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Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation
Affiliations- Department of Obstetrics and Gynecology, Fryderyk Chopin University Hospital No 1, Faculty of Medicine, Rzeszow University, Rzeszow, Poland, Poland
open access
Abstract
Objectives: Analysis of feasibility, efficacy and short-term results after six-arm transvaginal mesh OPUR implantation in women with apical prolapse.
Material and methods: The same surgeon operated all of 39 women using mesh OPUR. Preoperatively patients had a standardized interview and clinical examination. Intraoperative and postoperative complications were analyzed. Postoperative evaluation included standardized interview, clinical examination and standardized pelvic floor ultrasound performed with 2D transvaginal probe and 4D abdominal probe.
Results: There was no complication that needed operative intervention. Hematomas in 3 patients resolved spontaneously. Transient voiding difficulties which lasted less than 7 days were observed in 5 patients. No erosion was observed. Comparison of pre- and postoperative results in 34 women revealed that in all 3 compartments improvement in POP-Q scale was statistically significant (p < 0.0000). One patient with malposition and rolled up mesh needed re-operation. During PFS-TV in 94.1% of patients urethra was normobile or hypermobile. In all of the patients urethral end of the mesh was positioned far enough from the middle part of the urethra (ultrasound) to implant suburethral sling without risk of collision. Sexually active women did not inform of any important discomfort or pain during intercourse.
Conclusions: It seems that six-arm OPUR mesh, if implanted under strict surgical rules, gives low risk of complications and high chance to successfully reduce POP symptoms in short term after the operation. It seems that OPUR mesh should not have negative influence on the results after anti-incontinence suburethral sling.
Abstract
Objectives: Analysis of feasibility, efficacy and short-term results after six-arm transvaginal mesh OPUR implantation in women with apical prolapse.
Material and methods: The same surgeon operated all of 39 women using mesh OPUR. Preoperatively patients had a standardized interview and clinical examination. Intraoperative and postoperative complications were analyzed. Postoperative evaluation included standardized interview, clinical examination and standardized pelvic floor ultrasound performed with 2D transvaginal probe and 4D abdominal probe.
Results: There was no complication that needed operative intervention. Hematomas in 3 patients resolved spontaneously. Transient voiding difficulties which lasted less than 7 days were observed in 5 patients. No erosion was observed. Comparison of pre- and postoperative results in 34 women revealed that in all 3 compartments improvement in POP-Q scale was statistically significant (p < 0.0000). One patient with malposition and rolled up mesh needed re-operation. During PFS-TV in 94.1% of patients urethra was normobile or hypermobile. In all of the patients urethral end of the mesh was positioned far enough from the middle part of the urethra (ultrasound) to implant suburethral sling without risk of collision. Sexually active women did not inform of any important discomfort or pain during intercourse.
Conclusions: It seems that six-arm OPUR mesh, if implanted under strict surgical rules, gives low risk of complications and high chance to successfully reduce POP symptoms in short term after the operation. It seems that OPUR mesh should not have negative influence on the results after anti-incontinence suburethral sling.
Keywords
pelvic organ prolapse, apical prolapse, six-arms transvaginal mesh, pelvic floor ultrasound, PFS-TV, transvaginal probe
About this articleTitle
Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation
Journal
Issue
Article type
Research paper
Pages
302-306
Published online
2017-06-30
Page views
1648
Article views/downloads
2015
DOI
Pubmed
Bibliographic record
Ginekol Pol 2017;88(6):302-306.
Keywords
pelvic organ prolapse
apical prolapse
six-arms transvaginal mesh
pelvic floor ultrasound
PFS-TV
transvaginal probe
Authors
Tomasz Kluz
Edyta Wlaźlak
Grzegorz Surkont
References (27)- Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89(4): 501–506.
- Alas AN, Anger JT. Management of apical pelvic organ prolapse. Curr Urol Rep. 2015; 16(5): 33.
