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Liang R, Fisk A, King G, Meyn L, Xiao X, Moalli P. Characterization of vaginal immune response to a polypropylene mesh: Diabetic vs. normoglycemic conditions. Acta Biomater 2022; 143:310-319. [PMID: 35278688 PMCID: PMC9035125 DOI: 10.1016/j.actbio.2022.03.007] [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: 01/08/2022] [Revised: 02/20/2022] [Accepted: 03/03/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Urogynecology meshes, typically manufactured from polypropylene, are widely used in the surgical treatment of stress urinary incontinence and pelvic organ prolapse. However, mesh-associated complications such as mesh exposure can develop in women undergoing mesh implantation, for which diabetes is an independent risk factor. We aimed to define the impact of diabetes on the vaginal immune response to mesh by comparing diabetic vs. normoglycemic conditions longitudinally in a rat sacrocolpopexy model. METHODS Diabetes (blood glucose ≥ 300 mg/dL) was induced in middle-aged female Wistar rats with streptozotocin (STZ). A polypropylene mesh was implanted on the vagina via modified sacrocolpopexy following bilateral ovariectomy and supracervical hysterectomy for 3-, 7-, and 42-days. Sham-operated controls underwent the same procedures without mesh. Mesh-associated inflammation, immune cell populations and cytokine/chemokine profiles were examined in the excised vaginal tissues. RESULTS Diabetes was reliably induced starting on the 3rd day following STZ injection. Under both normoglycemic and diabetic conditions, mesh caused a prolonged inflammatory response in the vagina with increased proinflammatory chemokines MCP-1 and MIP-1α as compared to Sham. Major differences between the two conditions were found at the later stage (42 days post-surgery), including an increased inflammation with larger foreign body granuloma and more giant cells at the mesh-tissue interface, increased fraction of macrophages in the immune cell population, and higher proinflammatory chemokine IP-10 in the diabetic group. CONCLUSION Polypropylene mesh implanted on the vagina induces prolonged inflammation at the mesh-tissue interface. Diabetes increases the mesh-associated inflammation in the long term, which is related to a dysregulated macrophage response. STATEMENT OF SIGNIFICANCE This study investigated the mechanism underlying the increased risk in women with diabetes for developing mesh complications such as mesh exposure. The significance includes: (1) it is the first study investigating vaginal host response to a prosthesis under the influence of diabetes; (2) the longitudinal study design elucidated the dynamic changes of vaginal immune response to mesh from very early to late stages; (3) our findings may inform future mechanistic studies and studies investigating preventive/therapeutic strategies to improve the outcomes of women with diabetes receiving vaginal implants.
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Kanji S, Pascali D, Clancy AA. Short term complications in mesh augmented vaginal repair of pelvic organ prolapse are not higher when compared with native tissue repair. Int Urogynecol J 2021; 33:1941-1947. [PMID: 34331076 DOI: 10.1007/s00192-021-04915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Accumulating evidence regarding the negative long-term consequences of transvaginal mesh-based procedures for pelvic organ prolapse has led to a sharp decline in mesh-based procedures. We aimed to evaluate the short-term complications of mesh-based procedures for carefully selected patients with pelvic organ prolapse after Food and Drug Administration warnings. METHODS A retrospective database review of the ACS NSQIP database was completed to examine 30-day complications including re-operation, prolonged length of stay, blood transfusion, surgical site infection, urinary tract infection, readmission and wound dehiscence in mesh-augmented and native tissue-based transvaginal procedures for pelvic organ prolapse. RESULTS A total of 36,234 patients were included in the analysis, with only 7.1% (2574 women) having mesh-augmented repair. Using a multivariable logistical regression analysis adjusting for confounders, we found that the primary composite outcome (re-operation, hospital stay, blood transfusion and surgical site infection) was less common in the mesh group compared with the native tissue repair group (adjusted OR 0.80, CI 0.67-0.95, p = 0.009). The secondary outcomes (urinary tract infection, re-admission and wound dehiscence) were not different between the group. CONCLUSION These results suggest that in well-chosen patients, short-term complications are not increased when using transvaginal mesh for pelvic organ prolapse repair.
