Efficacy and safety of transvaginal mesh repair in a cohort with a minimum of 10-year follow-up

Although transvaginal mesh(TVM)repair is no longer used in some countries,long-term outcomes after TVM surgery are of great importance globally.However,reports with follow-up>10 years are limited.Thus,this study aimed to report outcomes in a prospective cohort with at least 10 years of follow-up.Women with stageⅢ–Ⅳsymptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary hospital.The main outcome measure was symptomatic failure.Secondary outcomes included anatomic failure,recurrence,patient satisfaction,complications,and reoperation.The Kaplan-Meier curve was used to estimate the cumulative failure rate.Of the 121 patients enrolled in the study,103(85.1%)completed a median follow-up of 11 years.The estimated probability rates of symptomatic and anatomic failure were 17.6%and 8.8%in 11 years,respectively.The estimated incidence of symptomatic failure increased by 8.2%between 5 and 11 years;however,the corresponding rate for anatomic failure was 3.7%.The most common complication was vaginal mesh exposure,and its estimated probability increased from 19.3%to 28.4%from 5 to 11 years,respectively.Office trimming resolved 80.0%of vaginal exposures.These patients did not report decreased overall satisfaction.Patients with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room(5.8%by 11 years)had lower satisfaction rates(P<0.01)and were defined as having severe mesh exposure.The rates of postoperative pain,reoperation,and Patient Global Impression of Improvement≥2 were 2.5%,3.3%,and 94.2%,respectively.The results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal wall.Vaginal mesh exposure was common in women who were largely not sexually active;however,80%of the cases could be managed in the outpatient clinic,which did not affect patient satisfaction.

Transvaginal mesh implant for pelvic organ prolapse:Huaxi protocol

With increasing age,pelvic organ prolapse(POP),due to its high incidence,has become a common disease that seriously affects patients’quality of life and places a heavy economic burden on families and society.Transvaginal mesh(TVM)is a minimally invasive and effective treatment for POP,although its use remains controversial due to the potential risk of mesh-related complications.The US Foods and Drugs Administration,along with authorities in England,Australia,New Zealand,and other countries,have banned the sale and distribution of commercial TVM kits designed for POP.The TVM procedure remains an option for POP treatment and still appeals to many surgeons and patients today in Asia and most European countries,which suggests that a considerable number of POP patients can benefit from its continued refinement.Here we introduce the Huaxi protocol of the TVM plant for the treatment of POP.

Risk Factors for Mesh Exposure after Transvaginal Mesh Surgery

Background： Mesh exposure after surgery continues to be a clinical challenge for urogynecological surgeons. The purpose of this study was to explore the risk factors for polypropylene （PP） mesh exposure after transvaginal mesh （TVM） surgery. Methods： This study included 195 patients with advanced pelvic organ prolapse （POP）, who underwent TVM from January 2004 to December 2012 at the First Affiliated Hospital of Chinese PLA General Hospital. Clinical data were evaluated including patient＇s demography, TVM type, concomitant procedures, operation time, blood loss, postoperative morbidity, and mesh exposure. Mesh exposure was identified through postoperative vaginal examination. Statistical analysis was performed to identify risk factors for mesh exposure. Results： Two-hundred and nine transvaginal PP meshes were placed, including 194 in the mltefior wall and 15 in the posterior wall. Concomitant tension-free vaginal tape was pertbrmed in 61 cases. The mean follow-up time was 35.1 ：e 23.6 months. PP mesh exposure was identified in 32 cases （16.4%）, with 31 in the anterior wall and 1 in the posterior wall. Significant difference was found in operating time and concomitant procedures between exposed and nonexposed groups （F = 7.443, P = 0.007; F = 4.307, P = 0.039, respectively）. Binary logistic regression revealed that the number of concomitant procedures and operation time were risk factors for mesh exposure （P = 0.001, P = 0.043）. Conclusion： Concomitant procedures and increased operating time increase the risk for postoperative mesh exposure in patients undergoing TVM surgery for POP.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse

Background:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time.The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse(POP)over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.Methods:A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1,2004 and September 30,2018 were included from 22 tertiary academic medical centers.The data were reported voluntarily and obtained from a database.We compared the proportion of each procedure in the 7 years before and 7 years after September 30,2011.The data were analyzed by performing Z test(one-sided).Results:The number of different procedures during October 1,2011-September 30,2018 was more than twice that during October 1,2004-September 30,2011.Regarding pelvic floor surgeries related to POP,the rate of synthetic mesh procedures increased from 38.1%(5298/13,906)during October 1,2004-September 30,2011 to 46.0%(14,107/30,688)during October 1,2011-September 30,2018,whereas the rate of non-mesh procedures decreased from 61.9%(8608/13,906)to 54.0%(16,581/30,688)(Z=15.53,P<0.001).Regarding synthetic mesh surgeries related to POP,the rates of transvaginal placement of surgical mesh(TVM)procedures decreased from 94.1%(4983/5298)to 82.2%(11,603/14,107)(Z=20.79,P<0.001),but the rate of laparoscopic sacrocolpopexy(LSC)procedures increased from 5.9%(315/5298)to 17.8%(2504/14,107).Conclusions:The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly.The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.Trial registration number:NCT03620565,https://register.clinicaltrials.gov.