Credibility of Ultrasound Detection of Female Genital Prolapse Mesh (KIDS)

August 18, 2023 updated by: Edward Morcos, Karolinska Institutet

The aim of the study is to investigate the credibility of ultrasound in detection of synthetic polypropylene vaginal implants. In detail, the study investigates if the ultrasound examiner experience and the standard method of examination may affect the detection of synthetic polypropylene vaginal implants by ultrasound.

The primary hypothesis is if 90% of prolapse mesh could be detected by the ultrasound examiners who are blinded to the previous prolapse surgery, the ultrasound is credible for prolapse mesh detection.

The secondary hypothesis is if the ultrasound detection is not significantly different between the ultrasound examiners, the method of ultrasound examination is mandatory to acheive credible ultrasound detection of the prolapse mesh.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Pelvic organ prolapse (POP) is a common condition in post-delivery and post-reproductive aged women (1). The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 is 11% (2). POP is mainly classified into three compartments: anterior, middle (apical) or posterior (1). Apical defects include descensus uteri or vaginal vault prolapse after previous hysterectomy. Traditional Surgical repairs of POP using native connective tissues are commonly used but the risk for POP recurrence is high if apical prolapse is present (ca 60%) (1). Thus, the development of different mesh types using different approaches to support the vaginal apex (uterus or vaginal top) is highly growing. Surgery may be done by transvaginal mesh (TVM) or robotic-assisted sacroclpopexy (3). Increasing evidence show effectivity of both methods and improved HR-QoL after surgery (4, 5, 6, 7, 8, 9). However, PFD including urinary incontinence, urinary bladder emptying disorders and prolapse recurrence may be postoperative conditions (1, 2).

Growing needs worldwide is to improve diagnostic methods such as ultrasonography (US). This may improve the clinical knowledge to be further used for management of pelvic floor disorders (PFD). US is a cheap and safe method as compared to magnetic resonance (MR) or computed tomography (CT) (10). Thus, if using US to provide clinical examination instead of MR and CT the health care cost may be reduced. Indeed, US can provide imaging in some cross sections giving same imaging results of MR (10).

Some studies have been investigating the use of endo-vaginal, trans-perineal/introital and trans-labial US techniques in detection of implants with more focus on TVT-surgery (Tension-free vaginal tape) for urinary incontinence (UI) and to some extent detection of prolapse mesh (11). However, sensitivity of depiction has been reported to 92% at rest and 72% on physical examination when using endovaginal US examination (11). Also, the depiction is dependent on the US expertise since no standardization has been achieved. Furthermore, the presence of scar tissues following previous POP or UI surgery in the pelvic floor region has been described as an interrupting factor for prediction (10).

Thus, development of a standardized US prediction of implants in order to elucidate anatomical and functional information in the pelvic floor when POP mesh is implanted may be useful in management of PFD. It is to investigate the sensitivity and reproducibility of this US model of examination.

The purpose of the present study is to investigate the credibility of the US detection of prolapse mesh implants when a standardized method of US examination is performed.

Methodology of the present study Perineal/introital and vaginal ultrasound examination is done using a standard protocol by two different US examiners of four groups of patients previously received prolapse surgery. Each examiner is to be entered from the pre-examination room, do all requested examinations in one time, and leave from the examination room to be followed by the next examiner without meeting each other. Thus, the ultrasound examiners are to be blinded to each other and to the previous prolapse surgery. A controller is appointed to introduce each examiner from the pre-examination room, record the time of each examination and collect the results of examinations. The statistician is also to be blinded to the group of examination.

References

  1. Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013; 24(11):1815-33.
  2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997 Apr;89(4):501-6.
  3. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD004014.
  4. Oliver JL, Kim JH. Robotic Sacrocolpopexy-Is It the Treatment of Choice for Advanced Apical Pelvic Organ Prolapse? Curr Urol Rep. 2017 Sep;18(9):66-74.
  5. Rahkola-Soisalo P, Mikkola TS, Altman D, Falconer C; for Nordic TVM Group. Pelvic Organ Prolapse Repair Using the Uphold Vaginal Support System: 5-Year Follow-up. Female Pelvic Med Reconstr Surg. 2017 Dec 11. Fortcoming 2018.
  6. Gutman RE, Rardin CR, Sokol ER, Matthews C, Park AJ, Iglesia CB, st al. Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study. Am J Obstet Gynecol. 2017. Jan;216(1):38.e1-38.e11.
  7. Lua LL, Vicente ED, Pathak P, Lybbert D, Dandolu V. Comparative analysis of overall cost and rate of healthcare utilization among apical prolapse procedures. Int Urogynecol J. 2017 Oct;28(10):1481-8.
  8. Rahkola-Soisalo P, Altman D, Falconer C, Morcos E, Rudnicki M, Mikkola TS. Quality of life after Uphold™ Vaginal Support System surgery for apical pelvic organ prolapse-A prospective multicenter study. Eur J Obstet Gynecol Reprod Biol. 2017 Jan;208:86-90. doi: 10.1016/j.ejogrb.2016.11.011. Epub 2016 Nov 14.
  9. Altman D, Geale K, Falconer C, Morcos E. A generic health-related quality of life instrument for assessing pelvic organ prolapse surgery: correlation with condition-specific outcome measures. Int Urogynecol J. 2018 Mar 6. doi: 10.1007/s00192-018-3587-5.
  10. Khatri G, Carmel ME, Bailey AA, Foreman MR, Brewington CC, Zimmern PE, Pedrosa I. Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction. Radiographics. 2016 Jul-Aug;36(4):1233-56.
  11. Manonai J, Rostaminia G, Denson L, Shobeiri SA. Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications. Neurourol Urodyn. 2016 Mar;35(3):407-11. doi: 10.1002/nau.22725. Epub 2015 Jan 25.

