The changes in bladder function and symptoms after robot-assisted sacrocolpopexy and transvaginal mesh surgery for pelvic organ prolapse.

OBJECTIVE: This study is aimed to compare the impact on bladder function and symptoms between robotic sacrocolpopexy (RSC) and transvaginal mesh surgery (TVM) in women with pelvic organ prolapse. MATERIALS AND METHODS: This prospective controlled study enrolled patients who received RSC or TVM at our hospital between March 2020 and June 2022. We compared preoperative and postoperative bladder function between two groups by using a questionnaire of lower urinary tract symptom (LUTs) for subjective assessment and urodynamic study for objective assessment. RESULTS: A total of 60 patients were enrolled, of whom 30 received RSC and 30 received TVM. In LUTs analysis, the RSC group had a higher risk of de novo stress urinary incontinence than the TVM group (33.3% vs. 3.3%, p = .007). Urodynamic studies showed that both groups had a deterioration in maximal urethral closure pressure postoperatively (RSC: 56.9 ± 17.1 vs. 44.2 ± 15.5 cmH2O; and TVM: 61.2 ± 29.4 vs. 47.6 ± 19.7 cmH2O, p < .01 and p = .03, respectively). The incidence of urodynamic stress incontinence was also significantly increased after RSC (33.3% vs. 76.7%, p = .01). The de novo urodynamic stress incontinence rate was 46.7% after RSC, which was not significantly different to the TVM group (26.7%, p = .16). In the TVM group, the incidence of voiding difficulty decreased after surgery (43.3% vs. 10.0%, p < .01), and urodynamic measurements revealed that the prevalence of urine retention decreased (43.3% vs. 16.7%, p < .01). In the RSC group, the incidence of incomplete emptying sensation decreased (36.7% vs. 13.3%, p = .04), and urodynamic measurements showed that none of the patients had bladder outlet obstruction, underactive detrusor, or urine retention after surgery. CONCLUSION: RSC and TVM are both beneficial to improve voiding function in women with pelvic organ prolapse. However, a deterioration in urethral function was observed and the de novo SUI rate was higher in the RSC group than in the TVM group.

Pressure-Volume Loop Analysis of Voiding Workload: An Application in Trans-Vaginal Mesh-Repaired Pelvic Organ Prolapse Patients.

Although trans-vaginal mesh (TVM) offers a successful anatomical reconstruction and can subjectively relieve symptoms/signs in pelvic organ prolapse (POP) patients, its objective benefits to the voiding function of the bladder have not been well established. In this study, we investigated the therapeutic advantage of TVM on bladder function by focusing on the thermodynamic workload of voiding. The histories of 31 POP patients who underwent TVM repair were retrospectively reviewed. Cystometry and pressure volume analysis (PVA) of the patients performed before and after the operation were analyzed. TVM postoperatively decreased the mean voiding resistance (mRv, p < 0.05, N = 31), reduced the mean and peak voiding pressure (mPv, p < 0.05 and pPv, p < 0.01, both N = 31), and elevated the mean flow rate (mFv, p < 0.05, N = 31) of voiding. While displaying an insignificant effect on the voided volume (Vv, p < 0.05, N = 31), TVM significantly shortened the voiding time (Tv, p < 0.05, N = 31). TVM postoperatively decreased the loop-enclosed area (Apv, p < 0.05, N = 31) in the PVA, indicating that TVM lessened the workload of voiding. Moreover, in 21 patients who displayed postvoiding urine retention before the operation, TVM decreased the residual volume (Vr, p < 0.01, N = 21). Collectively, our results reveal that TVM postoperatively lessened the workload of bladder voiding by diminishing voiding resistance, which reduced the pressure gradient required for driving urine flow.

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence.

BACKGROUND: Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. OBJECTIVES: To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. METHODS: Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). SELECTION CRITERIA: The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. RESULTS: The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. CONCLUSIONS: Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.

Impact of Weight Gain on Surgical Outcomes and Quality of Life among Women after Sling Surgeries.

