotic). On admission to hospital and during follow-up vaginal pH, vaginal maturation index and vaginal symptoms were assessed. RESULTS Vaginal suppositories with the base made from polyethylene glycol 1,000 without surfactants characterized the highest percentage of the released DHEA. In women treated with topical estradiol or DHEA a significant decrease in the number of parabasal cells, increase in superficial and intermediate cells in the vaginal smears, decrease in vaginal pH, and reduction of vaginal symptoms were observed. CONCLUSIONS The use of topical therapy with DHEA or the use of topical therapy with estradiol in the postoperative period were both shown to improve maturation index, vaginal pH, and vaginal symptoms. The benefits of topical therapy with DHEA after pelvic organ prolapse repair brings similar results as estradiol, without potential systemic exposure to increased concentrations of sex steroids above levels observed in postmenopausal women.
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Affiliation(s)
- Łukasz Nowakowski
- From the 1 Military Clinical Hospital with Polyclinic in Lublin, Poland
| | - Krzysztof Gałczyński
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Michał Dybowski
- Department of Chromatography Institute of Chemical Sciences Faculty of Chemistry, Maria Curie Skłodowska University in Lublin, Lublin, Poland
| | - Rafał Typek
- Department of Chromatography Institute of Chemical Sciences Faculty of Chemistry, Maria Curie Skłodowska University in Lublin, Lublin, Poland
| | - Andrzej Dawidowicz
- Department of Chromatography Institute of Chemical Sciences Faculty of Chemistry, Maria Curie Skłodowska University in Lublin, Lublin, Poland
| | - Paweł Miotła
- Second Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Olcha
- Department of Gynaecology and Gynaecological Endocrinology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Rechberger
- Second Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Braga A, Serati M. Re: Single-incision Mini-slings for Stress Urinary Incontinence in Women. Eur Urol 2023; 83:372. [PMID: 36604275 DOI: 10.1016/j.eururo.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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10
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Lau HH, Davila GW, Chen YY, Sartori MGF, Jármy-Di Bella ZIK, Tsai JM, Liu YM, Su TH. FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence. Int J Gynaecol Obstet 2023; 161:367-385. [PMID: 36786495 DOI: 10.1002/ijgo.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. OBJECTIVES To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. METHODS Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). SELECTION CRITERIA The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. RESULTS The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. CONCLUSIONS Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.
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Affiliation(s)
- Hui-Hsuan Lau
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - G Willy Davila
- Center for Urogynecology and Pelvic Health, Holy Cross Medical Group, Fort Lauderdale, Florida, USA
| | - Ying-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Marair G F Sartori
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jung-Mei Tsai
- MacKay Medical College, New Taipei City, Taiwan.,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Min Liu
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Tsung-Hsien Su
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
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11
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Zhou Q, Lu M, Li GS, Peng GL, Song YF. Knowledge mapping and visualization analysis of pelvic organ prolapse repair with mesh from 2001 to 2021. Front Bioeng Biotechnol 2023; 11:1104724. [PMID: 37091336 PMCID: PMC10113510 DOI: 10.3389/fbioe.2023.1104724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Aims: In recent decades, extensive attention has been paid to the application of mesh to repair pelvic floor defects. However, a large body of related literature has not been system summarized. The purpose of this study is to summarize and visualize the literature on pelvic organ prolapse (POP) repair with mesh using bibliometrics. Methods: Medical literature regarding POP repair with mesh were searched and obtained in the Web of Science™ Core (WoSCC) database from 2001 to 2021. Microsoft Excel 2020, CiteSpace and VOSviewer were used to conduct the bibliometric and knowledge-map analysis. Results: In the past 20 years, a total of 2,550 articles and reviews have been published in 35 journals, and the published and cited results show a growing trend. Cosson M and International Urogynecology Journal were the authors and journals with the highest output, respectively. The United States, France and the United Kingdom are among the top three countries/organizations in relevant publications in worldwide. 584 key words in the literature are divided into 8 clusters, which are mainly related to prolapse type, risk factors, surgical methods, imaging, quality of life and bioengineering. Using clinical research and tissue engineering technology to reduce mesh complications is the current hot spot in this field. Conclusion: Reasonable application of mesh and avoiding mesh complications are still the most concerned topics in POP research. Although clinical research, surgical improvement, biological mesh and bioengineering technology have shown promising results, it is still urgent to carry out clinical transformation application research.
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Affiliation(s)
- Quan Zhou
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
- *Correspondence: Quan Zhou, ; Yan-Feng Song,
| | - Man Lu
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Guo-Sheng Li
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Gan-Lu Peng
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Yan-Feng Song
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
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12
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Rajan S, Sagili H, Durairaj J, Gupta A. Vaginal mesh erosion - a challenging entity. Trop Doct 2023; 53:176-178. [PMID: 36131508 DOI: 10.1177/00494755221125625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pelvic reconstructive surgery with mesh for pelvic organ prolapse (POP) has been reported to have a superior anatomical cure rate compared with traditional repair methods. Mesh-related adverse events are increasing worldwide. We describe a case of excision of mesh erosion following vaginal hysterectomy. A 45yr old lady presented with 3 × 2 cm infected mesh erosion on the anterior vaginal wall following a vaginal hysterectomy a year earlier in a camp setting. Cystoscopy was normal. Under anesthesia, the mesh was dissected from the vagina and excised. The vaginal edges were freshened, and approximated Postoperative period was uneventful, and she was discharged home the next day. Surgical revision is indicated for large or multiple erosions. Mesh excision can be a challenging procedure with difficulty in gaining access and increased risk of surgical bleeding. A multidisciplinary approach in conjunction with a urologist will help optimise outcomes.
