Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up

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Abstract


Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient  effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction.

Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse.

Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment.

Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.

Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.


Dmitry D. Shkarupa

N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University

Author for correspondence.
Email: shkarupa.dmitry@mail.ru

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Сhief Urologist, Deputy Director for Medical Care

Nikita D. Kubin

N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University

Email: nikitakubin@gmail.com

Russian Federation, Saint Petersburg

MD, PhD

Eduard N. Popov

Research Institute of Obstetrics, Gynecology and Reproductology n.a. D.O. Ott

Email: edvardpopov@mail.ru

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), the Head of the Department of Operative Gynecology

Ekaterina A. Shapovalova

N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University

Email: katerina_andmed@mail.ru

Russian Federation, Saint Petersburg

MD, Obstetrician-Gynecologist

Gleb V. Kovalev

North-Western State Medical University named after I.I. Mechnikov

Email: kovalev2207@gmail.com

Russian Federation, Saint Petersburg

Student

Alexey V. Pisarev

N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University

Email: alexey.v.pisarev@gmail.com

Russian Federation, Saint Petersburg

MD

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Supplementary files

Supplementary Files Action
1. Fig. 1. Position of the Pelvix anterior mesh: 1 — mesh, 2 — cervix, 3 — obturator membrane, 4 — sacrospinous ligament View (193KB) Indexing metadata
2. Fig. 2. Pelvix anterior mesh (а); Urofix PL and tunneler (b) View (456KB) Indexing metadata
3. Fig. 3. Ba point dynamics: Ba_0, prior to the operation; Ba_1, after 12 months; Ва_2, after 24 months View (18KB) Indexing metadata
4. Fig. 4. PVR dynamics: PVR _0, prior to the operation; PVR _1, after 12 months; PVR _2, after 24 months View (51KB) Indexing metadata

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Copyright (c) 2018 Shkarupa D.D., Kubin N.D., Popov E.N., Shapovalova E.A., Kovalev G.V., Pisarev A.V.

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