Subjective outcomes 12 years after transvaginal mesh versus native tissue repair in women with recurrent pelvic organ prolapse; a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The present study describes an extended follow-up study after 12 years and focusses on subjective outcomes of women who underwent surgery for recurrent pelvic organ prolapse in the randomized index study. METHODS: One hundred and ninety-four (194) women had been randomized in the original study and in the present study, 45 (47%) in the vaginal mesh repair versus 43 (43%) women with conventional vaginal native tissue repair completed the long-term questionnaires. The mesh used was a first-generation non-absorbable mesh kit. All types of conventional vaginal native tissue repairs were allowed, and additional vaginal native tissue repairs were allowed in the mesh group. The questionnaires as applied at baseline were used. The Patient Global Impression of Improvement questionnaire (PGI-I) was the primary outcome. RESULTS: At 12 years, 30 (71%) women in the mesh group versus 23 (59%) women in the native tissue repair group reported to be PGI-I (very) much improved (p=0.24). There were no differences found in any of the questionnaire domains. There was, however, a higher number of women who had had additional operations for recurrent pelvic organ prolapse, stress urinary incontinence, and/or exposure in the mesh group: 18 women (40%) in the mesh group versus 8 women (19%) in the native tissue repair group (p=0.03). CONCLUSIONS: There was no difference in subjective outcome between the groups, but there was a statistically significant higher number of women who had needed further operations. This study confirms that vaginal mesh should not be used in all women with recurrent pelvic organ prolapse.

[A woman with post-partum ovarian vein thrombosis]. / Een kraamvrouw met pijn rechts in de onderbuik.

BACKGROUND: Pain in the lower abdomen is a common complaint with an extensive differential diagnosis. After childbirth, an ovarian vein thrombosis (OVT) needs to be considered as well. This is a relatively rare condition characterized by abdominal pain with fever. However, due to the non-specific symptoms, the diagnosis is often missed. CASE DESCRIPTION: A 26-year old woman, four days after delivery, presented with acute abdominal pain in the right lower quadrant. Blood results showed leukocytosis (10.8 x 109 mL) and an elevated CRP (138 mg/L). Ultrasound showed a tubular structure with fat infiltration, most likely due to appendicitis. Laparoscopy was performed, which revealed an appendix sana. Postoperative CT-abdomen showed an OVT, as an explanation of complaints. CONCLUSION: An OVT is an uncommon thrombotic complication in childbirth. Since clinical presentation can mimic that of appendicitis, specific attention for OVT is necessary for adequate diagnosis and prompt treatment of female patients with abdominal pain after delivery.