1
|
Kuroda K, Hamamoto K, Kawamura K, Kobayashi H, Horiguchi A, Ito K. Efficacy of Transvaginal Surgery Using an ORIHIME Mesh With Wider Arms and Adjusted Length. Cureus 2024; 16:e57106. [PMID: 38681380 PMCID: PMC11055613 DOI: 10.7759/cureus.57106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Transvaginal mesh surgery (TVM) is an effective treatment measure for pelvic organ prolapse (POP). However, the ORIHIME mesh (Kono Seisakusho, Japan, Tokyo), which has the disadvantage of poor adherence to tissues, is currently the only product available for this procedure. Our research team has previously developed a modified ORIHIME mesh with wider arms with the aim of minimizing the risk of POP recurrence. Additionally, the length of the mesh behind the anterior vaginal wall has been adjusted to prevent urinary incontinence. The current study aims to examine the efficacy of this modified mesh in minimizing postoperative complications in patients undergoing uphold-type TVM. METHODS The data of 84 patients who underwent TVM using ORIHIME at our hospital since July 2019 were retrospectively analyzed. The patients were divided into three groups as follows: (a) normal arms (NA; arm width < 6 cm; n = 29 cases); (b) wide arms without length adjustment (WA and LA (-); arm width > 6 cm; n = 27 cases); and (c) wide arms with length adjustment (WA and LA (+); n = 28 cases). Data were collected using various questionnaires, and the residual urine volume was measured before and after surgery. Additionally, the 60-minute pad test was performed where possible, and the recurrence and complication rates were recorded. RESULTS The incidence of mesh exposure and urinary incontinence in daily life tended to be lower in the WA and LA (+) groups, although this difference was not statistically significant. The one-year postoperative POP recurrence rate, residual urine volume, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score were significantly lower in the WA and LA (+) groups compared to the other groups. CONCLUSION Uphold-type TVM using the modified ORIHIME mesh with wider arms and adjusted length was associated with better postoperative treatment outcomes compared to TVM using the traditional ORIHIME mesh.
Collapse
Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, JPN
| | - Koetsu Hamamoto
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, JPN
| | - Kazuki Kawamura
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, JPN
| | - Hiroaki Kobayashi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, JPN
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, JPN
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, JPN
| |
Collapse
|
2
|
Guan Y, Han J. Quality-of-life improvements in patients after various surgical treatments for pelvic organ prolapse. Arch Gynecol Obstet 2024; 309:813-820. [PMID: 37464172 DOI: 10.1007/s00404-023-07140-3] [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: 05/14/2023] [Accepted: 07/01/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare the improvements in quality of life of patients with pelvic organ prolapse (POP) treated using various surgical methods. MATERIALS AND METHODS The PUBMED, MEDLINE and Cochrane Library online databases were searched using the keywords "pelvic organ prolapse", "surgery", "PFDI-20" and "PFIQ-7" for articles published from January 2010 to December 2022 that included quality-of-life scores before and after surgery. RESULTS Forty-nine articles were include. The mean postoperative PFDI-20 and PFIQ-7 scores decreased by 67.50% and 76.98%, respectively, compared with those before surgery. In 76.9% of patients, this change did not decrease with increased postoperative time. The improvement rate in PFDI-20 scores after colpocleisis did not differ statistically from that after sacrocolpopexy and was significantly higher than that after other procedures. The improvement rate in PFIQ-7 scores after colpocleisis did not statistically differ from that after high uterosacral ligament suspension and was significantly higher than that after other procedures. The improvement rate in PFDI-20 scores after transvaginal mesh-based repair (TVM) did not significantly differ from that after sacrospinous ligament fixation and was significantly lower than that after other procedures except traditional vaginal wall repair. The improvement rate in PFIQ-7 scores after TVM did not significantly differ from that after new procedures and was significantly lower than that after other procedures. CONCLUSIONS Surgical treatment can significantly improve the quality of life of patients with POP. Colpocleisis may offer more advantages than those of other surgical procedures, and improvement was lower after TVM than after other procedures.