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Affiliation(s)
- Saroj Rajan
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Haritha Sagili
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Jaylakshmi Durairaj
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Avantika Gupta
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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13
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Tvarozek S, Huser M, Dostalova M, Szypulova M, Horvath I. Evaluating sexual function among women after recurrent pelvic organ prolapse transvaginal mesh repair. J OBSTET GYNAECOL 2022; 42:3666-3671. [PMID: 36476069 DOI: 10.1080/01443615.2022.2153023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We aimed to evaluate women's sexual function before and after pelvic organ prolapse (POP) surgery utilising light transvaginal mesh after a prior hysterectomy. Only sexually active women with recurrent cystocele stage 3-4 according to POP-Q, who had previously undergone vaginal hysterectomy with anterior native tissue repair without apical fixation, were enrolled in the study. Women with previous mesh implant POP surgery, persistent vaginal infection or pelvic inflammatory disease were excluded. All patients were surgically treated between 2012 and 2015 using single-incision transvaginal mesh Calistar A. Sexual function was evaluated before a surgery and two years postoperatively. The assessment was accomplished via the standardised validated Czech translation of PISQ-12SF questionnaire. For each patient, age, BMI and parity were monitored. Out of all (89) eligible patients, 48 patients met inclusion criteria and were subsequently enrolled in our study. Two years postoperatively, 31 women (79.5%) improved their PISQ-12 score; five (12.8%) had equivalent scores, and three patients (7.7%) reported lower scores. Overall PISQ-12 score was 37.1 ± 2.6 postoperatively with a 2.9 ± 2.3 statistically significant positive difference compared to the score preceding surgery. The majority of patients undergoing surgery using Calistar A experienced a significant improvement in sexual function.IMPACT STATEMENTWhat is already known on this subject? Pelvic organ prolapse has a significant impact on women's sexual functioning in an adverse manner. Mesh implant repair is associated with lower rates of prolapse awareness and prolapse re-operation; however, it is linked with safety concerns. One of these concerns is the negative impact on women's sexual function. Evaluative study results following sexual function among women with mesh implant transvaginal repair are contradictory.What do the results of this study add? The results showed, that contrary to finding some of the previous studies, transvaginal mesh implant use could benefit patients with previous native tissue POP surgery failure with a low risk of sexual function deterioration.What are the implications of these findings for clinical practice and/or further research? The study provides clinical data for vaginal mesh implants on women's sexual function in the mid-term outcome. These data can be crucial for selecting the right POP surgical technique and evaluating its benefits and risks.
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Affiliation(s)
- Samuel Tvarozek
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Martin Huser
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
- Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Dostalova
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Martina Szypulova
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Ivan Horvath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Abebe D, Kure MA, Demssie EA, Mesfin S, Demena M, Dheresa M. One in ten ever-married women who visited health facilities for various reasons have pelvic organ prolapse in Harari regional state, Eastern Ethiopia. BMC Womens Health 2022; 22:223. [PMID: 35690856 PMCID: PMC9188719 DOI: 10.1186/s12905-022-01817-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pelvic organ prolapse remains a neglected public health problem in developing countries. The burden of pelvic organ prolapse varies by region and ranges from 9 to 20%. It poses an impact on women’s quality of life and affects their role at the community and family level. Although it has negative consequences and extensive burden, the true feature of pelvic organ prolapse is not well known among ever-married women attending health facilities for various reasons in the study area. Therefore, this study was aimed to assess the magnitude of pelvic organ prolapse and associated factors among ever-married women attending health care services in public Hospitals, Eastern Ethiopia.
Methods
A facility-based cross-sectional study design was conducted from March 4th to April 5th, 2020 among 458 ever-married women attending public Hospitals in Harar town, Eastern Ethiopia. The study subjects were selected through systematic sampling. The data were collected using a structured questionnaire through face-to-face interviews. Data were analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported by proportion and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at p-value < 0.05.
Result
Of 458 women enrolled in the study, 10.5% of them had pelvic organ prolapse based on women’s reporting of symptoms. History of lifting heavy objects [AOR = 3.22, 95% CI (1.56, 6.67)], history of chronic cough [AOR = 2.51, 95% CI (1.18, 5.31)], maternal age of greater than or equal to 55 years [AOR = 3.51, 95% CI (1.04, 11.76)], history chronic constipation (AOR = 3.77, 95% CI (1.54, 9.22) and no history of contraceptive utilization [AOR = 2.41, 95% CI (1.13, 5.05)] were significantly associated with pelvic organ prolapse.
Conclusion
In this study, one in ten ever-married women who visited health facilities for various reasons have pelvic organ prolapse. Modifiable and non-modifiable risk factors were identified. This result provides a clue to give due consideration to primary and secondary prevention through various techniques.
