Presentation Authors: Olesya Snurnitsyna*, Petr Glybochko, Leonid Rapoport, Mikhail Enikeev, Aleksandr Nikitin, Mikhail Enikeev, Abdusalam Abdusalamov, Moscow, Russian Federation
Introduction: Transvaginal mesh surgery is a promising yet disputable direction in urogenital prolapse treatment that requires further investigation. Modern 6-strap meshes and improved surgical techniques may move us closer to settling the debate concerning this controversial area of Urogynecology. The aim of our study was evaluate efficiency and safety transvaginal repair of anterior and apical prolapse using OPUR 6-strap mesh.
Methods: The study included 110 patients with urogenital prolapse: grade 3-4 cystocele and grade 2-4 hysteroptosis. The average age was 59 years. The maximum follow up was 5 years. Quality of life and sexual function were assessed with PFDI-20, PFIQ-7 and PSIQ-12 questionnaires. The main advantage of 6-strap meshes over their 4-strap predecessors is two additional straps designed for the correction of hysteroptosis and prevention of mesh shrinkage. These straps are introduced through the sacrospinal and underlying sacroiliac ligaments with the stylet inserted in-out under full manual control after preliminary ligament dissection and dislocation of the rectum medially. Apart from that, the transversal vaginal wall incision â€“ through which the mesh is introduced â€“ is located at the isthmus level. This allows for separation of the wound and mesh.
Results: We achieved the desired result in 107 (97%) cases (Stage â‰¤ I, POP-Q System). No patients developed postoperative dyspareunia. Quality of life improved in 106 patients (96%) according to PFDI-20 and in 107 cases (97%) according to PFIQ-7. Questionnaire scores were the same at 3 and 12 months after surgery. Ten patients had stress urinary incontinence prior to surgery. In 5 of them, it resolved postoperatively. Eight patients (7%) developed de novo incontinence that required mediurethral sling placement in 4 cases. At 3 months after surgery, the women reported less emotional stress during communication and sexual intercourse. The complications were as follows: 12 hematomas in the anterior wall of the vagina that resolved without treatment, acute ischuria in 10 cases that resolved within 3-7 days and two erosions that required excision of the mesh fragment. In one 40-year-old patient, we noted injury of the urinary bladder that was managed intraoperatively with transvaginal sacrospinous hysteropexy. The treatment was completed using one sacrospinal strap from the opposite side fixed to the isthmus with subsequent anterior colporrhaphy.
Conclusions: Transvaginal reconstructive surgery for anterior and apical urogenital prolapse using a 6-strap mesh may be considered effective and relatively safe. It offered good short- and long-term anatomical and functional outcomes.