Collapse
Affiliation(s)
- Yiqi Guan
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Garden Street, Beijing, 100191, China
| | - Jinsong Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Garden Street, Beijing, 100191, China.
| |
Collapse
|
3
|
Kuroda K, Hamamoto K, Kawamura K, Masunaga A, Kobayashi H, Horiguchi A, Ito K. Favorable Postoperative Outcomes After Transvaginal Mesh Surgery Using a Wide-Arm ORIHIME® Mesh. Cureus 2024; 16:e53388. [PMID: 38435168 PMCID: PMC10908251 DOI: 10.7759/cureus.53388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Transvaginal mesh surgery (TVM) is an effective treatment option for pelvic organ prolapse (POP). Although ORIHIME®, the only available mesh product, is thin, soft, and easy to handle, it has the disadvantages of sliding off or mildly adhering to the surrounding tissues. The current study compared the efficacy of using wide-arm ORIHIME (Kono Seisakusho, Japan, Tokyo), non-wide arm ORIHIME, Gynemesh PS (Johnson and Johnson, Japan, Tokyo), and Polyform (Boston Scientific Japan, Japan, Tokyo) meshes for TVM. Methods The study included 116 patients who underwent TVM (Prolift with Gynemesh PS (n = 14); Elevate with Polyform (n = 43); Uphold with non-wide-arm ORIHIME (n = 24); Uphold with wide-arm ORIHIME (n = 35)) at our hospital. Pre- and post-surgical changes in symptoms were measured using questionnaires and 60-minute pad weight testing and compared by mesh type and surgical methods used. Results The residual urine volume, 60-minute pad weight testing, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), and international consultation on incontinence questionnaire-short form score (ICIQ-SF) significantly improved one year postoperatively in the TVM with the wide-arm ORIHIME group. Comparison of pre and one-year postoperative findings by mesh type and surgical methods used showed no significant differences in the 60-minute pad test, IPSS, Quality of Life (QOL), OABSS, and urinary incontinence in daily life scores, and improvement in residual urine volume, ICIQ-SF, and mesh exposure and POP recurrence rates in the TVM with the wide-arm ORIHIME group. Conclusion TVM with wide-arm ORIHIME had better postoperative outcomes compared to TVM with other mesh products.
Collapse
Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| | - Koetsu Hamamoto
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| | - Kazuki Kawamura
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| | - Ayako Masunaga
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| | - Hiroaki Kobayashi
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, JPN
| |
Collapse
|
4
|
Chang CH, Su TH, Lau HH. The changes in bladder function and symptoms after robot-assisted sacrocolpopexy and transvaginal mesh surgery for pelvic organ prolapse. Taiwan J Obstet Gynecol 2024; 63:68-72. [PMID: 38216272 DOI: 10.1016/j.tjog.2023.05.016] [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] [Accepted: 05/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study is aimed to compare the impact on bladder function and symptoms between robotic sacrocolpopexy (RSC) and transvaginal mesh surgery (TVM) in women with pelvic organ prolapse. MATERIALS AND METHODS This prospective controlled study enrolled patients who received RSC or TVM at our hospital between March 2020 and June 2022. We compared preoperative and postoperative bladder function between two groups by using a questionnaire of lower urinary tract symptom (LUTs) for subjective assessment and urodynamic study for objective assessment. RESULTS A total of 60 patients were enrolled, of whom 30 received RSC and 30 received TVM. In LUTs analysis, the RSC group had a higher risk of de novo stress urinary incontinence than the TVM group (33.3% vs. 3.3%, p = .007). Urodynamic studies showed that both groups had a deterioration in maximal urethral closure pressure postoperatively (RSC: 56.9 ± 17.1 vs. 44.2 ± 15.5 cmH2O; and TVM: 61.2 ± 29.4 vs. 47.6 ± 19.7 cmH2O, p < .01 and p = .03, respectively). The incidence of urodynamic stress incontinence was also significantly increased after RSC (33.3% vs. 76.7%, p = .01). The de novo urodynamic stress incontinence rate was 46.7% after RSC, which was not significantly different to the TVM group (26.7%, p = .16). In the TVM group, the incidence of voiding difficulty decreased after surgery (43.3% vs. 10.0%, p < .01), and urodynamic measurements revealed that the prevalence of urine retention decreased (43.3% vs. 16.7%, p < .01). In the RSC group, the incidence of incomplete emptying sensation decreased (36.7% vs. 13.3%, p = .04), and urodynamic measurements showed that none of the patients had bladder outlet obstruction, underactive detrusor, or urine retention after surgery. CONCLUSION RSC and TVM are both beneficial to improve voiding function in women with pelvic organ prolapse. However, a deterioration in urethral function was observed and the de novo SUI rate was higher in the RSC group than in the TVM group.