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15
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Management of mesh complications after prolapse and incontinence surgery. Arch Gynecol Obstet 2022; 306:1837-1844. [PMID: 35994109 DOI: 10.1007/s00404-022-06759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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16
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Brady SS, Bavendam TG, Bradway CK, Conroy B, Dowling-Castronovo A, Epperson CN, Hijaz AK, Hsi RS, Huss K, Kim M, Lazar J, Lee RK, Liu CK, Loizou CN, Miran S, Mody L, Norton JM, Reynolds WS, Sutcliffe S, Zhang N, Hokanson JA. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden. Urology 2022; 166:39-49. [PMID: 34536410 PMCID: PMC8924010 DOI: 10.1016/j.urology.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Tamara G Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Christine K Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Cynthia Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Karen Huss
- Division of Extramural Science Programs, Symptom Science and Genetics, Self-Management Office, National Institute of Nursing Research, Bethesda, MD
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason Lazar
- Department of Medicine, SUNY Downstate Health Sciences University, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Section of Geriatrics, Department of Medicine, Boston University, Boston, MA
| | | | - Saadia Miran
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nicole Zhang
- The Valley Foundation School of Nursing, College of Health and Human Sciences, San Jose State University, San Jose, CA
| | - James A Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
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Dökmeci F, Şükür Y, Çetinkaya Ş, Seval M, Varlı B. Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy. Facts Views Vis Obgyn 2022; 14:139-145. [DOI: 10.52054/fvvo.14.2.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There is scarce information on the effectiveness of the laparoscopic single mesh sacrohysteropexy (smSHP). Attachment of a single sheet of flat mesh posteriorly to the cervix provides less mesh use and a less invasive distal mesh fixation.
Objectives: To assess medium to long-term follow-up results of patients who underwent laparoscopic smSHP utilising a less invasive technique with single sheet flat mesh.
Materials and Methods: In the present retrospective cohort study, the data of 71 women who underwent laparoscopic smSHP for apical uterine prolapse with or without colporrhaphy (anterior and/or posterior) at the urogynaecology unit of a university hospital between January 2008 and January 2020 was reviewed. Data was collected on demographics, presenting symptoms, preoperative findings, surgery, and postoperative outcomes.
Main Outcome Measures: Medium to long-term patient-reported outcomes.
Results: The median age of the study population was 44 years. Median follow-up duration was 5 years (1-12). Symptomatic recurrence over time and repeat surgery rates were 13.1% and 3.1% respectively. Comparison of the pre-operative and medium to long-term evaluation scores of the pelvic floor distress inventory-20 (PFDI-20) and assessment of the patient global impression of improvement (PGI-I) revealed long-standing improvement in pelvic floor dysfunction.
Conclusions: Laparoscopic smSHP appears to be successful and safe with low recurrence and complication rates and provides satisfactory patient reported outcomes.
What’s new? Medium to long-term patient-reported outcomes based on PFDI-20 and PGI-I surveys are satisfactory following smSHP.
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Chung E, Wang J. The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence. Sex Med 2022; 10:100529. [PMID: 35653877 PMCID: PMC9386625 DOI: 10.1016/j.esxm.2022.100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transvaginal pelvic mesh surgery has been shown to cause female sexual dysfunction. Aim To evaluate the sexual function impact of AdVance male sling (MS) on erectile and orgasmic domains. Methods A review of a prospectively collected database was conducted in all sexually active men who underwent AdVance MS for postprostatectomy stress urinary incontinence between 2012 and 2018. Outcomes Patient demographics, clinical outcomes, and validated questionnaires such as the Brief Male Sexual Function Inventory (BMSFI), International Index of Erectile Function (IIEF) and Patient Global Impression of Improvement (PGI-I) were reviewed at 6, 12 and 24 months. Results Of the total of 65 men who received AdVance sling, an increase in IIEF-5 score ≥5 points were reported in 10 (15%) patients with no patients complained of deteriorating erectile function at 24 months. The improvement in orgasmic function (Question 10 on IIEF-15) was reported in 22 (34%) patients while 3 (5%) patients reported lower orgasmic scores. The sexual domains scores in BMSFI were higher in 40 (62%) patients, especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). No patient reports pelvic or urethral pain. The reported improvement in erectile and orgasm scores remained similar throughout the 24-months follow-up period. All 20 patients with preoperative climacturia reported resolution of their symptoms during sexual activity. The overall PGI-I was 1.4 (1–3) and men with a higher continence rate were more likely to report better male sexual function (P = .044). Clinical implications AdVance MS appears to improve erectile and orgasmic domains, and there is a positive correlation between urinary continence and male sexual function. Strengths and limitations Strengths of this study include the prospective large patient population analyzed regarding the impact of MS on male sexual function with the use of validated instruments for erectile, orgasmic, and urinary domains. Limitations include single-centre data, relatively short-term follow-up study and lack of a comparative arm. Conclusion Despite the reported adverse effect of sexual dysfunction following pelvic mesh in the female population, the AdVance PMS appears to improve male sexual function with regards to erectile and orgasm domains. Chung E, Wang J. The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence. Sex Med 2022;10:100529.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD, Australia; University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; Macquarie University Hospital, Sydney, NSW, Australia.
