Poster, Podium & Video Sessions
Presentation Authors: Christian Twiss*, Miguel Craig, Frank Lin, Joel Funk, Tucson, AZ
Introduction: The reclassification of vaginal mesh to a high risk device for treatment of pelvic organ prolapse prompted our group to consider alternative graft materials. Based on the similar success rates and durability of mesh and autologous fascia in the treatment of female stress urinary incontinence (SUI), our objective was to develop a transvaginal repair for anterior and apical vaginal prolapse with the use of only autologous fascia lata graft thereby avoiding synthetic mesh, allograft and xenograft.
Methods: The video demonstrates our technique for Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair. Autologous fascia lata of suitable size (4 X 12 cm up to 5 X 14 cm) is harvested through a minimally invasive, lateral upper thigh incision. The graft is then cut into 3 strips (1cm X 12cm up to 1.3 cm X 14cm) and reassembled with one strip affixed to the bladder neck and sutured to the obturator internus fascia with 0-vicryl. The other 2 strips are sutured to the strip at the bladder neck with CV-2 Gore-Tex suture, crossed at the level of the vaginal apex, and sutured to the sacrospinous ligaments with 0-PDS. Patients were followed with subjective SEAPI scores, visual analog pain (VAP) scores (range 0-10), pelvic examination (Baden-Walker grading), and examination of the thigh harvest site.
Results: The AAA-POP procedure has been performed on 5 patients with a mean age of 61 and a mean follow-up of 2 months. Apical uterine suspension was performed in 3/5 patients and the other 2/5 patients were status post hysterectomy. Symptoms of pelvic organ prolapse resolved in all 5 patients, but 1 patient had an asymptomatic grade 1 cystocele without apical prolapse at 3 months follow-up. No patients complained of SUI or urge incontinence on SEAPI scoring. 1 patient required lysis of a concurrent pubovaginal sling 2 weeks postoperatively with resolution of urinary retention, and 1 patient had mild obstructive symptoms on SEAPI scoring. 2 patients developed thigh hernias postoperatively, and the mean VAP score at the harvest site was 1.8 for all patients.
Conclusions: Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair with fascia lata is a feasible option in the post-mesh era and appears to be safe and efficacious with short-term follow-up. Longer follow-up is needed to determine long term success and possible complications of the procedure. Although self-reported pain scores were low, patients should be aware of the risk of residual pain at the harvest site and possible development of a thigh hernia.
Source Of Funding: None
University of Arizona College of Medicine
Christian O. Twiss, MD, FACS is an Associate Professor in the Division of Urology at the University of Arizona College of Medicine. He attended medical school and completed his Urology residency at New York University. He completed his fellowship in Female Pelvic Medicine and Reconstructive Surgery at UCLA Medical Center. He is board certified in both Urology and Female Pelvic Medicine and Reconstructive Surgery. His referral practice specializes in complex pelvic reconstruction including mesh removal, pelvic reconstruction after mesh removal, and the treatment of incontinence, pelvic organ prolapse, and complex voiding dysfunction. He currently serves on the Executive Committee of the AUA Judicial Ethics Committee and also serves on the Board of the Western Section of the AUA.
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