Single incision apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery
IUGA Academy. Sardi J. Jun 30, 2018; 212862; 289 Topic: Pelvic Organ Prolapse

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Single incision apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery

Sardi, J1; Prieto, J2; Gomez, M3; Cosentino, A2; Farias, P3; Maya, G2

1: Hospital Britanico ; 2: Hospital Britanico; 3: TcbA

Introduction: POP causes serious impact on patient’s quality of life. Different surgical approaches have been described to correct it, but there is insufficient information to provide evidence-based recommendations regarding the optimal technique and materials, such as what is the proper shape to use or the best route to perform a more anatomical reconstruction.

Objective: Evaluate the outcomes and complication of a mesh kit that can be inserted via a single anterior incision with the mesh arms through the sacrospinous ligament using TAS to treat apical prolapses

Methods: This is a retrospective study of patients undergoing an apical prolapse surgery between 2013 and 2017 (POP Q ≥ stage III) All patients presenting with symptomatic stage III prolapse or higher were included when a minimum follow-up of 12 months was achieved. A structured interview and clinical examination were performed pre- and postoperatively. Primary outcome was treatment success defined as POP-Q less than or equal to stage I at 1 year. Secondary outcomes included validated quality-of-life measures. All patients were evaluated with transperineal ultrasound to assed anatomic result at least at 12 months of the surgery. The primary objectives were anatomical correction of apical prolapse of POP stage III or greater. Subjective outcome was measured via patient feedback using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), ICIQ-SF. Two-dimensional introit ultrasonography was performed in the third months after surgery and at 1-year follow-up. Descriptive statistics were used for demographic and perioperative data. The paired-samples T test was used for comparison of preoperative and postoperative continuous data. For all comparisons, a value of p < .05 was considered statistically significant. All statistical methods were performed using commercially available software (SPSS).

Results: Postoperative data were available for 65 patients. The mean age was 66.7 years. The anatomic success rate was 95.4% (95% confidence interval, 88.7%-99.1%) for the apical compartment. POP-Q measurements (Aa, Ba, and C) improved significantly (P < 0.001) with no significant changes to TVL (P = 0.2). Related adverse events reported were urinary tract infection (9; 13.8%), transient buttock pain (12; 18.46%), de novo stress incontinence (6; 9.2% four patients received treatment, whereas in the remaining patients the condition was not severe enough to require surgical intervention), dyspareunia (2; 3%), and infected hematoma (2; 3%). All quality-of-life scores significantly improved from baseline (P < 0.001). Four (4) experienced recurrence requiring further surgery. There was concomitant significant improvement in PISQ-12 scores after surgery. A subanalysis of POP quantification measurements at third month and at 1-year postoperative follow-up demonstrated that C point has no descent in 93.8% of the patients. There has been no documented patients with mesh extrusion. No vaginal hysterectomy was performed in any case.

Conclusions: Single-incision mesh surgery for treatment of advanced POP results in improvement in anatomical and quality-of-life outcomes. No mesh exposure was recorded in the first year after surgery; however, new onset of stress urinary incontinence may occur. Ultrasound evaluation demonstrated no descent of the C point.


Work supported by industry: no.

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