To compare apical correction in stage ≥3 cystocele between two mesh kits.
This was a retrospective, nonrandomized study that compared two groups matched on anterior/apical POP-Q stage: 84 received Elevate Ant™ single-incision mesh (Elevate Ant group) and 42 Perigee™ transvaginal mesh (Perigee group). Follow-up at 1 and 2 years comprised objective (POP-Q) and subjective (PFDI-20, PFIQ-7, PISQ-12) assessments. The primary endpoint was objective success: 2-year apical POP-Q stage ≤1. Secondary endpoints were anterior POP-Q stage, subjective results and complications.
Groups were comparable in terms of age (66.6 and 64.7 years, respectively; p = 0.19), BMI (both 25.4 kg/m(2); p = 0.93), and history of hysterectomy (7.2 % and 14.3 %; p = 0.21) or prolapse surgery (12 % and 14.3 %; p = 0.72). Operative time was shorter in the Elevate Ant group (54.1 vs. 62.5 min; p = 0.048), and the 2-year objective apical success rate was higher (92.9 % vs. 66.7 %; p < 0.0001), with better point C correction (-5 vs. -3.8; p = 0.006). Function improved in both groups, with significantly better PFIQ-7 (p = 0.03) and PFDI-20 (p = 0.02) scores in the Elevate Ant group at 2 years. Vaginal exposure was not seen in the Elevate Ant group but occurred in two patients in the Perigee group (p = 0.33). Factors associated with success were age >65 years (OR 7.16, 95 % CI 1.83 - 27.97) and treatment with Elevate Ant mesh (OR 10.16, 95 % CI 2.78 - 37.14). Postoperative stress urinary incontinence rate was greater with the Elevate Ant group (29.8 % and 16.7 %; p = 0.11).
The use of the Elevate Ant mesh was associated with significantly better apical correction at 2 years. Function improved in both groups, but with a significantly better PFDI-20 score in the Elevate Ant group at 1 and 2 years. The postoperative stress urinary incontinence rate, however, tended to be greater in the Elevate Ant group. The results need confirming with longer follow-up of these cohorts and in randomized studies.
International urogynecology journal. 2016 May 24 [Epub ahead of print]
Gery Lamblin, Chloé Gouttenoire, Laure Panel, Stéphanie Moret, Gautier Chene, Christophe Courtieu
Service de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Lyon-Bron, France. ., Clinique Beau Soleil, Service de Chirurgie Gynécologique, Montpellier, France., Clinique Beau Soleil, Service de Chirurgie Gynécologique, Montpellier, France., Service de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Lyon-Bron, France., Service de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Lyon-Bron, France., Clinique Beau Soleil, Service de Chirurgie Gynécologique, Montpellier, France.