Evidence-based Medicine for Polypropylene Mesh Use Compared With Native Tissue Vaginal Prolapse Repair REPLY
ABSTRACT A review of the current medical literature for the use of polypropylene (PP) mesh for vaginally performed prolapse repair, including only those studies reporting prospective, randomized, controlled trials compared with native tissue repairs was undertaken. Five full manuscript publications and 4 studies still in abstract form were all consistent with PP mesh producing better anatomical results for cystocele repair, but when functional results in terms of the patient's quality of life are considered, no significant difference is found between PP mesh and native tissue repairs. PP mesh use results in better anatomical results in the short term but at a cost of repeated surgeries because of erosions and other complications. Patients do not recognize any added benefit from the use of these prostheses in their daily lives.
Article: Post-hysterectomy Dyspareunia[Show abstract] [Hide abstract]
ABSTRACT: When appropriately performed, hysterectomy most often contributes substantially to quality of life. Postoperative morbidity is minimal, in particular after minimally invasive surgery. In a minority of women, pain during intercourse is one of the more long-lasting sequelae of the procedure. Complete evaluation and treatment of this complication requires a thorough understanding of the status and function of neighboring organ systems and structures (urinary system, gastrointestinal tract, and pelvic and hip muscle groups). Successful resolution of dyspareunia often may be facilitated with review of the patient's previous degree of comfort during sex and the nature of her relationship with her partner. Repeat surgery is needed in a small minority of patients. (C) 2014 Published by Elsevier Inc. on behalf of AAGL.Journal of Minimally Invasive Gynecology 07/2014; 21(4). DOI:10.1016/j.jmig.2014.02.008 · 1.58 Impact Factor
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ABSTRACT: Objective To compare short-term outcomes between prolapse repairs with and without mesh using a national data set. Mesh use in surgical treatment of pelvic organ prolapse has gained wide popularity. However, mesh complications have increased concomitantly with its use. Methods Public Use File data were obtained for a 5% random national sample of female Medicare beneficiaries aged 65 years and older. Women who underwent prolapse surgery were identified using Current Procedural Terminology Coding System, Fourth Edition (CPT-4) codes. Because the code for mesh placement was effected in 2005, we separated patients into 3 cohorts as follows: those who underwent prolapse repairs from 1999 to 2000 (presumably without mesh), those who underwent repairs from 2007 to 2008 (presumably without mesh), and those with mesh (based on CPT-4 code 57267) from 2007 to 2008. One-year outcomes were identified using International Classification of Diseases, Ninth Revision diagnosis and procedure codes and CPT-4 procedure codes. Results A total of 9180 prolapse repairs without mesh were performed from 1999 to 2000, 7729 without mesh from 2007 to 2008, and 1804 prolapse repairs with mesh from 2007 to 2008. Prolapse reoperation within 1 year of surgery was higher in nonmesh vs mesh cohorts (6%-7% vs 4%, P <.02). Mesh removal rates were higher in mesh vs nonmesh group (4% vs 0%-1%, P <.001). Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling. Conclusion Mesh to treat pelvic organ prolapse and stress urinary incontinence was associated with a small decrease in early reoperation for prolapse. This decrease came at the expense of increased rates of pelvic pain, retention, mesh-related complications, and mesh removal.Urology 04/2014; 83(4):768–773. DOI:10.1016/j.urology.2013.10.072 · 2.13 Impact Factor
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ABSTRACT: The objective was to analyse the feasibility, safety and outcome of surgical treatment for pelvic organ prolapse in women ≥ 65 years of age. A single-centre retrospective, cohort study was performed through a medical records review and telephone interview. Women ≥ 65 years of age, who underwent a surgical operation for pelvic organ prolapse, were considered. Overall, 305 women were included. The following procedures (alone or in combination) were performed: 168 (52.1%) vaginal hysterectomy; 264 (81.9%) anterior colporrhaphy; 261 (81.0%) posterior colpoperineorrhaphy and 45 (13.8%) Manchester operation. There were two cases of bladder injury (0.6%) and two cases of vaginal haematoma (0.6%). Urinary retention and febrile morbidity were found in 33 (10.8%) and 35 (11.5%) of women, respectively. Clinical follow-up, median 10 months, showed that 178 of 200 (89.0%) women had anatomical success. Traditional reconstructive surgical operation for pelvic organ prolapse is a viable treatment option in elderly women.Journal of Obstetrics and Gynaecology 07/2014; DOI:10.3109/01443615.2014.936840 · 0.60 Impact Factor