STUDY OBJECTIVE: To investigate the impact of body weight gain after sling surgeries on outcomes in women with stress urinary incontinence. DESIGN: A single-center, retrospective study. SETTING: Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taiwan. PATIENTS: A total of 248 women who underwent sling surgeries from 2010 to 2015 were reviewed. Patients who gained more than 10% body weight were compared with those with stable body weight. INTERVENTIONS: Midurethral sling surgery with single-incision, transobturator, or retropubic slings. MEASUREMENTS AND MAIN RESULTS: Objective success was defined as no urine leakage during the stress test in the filling phase of urodynamic studies. De novo overactive bladder (OAB) was defined as the appearance of urgency, frequency, and/or nocturia, with or without urinary incontinence after midurethral sling surgery persisting after 6 months. Quality of life evaluations included the short forms of the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7. A total of 248 women who underwent sling surgeries and had complete weight measurement and evaluation data before and after the surgeries were included, of whom 47 gained body weight, and 201 had a stable body weight. The median follow-up duration was 18 months (range, 6-47 months). There were no significant differences in surgical outcomes between the 2 groups regarding objective cure rate (86% vs 87%, p = .834), 1-hour pad test (4.5 ± 17.8 vs 3.6 ± 18.6 g, p = .770), or postoperative quality of life (Urogenital Distress Inventory-6: 1.9 ± 2.8 vs 2.8 ± 3.2, p = .122; Incontinence Impact Questionnaire-7: 1.8 ± 3.9 vs 2.6 ± 4.3, p = .307). A trend toward increased de novo OAB rate was observed, although this finding was not adequately powered. CONCLUSION: Weight gain after sling surgeries did not influence surgical outcomes, but there was a nonsignificant trend toward increased OAB in the weight gain group. It may be beneficial to counsel patients with regard to body weight maintenance after sling surgeries.

Evaluation of efficacy and safety of single-incision sling versus transobturator sling in women with stress incontinence and intrinsic sphincter deficiency.

INTRODUCTION AND HYPOTHESIS: Urethral intrinsic sphincter deficiency (ISD) is associated with severe urine leakage and a higher risk of sling failure. The aim of this study is to evaluate the efficacy and safety of single-incision slings (SISs) versus transobturator slings (TOSs) in such patients. METHODS: Patients who had stress incontinence and ISD who underwent SIS or TOS procedures from 2010 to 2017 were retrospectively reviewed. The objective and subjective cure rates and surgical adverse events were compared between different slings. Objective cure was defined as no stress urine leakage with a comfortably full bladder. Subjective cure was determined by the patient's satisfaction. Incontinence-related symptom distress and quality of life were evaluated using the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). RESULTS: Among 111 patients, 37 underwent SIS and 72 underwent TOS with a median follow-up of 21 (range: 12-72) months and 24 (range: 14-84) months (p = 0.265). For both groups, the UDI-6, IIQ-7, and 1-h pad test all significantly improved after surgery (all p < 0.001). The objective and subjective cure rates were comparable after SIS and TOS procedures (objective: 76% vs. 76%, p = 0.837; subjective: 78% vs. 83%, p = 0.212). There were no significant differences in adverse events, except SISs had a shorter surgery time (16.4 ± 9.3 vs. 27.3 ± 12.4 min, p = 0.020) and lower postoperative visual analog scale pain score (1.3 ± 1.1 vs. 3.9 ± 1.4, p < 0.001). CONCLUSION: SISs and TOSs had similar surgical results in women with stress incontinence and ISD after at least 1 year of follow-up. However, SISs had a shorter operation time and lower postoperative pain than TOSs.

Effect of aging on lower urinary tract symptoms and urodynamic parameters in women.

OBJECTIVE: Lower urinary tract symptoms (LUTS) are common in women. However, due to multifactorial etiologies, it is difficult to determine the prevalence, and functional changes with age. The aim of this study is to assess the effect of age on female LUTS, urethral and bladder function after their midlife. MATERIALS AND METHODS: This was an observational cohort study conducted at a tertiary referral medical center. Women who visited for bothersome LUTS, valid quality of life questionnaires, and urodynamic tests were recruited into the this study. Patients The patients were divided into four groups (<50, 50-59, 60-69, and >69 years). All LUTS, and urodynamic parameters were reviewed, and compared between groups. RESULTS: A total of 364 women were enrolled and analyzed. The urodynamic tests showed the that maximal cystometric bladder capacity, the average and maximal urine flow rate, and pressure of detrusor contractility at maximal urine flow rate were all significantly decreased with age. Besides, the voiding time, and post-voiding residual urine volume significantly increased with age. For urethral competence, the maximal urethral closure pressure deteriorated with age. All storage symptoms did not change with age, except for nocturnal enuresis. However, the effect of age on some voiding symptoms significantly increased with age, including straining to void, hesitancy, and intermittency. CONCLUSIONS: Lower urinary tract symptoms, bladder and urethral functions change with age, particularly voiding function. Physicians should be aware of the aging process when counseling and before implementing management strategies, particularly for older people.