| | - Juan Wang
- AndroUrology Centre, Brisbane, QLD, Australia
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Braga A, Caccia G, Papadia A, Castronovo F, Salvatore S, Scancarello C, Torella M, Ghezzi F, Serati M. The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up. Int Urogynecol J 2022; 33:947-953. [PMID: 35230479 PMCID: PMC8886556 DOI: 10.1007/s00192-022-05094-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction and hypothesis Few studies in literature have assessed the long-term durability and mesh-related complications of mid-urethral slings (MUSs). The aim of this study is to assess the efficacy and safety of retro-pubic tension-free vaginal tape (TVT) 20 years after implantation for the treatment of female stress urinary incontinence (SUI). Methods A prospective observational study was conducted in two urogynaecologic units in two countries. All the patients involved were consecutive women with urodynamically proven pure SUI treated by TVT. The patients underwent preoperative clinical and urodynamic evaluations. Subjective outcomes, objective outcomes and adverse events were recorded during the follow-up period. Results Fifty-two patients underwent a TVT surgical procedure. Twenty years after surgery, 32 out of 36 patients (88.8%) declared themselves cured (p = 0.98). Similarly, 33 out of these 36 patients (91.7%) were objectively cured (p = 0.98). No significant deterioration of subjective and objective cure rates was observed over time (p for trend 0.50 and 0.48). Fifteen of the 36 patients (41.6%) at the 20-year follow-up reported the onset of de novo overactive bladder (OAB) (p = 0.004). No significant vaginal bladder or urethral erosion or de novo dyspareunia was recorded and no patient required tape release or resection during this period. The cause of death of seven out of ten women who died in the last year of the follow-up period was coronavirus disease 19 (COVID 19). Conclusions The 20-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI. The impact of COVID 19 on the mortality rate of elderly women has drastically reduced the number of eligible patients for future evaluations in our region.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giorgio Caccia
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Obstetrics and Gynaecology, EOC - Civico Hospital, Lugano, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
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Fuschi A, Martoccia A, Al Salhi Y, Maggi M, Capone L, Suraci PP, Antonioni A, Bozzini G, Illiano E, Costantini E, Zucchi A, Cervigni M, Carbone A, Pastore AL. Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension. Langenbecks Arch Surg 2022; 407:1693-1700. [PMID: 35113228 DOI: 10.1007/s00423-022-02458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement. MATERIALS AND METHODS Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6 months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR). RESULTS At 6 months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001). CONCLUSIONS Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Martina Maggi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Capone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Alice Antonioni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Alessandro Zucchi
- Department of Translationals Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mauro Cervigni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy.
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21
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Zhang L, Zhao Z, Chen J, Ma Y, Zhang G, Zhu L. Path-related pain after implantation of anterior transvaginal mesh: perspective from anatomical study. Int Urogynecol J 2022; 33:2551-2556. [PMID: 35034164 DOI: 10.1007/s00192-021-04924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/11/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a common gynecological disease caused by defects in pelvic support tissue that manifests as the descent of the pelvic organs, significantly impacting patient quality of life. Transvaginal mesh (TVM) is an effective treatment (Grade A). However, postoperative pain in the groin and medial thigh is very common. Although the use of mesh for transvaginal POP repair has been prohibited or the indications for such use have been extensively limited in many places, it is still an alternative in some countries. Therefore, the safety of the use of mesh still needs to be discussed. The current research on postoperative pain has mainly focused on management. The pathophysiology is unclear. METHODS In this study, anterior TVM surgery was performed on ten frozen cadavers. The obturator area was carefully dissected. We explored the relative position of the polypropylene mesh to the internal segment of the obturator nerve in the obturator canal. RESULTS Four out of 20 obturator explorations were insufficient to allow conclusions to be drawn. We observed a small branch of the obturator nerve, which is a new anatomical finding that we named the obturator externus muscle branch. This structure terminated in the external obturator muscle in 6 out of the 16 successfully dissected obturator areas. The mean distance between the superficial mesh arm and this nerve branch was 7.5 mm. The mean distance between the deep mesh arm and the closest nerve branch was 5.5 mm. CONCLUSION The path of the obturator externus muscle branch of the obturator nerve ran close to the mesh arm. It may provide a clinical anatomical basis explaining the observed postoperative pain.
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Affiliation(s)
- Lin Zhang
- Peking Union Medical College, Chinese Academy of Medical Sciences, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No. 9 Dongdan Santiao, Beijing, 100730, Dongcheng District, China
| | - Zichen Zhao
- Peking Union Medical College, Chinese Academy of Medical Sciences, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No. 9 Dongdan Santiao, Beijing, 100730, Dongcheng District, China
| | - Juan Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetrics & Gynecologic Diseases, No. 1 Shuaifuyuan, Beijing, 100010, Dongcheng District, China
| | - Yidi Ma
- Peking Union Medical College, Chinese Academy of Medical Sciences, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No. 9 Dongdan Santiao, Beijing, 100730, Dongcheng District, China
| | - Guorui Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetrics & Gynecologic Diseases, No. 1 Shuaifuyuan, Beijing, 100010, Dongcheng District, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetrics & Gynecologic Diseases, No. 1 Shuaifuyuan, Beijing, 100010, Dongcheng District, China.