- Maher C, Feiner B, Baessler K, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016; 10: CD012376.
- Murphy M, Holzberg A, van Raalte H, et al. Pelvic Surgeons Network. Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication: "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse". Int Urogynecol J. 2012; 23(1): 5–9.
- Guyomard A, Delorme E. Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh. Int J Gynaecol Obstet. 2016; 133(3): 365–369.
- Shek KL, Dietz HP. Assessment of pelvic organ prolapse: a review. Ultrasound Obstet Gynecol. 2016; 48(6): 681–692.
- Wlaźlak E, Surkont G, Shek KaL, et al. Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data? Eur J Obstet Gynecol Reprod Biol. 2015; 193: 114–117.
- Dietz HP. Pelvic floor ultrasound in incontinence: what's in it for the surgeon? Int Urogynecol J. 2011; 22(9): 1085–1097.
- Viereck V, Kuszka A, Rautenberg O, et al. Do different vaginal tapes need different suburethral incisions? The one-half rule. Neurourol Urodyn. 2015; 34(8): 741–746.
- Wlaźlak E, Kociszewski J, Suzin J, et al. Urethral length measurement in women during sonographic urethrocystography – an analysis of repeatability and reproducibility. J Ultrason. 2016; 16(64): 25–31.
- Piskunowicz M, Świętoń D, Rybczyńska D, et al. Comparison of voiding cystourethrography and urosonography with second-generation contrast agents in simultaneous prospective study. J Ultrason. 2016; 16(67): 339–347.
- Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1): 10–17.
- Kociszewski J, Rautenberg O, Kuszka A, et al. Can we place tension-free vaginal tape where it should be? The one-third rule. Ultrasound Obstet Gynecol. 2012; 39(2): 210–214.
- Kociszewski J, Rautenberg O, Kolben S, et al. Tape functionality: position, change in shape, and outcome after TVT procedure – mid-term results. Int Urogynecol J. 2010; 21(7): 795–800.
- Wlazlak E, Viereck V, Surkont G, et al. The significance of urethral funneling and urine flow (pf-ultrasound) in evaluating stress urinary incontinence [Abstract]. Poster ICS 2014; Rio de Janeiro 20th–24th October 2014. Available from: www ics org/Abstracts/Publish/218. ; 000234: pdf.
- Wlaźlak E, Viereck V, Kociszewski J, et al. Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion. Neurourol Urodyn. 2017 [Epub ahead of print].
- Viereck V, Pauer HU, Hesse O, et al. Urethral hypermobility after anti-incontinence surgery – a prognostic indicator? Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17(6): 586–592.
- Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005; 25(6): 580–585.
- Dietz HP, Bernardo MJ, Kirby A, et al. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011; 22(6): 699–704.
- Viereck V, Rautenberg O, Kociszewski J, et al. Midurethral sling incision: indications and outcomes. Int Urogynecol J. 2013; 24(4): 645–653.
- Kociszewski J, Kolben S, Barski D, et al. Complications following tension-free vaginal tapes: accurate diagnosis and complications management. Biomed Res Int. 2015; 2015: 538391.
- Misraï V, Rouprêt M, Cour F, et al. De novo urinary stress incontinence after laparoscopic sacral colpopexy. BJU Int. 2008; 101(5): 594–597.
- Brubaker L, Nygaard I, Richter HE, et al. Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol. 2008; 112(1): 49–55.
- Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010; 22(4): CD004014–1457.
- Ouzaid I, Hermieu JF, Misraï V, et al. [Transvaginal repair of genital prolapse using the Prolift technique: a prospective study]. Prog Urol. 2010; 20(8): 578–583.
- Feiner B, Jelovsek JE, Maher C. Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG. 2009; 116(1): 15–24.
- Lowman JK, Jones LA, Woodman PJ, et al. Does the Prolift system cause dyspareunia? Am J Obstet Gynecol. 2008; 199(6): 707.e1–707.e6.
