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Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes

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Abstract

Introduction and hypothesis

Here we describe anatomic and quality of life (QOL) outcomes of an anterior and apical compartment prolapse repair involving a reduced mesh implant size and apex-only fixation.

Methods

One hundred and fifteen patients undergoing the repair at a single urogynecology center were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) and inpatient chart reviews. A horizontal incision eliminated overlap with the mesh, and each sacrospinous ligament was approached anteriorly by blunt dissection. Recurrence was defined as apical (C), or anterior (Aa or Ba) ≥0, and secondary analyses were performed using POP-Q ≥ −1 as the anatomic threshold. Pelvic Floor Distress Inventory (PFDI), Surgical Satisfaction Questionnaires (SSQ) and a dyspareunia symptom scale were analyzed pre- and postoperatively.

Results

Fifty-three women with uterus in situ demonstrated a combined anterior–apical recurrence rate of 1.89 %, including no anterior (Ba ≥ −1) and one apical (C ≥ −1) recurrence. Forty-seven women undergoing repair for vault prolapse had recurrence rates ranging from 0 % in those with prior hysterectomy to 4.2 % in those undergoing concurrent hysterectomy. The rate of mesh exposure was 3/115 (2.6 %), including two in women with concurrent hysterectomy. Self-reported dyspareunia was more common preoperatively (13.4 %) than postoperatively (9.3 %). PFDI scores improved in all domains, and 93 % completing the SSQ reported they were satisfied and would choose the surgery again.

Conclusions

This technique resulted in successful outcomes within both anterior and apical compartments with a low rate of mesh complication, and no cases required mesh removal or hospital readmission. High rates of satisfaction and improved condition-specific QOL were observed.

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Financial Disclosure/Conflict of interest

No financial support was received for this study. Dr. Goldberg is consultant for and receives royalties from Boston Scientific Corporation

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Authors and Affiliations

  1. University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem Division of Urogynecology, Evanston, IL, USA

    Manhan K. Vu, Juraj Letko, Kelly Jirschele, Adam Gafni-Kane, Aimee Nguyen & Roger P. Goldberg

  2. Center for Clinical and Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA

    Honyan Du

  3. 1300 W Terrell Ave, Suite 340, Fort Worth, TX, 76104, USA

    Manhan K. Vu

Authors
  1. Manhan K. Vu
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  2. Juraj Letko
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  3. Kelly Jirschele
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  4. Adam Gafni-Kane
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  5. Aimee Nguyen
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  6. Honyan Du
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  7. Roger P. Goldberg
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Correspondence to Manhan K. Vu.

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Vu, M.K., Letko, J., Jirschele, K. et al. Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes. Int Urogynecol J 23, 1753–1761 (2012). https://doi.org/10.1007/s00192-012-1780-5

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  • DOI: https://doi.org/10.1007/s00192-012-1780-5

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