Potassium bromate-induced cell model of age-related macular degeneration in vitro.

Age­related macular degeneration (AMD) progression occurs due to oxidative stress in retinal pigment epithelium (RPE) cells. To develop a new model of AMD, the present study investigated the effects of potassium bromate (KBrO3) on ARPE­19 cells. Incubation with KBrO3 for 24 h significantly decreased ARPE­19 cell viability in a concentration­dependent manner compared with the control group. The MTT and lactate dehydrogenase assay results indicated that KBrO3 induced cell apoptosis. Compared with the control group, KBrO3 treatment significantly decreased the Bcl2/Bax ratio, as determined via western blotting, and caspase­3 mRNA expression levels. Fluorescence microscopy indicated the increased ROS levels in cells treated with KBrO3. Endogenous antioxidant enzyme activities, including superoxide dismutase and glutathione peroxidase, were significantly inhibited by KBrO3 compared with the control group. Moreover, the antioxidants tiron and phloroglucinol inhibited KBrO3­mediated effects on ARPE­19 cells in a dose­dependent manner. Additionally, GPR109A is the binding site of 4­hydroxynonenal (4­HNE). KBrO3 displayed cytotoxic effects in 293 cells, which naturally lack the GPR109A gene, but these effects were not observed in 4­HNE­treated 293 cells, suggesting that KBrO3 induced apoptosis without increasing endogenous 4­HNE levels in cells. Moreover, the results suggested that KBrO3­induced oxidative stress may activate STAT3 to increase VEGF expression in ARPE­19 cells. Collectively, the results of the present study supported the potential use of KBrO3 to induce an in vitro model of AMD in ARPE­19 cells.

Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials.

INTRODUCTION AND HYPOTHESIS: Recurrent urinary tract infections (rUTIs) are commonly encountered in postmenopausal women. Optimal non-antimicrobial prophylaxis for rUTIs is an important health issue. The aim of this study was to evaluate the use of estrogen in the prevention of rUTIs versus placebo. METHODS: Eligible studies published up to December 2019 were retrieved through searches of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. We included randomized controlled trials of estrogen therapies versus placebo regarding the outcomes of preventing rUTIs. Changes in vaginal pH and estrogen-associated adverse events were also analyzed. RESULTS: Eight studies including 4702 patients (2367 who received estrogen and 2335 who received placebo) were identified. Five studies including 1936 patients evaluated the use of vaginal estrogen, which resulted in a significant reduction in rUTIs (relative risk, 0.42; 95% CI, 0.30-0.59). Three studies including 2766 patients evaluated the outcomes of oral estrogen in the prevention of UTIs and showed no significant difference in the number of rUTIs compared to treatment with placebo (relative risk, 1.11; 95% CI, 0.92-1.35). Two studies reviewed changes in vaginal pH and showed a lower pH (mean difference, -1.81; 95% CI, -3.10--0.52) after vaginal estrogen therapy. Adverse events associated with vaginal estrogen were reported, including vaginal discomfort, irritation, burning, and itching. There was no significance increase in the vaginal estrogen group (relative risk, 3.06; 95% CI, 0.79-11.90). CONCLUSIONS: Compared with placebo, vaginal estrogen treatment could reduce the number of rUTIs and lower the vaginal pH in postmenopausal women.

Amniotic Membrane Graft in the Management of Complex Vaginal Mesh Erosion.