Collapse
Affiliation(s)
- Chia-Hua Chang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Hsien Su
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Hui-Hsuan Lau
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
| |
Collapse
|
5
|
Martoccia A, Al Salhi Y, Fuschi A, Rera OA, Suraci PP, Scalzo S, Antonioni A, Valenzi FM, Sequi MB, De Nunzio C, Lombardo R, Sciarra A, Di Pierro G, Bozzini G, Asimakopoulos AD, Finazzi Agrò E, Zucchi A, Gubiotti M, Cervigni M, Carbone A, Pastore AL. Robot-Assisted Sacrocolpopexy versus Trans-Vaginal Multicompartment Prolapse Repair: Impact on Lower Bowel Tract Function. Biomedicines 2023; 11:2105. [PMID: 37626605 PMCID: PMC10452351 DOI: 10.3390/biomedicines11082105] [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: 04/21/2023] [Revised: 06/05/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study evaluated the effectiveness, safety, and possible changes in bowel symptoms after multicompartment prolapse surgery by comparing two different surgical approaches, transvaginal mesh surgery with levatorplasty (TVMLP) and robot-assisted sacrocolpopexy (RSC). METHODS All patients underwent pelvic (POP-Q staging system) and rectal examination to evaluate anal sphincter tone in the lithotomy position with the appropriate Valsalva test. The preoperative evaluation included urodynamics and pelvic magnetic resonance defecography. Patient Global Impression of Improvement (PGI-I) at follow-up measured subjective improvement. All patients completed Agachan-Wexner's questionnaire at 0 and 12 months of follow-up to evaluate bowel symptoms. RESULTS A total of 73 cases were randomized into the RSC group (36 cases) and TVMLP group (37 cases). After surgery, the main POP-Q stage in both groups was stage I (RCS 80.5% vs. TVMLP 82%). There was a significant difference (p < 0.05) in postoperative anal sphincter tone: 35%. The TVMLP group experienced a hypertonic anal sphincter, while none of the RSC group did. Regarding subjective improvement, the median PGI-I was 1 in both groups. At 12 months of follow-up, both groups exhibited a significant improvement in bowel symptoms. CONCLUSIONS RSC and TVMLP successfully corrected multicompartment POP. RSC showed a greater improvement in the total Agachan-Wexner score and lower bowel symptoms.
Collapse
Affiliation(s)
- Alessia Martoccia
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Yazan Al Salhi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Andrea Fuschi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Silvio Scalzo
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Alice Antonioni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Alessandro Sciarra
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giovanni Di Pierro
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant’Anna Hospital, 22100 Como, Italy;
| | - Anastasios D. Asimakopoulos
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | - Enrico Finazzi Agrò
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | | | | | - Mauro Cervigni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Carbone
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| |
Collapse
|
6
|
Declas E, Verdun S, Fauconnier A, Lucot JP. Risk factors for postoperative pain after cystocele repair with mesh. Int Urogynecol J 2023; 34:771-775. [PMID: 36063194 DOI: 10.1007/s00192-022-05285-4] [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: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Prolapse is a common condition seen in women and its therapeutical management consists first and foremost of surgery. Postoperative pain is one of the most common side effects seen after surgery. The objective of this study was to identify risk factors for postoperative pain after cystocele repair with mesh. METHODS This is a secondary analysis of the multicenter randomized trial PROSPERE, which compared cystocele repair with mesh according to the vaginal or laparoscopic approach. The presence of postoperative pain was assessed by a pain-specific self-reported questionnaire (Questionnaire de Baudelocque). The statistical analysis is based on the Wilcoxon, Chi-squared, and Fisher's tests. RESULTS The prevalence of postoperative pain (pain persisting more than 6 months) was 39% (80 out of 205, 95% CI 32.4-46.1), with 6.3% (13 out of 205) of chronic pain reports. Preoperative pain was the only statistically significant risk factor OR = 2.32 (p = 0,007; 95% CI 1.24-4.36). CONCLUSIONS Surgeons must be careful with preoperative painful prolapse and should inform their patient of the risk of developing postoperative chronic pain.
