Vaginal reconstruction for the remedy of pelvic organ prolapse: the effect, influence on urinary and sexual function and quality of life in two-years follow-up
Part I. Vaginal status and complications

Czech version

Authors: I. Čadková; I. Huvar
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice Milosrdných bratří p. o., Brno, primář MUDr. I. Huvar, CSc.
Published in: Ceska Gynekol 2017; 82(6): 430-435

Overview

Objective:
To evaluate the effect, risks and benefits of vaginal reconstruction surgery for pelvic organ prolapse (POP). This article (part I of the study) focuses on the vagina – POP-Q status, complications, re-operations.

Design:
Clinical prospective non-randomized trial, two years follow-up.

Setting:
Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.

Materials and methods:
The cohort consisted of 410 women who underwent anterior and/or posterior vaginal repair (with or without hysterectomy or anti-incontinence procedure) in our hospital in the two years period (1. 3. 2012 – 28. 2. 2014). From among the total, 297 women received transvaginal mesh (TVM group), 113 women underwent „native tissue reconstruction“ – NT group. Vaginal status was evaluated pre-operative, in the early postoperative period and 2 – 6 – 12 and 24 month after the surgery.

Results:
The number of women that had come to the vaginal investigation at 2 – 6 – 12 – 24 month in NT group: 96 – 49 – 58 – 65, in TVM group: 277 – 218 – 228 – 222. All percentage relates then to the number of vaginally checked cases in the appropriate time. The most distal point of vagina: NT group – preoperative mean 1,12 (median +1), after two years mean -1,30 (median -1). Vaginal wall reaching hymen or 1 cm under it found in 24 women (36.9%), POP stage III, IV, i.e. decrease ≥ 2 cm, was in two women (3.1%). TVM group: preoperative mean 2.93 (median +2), after two years mean -1.73 (median -2). Prolapse 0–1 cm under hymen developed in 39 women (17.6%), POP stage III, IV found in five women (2.3%). Clinically significant complications (symptomatic and/or dehiscence >1 cm) in the hospital period and after 2 – 6 – 12 – 24 month in NT group: 3.5% – 12.5% – 2% – 0 – 0 of the checked women, in TVM group these numbers were 3.5% – 12.3% – 8.7% – 6.1% – 3.2%. Reoperation for recurrent POP: in NT group once (0.9%), in TVM group three times (1.0%). Reoperation for vaginal complication after NT operation: six times (5.3%), after TVM procedure 15 times (5.1%). Protrusion resection from the above done in nine cases (three times resection itself, six times in combination with another indication).

Conclusion:
The vaginal reconstruction of POP has a good effect with acceptable rate of complications. The NT procedure had the higher percentage of POP recurrence (40% vs 19.9%), the TVM surgery had more late vaginal complications (6...3% vs 0 after NT). Number of re-operations for vaginal complications was similar in both groups (about 5%).

Keywords:
POP, pelvic organ prolapse, transvaginal mesh, colporrhaphy, complications, long-term follow-up

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