Vaginal mesh erosion is a devastating complication after pelvic floor mesh surgery and it can be treated conservatively or with surgical revision. However, the management options following a failed primary revision or complex vaginal erosions are very limited. The aim of this study is to describe a novel treatment using an amniotic membrane as an inlay graft for such patients. Eight patients who failed conservative or primary surgical revision were enrolled. The complex erosions included vaginal agglutination, multiple vaginal erosions, recurrent erosions, and mesh cutting through the urethra. We used an amniotic membrane as a graft to cover the vaginal defect after partial excision of the mesh erosion and we describe the technique in this study. There were no intraoperative complications and none of the patients reported any further symptoms at a mean of 27 months follow-up. Only one patient had recurrent erosion, however, the erosion size was narrower and was subsequently successfully repaired. No further vaginal mesh erosions were noted in the other patients who all had good functional recovery. The use of an amniotic graft can be an economic and alternative method in the management of complex vaginal mesh erosions.

The Outcome of a Single-Incision Sling versus Trans-Obturator Sling in Overweight and Obese Women with Stress Urinary Incontinence at 3-Year Follow-Up.

Background: Being overweight or obese is a risk factor for incontinence and has negative impacts on the surgical outcomes. Compared with trans-obturator sling (TOS), single incision sling (SIS) is a new generation of anti-incontinence surgery. However, the data on SIS in overweight and obese women remains limited. Methods: This retrospective study analyzed the objective and subjective cure rate of overweight and obese women who underwent sling surgeries. Other evaluations included valid questionnaires to assess quality of life and 1-hour pad test to quantify urine leakage. Surgical characteristics and adverse events were also analyzed. Results: A total of 217 patients were analyzed with a median follow-up period of 37.3 months (range, 9-84 months). For overweight and obese patients, the objective and subjective cure rate were comparable (all p > 0.05). However, the SIS group had worse post-operative incontinence-related symptom distress (p < 0.001) and 1-hour pad test (p = 0.047). On the other hand, SIS had a shorter surgery time (p = 0.017) and lower pain score (p < 0.001). Conclusions: Compared with TOS, SIS had non-significant cure rates in the overweight and obese women. SIS had worse urine leakage and incontinence symptoms, but less surgical and wound pain in obese women. Thorough pre-operative counseling is necessary.

Changes in Female Sexual Function After Vaginal Mesh Repair Versus Native Tissue Repair for Pelvic Organ Prolapse: A Meta-Analysis of Randomized Controlled Trials.

AIM: To evaluate changes in female sexual function after transvaginal mesh (TVM) repair versus native tissue repair for pelvic organ prolapse. METHODS: Eligible studies, published through November 2017, were retrieved through searches of ClinicalTrials.gov, MEDLINE, Embase, and Cochrane Review databases and associated bibliographies. We included randomized control trials of transvaginal prolapse surgery with either mesh repair or native tissue repair regarding the outcomes of sexual function, de novo and postoperative dyspareunia with a minimum of 3 months of follow-up. RESULTS: Seventeen trials including 2,976 patients (1,488 with TVM repair and 1,488 with native tissue repair) were identified. There was no significant difference in postoperative dyspareunia after TVM repair versus native tissue repair (risk ratio [RR] = 1.07; 95% confidence interval [CI] = 0.76-1.50). Likewise, there was no significant difference in de novo dyspareunia after TVM repair versus native tissue repair (RR = 0.91; 95% CI = 0.52-1.61). There was also no significant difference in the short form Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score after TVM mesh repair versus native tissue repair (mean difference = 0.26; 95% CI = -1.34 to 1.85). CONCLUSION: Sexual function and de novo and postoperative dyspareunia were similar between the patients who underwent TVM repair and those who underwent native tissue repair. Liao S-C, Huang W-C, Su T-H, et al. Changes in Female Sexual Function After Vaginal Mesh Repair Versus Native Tissue Repair for Pelvic Organ Prolapse: A Meta-Analysis of Randomized Controlled Trials. J Sex Med 2019;16:633-639.

Comparison between tension-free vaginal tape and transobturator tape in treating stress urinary incontinence after vaginal mesh surgery.

OBJECTIVE: A midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. MATERIALS AND METHODS: We enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). RESULTS: We included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p < 0.001) and hospital stay (p = 0.004), however the TOT group required more repeat surgeries for recurrent SUI (p = 0.045). CONCLUSION: Retropubic TVT is a more effective surgical option than TOT in women with SUI after vaginal mesh repair.