Collapse
Affiliation(s)
- E Declas
- Obstetrics and Gynecology Department, Saint Vincent de Paul Hospital, Groupe des hôpitaux de l'institut catholique de Lille (GHICL), Boulevard de Belfort, 59000, Lille, France.
| | - S Verdun
- Lille Catholic hospitals, Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - A Fauconnier
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France
| | - J P Lucot
- Obstetrics and Gynecology Department, Saint Vincent de Paul Hospital, Groupe des hôpitaux de l'institut catholique de Lille (GHICL), Boulevard de Belfort, 59000, Lille, France
| |
Collapse
|
7
|
Kusuda M, Kagami K, Takahashi I, Nozaki T, Sakamoto I. Comparison of transvaginal mesh surgery and robot-assisted sacrocolpopexy for pelvic organ prolapse. BMC Surg 2022; 22:268. [PMID: 35820857 PMCID: PMC9275127 DOI: 10.1186/s12893-022-01702-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pelvic organ prolapse (POP) is greatly affecting the quality of life (QOL) of women. There are some surgical techniques for POP repair, for example, transvaginal mesh surgery (TVM), laparoscopic sacrocolpopexy (LSC), and robot-assisted sacrocolpopexy (RSC). In the United States and Europe, the number of TVM has rapidly decreased since 2011 due to complications and safety concerns and has shifted to LSC/RSC. In Japan, RSC has increased after the insurance coverage of RSC in 2020. Therefore, we compared the surgical outcomes of TVM and RSC in POP surgery. Methods We retrospectively collected POP surgery underwent TVM or RSC at our hospital and compared the operative time, blood loss, postoperative hospital stay, postoperative complications, and preoperative and postoperative stress urinary incontinence (SUI) of two groups. Preoperative and postoperative SUI were classified into 3 groups: “improved preoperative SUI”, “persistent preoperative SUI” and “de novo SUI”, which occurred for the first time in patients with no preoperative SUI, and compared incidence rate. The Mann–Whitney U test and Fisher’s exact test were used to compare the two groups, and P < 0.05 was considered statistically significant. Results From August 2011 to July 2021, 76 POP surgery was performed and they were classified into two groups: TVM group (n = 39) and RSC group (n = 37). There was no difference in patient age and BMI between the TVM and RSC groups. The median of operative time was 78.0 vs. 111.0 min (p = 0.06), blood loss was 20.0 ml vs. 5.0 ml (p < 0.05), and postoperative hospital stay was 4.0 days vs. 3.0 days (p < 0.05), with less blood loss and shorter postoperative hospital stay in the RSC group. There was no difference in postoperative complications between the TVM and RSC groups (17.9% vs. 16.2%, p = 1.00). De novo SUI was 25.6% vs. 5.4% (p < 0.05) in the TVM and RSC groups, of which 23.1% vs. 5.4% (p < 0.05) occurred within 3 months of surgery. Conclusion RSC is more beneficial and less invasive for patients with pelvic organ prolapse than TVM. In addition, de novo SUI as postoperative complication of RSC was lower than of TVM.
Collapse
Affiliation(s)
- Mayuko Kusuda
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Keiko Kagami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Ikumi Takahashi
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Takahiro Nozaki
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan
| | - Ikuko Sakamoto
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu city, Yamanashi, 400-8506, Japan.
