STUDY OBJECTIVES: To study the surgical and functional outcome of single incision mesh surgery for advanced pelvic organ prolapse.
DESIGN: II-3 Evidence obtained from several timed series with intervention.
DESIGN: CLASSIFICATION: Case series.
SETTING: The study was done at Chang Gung Memorial Hospital Taipei and Linkou from May 2010 to December 2012.
PATIENTS: 65 patients underwent prolapse surgery for symptomatic Pelvic Organ Prolapse (POP) more than stage II, according to the Pelvic Organ Quantification System (POP-Q).
INTERVENTIONS: Anterior-apical single-incision mesh, Elevate® Anterior and Apical technique was performed on all patients.
MEASUREMENT: The primary objective outcome was anatomical correction of anterior and apical prolapse of POP stage ≤ 1 and absence of voiding dysfunction reported by multi-channel urodynamic study at 6 months post operation. Subjective outcome was measured by patient feedback on POPDI-6 (question 3 and question 2). The secondary outcome was the quality of life questionnaires using the following: Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Two-dimensional introital ultrasonography was performed in the first month, third month and at one-year follow-up. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test was applied for comparison of pre- and post-operation continuous data. Values of p < .05 were considered statistically significant for all comparisons. All statistical methods were performed using the commercial software SPSS, version 17.
MAIN RESULTS: Postoperative data were available for 64 patients. The objective outcome was 96.9% and the subjective outcome was 93.8%. All patients had significant improvements in anatomical outcomes after prolapse surgery (p < .05) and none had recurrence requiring further surgery. There were concomitant significant improvements of UDI-6, IIQ-7, POPDI-6 and PISQ-12 after surgery. A sub analysis on POP quantification measurements at post-operative follow-up between immediate and one year on respective magnitude has shown a deepening of the C point and total vaginal length (TVL). Ultrasound evaluation showed a significant increase in the length and thickness of mesh at one-year. In our study, there was no documented mesh extrusion to date. However, the study a number of patients with USI had increased. Four of the patients resorted to receiving treatment were as the remaining were not severe enough to require surgical intervention.
CONCLUSIONS: Single incision mesh surgery (SIMS) for advanced pelvic organ prolapse exhibited significant improvement in anatomical and quality of life outcomes. There is no mesh exposure recorded within the first year after surgery however new onset of stress urinary incontinence may occur as adverse events. Ultrasound evaluation showed an increase in mesh length and thickness over time with concurrent calculated lengthening of C point and total vaginal length.
Written by:
Lo TS, Tan YL, Cortes EF, Pue LB, Wu PY, Al-Kharabsheh A. Are you the author?
Institution(s): See publishing journal.
Reference: J Minim Invasive Gynecol. 2014 Jul 10. pii: S1553-4650(14)00346-X.
doi: 10.1016/j.jmig.2014.07.002
PubMed Abstract
PMID: 25017520
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