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Vaginal Repairs With Synthetic Mesh Improve Prolapse Stage, Quality of Life


 

CHAMPIONSGATE, FLA. — Vaginal prolapse repair with a synthetic propylene mesh kit yields significant improvements in prolapse stage and some quality-of-life variables, according to a study presented at the annual meeting of the Society of Gynecologic Surgeons.

“Surgical mesh kits were first approved in the United States in March 2004. Tens of thousands of kits have been used with little data to support their use,” Dr. Cheryl B. Iglesia said during an oral presentation of her poster.

The limited study findings suggest that there may be problems with mesh exposure in approximately 6%–10% of patients and that there is significant postoperative pain in about 5%, according to Dr. Iglesia, who is director of urogynecology and reconstructive pelvic surgery at Washington Hospital Center.

Dr. Iglesia and her associates prospectively evaluated 25 women undergoing vaginal reconstructive surgery using a synthetic propylene mesh kit (ProLift, Ethicon).

Patients' prolapse stage was assessed at baseline and 3 months using the Pelvic Organ Prolapse Quantification (POP-Q) system.

The researchers also compared preoperative and postoperative quality of life using the short forms of the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

At study entry, the mean age was 66 years, the mean parity was three, and mean body mass index was 28 kg/m

Most patients, 18 out of 25, had prior surgery, including hysterectomy.

All repairs were performed between July 2005 and April 2006.

Urodynamic stress incontinence, urodynamic detrusor overactivity, and mixed incontinence were among the presenting conditions.

A total of 18 patients had vaginal colpopexies with total ProLift mesh insertions; 5 patients had anterior ProLift placement, and 2 had a posterior ProLift procedure.

At the same time, three patients had a vaginal hysterectomy and four had suburethral tape sling placed.

There were four complications reported.

These included two vaginal mesh erosions that were surgically resected and two seromas with delayed bleeding. There were no mesh infections.

At baseline, the mean POP-Q score was 2.88. Before surgery, a total of 5 patients had stage 2 prolapse, 18 patients had stage 3 prolapse, and 2 had stage 4 prolapse.

The POP-Q mean score decreased to 0.55 at 3 months, Dr. Iglesia said at the meeting, which was jointly sponsored by the American College of Surgeons.

In terms of quality of life, there were statistically significant improvements in mean PFDI-20 summary scores, from136 at baseline to 33 at 3 months.

Researchers also found that baseline PFIQ-7 summary scores significantly decreased from a mean of 78 to 3 at 3 months. Mean PISQ-12 scores dropped from 13 to 9.

The findings of this study warrant further investigation, Dr. Iglesia said. “Longer-term data are needed for mesh complications and patient and partner sexual satisfaction.”

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