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22
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Mardina Z, Venezuela J, Maher C, Shi Z, Dargusch M, Atrens A. Design, mechanical and degradation requirements of biodegradable metal mesh for pelvic floor reconstruction. Biomater Sci 2022; 10:3371-3392. [DOI: 10.1039/d2bm00179a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic organ prolapse (POP) is the herniation of surrounding tissue and organs into the vagina and or rectum, and is a result of weakening of pelvic floor muscles, connective tissue,...
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An Unusual Delayed Complication of Urogynecologic Surgical Mesh: Perirectal Abscess 10 Years After Initial Placement Treated by Endoscopic Removal. ACG Case Rep J 2021; 8:e00703. [PMID: 34841001 PMCID: PMC8613340 DOI: 10.14309/crj.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Surgical mesh is commonly used for the management of pelvic organ prolapse and stress urinary incontinence with overall beneficial effects. However, the Food and Drug Administration has issued safety notifications about potentially serious complications assisted with the use of synthetic mesh in pelvic organ prolapse procedures. In this report, we describe a perirectal abscess in a patient which developed 10 years after initial mesh placement. Percutaneous management of the abscess was not possible because of the deep pelvic location. The abscess was successfully managed endoscopically, including the removal of a large piece of mesh. Endoscopic management of pelvic abscesses, including an endoscopic ultrasound-guided approach, should be considered early.
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Wang X, Chen Y, Hu C, Hua K. Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse: a retrospective cohort study. BMC WOMENS HEALTH 2021; 21:362. [PMID: 34635099 PMCID: PMC8507206 DOI: 10.1186/s12905-021-01505-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.
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Affiliation(s)
- Xiaojuan Wang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, China
| | - Yisong Chen
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, China
| | - Changdong Hu
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, China.
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Sun ZJ, Guo T, Wang XQ, Lang JH, Xu T, Zhu L. Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study. Int Urogynecol J 2021; 32:2149-2157. [PMID: 34165615 PMCID: PMC8346404 DOI: 10.1007/s00192-021-04892-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 01/23/2023]
Abstract
Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.
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Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Tao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Xiu-Qi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetirc & Gynecologic Diseases, Beijing, China.
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Contemporary trends for urological training and management of stress urinary incontinence in Ireland. Int Urogynecol J 2021; 32:2841-2846. [PMID: 34160634 PMCID: PMC8220110 DOI: 10.1007/s00192-021-04887-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Introduction and hypothesis The aim of this study is to evaluate the trends in stress urinary incontinence (SUI) surgery since the 2018 pause on use of the polypropylene (PP) mid-urethral sling (MUS) and to quantify the effect this has had on surgical training. Methods Two anonymous surveys were sent to all current urology trainees and to all consultant surgeons who specialise in stress urinary incontinence surgery. Results Prior to the pause, 86% (6 out of 7) of consultant urologists and 73% (11 out of 15) of consultant gynaecologists would “always”/“often” perform MUS for SUI. After that, 100% (22 out of 22) of consultants reported that they “never” perform MUS. There has been a modest increase in the use of urethral bulking agent (UBA) procedures among urologists, with 43% (3 out of 7) now “often” performing this, compared with 71% (5 out of 7) “never” performing it pre-2018. Trainee exposure to SUI surgery reduced by 75% between 2016 and 2020. Despite a ten-fold increase in UBA procedures logged by trainees, the decline in MUS has resulted in a major reduction in total SUI surgeries. Coinciding with this decrease in surgeries, there was a 56% reduction in trainees’ self-assessed competence at SUI surgery. Thirteen percent of trainees are interested in specialising in Female Urology and those trainees had significantly greater exposure to SUI procedures during their training than those who did not (p = 0.0072). Conclusions This study has identified a downward trend in SUI surgery, which is concerning for the undertreatment of females with SUI. A decline in SUI surgery training has resulted in reduced trainee confidence and interest in this subspecialty.
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Shek KL, Dietz HP. Ultrasound imaging of slings and meshes in urogynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:526-538. [PMID: 33206433 DOI: 10.1002/uog.23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K L Shek
- Liverpool Hospital, Western Sydney University, Liverpool, Australia
- Nepean Clinical School, University of Sydney, Penrith, Australia
| | - H P Dietz
- Nepean Clinical School, University of Sydney, Penrith, Australia
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Naumann G, Hüsch T, Mörgeli C, Kolterer A, Tunn R. Mesh-augmented transvaginal repair of recurrent or complex anterior pelvic organ prolapse in accordance with the SCENIHR opinion. Int Urogynecol J 2021; 32:819-827. [PMID: 32970175 PMCID: PMC8009781 DOI: 10.1007/s00192-020-04525-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the performance of mesh-augmented repair of anterior pelvic organ prolapse (POP) with or without apical vaginal wall involvement in women with recurrent or complex prolapse. METHODS This multicenter cohort study included women undergoing surgery with Calistar S (Promedon, Argentina) for anterior POP between 2016 and 2018. The SCENIHR opinion was considered for patient selection, surgeon's experience and choice of implant. Patients were prospectively invited to assess effectiveness and safety by anamnesis, validated questionnaires and pelvic examination. A composite endpoint defined by POP-Q ≤ 1, absence of a vaginal bulge symptom and repeated surgery for POP was used to define treatment success. Descriptive statistics were applied. McNemar or Wilcoxon signed rank tests were used as paired samples tests. The significance level was set at 5%. RESULTS A total of 107 non-fertile women with a mean age of 70.6 years were enrolled. Ninety-three (86.9%) women presented with recurrent prolapse. The mean follow-up time was 18.5 months. Treatment success was achieved in 76% of cases according the composite endpoint, with 98% reaching POP-Q ≤ 1 and a significant improvement in quality of life (p < 0.001). Mesh exposure occurred in six (5.6%) patients, although none required further surgery. Four (3.7%) patients reported dyspareunia, and a single (0.9%) patient displayed a prominence due to mesh folding. CONCLUSIONS Mesh-augmented repair of anterior POP is effective and safe in women with recurrent or complex prolapse. Hence, in a select patient population, the benefits of mesh-augmented POP repair still outweigh the risks.
