Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry.

OBJECTIVE: To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN: Prospective cohort study using a registry. SETTING: Nineteen French surgical centres. POPULATION: A total of 2309 women participated between 2017 and 2019. METHODS: A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES: Serious complications and subsequent reoperations for POP recurrence. RESULTS: The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS: Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT: Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.

[Transvaginal repair of genital prolapse using a light-weight mesh by the vaginal route]. / Traitement du prolapsus génital par renfort prothétique léger par voie vaginale.

OBJECTIVE: To evaluate the results associated with the transvaginal repair of genital prolapse using a tension free light-weight polypropylene mesh. PATIENTS AND METHODS: One hundred and fifteen patients have been treated in a single centre. Pre-operative and operative data and complications were recorded. Patients were examined at 1, 6 and 12 months. Anatomical failure was defined as follows: Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. RESULTS: Seventy-seven (67%) patients completed 6 months follow-up and 45 (39%) patients completed 12 months follow-up. Finally, 70 (61%) patients were lost to follow-up, including 2 deaths (not related to surgery). Mean age was 66 years. All patients were treated with an anterior and apical and 20 patients were additionally treated with a posterior mesh. Among the 77 patients who completed 6 months follow-up, the complications reported were: 2 (2%) bladder injuries, 1 (1%) hematoma, 1 (1%) bleeding>200 mL and 1 (1%) vaginal mesh exposure. At one year, 6 (7%) patients suffered from urinary stress incontinence, 5 (4%) suffered from urgency and 4 (5%) had dyspareunia. Among the 45 patients who completed 12 months follow-up, functional success was 95% and anatomical success was 77%. CONCLUSION: In this series, the placement of a light-weight transvaginal polypropylene mesh was associated with good functional results and a moderate prevalence of complications. LEVEL OF EVIDENCE: 4.

[Rectocele repair with porcine dermal collagen implant associated with infracoccygeal sacropexy]. / Traitement de la rectocèle par une prothèse biologique de derme porcin inter-rectovaginale associé à une sacropexie infracoccygienne.

OBJECTIVES: To evaluate an infracoccygeal colpopexy procedure by tension-free synthetic tape for vaginal apical prolapse associated with a posterior mesh procedure using porcine dermal graft for rectocele repair. METHODS: A retrospective study concerning 35 women. The surgical procedure included rectocele repair with porcine dermal collagen implant (porcine dermal matrix, native) associated with transgluteal infracoccygeal sacropexy using a polypropylene sling. RESULTS: Median follow up was 48 months (42-54). A vaginal hysterectomy was associated in 43% and a cure of cystocele was associated in 63% of cases. No intra-operative complication was noted. The prevalence of dyschesia decreased from 25% (eight patients) preoperatively to 3% (one patient) postoperatively. No cases of de novo dyspareunia was noted. Five (14%) patients had a recurrent prolapse (two cases of rectocele stage 2, one case of grade 3 rectocele associated with a cystocele, a case of uterine prolapse associated with cystocele and one case of recurrent isolated uterine prolapse). Among them, three patients (9%) required a re-intervention for prolapse recurrence. No vaginal mesh exposure was observed. Perineal pain was reported by 12 (33%) patients at one month follow-up, but no patient complained with perineal pain one year follow-up. CONCLUSION: Infracoccygeal sacropexy associated with rectocele repair using porcine dermal collagen implant was associated with satisfactory results at medium term follow-up.

[Urinary incontinence, should fertile women undergo surgical procedure?]. / Incontinence urinaire : faut-il traiter chirurgicalement les femmes en âge de procréer ?

The goal of this study was to make a Medline research about pregnancies which occur after surgical procedures for stress urinary incontinence (SUI). Therefore, we do not know the recurrence rate of SUI after pregnancy and the influence of the way of delivery on the risk of recurrence. We do not know either if we should apply a surgical procedure on women who have not achieved their pregnancies. In 1998, a questionnaire based survey conducted in the USA showed a lower risk of recurrence after a caesarean section than after a vaginal delivery (p=0,03) when women had previously colposuspension or sling procedures. We found ten case reports and a French national survey (2006) about pregnancies after TOT or TVT procedure. No complication related to the tape was described during pregnancy. The recurrence rate along the pregnancy is about 15%, and the global recurrence rate (during pregnancy and after the childbirth) is about 20%. As a conclusion, pregnancy itself has an influence, and vaginal delivery seams to increase the risk of recurrence after the birth compare to the c-section. However this recurrence rate and these data do not appear enough to us to refuse a surgical treatment for women who have not completed their pregnancies and who suffer from UI without efficacy of physiotherapy. We do not have objective data to assess the best way of delivery. Further and large studies are needed although they are difficult to be carried through.

[Episiotomy and prevention of perineal and pelvic floor injuries]. / Episiotomie et prévention des lésions pelvi-périnéales.

OBJECTIVES: The objective of this review was to assess the efficacy of episiotomy to prevent severe perineal tears, urinary incontinence, faecal incontinence and genital prolapse. MATERIAL AND METHODS: A systematic review on Medline database was performed between 1980 and 2005. One hundred seventy seven articles were selected. Trial quality was assessed on the following parameters: design (prospective, randomized, meta-analysis), sample size (>50) and relevant results. Finally, 43 articles were analysed. RESULTS: The routine use of episiotomy did not prevent severe perineal tears. It decreased the risk of moderate anterior perineal lacerations. The risk of severe perineal tears during episiotomy increased in the following circumstances: primiparity, Asian women, perineal length