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Affiliation(s)
- Sarah Kanji
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dante Pascali
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Aisling A Clancy
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, The Ottawa Hospital, Ottawa, ON, Canada. .,University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Gavlin A, Kierans AS, Chen J, Song C, Guniganti P, Mazzariol FS. Imaging and Treatment of Complications of Abdominal and Pelvic Mesh Repair. Radiographics 2021; 40:432-453. [PMID: 32125951 DOI: 10.1148/rg.2020190106] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surgical mesh is used most frequently for tension-free repair of abdominal wall hernias in adults, because the rate of hernia recurrence is lower with mesh than with primary soft-tissue repair. Since the introduction of polypropylene mesh in the middle of the 20th century, many mesh materials and configurations for specific surgical procedures have been developed. In addition to abdominal wall hernia repair, mesh may be used for repair of diaphragmatic hernias, urinary incontinence in women (female slings), genitourinary prolapse (vaginal mesh and sacrocolpopexy), rectal prolapse (rectopexy), and postprostatectomy male urinary incontinence (male slings). General mesh repair complications include chronic pain; fluid collections such as seromas, hematomas, and abscesses; adhesions that may lead to intestinal blockage; erosion into solid or hollow viscera including enterocutaneous fistulizing disease; and mesh failure characterized by mesh shrinkage, detachment, and migration with repair malfunction. Several mesh complications are often diagnosed with imaging, primarily with CT and less frequently with MRI and US, despite variable mesh visibility at imaging. This article reviews the common surgical mesh applications in the abdomen and pelvis, discusses imaging of mesh repair complications, and provides complication treatment highlights.©RSNA, 2020.
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Affiliation(s)
- Alexander Gavlin
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Andrea S Kierans
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Johnson Chen
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Christopher Song
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Preethi Guniganti
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Fernanda S Mazzariol
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
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Obut M, Oğlak SC, Akgöl S. Comparison of the Quality of Life and Female Sexual Function Following Laparoscopic Pectopexy and Laparoscopic Sacrohysteropexy in Apical Prolapse Patients. Gynecol Minim Invasive Ther 2021; 10:96-103. [PMID: 34040968 PMCID: PMC8140535 DOI: 10.4103/gmit.gmit_67_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: We sought to compare the surgical outcomes, safety, effectiveness, and mid-term outcomes in patients who had undergone laparoscopic hysterosacropexy and laparoscopic pectopexy due to apical prolapse. Materials and Methods: This prospective randomized study was conducted on a total of 62 women who underwent apical prolapse surgery (32 undergoing a pectopexy and 30 undergoing a sacrohysteropexy) between June 2015 and June 2017. Patients with symptomatic uterine or vaginal vault prolapse with stage 2 or worse were included in the sudy. Before and after the operation, we used the Pelvic Organ Prolapse Quantification System (POP-Q) and questionnaires, which are the Prolapse Quality of Life Questionnaire (P-QOL) and Female Sexual Function Index (FSFI), to evaluated cases. Baseline characteristics, perioperative and postoperative complications, and follow-up results at 12 months were also evaluated. Results: All domains of POP-Q, P-QOL, and FSFI scores improved significantly after surgery both in pectopexy and sacrohysteropexy group. The postoperative complications of both procedures were similar except for constipation after surgery (3.2% in the pectopexy group and 20% in the hysterosacropexy group [P = 0.036]). Conclusion: Both sacrohysteropexy and pectopexy are effective surgical options for apical prolapse patients. The pectopexy is an acceptable alternative to laparoscopic sacrohysteropexy because of its less complexity and not reducing pelvic space for the rectum to exist. We suggest that the laparoscopic pectopexy may be widely used in clinical routine.
