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Outcome after transvaginal surgery using self-cut mesh for pelvic organ prolapse: 3-year follow up
IUGA Academy. Gonocruz S. Jun 30, 2018; 212896
Topic: Pelvic Organ Prolapse
Sheryl Gonocruz
Sheryl Gonocruz

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484

Outcome after transvaginal surgery using self-cut mesh for pelvic organ prolapse: 3-year follow up

Gonocruz, S1; Nomura, J1; Moriyama, S1; Tokiwa, S1; Hayashi, T1; Sawada, Y1; Huang, T1; Krisna, R1; Meutia, A2

1: Kameda Medical Center; 2: Faculty of Medicine University of Indonesia

Introduction: Transvaginal mesh surgery (TVM) is currently considered as management of pelvic organ prolapse (POP) especially in recurrent cases. However, we hypothesized that TVM surgery can be one of safe, effective and cost-efficient option even for primary management of POP in carefully selected patients.

Objective : To evaluate the subjective and objective outcomes, complication, recurrence and reoperation rate following TVM.

Methods: This was a retrospective analysis of TVM performed using self-cut mesh measuring subjective outcome using validated questionnaires and objective outcomes using Pelvic Organ Prolapse Quantification (POPQ) and uroflowmetry. Careful selection was made for patients planned for TVM. Patients diagnosed with POP Stage > 2 were counseled about all possible surgical options and for those who refuse either hysterectomy, colpocleisis or general anesthesia are potential subjects for TVM. After thorough explanation about benefit and risk of complication during TVM surgery, patient who signed consent accepting the potential risk of TVM complication was scheduled for surgery. We performed TVM to both primary and recurrent cases in which all use spinal anesthesia. The procedures were performed by experienced urogynecologist with standardized technique and materials. Intraoperative and postoperative complications were assessed. Patients were evaluated at 1 year and 3 years postoperatively.

Results: One hundred one patients were included in this study by completing a minimum of 3-year follow-up. One year and 3-year follow up showed significant improvement both on subjective and objective outcomes. Recurrences were observed in 3 patients (3%) with 1 (1%) patient underwent reoperation. One case (1%) of intraoperative complication (bladder injury) and 4 cases of (4%) postoperative complications (1 mesh exposure, 1 hematoma and 1 significant increase in PVR were recorded. Patient satisfaction comment was positively documented.

Conclusions: TVM using self- cut mesh is associated with significant improvement in both subjective and objective outcomes, offering low recurrence and complication rate and high patient satisfaction rates. It can be a safe, effective and cost efficient option not only for recurrent cases but also as primary management of POP using standardized technique and proper selection of patients.

Subjective and Objective Outcomes in 1 year and 3 years follow- up

Variables Preoperative 1-year follow-up 3 years follow-up

OABSS

Q1 (daytime frequency) 0.6 0.4 a 0.5 a

Q2 (night time frequency) 1.3 1.1 a 1.1 a

Q3 (urinary urgency) 1.7 0.7 a 1.0 a

Q4 (urge incontinence) 1.1 0.6 a 0.6 a

Total score 4.8 2.7 a 3.1a

QOL 4.1 1.6 a 1.6 a

ICIQ

Q1 1.5 1.0 a 0.8 a

Q2 1.7 1.1a 1.0 a

Q3 2.8 1.0a 1.0 a

Total score 6.0 3.2 a 2.8 a

CRADI-8

Q7 (Strain) 1.4 0.7 a 0.7 a

Q8 (Not completely emptied) 1.3 0.7 a 0.8 a

Q9 (Loose stool -well formed) 0.6 0.1 a 0.2 a

Q10 (Loose stools -beyond control) 0.8 0.3 a 0.3 a

Q11 (Gas) 1.5 0.9 a 0.8 a

Q12 (Pain) 0.3 0.1 a 0.1 a

Q13 (Urgency) 0.9 0.4 a 0.3 a

Q14 (Bulge) 0.8 0.1 a 0.1 a

Uroflometry

VV (ml) 327.7 + 130.2 295.7 + 98.2a 288.4 + 101.7a

Qmax (ml/s) 20.1 + 10.1 20.2 + 9.9b 18.6 + 8.0a

Qave 12.6 + 6.0 11.6 + 5.2a 11.4 + 16.5a

PVR (ml) 27.6 + 42.4 18.0 + 21.8a 13.8 + 22.7a

POP-Q Scores

Aa +1 -2.9 a -2.9 a

Ba +3.0 -2.9 a -2.9 a

C +1.5 -6.6 a -6.4 a

Gh 5.0 3.7 a 3.4 a

Pb 3.6 3.6 b 3.5 b

TVL 8.0 7.5 a 7.4 a

Ap -0.1 -2.9 a -2.9 a

Bp -0.8 -2.9 a -2.8 a

D -2.5 -7.7 a -7.3 a

Values are expressed as the mean; Wilcoxon signed-rank test

a: p<0.01 versus preoperative, b: p>0.05 versus preoperative

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Work supported by industry: no.

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