Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I.

OBJECTIVE: To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). MATERIALS AND METHODS: One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. RESULTS: There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. CONCLUSION: The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II.

OBJECTIVE: To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). MATERIALS AND METHODS: One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and ″de novo″ urinary symptoms after 12 months of surgery in both groups. RESULTS: Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and ″de novo ″ urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. CONCLUSION: There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and ″de novo ″ urinary symptoms between both groups after 12 months of surgery.

Successful use of pessary for uterine prolapse after pelvic trauma in a nulliparous young female: A case report.

RATIONALE: To date, sporadic studies have shown that a relationship exists between delayed pelvic organ prolapse (POP) and pelvic trauma, and these cases have all been managed with surgical procedures. PATIENT CONCERNS: A 29-year-old, nulliparous (Gravida 0) woman without sexual experience was referred to our gynecology outpatient clinic, complaining of a protruding vaginal mass 5 years after a traffic accident (hit by a truck when she was walking) that caused serious multiple injuries. DIAGNOSES: Stage 2 cystocele, stage 3 uterine prolapse, and stage 2 rectocele, pelvic trauma history. INTERVENTIONS: The woman was successfully managed with the Gellhorn size 2 pessary use. OUTCOMES: The short-term effect of pessary use was significant improvement. LESSONS: This is the first case report of the successful use of a pessary for POP after pelvic trauma in a nulliparous young female.

Postoperative pain and perceptions of recuperation after suture- and mesh-based apical sacrospinous ligament suspension.

OBJECTIVE: To compare the incidence of postoperative pain after suture- or mesh-based sacrospinous ligament suspension (SSLS). METHODS: In a retrospective study, data were reviewed from patients who underwent suture- or mesh-based SSLS at a center in Skokie, IL, USA, between 2006 and 2011. The primary outcome was self-reported postoperative pain scores (range 0-10) on the day of surgery (day 0) and 1 day later (day 1). RESULTS: Overall, 90 women were included in the study: 66 underwent mesh-based SSLS and 24 underwent suture-based SSLS. Day-0 mean pain score was 4.65 ± 1.57 in the mesh group and 5.24 ± 1.44 in the suture group (adjusted P=0.159). Day-1 mean pain score was 4.06 ± 1.78 in the mesh group and 4.31 ± 1.21 in the suture group (adjusted P=0.596). CONCLUSION: Postoperative pain did not differ between patients undergoing suture-based and those undergoing mesh-based SSLS. These observations should be considered in preoperative counseling of patients.

The effectiveness of supportive underwear in women with pelvic organ prolapse: a pilot study.

The objective was to assess the effectiveness of supportive underwear (Pro-Portare) in women with pelvic organ prolapse. Symptomatic women with all stages of prolapse participated in the study and were followed up for 4 weeks. The effectiveness of Pro-Portare was measured by three validated disease-specific quality-of-life questionnaires, a daily diary and a questionnaire on comfort and effectiveness. Thirteen women were included in the study. No improvement on quality of life was found with the use of Pro-Portare. None of the women regarded Pro-Portare as very effective, whereas five women regarded the device as (reasonably) effective. The women's major concern was on the size, shape and hard consistency of the inlet. Two women experienced worsening of their prolapse. Pro-Portare was not effective in the alleviation of prolapse symptoms and was no final solution in any of the women.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

Objective To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). Materials and Methods One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. Results There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups. .

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II

Objective To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). Materials and Methods One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and “de novo” urinary symptoms after 12 months of surgery in both groups. Results Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and “de novo” urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. Conclusion There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and “de novo” urinary symptoms between both groups after 12 months of surgery. .

Short convalescence after vaginal prolapse surgery.

OBJECTIVE: Retrospectively to describe the recommended convalescence according to patients who had undergone vaginal prolapse surgery in 1996-98, and prospectively to describe the need for and limiting factors for convalescence after vaginal prolapse surgery in 1999-2000 at a Danish University Hospital. METHODS: The retrospective study included a validated, postal, questionnaire and review of patient files. In the prospective study, we followed consecutive women after vaginal surgery in a fast-track setting using a multimodal rehabilitation model with well-defined recommendations for the convalescence period. RESULTS: In the retrospective study, 188 women (79%) with a median age of 66 years (range, 30-88) answered the questionnaire. They had been recommended a convalescence of median 6 weeks (range, 1-12) for most activities. The subjective recurrence rate was 22% within median 6 months (range, 0-24) after first-time prolapse surgery. In the prospective study, there were 41 consecutive women with a median age of 69 years (range, 44-88). Convalescence was median <1 week for most non-strenuous activities, <2 weeks for light work and <4 weeks for sexual intercourse, sports and work with lifts exceeding 10 kg. Limiting factors were fatigue and pain. The 1-year subjective recurrence rate was 17%. CONCLUSION: Traditionally, recommended convalescence has been median 6 weeks after vaginal prolapse surgery. Convalescence has been shortened to 1-3 weeks with a multimodal rehabilitation model with revised, non-restrictive recommendations. Further studies are necessary to evaluate the impact of different convalescence recommendations on the recurrence of prolapse.