Reconstruction of the posterior and central compartment with the Prolift Posterior: cohort study with a 5-year follow-up
Authors:
K. Brányik 1; L. Krofta 1,2; P. Kraus 1; M. Krčmář 1,2; O. Gojiš 1; I. Urbánková 1,2; J. Feyereisl 1,2,3
Authors‘ workplace:
Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc.
1; 3. lékařská fakulta Univerzity Karlovy, Praha, děkan prof. MUDr. M. Anděl, CSc.
2; Katedra gynekologie a porodnictví IPVZ, Praha, vedoucí MUDr. A. Malina, Ph. D., MBA
3
Published in:
Ceska Gynekol 2017; 82(4): 268-276
Overview
Objective:
To analyse the results of the long-term prospective follow-up study of vaginal prolapse reconstructed using a Prolift Posterior.
Study design:
Prospective, cohort study.
Setting:
Institute for the Care of Mother and Child, Prague.
Methods:
Over a 5-year period (I/2006 – XII/2011) we prospectively followed a cohort of patients with posterior vaginal wall defect who underwent surgical reconstruction using a monofilament polypropylene implant Prolift Posterior™ (Gynecare, Ethicon, Inc., Piscataway, NJ, USA). Patients were invited for review at six weeks, three months, six months, 12 months and then yearly up to five years. Postoperative follow-up included the clinical examination and subjective evaluation using VAS, PISQ 12 and ICIQ SF.
Results:
One hundred twenty-four women were included in the study, of which 14 (11.3%) had no prolapse surgery in their health history. There were no concomitant vaginal procedures such as hysterectomy or another implant surgery. The average operation time and blood loss were 64.25 min (min. 10, max. 205 min) and 115 ml (min. 10 ml, max. 1000 ml), respectively. Only one patient had a blood loss 1000 ml. There were no injuries of the urinary bladder or intestines during the needle insertion of the mesh. In the five-year period, the recurrence of posterior vaginal wall defect was observed in 4 cases (3.3%). The average time to the posterior vaginal wall recurrence prolapse was 19.5 months (min. 6, max. 36). De novo prolapse in the anterior compartment was observed in 25 patients (20.5%).
Conclusion:
In this prospective single centre study, we observed anatomical improvement in the implanted compartment with low recurrence rate. During five years follow-up period there was de novo anterior vaginal wall defect observed in 20.5% cases. The question of implant employment in urogynecology remain to be answered, however, our results show that implants have their position in reconstructive surgery.
Keywords:
pelvic organ prolapse, Prolift Posterior, rectocoele
Sources
1. Avery, K., Donovan, J., Peters, JF. ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol. Urodyn, 2004, 23, p. 322–330.
2. Barber, MD., Maher, CM. Apical prolapse. Int Urogynecol J, 2013, 24, p. 1815–1833.
3. Bump, RC., Mattiasson, A., Bo, K. The standardization of terminology of fiale pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 1996, 175, p. 10–17.
4. Delancey, JOL. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol, 1992, 166, p. 1117–1128.
5. FDA. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. Rev Lit Arts Am, 2011.
6. FDA. Serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ and stress urinary incontinence. U.S. Food Drug Adm, 2008.
7. Handa, VL., Garrett, CG., Schmidt, C. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol, 2004, 190, p. 27–32.
8. Haylen, BT., Freeman, RM., Swift, SE., et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes , implants , tapes) & grafts in female pe. Int Urogynecol J, 2011, 22, p. 3–15.
9. Haylen, B., Naidoo, S., Kerr, S., et al. Posterior vaginal compartement repairs: Where are the main anatomical defects? Int Urogynecol J, 2016, 27, p. 741–745.
10. Chmielewski, L., Walters, MD., Weber, AM., Barber, MD. Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol, 2011, 205, 69, p. e1-8.
11. Kahn, M., Stannton, S. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynecol, 1997, 104, p. 82–86.
12. Karram, M., Maher, CM. Surgery for posterior vaginal wall prolapse. Int Urogynecol J, 2013, 24, p. 1835–1841.
13. Lukacz, ES. The use of Visual Analog Scale in urogynecologic researsch: A psychometric evaluation. Am J Obstet Gynecol, 2004, 191, p. 165–170.
14. Maher, C. Anterior vaginal compartment surgery. Int Urogynecol J Pelvic Floor Dysfunct, 2013, 24, p. 1791–1802.
15. Maher, CM., Baessler, K. Surgical management of posterior vaginal wall prolapse: an evidence-based literature review. Int Urogynecol J, 2006, 17, p. 84–88.
16. Maher, CM., Feiner, B., Baessler, K., Glazener, CMA. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J, 2011, 22, p. 1445–1457.
17. Nichols, DH., Randall, CL. Posterior colporrhaphy and perineorrhaphy. Vaginal Surg, 1994, p. 279.
18. Ow, L., Lim, Z., Dwyer, PL., et al. Native tissue repair or transvaginal mesh for recurrent vaginal prolapse: what are the long-term outcomes? Int Urogynecol J, 2016, 27, p. 1313–1320.
19. Petros, PE, Ulmsten, U. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol, 1993, 153, p. 1–93.
20. Sand, PK., Koduri, S., Lobel, R. Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol, 2001, 184, p. 1357–1362.
21. Summers, A., Winkel, LA., Hussain, HK., DeLancey, JOL. The relationship between anterior and apical compartment support. Am J Obstet.Gynecol, 2006, 194, p. 1438–1443.
22. Sung, VW., Rardin, CR., Rarker, C., et al. Porcine subintestinal submucosal graft augmentativ for rectocele repair: a randomized controlled trial. Obstet Gynecol, 2012, 119, p. 125–133.
23. Ulmsten, U., Hendriksson, L., Johson, P. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J, 1996, 7, p. 81–87.
24. Weber, AM., Walters, MD., Piedmonte, MR., Ballard, L. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol, 2001, 185, p. 1299–1306.
25. Withagen, MI., Milani, AL., den Boon, J., et al. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse. Obstet Gynecol, 2011, 117, p. 242–250.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2017 Issue 4
Most read in this issue
- Catamenial pneumothorax – case reports and literature review
- Large hematoma – early postoperative complication after the transobturator tape procedure
- Suburethral sling removal due to chronic pain
- Laparoscopic and robotic sacropexy: retrospective review of learning curve experiences and follow-up