La chirurgie vaginale prothétique est-elle une stratégie valide chez une patiente présentant une cystocèle récidivée après promontofixation ? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2010-05-05

AUTHORS

L. Mamy, V. Letouzey, P. Merviel, J. Gondry, P. Mares, P. Costa, R. de Tayrac

ABSTRACT

ObjectiveThe aims of this study were to evaluate the efficacy and safety of vaginal surgery using mesh in women with recurrent anterior vaginal wall prolapse after abdominal sacrocolpopexy, in comparison with primary repair.Material and methodsPatients operated for recurrent anterior vaginal wall prolapse after abdominal sacrocolpopexy (study group) were retrospectively analyzed and compared with patients operated for anterior vaginal wall prolapse as primary repair (control group). All patients have been operated with an anterior type 1 polypropylene mesh. Preoperative evaluation included history, POP-Q classification and symptoms and quality of life questionnaires. Intra- and post-operative complications were recorded. Associated procedures, such as vaginal hysterectomy, sacrospinous fixation, posterior repair and sub-urethral sling, were also reported. After surgery, patients were seen at 6 weeks, 6 months, one and two years, using POP-Q classification, satisfaction index and symptoms and quality of life questionnaires. To complete follow-up, patients who were not seen recently had phone interviews on POP symptoms, satisfaction and late complications. Objective success was defined by the absence of anatomical recurrence of anterior vaginal wall prolapse (Ba < −1) at last follow-up.ResultsThe study included 65 implanted patients (32 in the study group and 33 in the control group). In the study group, one patient died from a cancer and two were lost to followup, leaving 29/32 patients available for analysis. In the control group, three patients have previously undergone vaginal surgery and one was lost to follow-up, leaving 29/33 patients available. In the study group, 17/29 patients underwent a transobturator four arms mesh (Ugytex®, Sofradim-Covidien), and 12/29 under went another operation — type 1 polypropylene mesh (Polyform®, Boston Scientific) fixed bilaterally to the arcus tendineus fascia pelvis and to the sacrospinous ligament using the Capio® (Boston Scientific). In the control group, 20/29 patients underwent the transobturator four arms mesh, and 9/29 underwent the mesh fixed bilaterally to the arcus tendineus fascia pelvis and to the sacrospinous ligament operation. Demographic and clinical characteristics at baseline were similar in both groups, except for previous POP surgery, previous hysterectomy and previous SUI surgery, more frequent in the study group. Associated procedures (sacrospinous fixation, posterior repair and sub-urethral sling) were more frequent in the control group.With a mean follow-up time of 22 ± 12 months in the study group and 23 ± 14 months in the control group, objective success on the anterior compartment were 25/29 (86.2%) and 28/29 (93.1%), respectively (P > 0.05). Although all patients were satisfied with results of surgery, one patient in each group had a recurrence of apical defect (P > 0.05), no patient in the control group had a recurrence of posterior compartment prolapse (P > 0.05), and 7/20 (35%) patients in the study group had de novo posterior compartment prolapse (P < 0.05). Postoperative symptoms and quality of life evaluation were similar in both groups. De novo dyspareunia occurred in1/8 (12.5%) and 2/13 (15.4%) patients, in the study and the control group, respectively (P > 0.05). Overall rates of complications were 6/29 (20.7%) and 5/29 (17.2%), in the study and the control group (P > 0.05), respectively, including one ureteral kinking (3.4%) in the study group and 1/29 (3.4%) rate of vaginal erosion, which has necessitated re-operation in each group.ConclusionVaginal surgery using mesh is a valid option in women with recurrent anterior vaginal wall prolapse after abdominal sacrocolpopexy. More... »

PAGES

89-96

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11608-010-0312-3

DOI

http://dx.doi.org/10.1007/s11608-010-0312-3

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https://app.dimensions.ai/details/publication/pub.1046120334


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