AUA 2019: Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair: Experience in Thirty-Three Patients
They used 4 cm x 14 cm piece of fascia lata harvested through a single 3-4 inch lateral upper thigh incision for Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair. The graft is cut into 3 strips approximately 1.3 cm x 14 cm which is reconfigured to provide apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia at the level of the bladder neck. Patients were followed by history, SEAPI scores, POP-Q scores, and symptoms related to thigh harvest including visual analog pain (VAP) scores. Treatment failure was defined as symptomatic anterior and/or apical POP.
There was AAA-POP procedure performed on 33 patients with a mean age of 62. Mean follow-up was 8 months (range 1-25 months), with 10 patients having 12 or more months of follow-up. 13 patients had prior vaginal mesh removal. POP symptoms resolved in 32 patients, and there was one treatment failure (Stage II uterine POP). Ten patients developed post-operative retention, 9 of whom had undergone concurrent pubvaginal sling. Four of the retention patients required urethral dilation, and five underwent sling lysis. The overwhelming majority of harvest site issues were minor and managed expectantly. Mean VAP score at the harvest site was 0.24. Five patients developed non-bothersome thigh bulges, all of which were managed expectantly. Harvest site soeroma occurred in 4 patients and all resolved with 2 requiring simple aspiration. Eight patients reported mild, non-bothersome harvest site paresthesia. No thromboembolic events occurred.
At the end, they concluded that AAA-POP repair is an efficacious treatment for the mesh-injured and other patients who desire non-mesh POP repair. Patients should be counseled regarding harvest site issues, which typically resolve with expectant management alone. Patients undergoing concurrent pubovaginal sling should be counseled regarding the risk of urinary retention. Continued follow-up of this series is ongoing to determine long-term success of AAA-POP repair.
Presented by: Fahad Chaus, MD, The Department of Surgery, University of Arizona Health Sciences, Tucson, Arizona
Co-Authors: Jayce Pangilinan, Joel Funk, Christian Twiss
Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine @BilalfarhanMD at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois