Anterior intravaginal slingplasty tunneller device for stress incontinence and posterior intravaginal slingplasty for apical vault prolapse: a 2-year prospective multicenter study. Am J Obstet Gynecol 197(1):104 e1-8

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 08/2007; 197(1):104.e1-8. DOI: 10.1016/j.ajog.2007.03.056
Source: PubMed


The purpose of this study was to report the outcome for (1) anterior intravaginal slingplasty in the treatment of urodynamic stress incontinence and (2) posterior intravaginal slingplasty for apical prolapse (> or = stage II).
This was a 2-year prospective multicenter study: patients, 430; anterior intravaginal slingplasty, 144; posterior intravaginal slingplasty, 164; both procedures, 122 (552 tapes total). At 6 and 12 months, the results of the Pelvic Floor Impact Questionnaire, cough stress test, and Pelvic Organ Prolapse Quantitation were assessed. Statistical analyses used paired t-tests.
Of the women in the study, 95% (42 women) had a negative cough stress test result through 12 months (n = 44 women), and 96% (127 women) had a negative cough stress test result at 6 months (n = 132). At 6 months, apical support was optimal in 95.3% (143/150 women) and was satisfactory in 2.7% (4/150 women) and at 12 months, 98.1% (52/53 women), 1.9% (1/53 women). Seventeen of 430 patients (4.0%) had vaginal mesh extrusion. Pelvic Floor Impact Questionnaire scores significantly improved (P < .0001).
Anterior intravaginal slingplasty and posterior intravaginal slingplasty are safe and effective when performed with other procedures. For anterior intravaginal slingplasty, the rates of perforation and retention are low, but early extrusions are seen. Patients showed improvements in the Pelvic Floor Impact Questionnaire, regardless of extrusion.

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    • "According to the Austrian registry, 7 of 577 (1.2%) patients were reported to have increased intraoperative bleeding [19]. This complication is more related to the concomitant surgeries, especially hysterectomy, than to the procedure of P-IVS [18,19]. Although hematomas requiring reoperation were reported in 0.9% of cases [19]; generally, the bleeding could be managed conservatively without surgical intervention [10,18,19]. "
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    ABSTRACT: We aimed to evaluate the anatomical and functional outcomes of posterior intravaginal slingplasty (P-IVS) for the treatment of a vaginal vault or uterine prolapse (VP/UP). This was a 12-month prospective, multicenter, observational study. Women aged over 30 years who presented with stage II or greater VP/UP underwent P-IVS by four urologists at four university hospitals. Preoperatively, pelvic examination by use of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Pelvic Floor Distress Inventory (PFDI) questionnaire, the 3-day frequency volume chart, and uroflowmetry were completed. At the 12-month follow-up, changes in the POP-Q, PFDI, frequency volume chart, and uroflowmetry parameters were assessed. Cure was defined as VP/UP stage 0 and improvement as stage I. The cure and improvement rates among the 32 women were 65.6% and 34.4%, respectively. All subscale scores of the Urinary Distress Inventory, the general subscale score of the Pelvic Organ Prolapse Distress Inventory, and the rectal prolapse subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. There were no significant changes in the frequency volume chart or uroflowmetry parameters. There was one case of surgery-related transfusion. Trans-vaginal repair by P-IVS is an effective and safe procedure for restoring the anatomical defect and improving the associated pelvic floor symptoms in women with VP/UP.
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    ABSTRACT: An ever-growing, aging population increases demand for effective, minimally invasive surgeries for pelvic organ prolapse (POP). The most recent urogynecologic debate relates to the use of mesh kits for the transvaginal placement of synthetic grafts to surgically repair POP. Recent publications demonstrate improved outcomes compared with traditional endogenous tissue suture repairs, yet many question the use of these kits due to complications and lack of long-term related research. Some believe that proper technique and training enable patients to achieve durable outcomes with low morbidity via a minimally invasive, cost-effective surgical approach. However, because these kits are often used by novice surgeons with little understanding of pelvic floor anatomy and traditional repairs, others urge caution before their routine use and implementation. Further, some believe that surgeons must not always wait for robust level I support, but others insist that the medical community should encourage restraint and promote well-designed prospective studies comparing these kits to traditional repairs before subjecting patients to potentially harmful, ineffective products. This article presents arguments in favor and against transvaginal placement of synthetic grafts to repair POP.
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