Sonographic assessment of mesh placement after laparoscopic sacrocolpopexy
IUGA Academy. Rusavy Z. Jun 30, 2018; 212797; 335 Topic: Pelvic Organ Prolapse
Dr. Zdenek Rusavy
Dr. Zdenek Rusavy

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Sonographic assessment of mesh placement after laparoscopic sacrocolpopexy

Rusavy, Z1; Smazinka, M1; Havir, M1; Kalis, V1

1: University Hospital and Medical Faculty in Pilsen, Charles University

Introduction: Laparoscopic sacrocolpopexy is currently considered a gold standard for treatment of apical pelvic organ prolapse. Proper placement of the mesh is paramount for long-term success as well as reduction of complications such as mesh extrusion. Ultrasound seems to be a suitable method for assessment of the placement of the mesh, however, no clear methodology has been proposed.

Objective: The aim of this study was to assess the placement of the mesh at three months after laparoscopic sacrocolpopexy and determine the success rate of intended mesh implantation.

Methods: All women attending a 3-month follow-up visit after laparoscopic sacrocolpopexy for apical pelvic organ prolapse in 2016 were included in this prospective ultrasound cohort study. Mesh position and placement were evaluated using transperineal and transvaginal ultrasound. The following four composite criteria for properly placed mesh were created; distance of the lowest margin of the anterior leaf of the mesh from the bladder neck < 20 mm, regular shape of the mesh upon visualization of the whole mesh, no folding and no mesh descent > 20 mm on Valsalva. Mesh margins were considered where the typical echogenic mesh appearance could no longer be seen. The vaginal approach was chosen to approximate the transducer as closely to the mesh for better visualization and to allow assessment of the vaginal wall and mesh upon stretch where necessary. Folding was defined as doubling over of mesh, creating two or more layers of mesh in one location. Mesh descent was defined as more than 20mm mobility of the mesh at the level of cervix/vaginal apex on Valsalva.

Results: In total, 113 women were enrolled in the study. Mesh could not be visualized transperineally in 26 (23%) women and transvaginal approach for mesh visualization had to be used. All parameters for composite criteria of intended mesh placement could be assessed in 105 (93%) women. However, the distance of the lowest margin of anterior leaf of the mesh from the bladder neck could be visualized in all 113 cases. The distance was < 20 mm in 105 (93%) cases. Shape of the mesh was regular in 97 (92%) of 105 assessable cases. Mesh folding was observed in 11 (10%) of 107 visualizable cases and a significant mesh descent on Valsalva was observed in 2 (2%) of 107 cases. Overall, according to the devised composite criteria the mesh placement, the mesh was inserted as intended in 82 (78%) of 105 women.

Conclusions: Ultrasound seems to be a useful tool for visualizing mesh after laparoscopic sacrocolpopexy. Most assessments were possible by transperineal ultrasound, in 23% of cases transvaginal ultrasound had to be used for proper mesh visualization. All proposed criteria for properly placed mesh were assessable in 93% of cases. There is a need for standardization of ultrasound examination of the mesh in patients after sacrocolpopexy.


Work supported by industry: no.

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