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Affiliation(s)
- Mehmet Obut
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Sedat Akgöl
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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Tsiapakidou S, Campani Nygaard C, Pape J, de Mattos Lourenço TR, Falconi G, Betschart C, Doumouchtsis SK. Evaluation of guidelines on the use of vaginal mesh implants for pelvic organ prolapse using the AGREE II instrument. Int J Gynaecol Obstet 2021; 154:400-411. [PMID: 33486756 DOI: 10.1002/ijgo.13622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To systematically evaluate the content and quality of national and international guidelines on vaginal mesh procedures for pelvic organ prolapse (POP). METHODS We searched PubMed, Medline, Web of Science, and ScienceDirect from inception to March 2020 and organizations' websites. The quality of the guidelines was assessed independently by six appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS Five guidelines were included. Most guidelines recommended individualized treatments, clinical observation, and conservative treatment for asymptomatic women discouraging the use of mesh. Vaginal pessary and pelvic floor muscle training are unanimously considered effective treatments. Only two guidelines recommended weight loss. Each guideline recommended patient counseling supported by data on success rates and complications. Most guidelines highlighted the importance of a specialist experienced surgeon, multidisciplinary teams, and national/international registries. All guidelines highlighted potential benefits of the use of mesh and reported possible complications. The overall quality rating ranged between 4.2 and 6.3, suggestive of moderate to high quality. The highest mean score (92.5%) pertained to "Scope and Purpose" and "Clarity of Presentation", and the lowest to "Editorial Independence" (18%). Three out of five guidelines were "strongly recommended" by the appraisers. CONCLUSION Although most guidelines were of moderate to high quality, methodological applicability, stakeholder involvement, and editorial independence were domains with low scores.
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Affiliation(s)
- Sofia Tsiapakidou
- 1st Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christiana Campani Nygaard
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,Department of Obstetrics and Gynecology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janna Pape
- Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Thais R de Mattos Lourenço
- Department of Urogynecology, Discipline of Gynecology, Hospital das Clínicas da Faculdade de Medicina da USP, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriele Falconi
- Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK.,School of Medicine, American University of the Caribbean, Pembroke Pines, FL, USA
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Huang E, Koh WS, Han HC. Five-year outcomes of an anterior mesh kit for severe pelvic organ prolapse in women. Neurourol Urodyn 2021; 40:910-919. [PMID: 33645861 DOI: 10.1002/nau.24647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/07/2022]
Abstract
AIMS The Elevate™ Anterior mesh was designed to correct anterior vaginal wall defects by providing level 1 and 2 support via a single incision and transvaginal approach. This study aimed to examine the objective and subjective outcomes following prolapse repair using the Elevate™ Anterior mesh kit. METHODS A retrospective case series review of 270 patients with Baden-Walker Grades 3 or 4 anterior compartment prolapse who underwent the Elevate™ Anterior mesh kit was undertaken. Operative complications were recorded with follow-up intervals arranged at 1, 6, 12, 24, 36, 48 and 60 months. A standardized questionnaire directed at urinary, pain and recurrence symptoms was used at each follow-up visit. Pelvic examinations were performed at each follow-up visit to assess for objective cure and for detection of complications. The primary outcome was to assess the cure rate defined as anterior vaginal wall prolapse ≤ Grade 1. RESULTS The follow-up rate was 28.9%. Subjective and objective cure rates at 60 months were 100% and 96.2%, respectively. Ten (3.7%) intraoperative complications were recorded. At 60 months, three (3.8%) patients complained of de novo stress/urge urinary incontinence. One patient had dyspareunia at 6 months postsurgery which resolved by the end of 1 year. Prolapse recurrences in the anterior compartment was 3.8% at the end of 5 years. Mesh exposure into the vagina occurred in three patients. CONCLUSIONS In conclusion, our experience with the Elevate™ Anterior mesh kit had promising subjective and objective outcomes with high patient satisfaction rates.
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Affiliation(s)
- Eugene Huang
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wei Shung Koh
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - How Chuan Han
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
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Roa L, Kent S, Yaskina M, Schulz J, Poirier A. Knowledge of pelvic floor disorders amongst immigrant women in Canada. Int Urogynecol J 2021; 32:3077-3084. [PMID: 33620531 DOI: 10.1007/s00192-020-04662-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor disorders (PFD) have a detrimental effect on quality of life. Despite the available treatments, women often do not seek medical care. Patient knowledge has been identified as a major barrier to accessing care. The objective of this study was to assess knowledge on PFD amongst women in Edmonton, hypothesizing that immigrant women are less knowledgeable about PFD than Canadian-born women. METHODS A cross-sectional study of immigrant women and Canadian-born women was conducted. Immigrant women were recruited at the Multi-Cultural Health Brokers Co-op (MCHB) and Canadian-born women at a colposcopy clinic. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was administered. Scores for UI and POP were calculated and compared using a Mann-Whitney U test and a t test. A subgroup analysis of immigrants was carried out according to length of stay in Canada and ethnicity. Ethics approval was obtained from the University of Alberta Human Research Ethics Office. RESULTS A total of 106 immigrants and 102 Canadian-born women completed the PIKQ. The overall PIKQ scores were 12.7 for immigrant women and 14.4 for Canadian-born women (p = 0.04). Immigrant women who had lived in Canada for >10 years had higher scores (mean = 13.2) compared with women with less than 10 years in Canada (mean = 11.8). Women from South Asia had higher overall PIKQ scores (mean = 14.6) whereas women from sub-Saharan Africa had the lowest scores (mean = 12.1). CONCLUSIONS Immigrant women in Edmonton were found to have less knowledge on PFD than Canadian-born women.
