Investig Clin Urol.  2018 Mar;59(2):133-140. 10.4111/icu.2018.59.2.133.

Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse

• Takazawa N
• Fujisaki A
• Yoshimura
• Tsujimura
• Horie S

• KMID: 2404983
• DOI: http://doi.org/10.4111/icu.2018.59.2.133

Abstract

PURPOSE
This study aimed to evaluate the clinical outcomes and complications of transvaginal minimal mesh repair without using commercially available kits for treatment of pelvic organ prolapse (POP).
MATERIALS AND METHODS
This retrospective cohort study involved 91 women who underwent surgical management of POP with originally designed small mesh between July 2014 and August 2015. This mesh is 56% smaller than the mesh widely used in Japan, and it has only two arms delivered into each right and left sacrospinous ligament. The main study outcome was the anatomic cure rate defined as recurrence of POP quantification (POP-Q) stage II or more. We also assessed changes in the overactive bladder symptom score (OABSS) and prolapse quality of life questionnaire (P-QOL) and evaluated adverse events. Finally, we compared patient backgrounds between the patients with and without recurrence.
RESULTS
Prolapse recurred in 10 of 91 patients (11.0%), and all patients with recurrence were diagnosed as POP-Q stage II. As adverse events, only mesh erosion occurred in two (2.2%) and pelvic pain in one (1.1%) of the 91 patients. The OABSS and P-QOL were significantly improved by the operation. When we compared patient backgrounds between the patients with and without recurrence, body mass index was the only factor influencing affecting recurrence.
CONCLUSIONS
Transvaginal minimal mesh repair resulted in successful outcomes with low mesh-related complications and anatomic recurrence at one year. Furthermore, significant improvement in QOL was offered by this procedure. Our minimal mesh technique should be considered as one treatment option for the management of POP.

Keyword

Pelvic organ prolapse; Reconstructive surgical procedures; Surgical mesh

MeSH Terms

Arm
Body Mass Index
Cohort Studies
Female
Humans
Japan
Ligaments
Pelvic Organ Prolapse*
Pelvic Pain
Prolapse
Quality of Life
Reconstructive Surgical Procedures
Recurrence
Retrospective Studies
Surgical Mesh
Urinary Bladder, Overactive

Figure

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  Fig. 1 Avulsion: the puborectalis muscle is detached from the pubis (yellow arrow).

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  Fig. 2 Surgical details. (A) Polyform™ (15×20 cm, Boston Scientific, USA) is cut in a 5×7-cm semicircular shape with 2 arms. (B) The puncture point by the Shimada needle is 3 cm down on a vertical line from a point 3 cm lateral to the anal verge. (C) The original Shimada needle developed in Japan. (D, E) The needle and mesh arms pass through the location of the sacrospinous ligament (SSL) at a point that is 2 fingerbreadths (approximately 3 cm) medial to the ischial spine.

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