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Affiliation(s)
- Gert Naumann
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany.
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
- Promedon GmbH, Clinical Research, Kolbermoor, Germany
| | - Claudia Mörgeli
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
| | - Anna Kolterer
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | - Ralf Tunn
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
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29
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MacCraith E, Cunnane EM, Joyce M, Forde JC, O'Brien FJ, Davis NF. Comparison of synthetic mesh erosion and chronic pain rates after surgery for pelvic organ prolapse and stress urinary incontinence: a systematic review. Int Urogynecol J 2020; 32:573-580. [PMID: 33237357 DOI: 10.1007/s00192-020-04612-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study is to systematically compare rates of erosion and chronic pain after mesh insertion for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery. METHODS A systematic electronic search was performed on studies that evaluated the incidence of erosion and chronic pain after mesh insertion for POP or SUI. The primary outcome measurement was to compare mesh erosion rates for POP and SUI surgery. Secondary outcome measurements were incidence of de novo pain and a comparison of patient demographics for both surgeries. RESULTS Twenty-six studies on 292,606 patients (n = 9077 for POP surgery and n = 283,529 for SUI surgery) met the inclusion criteria. Median follow-up was 26.38 ± 22.17 months for POP surgery and 39.33 ± 27.68 months for SUI surgery. Overall, the POP group were older (p < 0.0001) and had a lower BMI (p < 0.0001). Mesh erosion rates were significantly greater in the POP group compared to the SUI group (4% versus 1.9%) (OR 2.13; 95% CI 1.91-2.37; p < 0.0001). The duration from surgery to onset of mesh erosion was 306.84 ± 183.98 days. There was no difference in erosion rates between abdominal and transvaginal mesh for POP. There was no difference in erosion rates between the transobturator and retropubic approach for SUI. The incidence of chronic pain was significantly greater in the POP group compared to the SUI group (6.7% versus 0.6%) (OR 11.02; 95% CI 8.15-14.9; p < 0.0001). The duration from surgery to onset of chronic pain was 325.88 ± 226.31 days. CONCLUSIONS The risk of mesh erosion and chronic pain is significantly higher after surgery for POP compared to SUI. These significant complications occur within the first year after surgery.
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Affiliation(s)
- Eoin MacCraith
- Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland. .,Blackrock Clinic, Dublin, Ireland.
| | - Eoghan M Cunnane
- Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland
| | - Michael Joyce
- Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland
| | - James C Forde
- Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland.,Blackrock Clinic, Dublin, Ireland
| | - Fergal J O'Brien
- Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland
| | - Niall F Davis
- Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland.,Blackrock Clinic, Dublin, Ireland
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MacCraith E, Cunnane EM, Joyce M, Do Amaral RJ, O'Brien FJ, Davis NF. Mechanical characterization of a biodegradable mesh for the treatment of stress urinary incontinence. Int J Urol 2020; 28:243-245. [PMID: 33179308 DOI: 10.1111/iju.14430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eoin MacCraith
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Blackrock Clinic, Dublin, Ireland
| | - Eoghan M Cunnane
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Joyce
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronaldo Jfc Do Amaral
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall F Davis
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Blackrock Clinic, Dublin, Ireland
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Mikos T, Gordts S, Grimbizis GF. Current knowledge about the management of congenital cervical malformations: a literature review. Fertil Steril 2020; 113:723-732. [PMID: 32228875 DOI: 10.1016/j.fertnstert.2020.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
The prevalence of congenital cervical agenesis or dysgenesis ranges from 1/80,000 to 1/100,000, and in about 50% of these cases it coexists with congenital vaginal agenesis. This narrative review summarizes the contemporary knowledge in the field of conservative surgical restoration of the reproductive tract. The management of congenital cervical malformations aims to [1] provide relief from the obstructive symptoms, [2] establish normal sexual function, and [3] preserve the uterus for future fertility. In cases of cervical agenesis and vaginal aplasia, the surgical approach involves the creation of neovagina, the creation of neocervix, and then subsequent restoration of the continuity of the genital tract. In cases where vagina is not congenitally absent, the surgical approach involves either a direct uterovaginal anastomosis or initial creation of neocervix and then subsequent restoration of the continuity of the genital tract. The neocervix can be surgically created with small intestinal submucosa, split-thickness skin graft, full-thickness skin graft, peritoneal flap, or vaginal mucosa lined with a polytetrafluoroethylene graft. Most of the published cases report long-term menstruation and sporadic pregnancies. Conservative surgery of cervical congenital malformations could serve as a first-line treatment. Sexual function and menstruation are established in the majority of patients. Extirpatory surgery may be preserved for surgical failures after initial restoration of the continuity of uterus-cervix-vagina or in cases with more complex anatomy.