Study Type

Observational

Enrollment (Actual)

120

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Sweden
      • Stockholm, Sweden, 18288
        • Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Probability Sample

Study Population

Patients operated by one of the procedures:

  1. Anterior TVM (Uphold™ Lite Vaginal mesh - Boston Scientific.
  2. Posterior POP mesh (Pinnacle posterior - Boston Scientific or equal)
  3. Y-shaped mesh via robotic assisted sacroclpopexy (Artisyn® Y-Shaped Mesh - Ethicon or equal).
  4. patients received anterior and/or posterior colporraphy i.e. native tissue repair i.e. no synthetic materials used (control group).

Description

Inclusion Criteria:

  • Patients operated by one of the procedures mentioned 1. Anterior TVM (Uphold™ Lite Vaginal mesh - Boston Scientific. 2. Posterior POP mesh (Pinnacle posterior - Boston Scientific or equal) 3. Y-shaped mesh via robotic assisted sacroclpopexy (Artisyn® Y-Shaped Mesh - Ethicon or equal). and 4. patients received anterior and/or posterior colporraphy i.e. native tissue repair i.e. no synthetic materials used (control group).
  • All patients should have suffered prolapse symptoms before surgery such as pelvic heaviness and/or vaginal bulging, extra.
  • Being able to make an informed consent on participation
  • Physically and cognitively capable of participating in the examination
  • No exclusion criteria fulfilled

Exclusion Criteria:

  • Patients operated by different procedures t.ex. two different mesh types
  • Advanced procedure in the pelvic floor such as current pelvic organ cancer (regardless of treatment)
  • Other clinically relevant pelvic disorders for which surgery with other materials (not polypropylene mesh) was previously provided.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Uphold™ Lite Vaginal mesh - Boston Scientific (Anterior)
Patients previousely received the Uphold™ Lite for the surgical management of apical and/or anterior vaginal mesh prolapse.
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.
Pinnacle posterior Vaginal mesh - Boston Scientific
Patients previousely received the Pinnacle posterior Vaginal mesh for the surgical management of posterior and/or apical vaginal mesh prolapse.
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.
Artisyn® Y-Shaped Mesh (Robotic-assisted Sacral colpopexy)
Patients previousely received the Artisyn® Y-Shaped Mesh via robotic-assisted approach Patients previousely received th Artisyn® Y-Shaped Mesh via robotic-assisted approach for the surgical management of apical prolapse..
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.
Native tissue repair
Patients previousely received native tissue repair for the surgical management of prolapse.
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners are blinded to each other and to the previous prolapse surgery
Diagnostic test: Perineal/introital ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.

Each examiner to answer:

  1. Is there a mesh or not: Yes or No

  2. If Yes:

    • Which type of mesh? Uphold, Pinnacle Posterior or Artisyn® Y-Shaped Mesh
    • What is the length of the mesh in a single midsagittal view image
  3. Examination record time is to be registered.
Other Names:
  • Vaginal ultrasound examination, two different examiners. The examiners is now being informed of the previous prolapse surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Detection of which mesh without being informed of previous surgery
Time Frame: Maximum of 10 minutes for all examination
Without being informed of previous surgery, examiners are to separately diagnose which mesh vs no mesh
Maximum of 10 minutes for all examination
Precision of mesh detection
Time Frame: Maximum of 10 minutes for all examination
Being informed of which surgery, examiners are to separately measure the midsagittal lengths of the mesh.
Maximum of 10 minutes for all examination

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Karolinska Institutet

Investigators

  • Principal Investigator: Edward Morcos, MD, PhD, Karolinska Institutet - Danderyds Sjukhus (KIDS)

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 21, 2018

Primary Completion (Actual)

December 21, 2018

Study Completion (Actual)

December 21, 2018

Study Registration Dates

First Submitted

February 16, 2023

First Submitted That Met QC Criteria

August 12, 2023

First Posted (Actual)

August 21, 2023

Study Record Updates

Last Update Posted (Actual)

August 22, 2023

Last Update Submitted That Met QC Criteria

August 18, 2023

Last Verified

August 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Dnr: 2018/1523-31

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

IPD is only available to the principal investigator.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

Yes

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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