| |
Collapse
|
8
|
Zhang YA, Wang W, Li XL, Xian-hui-Zhang, Pan J, Li ZA. The effect evaluation of traditional vaginal surgery and transvaginal mesh surgery for severe pelvic organ prolapse: 5 years follow-up. Open Med (Wars) 2022; 17:801-807. [PMID: 35529471 PMCID: PMC9034344 DOI: 10.1515/med-2022-0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
The objective of this study was to compare the clinical effectiveness of traditional vaginal surgery and transvaginal mesh (TVM) surgery on severe pelvic organ prolapse (POP). We performed a retrospective chart review study of 258 severe POP patients who underwent surgery between November 2010 and September 2016. One hundred forty patients underwent traditional vaginal surgery and 118 TVM surgery. The Pelvic Organ Prolapse Quantitation (POP-Q) staging was used for objective evaluation. The Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Disease Life Impact Questionnaire Simplified Version-7 (PFIQ-7), and Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) were used for subjective evaluation. Their complications were also recorded. All the data were collected in the outpatient department through the follow-up at 3 months, 1, 3, and 5 years after the operation. Forty patients in the traditional vaginal surgery group and 25 in the TVM group were lost to follow-up. There was no difference in the POP-Q score between the groups (P = 0.346). The recurrence rate increased with follow-up time, reaching nearly 20% in the two groups by 5 years. The TVM group has higher PFDI-20 and PFIQ-7 scores and lower PISQ-12 scores than the traditional vaginal surgery group at six months, 1, 3, and 5 years, respectively (P < 0.001). Mesh exposure has occurred in the TVM group. Both surgeries showed similar objective satisfaction and recurrence rate. However, traditional vaginal surgery has higher subjective satisfaction than TVM in our study and does not risk exposure to prosthetic material.
Collapse
Affiliation(s)
- Ying-an Zhang
- Department of Gynecology and Obstetrics, Children’s Hospital of Shanxi and Women Health Center of Shanxi , Taiyuan , China
| | - Wei Wang
- Department of Laboratory Medicine, Shanxi Provincial People’s Hospital , Taiyuan , China
| | - Xiao-li Li
- Department of Gynecology and Obstetrics, Children’s Hospital of Shanxi and Women Health Center of Shanxi , Taiyuan , China
| | - Xian-hui-Zhang
- Department of Gynecology and Obstetrics, Children’s Hospital of Shanxi and Women Health Center of Shanxi , Taiyuan , China
| | - Jie Pan
- Department of Pathology, Stanford University School of Medicine , Stanford , CA 94305 , United States of America
| | - Zhao-ai Li
- Department of Gynecology and Obstetrics, Children’s Hospital of Shanxi and Women Health Center of Shanxi , Taiyuan , China
- Department of Gynecology and Obstetrics, Coal Hospital of Shanxi , Taiyuan , China
| |
Collapse
|
9
|
Serino MA, Collins SA, Kenton K, Geynisman-Tan J. Ultrasound-Measured Urethral Length Does Not Change following Minimally Invasive Sacrocolpopexy for Pelvic Organ Prolapse. South Med J 2022; 115:187-191. [PMID: 35237836 DOI: 10.14423/smj.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare urethral length (UL), as measured by three-dimenstional transvaginal ultrasound, before and after minimally invasive sacrocolpopexy (SCP). METHODS Secondary analysis of a prospective cohort study of women undergoing SCP for prolapse beyond the hymen with or without a concomitant anti-incontinence procedure. Participants underwent ultrasound at baseline and 14 weeks postoperatively. UL was measured in a reconstructed sagittal plane from the bladder neck to the urethral meatus. All of the participants underwent multichannel urodynamics preoperatively. Data were analyzed in SPSS using independent or paired t tests as indicated for continuous variables and the McNemar test for paired dichotomous variables. Correlations including nonparametric data are reported as Spearman rho. RESULTS A total of 28 participants, with a mean ± standard deviation age of 56 ± 10 years and median (interquartile range) preoperative prolapse stage of 3 (3-3), were analyzed. There was no change in UL between the baseline and 14-week visits (29.8 ± 11.0 mm vs 29.3 ± 10.0 mm, P = 0.83). There was no difference in baseline UL (29.4 ± 11.8 mm vs 30.9 ± 8.9 mm, P = 0.74) in those with and without preoperative stress urinary incontinence (SUI), nor was there a difference in baseline functional UL on multichannel urodynamics between these groups. In total, 21 participants (75%) had preoperative SUI and 19 (90%) underwent a concomitant anti-incontinence procedure. UL at 14 weeks was similar in those with and without SUI symptoms (26.5 ± 10.9 mm vs 31.1 ± 11.3 mm, P = 0.32) when controlling for those who underwent anti-incontinence procedures. CONCLUSION UL does not change following suspension of the anterior vaginal wall with SCP.
