OBJECTIVES: To explore the need for secondary surgical procedures after transvaginal prolapse repair with mesh.
METHODS: Women that had prolapse repair (Prolift® or Elevate®) were reviewed for reoperation and clinical/demographic data such as prior prolapse repair, prolapse grade, operative details, length of stay (LOS) and time to reoperation. Pearson's Chi-square, Fisher's exact tests and Wilcoxon rank tests were used.
RESULTS: 77/335 women (23 %) had 100 additional procedures. Median (range) time to reoperation was 51 (5-1168) days: four (1 %) had primary prolapse surgery at a different site, three (1 %) repeat prolapse repair from the same site, 23 (7 %) surgery for complications and 50 (15 %) had stress urinary incontinence (SUI)/sling-related procedures. When no reoperation versus reoperation groups were compared, mean LOS (1.8 vs. 2.0 days; p = 0.044) and follow-up (228 vs. 354 days; p = 0.002) were longer in the reoperations group; postoperative hemoglobin was lower (10.8 vs. 10.4; p = 0.031). Patients with a prolapse reoperation were 10 years younger (67 vs. 57 years; p = 0.027) than patients that either had a reoperation for other reasons or had no reoperations. Patients with concomitant sling and persistent SUI requiring repeat SUI surgery were older (mean 72 vs. 66 years; p = 0.038), had prior prolapse repair (53 vs. 27 %; p = 0.017) and had anterior compartment mesh (84 vs. 56 %; p = 0.037); median operative times (78 vs. 104 min; p = 0.008) and mean LOS were shorter (median 1.6 vs. 1.9 days; p = 0.045). For patients without concomitant sling, no demographic or perioperative differences were found between those that did (n = 10) and did not (n = 86) develop de novo SUI that required reoperation.
CONCLUSIONS: Most reoperations were for sling management and SUI; few were for mesh complications or prolapse recurrence.
Written by:
Bartley JM, Sirls LT, Killinger KA, Boura JA. Are you the author?
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Reference: Int Urol Nephrol. 2015 Feb 20. Epub ahead of print.
doi: 10.1007/s11255-015-0930-3
PubMed Abstract
PMID: 25697161