A retrospective comparison of two vaginal mesh kits in the management of anterior and apical vaginal prolapse: long-term results for apical fixation and quality of life

Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis

Introduction: Quality of life (QoL) improvement is one of the main outcomes in the management of pelvic organ prolapse as a chronic illness in women. This systematic review aimed to investigate the impact of surgical or pessary treatment for pelvic organ prolapse (POP) on quality of life. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied. Electronic databases, including PubMed, Scopus, and Web of Science, were searched for original articles that evaluated the QoL before and after surgical interventions or pessary in pelvic organ prolapse from 1 January 2012 until 30 June 2022 with a combination of proper keywords. Included studies were categorized based on interventions, and they were tabulated to summarize the results. Results: Overall, 587 citations were retrieved. Of these, 76 articles were found eligible for final review. Overall, three categories of intervention were identified: vaginal surgeries (47 studies), abdominal surgeries (18 studies), and pessary intervention (11 studies). Almost all interventions were associated with improved quality of life. The results of the meta-analysis showed a significant association between the employment of surgical approach techniques (including vaginal and abdominal surgeries) and the quality of life (Pelvic Floor Distress Inventory (PFDI) (MD: −48.08, 95% CI: −62.34 to −33.77, p-value < 0.01), Pelvic Floor Impact Questionnaire (PFIQ) (MD: −33.41, 95% CI: −43.48 to −23.34, p < 0.01)) and sexual activity of patients with pelvic organ prolapse (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) (MD: 4.84, 95% CI: 1.75 to 7.92, p < 0.01)). Furthermore, narrative synthesis for studies investigating the effect of the pessary approach showed a positive association between the use of this instrument and improvement in the quality of life and sexual activity. Conclusions: The results of our study revealed a significant improvement in the women’s quality of life following abdominal and vaginal reconstructive surgery. The use of pessary was also associated with increased patient quality of life.

Update in Transvaginal Grafts: The Role of Lightweight Meshes, Biologics, and Hybrid Grafts in Pelvic Organ Prolapse Surgery

Transvaginal mesh/grafts have been popularized over the past 20 years in an attempt to improve the longevity of traditional vaginal pelvic organ prolapse (POP) surgery. Several national bodies have concluded that the proposed benefits of mesh/graft implantation are outweighed by the significant increase in surgery complications related to these products. As a consequence mesh products for vaginal POP surgery have been withdrawn from use in many countries. This article is a narrative review of newer mesh and graft products including lightweight polypropylene mesh products, biological grafts, hybrid grafts, and tissue engineered grafts.

Medium-term outcomes for primary native tissue reconstructive surgeries with and without transobturator vaginal meshes in stress continent women with stage 3 or higher pelvic organ prolapse

AIMS

To compare the surgical outcomes of conventional surgeries with or without concomitant transobturator vaginal mesh (TVM) for ≥Stage 3 pelvic organ prolapse (POP).

METHODS

We retrospectively investigated 166 women who received conventional surgery including vaginal total hysterectomy, modified McCall culdoplasty, and AP-repair (conventional group) and 98 women with concomitant TVM (mesh group). Follow-up at 3, 12, and 24 months comprised symptom interview, pelvic examination, and ultrasound assessments. The primary outcome was anatomical success defined as ≤Stage 1 POP. Secondary outcomes were subjective symptoms, ultrasound manifestations, and complications.

RESULTS

Both groups showed improvements in functional and anatomical outcomes after operations. Compared with the conventional group, the mesh group had higher rates of de novo stress urinary incontinence (SUI) at 3-month (3.6% vs 19.4%; P < .001), 12-month (3.7% vs 26.4%; P < .001), and 24-month (2.4% vs 21.4%; P = .001) follow-up, a higher POP-C point (-7.3 ± 0.7 cm vs -7.6 ± 0.6 cm; P < .001) at 3-month follow-up, a smaller straining bladder neck angle indicating a more cranioventral straining bladder neck position (117 ± 25° vs 102 ± 20°; P < .001) at 3-month follow-up, and a less bladder neck mobility at 3-month (19 ± 24° vs 8 ± 14°; P = .002) and 12-month (26 ± 18° vs 12 ± 15°; P = .003) follow-up.