Collapse
Affiliation(s)
- Maeve A Serino
- From the Feinberg School of Medicine and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Sarah A Collins
- From the Feinberg School of Medicine and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Kimberly Kenton
- From the Feinberg School of Medicine and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Julia Geynisman-Tan
- From the Feinberg School of Medicine and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| |
Collapse
|
10
|
Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial. Int Urogynecol J 2022; 33:2021-2030. [PMID: 35044477 DOI: 10.1007/s00192-021-05071-8] [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: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The main objective of the study was to evaluate the rates of de novo stress urinary (SUI) and postoperative dyspareunia after both sacrocolpopexy/hysteropexy (SCP) and vaginal mesh surgery. METHODS A prospective, multicenter, randomized, open-label study with two parallel groups treated by either SCP or Uphold Lite vaginal mesh was carried out. Study participants were ≥ 50 and < 80 years old patients with Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 who were considered eligible for reconstructive surgery and who were sexually active with no dyspareunia and free from bothersome SUI at presentation. Women were assessed before surgery and at 4-8 weeks and 11-13 months after using validated measures including POP-Q, Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Patient Global Impression of Improvement (PGI-I). Data were also collected for health economics evaluation. RESULTS Of the required sample of 156 women, 42 women (19 SCP and 23 vaginal mesh) were only recruited owing to the discontinuation of vaginal mesh worldwide. The median follow-up was 376 days. The rates of bothersome de novo SUI were similar in the SCP and Uphold vaginal mesh groups (15.79 vs 15.00%, OR 0.95 [95% CI 0.22-4.14]). Among 30 sexually active patients at follow-up, the rates of women reporting de novo dyspareunia "usually or always" were 6.7% after SCP vs 13.3% after vaginal mesh (p = 1). Health economics evaluation showed a cost saving of 280€ in favor of the Uphold vaginal mesh technique, but no significant difference in the total cost (2,934.97€ for SCP vs 3,053.26€ for Uphold vaginal mesh). CONCLUSIONS Bothersome de novo SUI and de novo dyspareunia occurred in approximately 15% and 23% of our study cohorts, with no significant difference between sacrocolpopexy/hysteropexy and anterior/apical vaginal mesh surgery. However, these results should be interpreted with caution owing to the small sample size.
Collapse
|
11
|
Lucot JP, Cosson M, Verdun S, Debodinance P, Bader G, Campagne-Loiseau S, Salet-Lizee D, Akladios C, Ferry P, De Tayrac R, Delporte P, Curinier S, Deffieux X, Blanc S, Capmas P, Duhamel A, Fritel X, Fauconnier A. Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial. BJOG 2021; 129:127-137. [PMID: 34264001 DOI: 10.1111/1471-0528.16847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN Extended follow up of a randomised trial. SETTING Eleven centres. POPULATION Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).
Collapse
Affiliation(s)
- J-P Lucot
- Service de gynécologie-obstétrique, Hôpital Saint Vincent de Paul, Groupe des Hôpitaux de l'Institut Catholique de Lille (GHICL), Lille, France
| | - M Cosson
- Service de Gynécologie médico chirurgicale Pôle Femme, mère, nouveau-né, Hôpital Jeanne de Flandre, CHRU de Lille, France
| | - S Verdun
- Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | | | - G Bader
- Service de gynécologie-obstétrique CHI Poissy-St-Germain, Université Versailles Saint-Quentin, Poissy, France
| | | | - D Salet-Lizee
- Groupe Hospitalier Diaconesses Croix St-Simon, Paris, France
| | | | - P Ferry
- Service de Gynécologie Obstétrique, Centre Hospitalier, La Rochelle, France
| | - R De Tayrac
- Hôpital Carémeau CHU de Nîmes, Nîmes, France
| | - P Delporte
- Centre Hospitalier de Dunkerque, Dunkerque, France
| | | | - X Deffieux
- Hôpital Antoine Béclère, Clamart, France
| | - S Blanc
- Service de Gynécologie, Centre Hospitalier de la Région d'Annecy, Pringy, France
| | - P Capmas
- Service de Gynécologie Obstétrique Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - A Duhamel
- Univ Lille, CHU Lille, ULR 2694 METRICS, Lille, France
| | - X Fritel
- Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - A Fauconnier
- Centre Hospitalier de Dunkerque, Dunkerque, France.,Unité de recherche EA 7285, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
| |
Collapse
|
12
|
Sun ZJ, Wang XQ, Lang JH, Xu T, Lu YX, Hua KQ, Han JS, Li HF, Tong XW, Wang P, Wang JL, Yang X, Huang XH, Liu PS, Song YF, Jin HM, Xie JY, Wang LW, Wu QK, Gong J, Wang Y, Wang LQ, Li ZA, Xu HC, Xia ZJ, Gu LN, Liu Q, Zhu L. A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse. Chin Med J (Engl) 2021; 134:200-205. [PMID: 33443938 PMCID: PMC7817324 DOI: 10.1097/cm9.0000000000001237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011. METHODS A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided). RESULTS The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107). CONCLUSIONS The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly. TRIAL REGISTRATION NUMBER NCT03620565, https://register.clinicaltrials.gov.
