Clinical Outcomes and Urodynamic Effects of Tailored Transvaginal Mesh Surgery for Pelvic Organ Prolapse

Ting-Chen Chang, Sheng-Mou Hsiao, Chi-Hau Chen, Wen-Yih Wu, Ho-Hsiung Lin, Ting-Chen Chang, Sheng-Mou Hsiao, Chi-Hau Chen, Wen-Yih Wu, Ho-Hsiung Lin

Abstract

Objective: To evaluate the clinical outcomes and urodynamic effects of tailored anterior transvaginal mesh surgery (ATVM) and tailored posterior transvaginal mesh surgery (PTVM).

Methods: We developed ATVM for the simultaneous correction of cystocele and stress urinary incontinence and PTVM for the simultaneous correction of enterocoele, uterine prolapse, vaginal stump prolapse, and rectocele.

Results: A total of 104 women enrolled. The median postsurgical follow-up was 25.5 months. The anatomic cure rate was 98.1% (102/104). Fifty-eight patients underwent urodynamic studies before and after surgeries. The pad weight decreased from 29.3 ± 43.1 to 6.4 ± 20.9 g at 3 months. Among the 20 patients with ATVM, 13 patients had objective stress urinary incontinence (SUI) at baseline while 8 patients came to have no demonstrated SUI (NDSUI), and 2 improved after surgery. Among the 38 patients who underwent ATVM and PTVM, 24 had objective SUI at baseline while 18 came to have NDSUI, and 2 improved after surgery. Mesh extrusion (n = 4), vaginal hematoma (n = 3), and voiding difficulty (n = 2) were noted postoperatively. Quality of life was substantially improved.

Conclusions: Our findings document the advantages of these two novel pelvic reconstructive surgeries for pelvic organ prolapse, which had a positive impact on quality of life. ATVM surgery additionally provided an anti-incontinence effect. This clinical trial is registered at ClinicalTrials.gov (NCT02178735).

Figures

Figure 1
Figure 1
Components of the anterior transvaginal tailored mesh surgical procedure. (a) Separation of the bladder from the anterior vagina. White dotted circles indicate the area of the bladder base. (b) Use of the purse-string suture technique to reduce the cystocele size. The white dotted circles indicate the area of the reduced bladder base. (c) A drawing of the diamond body with its four arms and the polypropylene mesh (Gynemesh, 15 × 10 cm), which was trimmed according to the required shape. (d) Custom-tailored mesh with central diamond body and four arms. (e) Complete positioning of the body and arms of the mesh beneath the bladder, with the head of the diamond body underneath the bladder neck and proximal urethra without tension.
Figure 2
Figure 2
Components of the posterior transvaginal tailored mesh surgical procedure. (a) Separation of the rectum until the posterior fornix of the cervix is separated from the posterior vagina. (b) Drawing of the grasshopper body with its six arms and the polypropylene mesh (Gynemesh, 15 × 10 cm). (c) Custom-tailored mesh with the central grasshopper body and six arms. (d) Fixation of the head of the grasshopper-shaped portion to the posterior upper cervix and the insertion of the P1 and P2 arms into the bilateral uterosacral space without fixation. The P3 and P4 arms have already been inserted through the buttocks. (e) Complete positioning of the body and arms of the mesh covering the entire upper surface of the rectum without tension, with the exception of the P1 and P2 arms, which are to be inserted into the bilateral uterosacral spaces without fixation. The redundant tail part of the mesh will be trimmed to an appropriate length.

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