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Affiliation(s)
- Lina Roa
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Sarah Kent
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Jane Schulz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Annick Poirier
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada. .,Pelvic Floor Clinic-Lois Hole Hospital for Women, RAH Hallway C & D, 10240 Kingsway Avenue NW, Edmonton, Alberta, T5H 3V9, Canada.
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Geoffrion R, Larouche M. Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:511-523.e1. [PMID: 33548503 DOI: 10.1016/j.jogc.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse. TARGET POPULATION Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction. OPTIONS Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ). Individual procedures or broad categories of procedures were compared: (1) vaginal versus abdominal routes for reconstruction, (2) abdominal procedures for reconstruction, (3) vaginal procedures for reconstruction, (4) hysterectomy and suspension versus hysteropexy for reconstruction, and (5) reconstructive versus obliterative options. OUTCOMES The Urogynaecology Committee selected outcomes of interest: objective failure (obtained via validated pelvic organ prolapse [POP] quantification systems and defined as overall objective failure as well as failure rate by compartment); subjective failure (recurrence of bulge symptoms determined subjectively, with or without use of a validated questionnaire); reoperation for POP recurrence; complications of postoperative lower urinary tract symptoms (de novo or postoperative stress urinary incontinence; reoperation for persistent, recurrent, or de novo stress urinary incontinence; urge urinary incontinence; and voiding dysfunction); perioperatively recognized urinary tract injury (bladder or ureter); other complications (mesh exposure, defined as mesh being visible and exposed in the vagina, and non-sexual pelvic pain); and sexual function (de novo dyspareunia and sexual function score according to a validated questionnaire). BENEFITS, HARMS, AND COSTS This guideline will benefit patients seeking surgical correction of apical POP by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. EVIDENCE We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from 2002 to 2019. The search included multiple terms for apical POP surgical procedures, approaches, and complications. We excluded POP repairs using transvaginal mesh and studies that compared procedures without apical suspension. We included randomized controlled trials and prospective or retrospective comparative studies. We limited language of publication to English and French and accessibility to full text. A systematic review and meta-analysis was performed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED USERS Gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and care for women with POP. SUMMARY STATEMENTS All statements refer to correction of apical vaginal prolapse in the short and medium term (up to 5 years), except when otherwise specified. RECOMMENDATIONS
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Chen J, Yu J, Morse A, Fünfgeld C, Huang K, Gong J, Tao G, Wang B, Wang Y, Jiang X, Ababaikeli G, Liu P, Nisier H, Zhang X, Wang P, Sun X, Zhu L. Self-cut titanium-coated polypropylene mesh versus pre-cut mesh-kit for transvaginal treatment of severe pelvic organ prolapse: study protocol for a multicenter non-inferiority trial. Trials 2020; 21:226. [PMID: 32102687 PMCID: PMC7045611 DOI: 10.1186/s13063-019-3966-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 12/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is a common health problem and has significant negative effects on a woman's quality of life. The transvaginal mesh procedure is a durable reconstructive surgery, but the mesh kits are expensive for underdeveloped countries. Our previous case-series study showed that the use of self-cut mesh had a good success rate (91.8% at 1-year follow-up) and low complication rate. This trial is designed to compare a self-cut titanium-coated polypropylene mesh procedure with a mesh kit for the treatment of symptomatic stage III-IV anterior or apical prolapse in terms of efficacy, safety and cost-effectiveness. METHODS The trial is a randomized controlled multicenter non-inferiority trial. The primary outcome measure is the composite success rate at 1-year follow-up. The secondary outcomes are anatomic outcomes of each vaginal segment (anterior, posterior and apical) using the POP-Q score, subjective improvement of quality of life according to questionnaires, intraoperative parameters, complications and costs. Analysis will be performed according to the intention-to-treat principle. Based on a comparable success rate of 90% and 10% as the margin (β = 0.2 and one-sided α = 0.025), about 312 patients in total from 11 centers will be recruited including 10% dropout. The aims of the research are to demonstrate whether the self-cut mesh procedure is non-inferior to the mesh-kit procedure and to investigate the performance of titanium-coated mesh for vaginal prolapse repair. DISCUSSION This multicenter non-inferiority trial will evaluate whether the efficacy and safety of self-cut mesh is non-inferior to mesh kits in women with severe symptomatic stage III-IV anterior or apical prolapse. If we are able to show that the self-cut mesh procedure is non-inferior to the mesh-kit procedure in success rates, then the self-cut mesh procedure may be more cost-effective. TRIAL REGISTRATION ClinicalTrials.gov, NCT03283124. Registered on 17 January 2018.
