A Novel Operative Procedure for Pelvic Organ Prolapse Utilizing a MRI-Visible Mesh Implant: Safety and Outcome of Modified Laparoscopic Bilateral Sacropexy

Ralf Joukhadar, Gabriele Meyberg-Solomayer, Amr Hamza, Julia Radosa, Werner Bader, Dimitri Barski, Fakher Ismaeel, Guenther Schneider, Erich Solomayer, Sascha Baum, Ralf Joukhadar, Gabriele Meyberg-Solomayer, Amr Hamza, Julia Radosa, Werner Bader, Dimitri Barski, Fakher Ismaeel, Guenther Schneider, Erich Solomayer, Sascha Baum

Abstract

Introduction: Sacropexy is a generally applied treatment of prolapse, yet there are known possible complications of it. An essential need exists for better alloplastic materials.

Methods: Between April 2013 and June 2014, we performed a modified laparoscopic bilateral sacropexy (MLBS) in 10 patients using a MRI-visible PVDF mesh implant. Selected patients had prolapse POP-Q stages II-III and concomitant OAB. We studied surgery-related morbidity, anatomical and functional outcome, and mesh-visibility in MRI. Mean follow-up was 7.4 months.

Results: Concomitant colporrhaphy was conducted in 1/10 patients. Anatomical success was defined as POP-Q stage 0-I. Apical success rate was 100% and remained stable. A recurrent cystocele was seen in 1/10 patients during follow-up without need for intervention. Out of 6 (6/10) patients with preoperative SUI, 5/6 were healed and 1/6 persisted. De-novo SUI was seen in 1/10 patients. Complications requiring a relaparoscopy were seen in 2/10 patients. 8/10 patients with OAB were relieved postoperatively. The first in-human magnetic resonance visualization of a prolapse mesh implant was performed and showed good quality of visualization.

Conclusion: MLBS is a feasible and safe procedure with favorable anatomical and functional outcome and good concomitant healing rates of SUI and OAB. Prospective data and larger samples are required.

Figures

Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
Figure 4
Figure 4
Figure 5
Figure 5
Correction of prolapse in each compartment. The dots correlate to the mean measurements of Aa, Ba, C, D, Ap, and Bp. Red line: lines out the preoperative status (POP-Q measurements). Green line: lines out the postoperative status (POP-Q measurements) before discharge.
Figure 6
Figure 6
Coronal subvolume minimum intensity projection of a T2-weighted dataset, displaying the implant with a low signal intensity (arrows), comparable to the signal of muscle tissue.
Figure 7
Figure 7
Same patient as in Figure 6, this time a T1-weighted dataset, again with a coronal subvolume minimum intensity projection. Using the T1-weighted images, the contrast between the implant and the surrounding tissue is even better. Due to the iron oxide particles, a signal loss in the area of the implant is obvious (arrows), which allows for exact identification of the implant.

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Source: PubMed

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