Did surgical failure and complications affect incontinence-related quality of life in women after transobturator sling procedure?

OBJECTIVE: To report the objective outcome, subjective measurement of incontinence-related quality of life (QoL) for female urodynamic stress incontinence (USI) after transobturator sling surgery (TVT-O) and to evaluate the effects of surgical failure and complications on QoL. MATERIALS AND METHODS: We analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. RESULTS: A total of 78 women were followed for a median of 13.5 months (range 12-15 months) after surgery. Within this group, 75 (96%) were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. CONCLUSIONS: TVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL.

Risk factors and management of vaginal mesh erosion after pelvic organ prolapse surgery.

OBJECTIVE: Mesh erosion is a serious and not uncommon complication in women undergoing vaginal mesh repair. We hypothesized that mesh erosion is associated with the patient's comorbidities, surgical procedures, and mesh material. The aims of this study were to identify the risk factors and optimal management for mesh erosion. MATERIALS AND METHODS: All women who underwent vaginal mesh repair from 2004 to 2014 were retrospectively reviewed. Data on patients' characteristics, presenting symptoms, treatment and outcomes were collected from their medical records. RESULTS: A total of 741 women underwent vaginal mesh repairs, of whom 47 had mesh erosion. The median follow-up period was 13 months (range 3-84 months). Another nine patients with mesh erosion were referred form other hospitals. Multivariate analysis revealed that concomitant hysterectomy (odds ratio 27.02, 95% confidence interval 12.35-58.82; p < 0.01) and hypertension (odds ratio 5.95, 95% confidence interval 2.43-14.49; p < 0.01) were independent risk factors for mesh erosion. Of these 56 women, 20 (36%) were successfully treated by conservative management, while 36 (64%) required subsequent surgical revision. Compared with surgery, conservative treatment was successful if the size of the erosion was smaller than 0.5 cm (p < 0.01). Six patients (17%) had recurrent erosions after primary revision, but all successfully healed after the second surgery. CONCLUSION: Concomitant hysterectomy and hypertension were associated with mesh erosion. In the management of mesh erosion, conservative treatment can be tried as the first-line treatment for smaller erosions, while surgical repair for larger erosions. Recurrent erosions could happen and requires repairs several times.

Changes in urodynamic measurements and bladder neck position after single-incision trans-vaginal mesh for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is common in patients with pelvic organ prolapse. This study hypothesized that SUI may be persistent, de novo, or even cured in women after Elevate™ mesh repair alone and that SUI is associated with urodynamic changes and bladder neck position. METHODS: This secondary analysis included a study cohort of 100 women who underwent Elevate repair. All of them underwent multi-channel urodynamic measurements, 1-h pad test, and bead chain urethrocystography to measure the bladder neck position pre-operatively and at 3 months post-surgery. RESULTS: Fifty-five women with pelvic organ prolapse were continent and 45 had concomitant SUI. Of the 55 continent women, 19 (35%) had de novo SUI after mesh repair surgery and 5 (9%) subsequently underwent anti-incontinence surgery. Of the 45 incontinent women, 11 (24%) became dry after mesh repair without additional anti-incontinence surgery. Of the remaining 34 (76%) with persistent SUI, 15 (33%) underwent subsequent anti-incontinence surgery. Patients with de novo and persistent SUI had a greater decrease in maximal urethral closure pressure (MUCP) after mesh repair (p = 0.03 and 0.01 respectively). Those cured of SUI also had decreased MUCP (p = 0.12), but the bladder neck position while straining was significantly more elevated after mesh repair (p < 0.01) compared with those with persistent SUI. CONCLUSIONS: Elevate mesh reinforcement significantly decreases post-operative MUCP, which is associated with SUI, but can elevate the bladder neck position. Correcting a hyper-mobile urethra is associated with treatment of the concomitant SUI.

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study.

