Email this article Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up
- Authors: Shkarupa D.D.1, Kubin N.D.1, Popov E.N.2, Shapovalova E.A.1, Kovalev G.V.3, Pisarev A.V.1
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Affiliations:
- N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University
- Research Institute of Obstetrics, Gynecology and Reproductology n.a. D.O. Ott
- North-Western State Medical University named after I.I. Mechnikov
- Issue: Vol 67, No 3 (2018)
- Pages: 55-63
- Section: Articles
- URL: https://journals.rcsi.science/jowd/article/view/9086
- DOI: https://doi.org/10.17816/JOWD67355-63
- ID: 9086
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Abstract
Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction.
Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse.
Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment.
Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.
Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.
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##article.viewOnOriginalSite##About the authors
Dmitry D. Shkarupa
N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University
Author for correspondence.
Email: shkarupa.dmitry@mail.ru
MD, PhD, DSci (Medicine), Сhief Urologist, Deputy Director for Medical Care
Russian Federation, Saint PetersburgNikita D. Kubin
N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University
Email: nikitakubin@gmail.com
MD, PhD
Russian Federation, Saint PetersburgEduard N. Popov
Research Institute of Obstetrics, Gynecology and Reproductology n.a. D.O. Ott
Email: edvardpopov@mail.ru
MD, PhD, DSci (Medicine), the Head of the Department of Operative Gynecology
Russian Federation, Saint PetersburgEkaterina A. Shapovalova
N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University
Email: katerina_andmed@mail.ru
MD, Obstetrician-Gynecologist
Russian Federation, Saint PetersburgGleb V. Kovalev
North-Western State Medical University named after I.I. Mechnikov
Email: kovalev2207@gmail.com
Student
Russian Federation, Saint PetersburgAlexey V. Pisarev
N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University
Email: alexey.v.pisarev@gmail.com
MD
Russian Federation, Saint PetersburgReferences
- Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1037-1045. doi: 10.1007/s00192-009-0902-1.
- Буянова С.Н., Щукина Н.А., Зубова Е.С., и др. Пролапс гениталий // Российский вестник акушера-гинеколога. - 2017. - Т. 17. - № 1. - C. 37-45. [Buyanova SN, Shchukina NA, Zubova ES, et al. Genital prolapse. Rossiiskii Vestnik Akushera-Ginekologa. 2017;17(1):37-45. (In Russ.)]
- Коршунов М.Ю. Пролапс тазовых органов у женщин: персонализированный подход к диагностике, хирургической коррекции и оценке результатов лечения: Автореф. дис. … д-ра мед. наук. - СПб., 2017. [Korshunov MY. Prolapse of pelvic organs in women: a personalized approach to diagnosis, surgical correction and evaluation of treatment outcomes. [dissertation] Saint Petersburg; 2017. (In Russ.)]
- Hendrix SL, Clark A, Nygaard I, et al. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160-1166. doi: 10.1067/mob.2002.123819.
- Kelly HA. Incontinence of urine in women. Urol Cutan Rev. 1913;(17):291-293.
- Lensen EJ, Stoutjesdijk JA, Withagen MI, et al. Technique of anterior colporrhaphy: a Dutch evaluation. Int Urogynecol J. 2011;22(5):557-561. doi: 10.1007/s00192-010-1353-4.
- Maher CM, Feiner B, Baessler K, Glazener CM. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J. 2011;22(11):1445-1457. doi: 10.1007/s00192-011-1542-9.
- Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11:CD004014. doi: 10.1002/14651858.CD004014.pub6.
- Rooney K, Kenton K, Mueller ER, et al. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837-1840. doi: 10.1016/j.ajog.2006.06.065.
- Elliott CS, Yeh J, Comiter CV, et al. The predictive value of a cystocele for concomitant vaginal apical prolapse. J Urol. 2013;189(1):200-203. doi: 10.1016/j.juro.2012.08.177.
- Petros PE. New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge and abnormal emptying. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(5):270-277. doi: 10.1007/BF02765483.
- Шкарупа Д.Д., Кубин Н.Д., Пешков Н.О., и др. Русскоязычные версии опросников для оценки качества жизни больных с пролапсом тазовых органов и стрессовым недержанием мочи // Экспериментальная и клиническая урология. - 2016. - № 1. - C. 94-97. [Shkarupa DD, Kubin ND, Peshkov NO, et al. Russian version of questionnaires for life quality assessment in patients with pelvic organprolapse and stress urinary incontinence. Experimental & Clinical Urology. 2016;(1):94-97. (In Russ.)]
- United States Food and Drug Administration. Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse. FDA; 2011.
- Попов A.A., Мананникова Т.Н., Мачанските О.В., и др. Осложнения экстраперитонеальной кольпопексии (PROLIFT) // Журнал акушерства и женских болезней. - 2009. - T. 58. - № 5. - C. M40. [Popov AA, Manannikova TN, Machanskite OV, et al. Complications of extraperitoneal colpopexia. Journal of Obstetrics and Women’s Diseases. 2009;58(5):M40. (In Russ.)]
- Jacquetin B, Fatton B, Rosenthal C, et al. Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 3-year prospective follow-up study. Int Urogynecol J. 2010;21(12):1455-1462. doi: 10.1007/s00192-010-1223-0.
- Miller D, Lucente V, Babin E, et al. Prospective clinical assessment of the transvaginal mesh technique for treatment of pelvic organ prolapse-5-year results. Female Pelvic Med Reconstr Surg. 2011;17(3):139-143. doi: 10.1097/SPV.0b013e3182175da6.
- MacDonald S, Terlecki R, Costantini E, Badlani G. Complications of transvaginal mesh for pelvic organ prolapse and stress urinary incontinence: tips for prevention, recognition, and management. Eur Urol Focus. 2016;2(3):260-267. doi: 10.1016/j.euf.2016.06.016.
- Amid PK, Shulman AG, Lichtenstein IL, Hakakha M. Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Surg. 1994;379(3):168-171. doi: 10.1007/BF00680113.
- Castellani D, Galica V, Saldutto P, et al. Efficacy and safety of Elevate(R) system on apical and anterior compartment prolapse repair with personal technique modification. Int Braz J Urol. 2017;43(6):1115-1121. doi: 10.1590/S1677-5538.IBJU.2016.0233.
- Su TH, Lau HH, Huang WC, et al. Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study. Int Urogynecol J. 2014;25(7):901-908. doi: 10.1007/s00192-013-2294-5.
- Rapp DE, King AB, Rowe B, Wolters JP. Comprehensive evaluation of anterior elevate system for the treatment of anterior and apical pelvic floor descent: 2-year followup. J Urol. 2014;191(2):389-394. doi: 10.1016/j.juro.2013.08.023.
- 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. doi: 10.1016/j.ijgo.2015.10.016.
- Никитин А.Н., Ищенко А.И. Методика OPUR для хирургической коррекции урогенитального пролапса. Первый опыт в России // Журнал акушерства и женских болезней. - 2016. - Т. 65. - № S. - С. 58-59. [Nikitin AN, Ishchenko AI. OPUR technique for surgical correction of urogenital prolapse. First experience in Russia. Journal of Obstetrics and Women’s diseases. 2016;65(S):58-59. (In Russ.)]
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