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Affiliation(s)
- Themistoklis Mikos
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki Greece.
| | | | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki Greece
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Consensus statement of the Spanish Association Of Urology on the use of meshes in pelvic organ prolapse. Actas Urol Esp 2020; 44:529-534. [PMID: 32718735 DOI: 10.1016/j.acuro.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Recently the Food and Drug Administration has banned the use of transvaginal meshes for the surgical treatment of pelvic organ prolapse (POP) in the United States. This has caused a worldwide impact on the management of pelvic floor pathology by different specialists. OBJECTIVE To achieve a consensus on the use of meshes in the surgical treatment of POPs. ACQUISITION OF DATA/EVIDENCE A Committee of experts of the Spanish Association of Urology (AEU) was organized to review the literature and analyze the safety and efficacy of the use of polypropylene meshes in POP surgery. RESULTS/EVIDENCE FROM THE LITERATURE The evidence reflects that the use of meshes, compared to the use of native tissues, offers better efficacy at the expense of new complications and a higher rate of surgical reviews, these being minor in the hands of expert surgeons. CONCLUSIONS POP surgery must be performed by experienced surgeons, properly trained and in referral centers. The patient should receive correct information about the different treatment options. Transvaginal meshes should only be indicated in complex cases and in recurrences after POP surgery. AEU PROPOSAL Creation of a clinical guideline and a national registry for long-term evaluation. Preparation of an Informed Consent available to all professionals and patients, as well as a specific training plan to achieve better training in complex pelvic floor surgery.
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Syed KK, Consolo MJ, Gousse AE. Anterior Vaginal Wall Prolapse Repair and the Rise and Fall of Transvaginal Mesh. Did We Come Full Circle? A Historical Perspective. Urology 2020; 150:110-115. [PMID: 32827535 DOI: 10.1016/j.urology.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/27/2020] [Accepted: 08/09/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To present a brief historical review of treatment options for pelvic organ prolapse with a focus on anterior vaginal wall defects and highlight changing practice patterns in the era of synthetic mesh controversy. METHODS A MEDLINE and PubMed search was performed using the keywords pelvic organ prolapse, anterior colporrhaphy, and cystocele followed by a manual search of bibliographies. RESULTS Ancient treatments included Hippocratic succession, local astringent, and use of pomegranates as crude pessaries. More sophisticated surgical techniques evolved in the 19th century with further refinement in the early 20th century. Numerous native tissue apposition techniques were popularized by Kelly, Kennedy, Burch, and Raz. Due to poor durability, surgeons sought alternate approaches including biologic and synthetic grafts. Synthetic transvaginal mesh (TVM) initially included use of Tantalum and Marlex to repair anterior wall defects. Both were eventually abandoned due to complications. TVM was re-designed, re-marketed, and re-introduced. Type 1 polypropylene monofilament TVM use became ubiquitous in female pelvic surgery peaking between 2004 and 2008. Initial promising outcomes were soon eclipsed by a surge of adverse events leading to multiple FDA warnings, reclassification to Class III, high-risk medical device, and ultimately a complete recall in 2019. CONCLUSION The bidirectional pendulum swing on use of synthetic TVM has been occurring since its introduction 50 years ago. In the current era of mesh controversy, more practitioners are now revisiting previously described native tissue and biologic graft techniques. It appears that history has repeated itself.
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Affiliation(s)
- Kirin K Syed
- Department of Urology, Holy Cross Hospital, Fort Lauderdale, FL.
| | | | - Angelo E Gousse
- Bladder Health and Reconstructive Urology Institute, Miramar, FL
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Ng-Stollmann N, Fünfgeld C, Gabriel B, Niesel A. The international discussion and the new regulations concerning transvaginal mesh implants in pelvic organ prolapse surgery. Int Urogynecol J 2020; 31:1997-2002. [PMID: 32696186 PMCID: PMC7497328 DOI: 10.1007/s00192-020-04407-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023]
Abstract
The use of transvaginal mesh implants for POP and urinary incontinence is currently being extensively debated among experts as well as the general public. Regulations surrounding the use of these implants differ depending on the country. Although in the USA, the UK, in Canada, Australia, New Zealand, and France, transvaginal mesh implants have been removed from the market, in most mainland European countries, Asia, and South America, they are still available as a surgical option for POP correction. The aim of this review is to provide an overview of the historical timeline and the current situation worldwide, as well as to critically discuss the implications of the latest developments in urogynecological patient care and the training of doctors.