INTRODUCTION AND HYPOTHESIS: To compare the efficacy and safety of the Elevate™ anterior and posterior prolapse repair system and traditional vaginal native tissue repair in the treatment of stage 2 or higher pelvic organ prolapse. METHODS: A cohort study was conducted between January 2010 and July 2012. Patients who underwent transvaginal pelvic reconstruction surgery for prolapse were recruited. The primary outcome was anatomical success 1 year after surgery. The secondary outcome included changes in the quality of life and surgical complications. Recurrence of prolapse was defined as stage 2 or higher prolapse based upon the pelvic organ prolapse qQuantification system. RESULTS: Two hundred and one patients (100 in the Elevate™ repair group and 101 in the traditional repair group) were recruited and analyzed. The anatomical success rate of the anterior compartment was significantly higher in the Elevate™ repair group than in the traditional repair group (98 % vs 87 %, p = 0.006), but not for the apical (99 % vs. 6 %, p = 0.317) or posterior (100 % vs 97 %, p = 0.367) compartments after a median 12 months of follow-up. Both groups showed significant improvements in the quality of life after surgery with no statistical difference. Mesh-related complications included extrusion (3 %) and the need for revision of the vaginal wound (1 %). Those in the mesh repair group had a longer hospital stay (p = 0.04), operative time (p < 0.001), and greater estimated blood loss (p = 0.05). Other complications were comparable with no statistical difference. CONCLUSIONS: The Elevate™ prolapse repair system had a better 1-year anatomical cure rate of the anterior compartment than traditional repair, with slightly increased morbidity.

A prospective study of transobturator tape as treatment for stress urinary incontinence after transvaginal mesh repair.

INTRODUCTION AND HYPOTHESIS: The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone. METHODS: This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3-6 months postoperatively. RESULTS: One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86%, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001). CONCLUSIONS: The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.

Impact of Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: This study aims to investigate the impact of the Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse. METHODS: Seventy-one consecutive patients who underwent the Prolift procedure were evaluated on the subjective reporting of symptoms and objective urodynamic measurements pre- and 1 year postoperatively. RESULTS: Subjective symptoms significantly improved after surgery included frequency, urgency incontinence, straining to void, incomplete bladder emptying, and poor urine stream but the incidence of stress urinary incontinence was unchanged. Compared with preoperative urodynamic measurements, the residual urine volume, maximal bladder capacity, and urethral closure pressure significantly decreased postoperatively. CONCLUSIONS: After 1-year follow-up, the Prolift procedure resulted in reduced storage function and impaired bladder capacity urodynamically, but emptying function improved. Lower urinary tract symptoms were significantly improved, except for an unchanged incidence of stress urinary incontinence. Women should be informed of the possible impacts before the procedure.

Outcome of tension-free obturator tape procedures in obese and overweight women.

INTRODUCTION AND HYPOTHESIS: Little data are available on the outcome of tension-free obturator tape (TVT-O) procedures in obese and overweight women. We hypothesized that the subjective and objective outcomes of TVT-O in women with a higher body mass index (BMI) would differ from those with a lower BMI. METHODS: We retrospectively reviewed the records of 129 patients who had undergone TVT-O, stratifying by BMI into normal weight (n = 39), overweight (n = 58), and obese (n = 32) groups. We compared pre- and postoperative evaluations, including subjective and objective outcome of TVT-O, complications, and quality of life assessed by validated questionnaires. RESULTS: The median follow-up was 24 months. There were no significant differences between groups in terms of objective cure rate and subjective success, quality of life scores, or postoperative complications. CONCLUSION: BMI did not influence the outcome of TVT-O procedures at a median of 24 months after surgery.

Outcome of transvaginal pelvic reconstructive surgery with Prolift after a median of 2 years' follow-up.

INTRODUCTION AND HYPOTHESIS: This study seeks to analyze the medium- to long-term outcome of transvaginal pelvic reconstructive surgery using the Prolift™ system for pelvic organ prolapse. METHODS: Sixty-five patients who underwent pelvic floor reconstruction using Prolift™ were followed for 1 to 3 years postoperatively. Assessment included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) scores. RESULTS: The overall anatomic success rate was 97% after a median of 24.5 months and 94% for the 34 women followed for more than 2 years. POP-Q stage, UDI-6, and IIQ-7 scores all improved significantly after surgery. Complications included one bladder perforation (1.5%) and one bowel perforation (1.5%), prolonged catheterization in four patients (6%), and mesh erosion in one (2%). Eight received blood transfusion (12%). CONCLUSIONS: Prolift™ surgery yielded a good anatomical outcome and satisfactory symptom improvement that appeared to be durable after 2 years.