Evidence-based Medicine for Polypropylene Mesh Use Compared With Native Tissue Vaginal Prolapse Repair REPLY

ArticleinUrology 79(1):12-4 · November 2011with14 Reads
DOI: 10.1016/j.urology.2011.07.1438 · Source: PubMed
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.
    • "Some of these complications are irreversible pelvic pain, vaginal shortening, severe vaginal pain and dyspareunia (Elliott 2012). Furthermore, a recent review concluded that polypropylene mesh use results in better anatomical results in the short term but at a cost of repeated surgeries because of erosions and other complications (Ostergard 2012). Modern defi nitions of success based on the absence of vaginal bulge symptoms reconfi rm that anterior colporrhaphy is an excellent surgical option with a lower risk of complications than mesh-augmented prolapse repair. "
    [Show abstract] [Hide abstract] 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.
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    Full-text · Article · Jan 2012 · Current opinion in urology
  • [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.
    Article · May 2012
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