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Affiliation(s)
- Nathalie Ng-Stollmann
- Department of Obstetrics and Gynecology, Medizin-Campus-Bodensee, Hospital Tettnang, Emil-Münch-Strasse 16, 88069, Tettnang, Germany.
| | - Christian Fünfgeld
- Department of Obstetrics and Gynecology, Medizin-Campus-Bodensee, Hospital Tettnang, Emil-Münch-Strasse 16, 88069, Tettnang, Germany
| | - Boris Gabriel
- Department of Obstetrics and Gynecology, St. Josefs-Hospital Wiesbaden Academic Teaching Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department of Obstetrics and Gynecology, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Achim Niesel
- Department of Obstetrics and Gynecology, Hospital Preetz, Am Krankenhaus 5, 24211, Preetz, Germany
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35
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Lo TS, Lin YH, Chua S, Chu HC, Uy-Patrimonio MC, Ng KL. Immunochemical analysis on polypropylene mesh: does mesh size make a difference? Int Urogynecol J 2020; 32:47-55. [PMID: 32651643 DOI: 10.1007/s00192-020-04399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study is to demonstrate the impact of the size of implanted mesh in relation to its immunohistochemical reaction implanted into animal models. METHODS An experimental study utilizing 54 female Sprague Dawley (SD) rats was divided into five groups: control, sham, and study groups (mesh-small [M-S], mesh-medium [M-M], mesh-large [M-L]). The M-S group used a mesh size of 0.2 × 0.2 cm, the M-M group a mesh size of 0.5 × 0.5 cm, and the M-L a mesh size of 0.7 × 1.0 cm. The sham group underwent vaginal dissection with no mesh implantation. The rats were sacrificed using isoflurane overdose on days 7 and 30. The mesh with the surrounding vaginal and bladder wall tissues were removed and processed for histochemical and western blot analysis. RESULTS There is a significant increase in IL-1 and TNF-α immunoreactivity in the M-M and M-L groups on day 7 when compared with the sham group with p values of 0.001 and < 0.001 respectively. M-L showed significantly higher immunoreactivity to TNF-α persisting until day 30. All study groups presented a significantly higher immunoreactivity to MMP-2 and NGF on day 7. However, reactivity to NGF does not persist to day 30 in all groups. Immunoreactivity to CD 31 on days 7 and 30 appears significantly greater in the M-M and M-L groups, with the reaction in the M-L group continuing until day 30. CONCLUSION Mesh size is directly proportional to the inflammatory reaction in the host tissue. The prolonged inflammatory process leads to delayed tissue remodeling and angiogenesis, which could delay mesh-tissue integration.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Medical Center, Taipei, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Hsiao-Chien Chu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
| | - Ma Clarissa Uy-Patrimonio
- Department of Obstetrics and Gynecology, Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod City, Philippines
| | - Kai Lyn Ng
- Department of Obstetrics and Gynecology, National University Hospital of Singapore, Singapore, Singapore
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36
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Whooley J, Cunnane EM, Do Amaral R, Joyce M, MacCraith E, Flood HD, O'Brien FJ, Davis NF. Stress Urinary Incontinence and Pelvic Organ Prolapse: Biologic Graft Materials Revisited. TISSUE ENGINEERING PART B-REVIEWS 2020; 26:475-483. [PMID: 32192400 DOI: 10.1089/ten.teb.2020.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Symptomatic stress urinary incontinence (SUI) and pelvic organ prolapse (POP) refractory to conservative management with pelvic floor muscle training or vaginal pessaries may warrant surgical intervention with different forms of biologic or synthetic material. However, in recent years, several global regulatory agencies have issued health warnings and recalled several mesh products due to an increase in complications such as mesh erosion, infection, chronic pain, and perioperative bleeding. At present, current surgical treatment strategies for SUI and POP are aimed at developing biological graft materials with similar mechanical properties to established synthetic meshes, but with improved tissue integration and minimal host response. This narrative review aims to highlight recent studies related to the development of biomimetic and biologic graft materials as alternatives to traditional synthetic materials for SUI/POP repair in female patients. We also investigate complications and technical limitations associated with synthetic mesh and biological biomaterials in conventional SUI and POP surgery. Our findings demonstrate that newly developed biologic grafts have a lower incidence of adverse events compared to synthetic biomaterials. However there remains a significant disparity between success in preclinical trials and long-term clinical translation. Further characterization on the optimal structural, integrative, and mechanical properties of biological grafts is required before they can be reliably introduced into clinical practice for SUI and POP surgery. Impact statement Our review article aims to outline the clinical history of developments and controversies associated with the use of synthetic mesh materials in the surgical treatment of stress urinary incontinence and pelvic organ prolapse, as well as highlighting recent advancements in the area of biological graft materials and their potential importance in an area that remains an enduring issue for patients and clinicians alike. This article aims to provide a concise summary of previous controversies in the field of urinary incontinence, while evaluating the future of potential biomaterials in this field.
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Affiliation(s)
- Jack Whooley
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland
| | - Eoghan M Cunnane
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Ronaldo Do Amaral
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Michael Joyce
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Eoin MacCraith
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland
| | - Hugh D Flood
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland.,Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
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37
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Digesu GA, Vieira‐Baptista P, Tailor V, Stockdale C, Preti M. Response letter to comments related to “The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document”. Neurourol Urodyn 2020; 39:473-476. [DOI: 10.1002/nau.24229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Pedro Vieira‐Baptista
- Department of Obstetrics and Gynecology Hospital Lusíadas Porto Porto Portugal
- Lower Genital Tract Unit Centro Hospitalar de São João Porto Portugal
| | - Visha Tailor
- Department of Urogynaecology Imperial College Healthcare London UK
| | - Colleen Stockdale
- Department of Obstetrics and Gynecology University of Iowa Iowa City Iowa
| | - Mario Preti
- Department of Obstetrics and Gynecology University of Torino Torino Italy
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