Collapse
Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiu-Qi Wang
- Department of Obstetrics and Gynecology, Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing 100730, China
| | - Yong-Xian Lu
- Department of Obstetrics and Gynecology, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Ke-Qin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200433, China
| | - Jin-Song Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100083, China
| | - Huai-Fang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - Xiao-Wen Tong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - Ping Wang
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan 061110, China
| | - Jian-Liu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xiang-Hua Huang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 075100, China
| | - Pei-Shu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250002, China
| | - Yan-Feng Song
- Department of Obstetrics and Gynecology, 900 Hospital of the Joint Logistics Team, Fuzhou, Fujian 350025, China
| | - Hang-Mei Jin
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, China
| | - Jing-Yan Xie
- Department of Obstetrics and Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Lu-Wen Wang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Qing-Kai Wu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Sixth Hospital, Shanghai 200300, China
| | - Jian Gong
- Department of Gynecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Li-Qun Wang
- Department of Gynecology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006, China
| | - Zhao-Ai Li
- Department of Gynecology, Shanxi Maternal and Child Health Hospital, Taiyuan, Shanxi 030013, China
| | - Hui-Cheng Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Army Medical University (Southwest Hospital), Chongqing 400038, China
| | - Zhi-Jun Xia
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Li-Na Gu
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 831118, China
| | - Qing Liu
- Department of Gynecology, Gansu Province Maternity and Child-care Hospital, Lanzhou, Gansu 730050, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
13
|
Four-arm polypropylene mesh for vaginal vault prolapse-surgical technique and outcomes. Eur J Obstet Gynecol Reprod Biol 2020; 255:203-210. [PMID: 33152564 DOI: 10.1016/j.ejogrb.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Advanced vaginal vault prolapse (VVP) can occur rarely after any type of hysterectomy. Several types of procedures have been applied to correct this defect, but optimal management is still pending. The aim of this study was to describe the surgical technique and results of four-arm transvaginal mesh (FATVM) application for advanced VVP. STUDY DESIGN We followed up for 24 months, 160 patients with VVP > II vc (according to the Pelvic Organ Prolapse Quantification Scale (POPQ)), who underwent FAMTVM from 2014 to2017. FAMTVM was inserted with the anterior arms through the obturator foramens and the posterior arms through the ischiorectal fossas and sacrospinal ligaments. Clinical data were prospectively collected in a customized database and retrospectively analyzed. To assess QoL SF 36, KHQ and FSFI questionnaires were used. POPQ was employed to measure degree of VVP. Non-parametric tests (The Wilcoxon signed-rank test) were applied to verify statistical hypotheses. RESULTS According to SF 36, significant improvement was evident in almost all aspects of general QoL (PCS p = 0.002, MCS p = 0.01). KHQ showed statistically significant improvement in all domains. FSFI scores after surgery indicated significantly improvement in all domains of the questionnaire, apart from lubrication (p = 0.02). Intraoperative bladder injury occurred in 3.75 % (n = 6) of all cases. Five patients (3.1 %) complained of de novo stress urinary incontinence. VVP reoccurred in nine cases (5.6 %). Only two patients (1.25 %) saw mesh exposure after 6 months postoperative recovery. CONCLUSION We consider FAMTVM for VVP to be safe and effective. Hence, it applied as an optional treatment, especially in patients with contraindications to laparotomy and laparoscopy.