CONCLUSIONS

Concomitant TVM is associated with a higher rate of de novo SUI, more cranioventral straining bladder neck position, and less bladder neck mobility.

Efficacy and safety of the Calistar and Elevate anterior vaginal mesh procedures

OBJECTIVES

The pelvic organ prolapse (POP) surgery with implantation of anterior transvaginal mesh (e.g. Elevate or Calistar) may provide objective and subjective improvement as compared to traditional POP repair without mesh. Given differences between the Elevate and the Calistar mesh and their different placement methods, some variation inlong-term clinical outcomes of these anterior vaginal mesh procedures can be expected.

STUDY DESIGN

The purpose of the study was to compare the 18-month operative success in patients who had undergone anterior POP surgery with either the Calistar (n = 54) or Elevate mesh (n = 50).

RESULTS

There were no between-group differences in objective measures of operative efficacy, including POP-Q anterior stage 0 or I (94% for Calistar, 92% for Elevate) and "no descent beyond the hymen" (98% for Calistar, 94% for Elevate). The proportion of patients with subjective measure of operative efficacy (no vaginal bulge symptoms) did not differ between the groups (91% for Calistar, 78% for Elevate). There were no between-group differences in the proportion of women suffering from vaginal exposure, de novo stress urinary incontinence (SUI), de novo overactive bladder (OAB) symptoms, pelvic floor pain or dyspareunia. The operative cure of OAB symptoms was similar in the groups. The proportion of patients with the operative cure of SUI symptoms was significantly higher in the Calistar as compared to the Elevate group.

CONCLUSIONS

The results suggestthat the Calistar system offers similar efficacy in the treatment of anterior and both anterior and apical POP as compared to the Elevate. The use of anterior Calistar is associated with some additional benefits, i.e. SUI treatment in patients with concomitant anterior and both anterior and apical POP and SUI symptoms.

Anterior and middle pelvic organ prolapse repair using a six tension-free strap low weight transvaginal mesh: long-term retrospective monocentric study of 311 patients

INTRODUCTION

Treatment of pelvic organ prolapse is an important public health issue due to the ageing population. The Food and Drug Administration, in 2011, issued a warning on complications after transvaginal insertion of high weight mesh. We evaluated a 6 tension-free straps, light prosthesis made from polypropylene monofilaments.

MATERIALS AND METHODS

This monocentric, retrospective study included patients undergoing anterior or apical prolapse repair surgery by placement of a six tension-free strap low weight vaginal mesh between 2008 and 2017. The surgical history, concomitant surgery, clinical examination results, pre and postoperative results of the Urinary Symptom Profile questionnaire, and intraoperative and postoperative complications were collected from patients' medical records.

RESULTS

311 patients were included (median follow-up: 33 months). The majority (93%) had stage ≥ III cystocele and 26% had stage ≥ III hysterocele. Postoperatively, there were nine cases (2.9%) of asymptomatic cystocele recurrence and 11 (3.5%) cases of hysterocele recurrence, among them six underwent reoperation. Vaginal comfort was significantly improved in 92% vs. 17% before surgery (p < 0,0001); two (1,76%) patients had de novo dyspareunia. Preoperatively, 104 patients had stress urinary incontinence (SUI), 45,2% of them were cured postoperatively. There were 62 (30%) cases of de novo SUI. A significant improvement of dysuria (p < 0,0001) and overactive bladder (OAB) was found for all severity stages (p < 0,0001). Severe complications included haematoma (7,4%), mesh exposure (1.3%), retraction (0.6%), bladder injury (0.6%) and chronic pain (0.6%).

CONCLUSION

Treatment of anterior and/or mid-segment prolapse by transvaginal insertion of a six-strap low-weight mesh is long-term effective, with acceptable morbidity.