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Affiliation(s)
- Juan Chen
- Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jiajie Yu
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Abraham Morse
- Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Christian Fünfgeld
- Center for surgery of Pelvic Prolapse and Incontinence, Tettnang Hospital (Klinik Tettnang GmbH), Tettnang, Germany
| | - Kuanhui Huang
- Department of Obstetrics and Gynecology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian China
| | - Jian Gong
- Department of Obstetrics/Gynecology, the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University Hospital, Wuxi, Jiangsu China
| | - Guangshi Tao
- Department of Obstetrics/Gynecology, The Second Xiangya Hospital of Central South University Changsha, Hunan, China
| | - Binan Wang
- Department of Obstetrics/Gynecology, Changsha Hospital for Maternal and Child Health Care, Changsha, Hunan China
| | - Yuling Wang
- Department of Obstetrics/Gynecology, Foshan Maternal and Child Health Care Hospital, Foshan, Guangdong China
| | - Xiangyang Jiang
- Department of Gynecology, Shaanxi Provincial People’s Hospital, Xi’an, Shanxi China
| | - Gulina Ababaikeli
- Department of Obstetrics/Gynecology, The First Affiliated Hospital of Xinjiang Medical University Ürümqi, Xinjiang, China
| | - Peishu Liu
- Department of Obstetrics/Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong China
| | - Hatiguli Nisier
- Department of Obstetrics/Gynecology, The People’s Hospital of Xinjiang Uygur Autonomous Region Ürümqi, Xinjiang, China
| | - Xiaowei Zhang
- Department of Obstetrics/Gynecology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Ping Wang
- Department of Obstetrics/Gynecology, Sichuan University West China Second University Hospital, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan China
| | - Lan Zhu
- Department of Obstetrics/Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 China
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Making surgery safer through adequate communication with the stakeholders: vaginal slings. World J Urol 2019; 38:1351-1358. [PMID: 31273442 DOI: 10.1007/s00345-019-02859-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE In this review, we explore the evidence behind mid-urethral sling (MUS) surgery, review the rising reports of complications and the subsequent US Food and Drug Administration (FDA) and society statements, and evaluate risk perception and communication with patients, doctors, governing bodies, manufacturers and insurance companies. Our aim was to explore the pitfalls in communication that may be contributing to the decline in MUS use, and develop strategies to make MUS surgery safer. METHODS We searched the English language literature using PubMed for articles related to the management of stress urinary incontinence (SUI), MUS, safety and monitoring of transvaginal mesh (TVM), and reviewed all online FDA publications and international position statements regarding MUS for SUI. RESULTS Polypropylene mesh has been used in MUS since the 1990s, with robust evidence to support its use. There has been a decline in the use of MUS ever since the FDA notifications. In response to the controversy surrounding TVM, position statements have been released portending the safety of, and advocating for the continued use of, MUS for the management of SUI. CONCLUSIONS MUS is a viable, effective and safe treatment for SUI management. Physicians should obtain and document informed consent, be adequately trained, and monitor and report their outcomes using registries. With publication of registry results and ongoing health advocacy, the perception of the safety of MUS can improve and MUS can still be offered as a treatment option for SUI.