Collapse
|
14
|
Liang C, Ling Y, Wei F, Huang L, Li X. A novel antibacterial biomaterial mesh coated by chitosan and tigecycline for pelvic floor repair and its biological performance. Regen Biomater 2020; 7:483-490. [PMID: 33149937 PMCID: PMC7597805 DOI: 10.1093/rb/rbaa034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 01/28/2023] Open
Abstract
The biomaterials composed of mammalian extracellular matrix (ECM) have a great potential in pelvic floor tissue repair and functional reconstruction. However, bacterial infection does cause great damage to the repair function of biomaterials which is the major problem in clinical utilization. Therefore, the development of biological materials with antimicrobial effect is of great clinical significance for pelvic floor repair. Chitosan/tigecycline (CS/TGC) antibacterial biofilm was prepared by coating CS/TGC nanoparticles on mammalian-derived ECM. Infrared spectroscopy, scanning electron microscopy, bacteriostasis circle assay and static dialysis methods were used to characterize the membrane. MTS assay kit and DAPI fluorescence staining were used to evaluate cytotoxicity and cell adhesion. The biocompatibility was assessed by subabdominal implantation model in goats. Subcutaneous antimicrobial test in rabbit back was used to evaluate the antimicrobial and repairing effects on the infected wounds in vivo. Infrared spectroscopy showed that the composite coating had been successfully modified. The antibacterial membrane retained the main structure of ECM multilayer fibers. In vitro release of biomaterials showed sustained release and stability. In vivo studies showed that the antibacterial biological membrane had low cytotoxicity, fast degradation, good compatibility, anti-infection and excellent repair ability.
Collapse
Affiliation(s)
- Changyan Liang
- Department of Gynecology and Obstetrics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - You Ling
- National Engineering Laboratory for Regenerative Medical Implant Devices, Guanhao Biotech Group, Guangzhou Juming Biotech Co., Ltd, Guangzhou, Guangdong, China
| | - Feng Wei
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Lijie Huang
- National Engineering Laboratory for Regenerative Medical Implant Devices, Guanhao Biotech Group, Guangzhou Juming Biotech Co., Ltd, Guangzhou, Guangdong, China
| | - Xiaomao Li
- Department of Gynecology and Obstetrics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
15
|
Sukgen G, Altunkol A, Yiğit A. Effects of mesh surgery on sexual function in pelvic prolapse and urinary incontinence. Int Braz J Urol 2020; 47:82-89. [PMID: 32539249 PMCID: PMC7712677 DOI: 10.1590/s1677-5538.ibju.2019.0618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/16/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose: We aimed to determine pre-operative and post-operative sexual function scores of patients who underwent four-arm polypropylene mesh implantation surgery to treat urinary incontinence and pelvic organ prolapse. Materials and Methods: A prospective study from January 2011 to November 2015 including patients (n: 72) submitted to surgical mesh implantation (four-arm anterior mesh implant (Betamix POP4®, Betatech Medical, Turkey) questioned the patients with Female Sexual Function Index evaluation form. The questionnaire was applied to all patients at pre-operative, post-operative 3rd month and post-operative 1st year periods. Results: The mean age of the patients was 47.2±7.1 years. The mean Body Mass Index (kg/m2) was 28.7±3.7. The average of incontinence duration (year) was 4.6±2.6 and the average for operation time (min) was 35.7±2.1. After the urinary incontinence and pelvic organ prolapse surgery, it was observed that incontinence complaints of patients reduced. Furthermore, there was a positive change in quality of life and sexual function of patients at the post-operative period. There was a statistically significant increase according to Female Sexual Function Index score among all three periods (16%, 86% and 100% respectively, p=0.001) and improvement of sexual functions was observed. Conclusions: Transvaginal mesh use in the surgical treatment of pelvic organ prolapse improves quality of life. However, risk factors such as transvaginal mesh usage indication, surgical technique and experience of the surgeon, suitability of the material, the current health status of the patient and postoperative personal care of the patient may affect the success of operations.
Collapse
Affiliation(s)
- Gökmen Sukgen
- Sukgen Gynecology and Obstetrics Clinic, Adana, Turkey
| | - Adem Altunkol
- Department of Urology, University of Health Sciences, Adana City Teaching and Research Hospital, Adana, Turkey
| | - Ayşe Yiğit
- Special Megapol Hospital, Gynecology and Obstetrics Clinic, Istanbul, Turkey
| |
Collapse
|