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.
[Show abstract][Hide abstract] ABSTRACT: Genitaldeszensus in der zweiten Lebenshälfte ist sehr häufig und kann mit Fremdkörper- oder Senkungsgefühl, Miktions- und Defäkationsstörungen oder sogar mit Ulzerationen einhergehen. Wenn die konservative Behandlung mit Physiotherapie und Pessartherapie ausgeschöpft ist, hat die klassische Deszensuschirurgie ihren Platz.
Beim Genitaldeszensus handelt es sich um eine Senkung der vorderen oder hinteren Vaginalwand mit Tiefertreten von Blase oder Rektum (Zysto- oder Rektozele)oder des Apex (Deszensus uteri bzw. Vaginalstumpfdeszensus nach Hysterektomie).
[Show abstract][Hide abstract] ABSTRACT: Native tissue repair of the anterior vaginal wall was thought to have a poor success rate based on anatomic outcome. This high rate of anatomic failure was often quoted as the underlying reason for performing mesh-augmented prolapse repair. The purpose of this article is to review the outcomes of native tissue repair of anterior vaginal prolapse repair in the mesh era.
Success in pelvic organ prolapse surgery has been redefined. The contemporary definition of success includes the absence of symptoms associated with a vaginal bulge, which correlates best with a patient's perception of success. When this concept is applied to 12 randomized controlled trials that compared native tissue anterior colporrhaphy and mesh repairs for anterior vaginal wall prolapse, it is apparent that although mesh repair had superior anatomic success (38-93 vs. 27-71%), both mesh and native tissue repair had excellent rates of symptomatic success (75-96 and 62-100%, respectively). Taken together, the overall reoperation rate for native tissue repair was 5.0% compared with 9.0% for mesh-augmented repair.
Although anatomic stage 0 results are not achieved in many cases, patients do experience symptomatic relief and improvement in their quality of life, only seeking retreatment in a small proportion of cases with anatomic recurrence. Thus, the definition of success must include subjective symptom-based outcome in addition to anatomic outcome. In addition, the degree of later complications, including additional surgeries, must also be taken into account when defining success based on patient satisfaction.
Current opinion in urology 05/2012; 22(4):265-70. DOI:10.1097/MOU.0b013e32835459bb · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction and hypothesis:
In surgery for pelvic organ prolapse (POP) the use of alloplastic meshes has become common. Among possible complications, mesh exposure is the most frequent problem. It is hypothesized that exposure rates are correlated to mesh weight and the amount of foreign material. Therefore, we conducted a prospective open-label randomized multicenter trial comparing a conventional polypropylene mesh (PP) with a partially absorbable polypropylene mesh (PA) for cystocele treatment.
A total of 200 patients with POP > stage I were randomized either to a conventional or a partially absorbable mesh. Exposure rates were observed after 3, 12, and 36 months and correlated to mesh material, patient characteristics, intraoperative data, and treatment centers. Furthermore, management of mesh exposure, satisfaction with surgery, and postoperative pain were evaluated.
At all follow-up intervals mesh exposure rate was smaller in the group of the partially absorbable mesh (3 months PP 11.3 % vs PA 3.2 %, p=0.0492; 12 months 6.6 % vs 6.3 %; 36 months 7.5 % vs 3.4 %). Over the course of time, mesh exposure was observed in 27 patients, with surgical intervention necessary in 11 patients. The rate of recurrent POP was higher (p>0.05) in patients with the partially absorbable mesh. The majority of patients were fully satisfied with the operation (52.8 %) and had no pelvic floor pain (67.5 %).
In this prospective, randomized trial with a long-term follow-up there was a low exposure rate in both treatment groups with a trend toward fewer exposures in the group of the partially absorbable mesh.
International Urogynecology Journal 08/2012; 24(5). DOI:10.1007/s00192-012-1929-2 · 1.96 Impact Factor
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