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Wu YM, Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Rep Urol 2019; 11:179-188. [PMID: 31355157 PMCID: PMC6590839 DOI: 10.2147/rru.s191555] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 02/02/2023] Open
Abstract
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Vaginal pessaries continue to be an effective and reversible option to manage SUI and POP symptoms. The midurethral sling remains the gold standard for surgical treatment of SUI, although patients and clinicians should acknowledge the potentially serious complications of TVM. Burch urethropexy and pubovaginal sling offer good SUI cure and may be preferred in women wishing to avoid mesh implants; however, their operative morbidities and more challenging surgical approach may limit their use. Site-specific cystocele or rectocele repairs may be indicated for isolated anterior or posterior vaginal compartment prolapse; however, in women with more severe POP, evidence supports using a vaginal native-tissue repair involving apical suspension as the primary surgical technique. Although abdominal and laparoscopic sacrocolpopexies are both effective in treating POP, their failure and mesh complication rates increase with time. There is insufficient evidence to support the widespread use of uterine-preserving surgical POP repairs at present due to the lack of long-term data. Routine TVM use is not recommended in POP surgeries and should only be considered on a case-by-case basis by trained surgeons, primarily in women with multiple risk factors for POP recurrence. In general, clinicians should individualize SUI and POP treatment options for women based on their symptoms, comorbidities, and risk factors for mesh-related complications.
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Affiliation(s)
- You Maria Wu
- Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
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12
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Shyu IL, Wang PH, Huang BS. A large bladder hematoma resulting from infectious hemorrhagic cystitis after pelvic reconstruction with transvaginal mesh: An unusual complication. SAGE Open Med Case Rep 2019; 7:2050313X19846709. [PMID: 31105946 PMCID: PMC6501478 DOI: 10.1177/2050313x19846709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/03/2019] [Indexed: 11/17/2022] Open
Abstract
A large hematoma resulting from hemorrhagic cystitis after uncomplicated pelvic reconstruction surgery with a transvaginal mesh is rare. A 66-year-old female who underwent pelvic reconstruction with transvaginal mesh presented with acute urinary retention and hematuria on postoperative day 10. Leukocytosis, pyuria, and hematuria were noted in the emergency room. After using cystoscopy to irrigate the coagulum, there was no mesh erosion or bladder perforation on inspection. A large bladder hematoma resulting from infectious hemorrhagic cystitis was confirmed, and uropathogenic Escherichia coli was isolated. The clinical condition improved after a 1-week treatment with an indwelling Foley catheter and oral antibiotics. Careful aseptic techniques and antibiotic prophylaxis reduce bacterial contamination only for brief periods of time, and patients may still be at risk for delayed infections. The possible modalities to prevent postoperative urinary tract infection after pelvic reconstruction surgery with transvaginal mesh include shortening the indwelling Foley catheter period and administration of an additional antibiotic during catheter removal. However, the antibiotic policies for pelvic reconstruction with transvaginal mesh demand further cost analyses.
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Affiliation(s)
- Ing-Luen Shyu
- Department of Obstetrics and Gynecology, ChiMei Hospital, Tainan City
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei.,Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei.,Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Ben-Shian Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei.,Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei.,Institute of Clinical Medicine, National Yang-Ming University, Taipei
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13
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Cameron B, Sabourin J, Sanaee MS, Koenig NA, Lee T, Geoffrion R. Pelvic floor hypertonicity in women with pelvic floor disorders: A case control and risk prediction study. Neurourol Urodyn 2018; 38:696-702. [DOI: 10.1002/nau.23896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Brianna Cameron
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Johanne Sabourin
- Providence Health Care/St Paul's Hospital Physiotherapy DepartmentVancouverBritish ColumbiaCanada
| | - May S Sanaee
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nicole A Koenig
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Terry Lee
- Centre for Health Evaluation and Outcome SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Roxana Geoffrion
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Wu Y(M, Reid J, Chou Q, MacMillan B, Leong Y, Welk B. Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study. Int Urogynecol J 2018; 30:537-544. [DOI: 10.1007/s00192-018-3792-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022]
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15
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Giannini A, Russo E, Cano A, Chedraui P, Goulis DG, Lambrinoudaki I, Lopes P, Mishra G, Mueck A, Rees M, Senturk LM, Stevenson JC, Stute P, Tuomikoski P, Simoncini T. Current management of pelvic organ prolapse in aging women: EMAS clinical guide. Maturitas 2018; 110:118-123. [DOI: 10.1016/j.maturitas.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
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