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Anterior-apical single-incision mesh surgery (Uphold): outcomes on lower urinary tract symptoms, anatomy and ultrasonography at 1 year
IUGA Academy. Lo T. Jun 30, 2018; 212828; 283 Topic: Pelvic Organ Prolapse
Prof. Tsia-Shu Lo
Prof. Tsia-Shu Lo

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283

Anterior-apical single-incision mesh surgery (Uphold): outcomes on lower urinary tract symptoms, anatomy and ultrasonography at 1 year

Lo, T1; Kao, C1; Hsieh, W1; Ibrahim, R2; Nusee, Z3; Tseng, L4

1: ChangGung Memorial Hospital, Keelung, Taiwan; 2: Al-Bashir Hospital, Amman, Jordan; 3: Obstetrics & Gynecology, International Islamic, University, Kuantan, Pahang, Malaysia; 4: ChangGung Memorial Hospital, Linko, Taiwan

Introduction: The UpholdTM vaginal mesh system is designed for apical/anterior support with proximal mesh placement on bilateral sacrospinous ligament and no distal anchorage. With the smaller mesh footprint and plausibly lesser paravesical dissection, we study its surgical outcomes, including its morphology and whether this mesh system with no caudal fixation and plausibly lesser paravesical dissection would predisposes to urodynamic stress incontinence (USI).

Objective: Our primary objective is to see the presence of USI after 12 months on UpholdTM System surgery. Secondary objective is to find the objective and subjective outcomes of POP.

Materials and Methods: A retrospective study done between February 2015 and July 2016 on patients with symptomatic anterior or apical prolapse with POPQ stage?III who undergone pelvic reconstructive surgery (PRS) using UpholdTM LITE. Exclusion criteria were previous PRS with mesh augmentation and previous anti-incontinence procedures. Patients were asked to complete a 3-days voiding diary, urodynamics, sonography and validated questionnaires IIQ-7, UDI-6 POPDI-6, CRADI-8, PISQ-12 at baseline and 12 months follow-up. The primary outcome is the absence of USI. Secondary outcomes include objective cure rate of POP, stage≤1 at anterior/apical vaginal wall and subjective cure rate, negative feedback to POPDI-6. The comparison of two-dimensional introital ultrasonography at first, third months and 1-year after surgery were also measured as the secondary outcome.

Results: 89 were included. Mean age was 64.7±9.2 year old. Median follow-up was 18.3±4.8 months. Vaginal hysterectomy (92%), trans-obturator tape (16%) posterior colporraphy (100%) was concomitant. Complications were minor with a case of bladder injury (1%). The post-operative de novo USI and SUI was 22.7% and 19.7% respectively. There was significant improvement of USI in patients who had MUS insertion (93.8%) and bladder outlet obstruction (96.7%). On the other hand, patients who had USI pre-operatively and have no concurrent MUS, 6 out of 7 (85.7%, p=0.733) persist with USI post-operatively. 22 patients presented with USI preferred to treat with conservative treatment and none requested for anti-SUI surgery. As for urodynamic, there were significant improvements in residual volume, MUCP, FUL and Dmax. POP-Q measurements at pre-operative and post-operative were significantly improved at all points except for Gh and Pb. As for sonography, there was significant difference of the distance between bladder neck (BN) to the distal end of mesh during straining (TVM-BN-strain) both at post-operative 3rd month and 1 year. As for the length and thickness of the mesh (TVM-T), a significant difference at 1 year post-operatively as compared to 3rd months after surgery was revealed. There was significant improvement on the scores for UDI-6, IIQ-7, POPDI-6, (CRADI-8), and PISQ-12 at pre and one-year post surgery.

Conclusion: De novo USI was high in patient with uphold but were not bothersome to require surgical intervention. UpholdTM mesh has short-term objective and subjective cure rate of anterior and apical prolapse with low mesh complication. POP-Q findings of lengthening of the point C and total vaginal length were supported by ultrasound which showed an increase in mesh length over one year follow up.

Disclosure:

Work supported by industry: no.

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