OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure. (+info)
New surgical technique for the treatment of urinary incontinence in Clinic of Obstetrics and Gynecology of Kaunas University of Medicine.
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There are various surgical methods for the treatment of female urinary stress incontinence. The aim of this study was to evaluate the effectiveness of tension-free vaginal tape (TVT) operation based on a three-year clinical experience and the possibility of its use in the outpatient settings. MATERIALS AND METHODS: The patients were examined according to a standardized protocol for urinary incontinence and were operated on according to the original "Gynecare TVT" protocol. A total of 57 women were operated on and followed up during the study period (02/25/2000-12/31/2002). The average age was 52 years. Out of them 31 (54.4%) women were after menopause and 56 (97.9%) gave birth. Nine women had operations in their medical histories: five had hysterectomies and the other four were operated on because of urinary incontinence. Besides, five women were operated due to mixed urinary incontinence. Among the operated women, 6 had local anesthesia, 13 had epidural, and 38 had lumbar anesthesia. The average time of the operation was 22.3 minutes. The mean hospital stay was 4.4 days. Five patients were hospitalized for one day. Besides TVT operation, eight patients had anterior colporrhaphy, two patients had posterior colporrhaphy, and two patients had "mesh" application for cystocele treatment. RESULTS: One woman had stress urinary incontinence symptoms after operation (the effectiveness of operation was 98.2%). The main complications were: perforation of the urinary bladder was present in 1 (1.8%) patient and infection of urinary tract - in 4 (7.0%) patients. CONCLUSION: TVT operation is a minimal invasive, fast, safe and very effective surgical procedure for the treatment of urinary stress incontinence, which has to be implemented in Lithuania as a routine outpatient procedure. (+info)
The effectiveness of transvaginal anterior colporrhaphy reinforced with polypropylene mesh in the treatment of severe cystoceles.
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INTRODUCTION: Grade 4 cystoceles are among the most challenging to achieve a successful repair for gynaecologists. The high rate of recurrence of severe prolapse encouraged surgeons to use meshes. Only recently have meshes been used transvaginally for pelvic organ prolapse. The aim of our pilot study was therefore to determine the effectiveness of transvaginal anterior colporrhaphy reinforced with prolene mesh in the treatment of severe or recurrent cystoceles by looking at their primary surgical outcomes as well as their complications. MATERIALS AND METHODS: This was a retrospective study conducted by the urogynaecology unit at KK Women's and Children's Hospital (KKWCH) in Singapore based on operations performed from April 2002 to December 2003. The inclusion criterion was that women had to have at least a grade 4 or recurrent grade 3 cystocele and had undergone a vaginal anterior colporrhaphy reinforced with prolene mesh. The women were further subdivided into 3 groups depending on whether vaginal hysterectomies were performed or not as well as the absence or presence of the uterus. RESULTS: Thirty-seven patients with severe cystoceles underwent this procedure. The 3 mean follow-up times for the 3 groups ranged from 14.4 to 19.2 months (range, 2 to 32). Overall for the 3 groups, 75.7% were cured with no or grade 1 cystocele, 18.9% had asymptomatic grade 2 cystocele while 5.4% developed grade 3 or 4 cystocele. There were no mesh erosions. CONCLUSION: Transvaginal anterior colporrhaphy reinforced with a tension-free prolene mesh in the treatment of severe or recurrent cystoceles is simple, safe, easily performed and is associated with a low failure rate and morbidity. (+info)
Sonomorphological evaluation of polypropylene mesh implants after vaginal mesh repair in women with cystocele or rectocele.
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OBJECTIVE: To investigate whether the sonographically measured size of the mesh implant in women who had undergone vaginal polypropylene mesh repair 6 weeks previously correlates with the original size of the mesh and whether the mesh ensures complete support of the anterior or posterior compartment. METHODS: Forty postmenopausal women with anterior or posterior vaginal wall prolapse and sonographically proven cystocele (n = 20) or rectocele (n = 20) were evaluated preoperatively and 6 weeks after vaginal mesh repair. Introital ultrasound was performed to identify the polypropylene mesh and measure its distal to proximal length and configuration as well as its thickness. The initial mesh length was compared with that measured by ultrasound 6 weeks postoperatively. Vaginal length was measured pre- and postoperatively. RESULTS: The mean +/- SD age of the women was 68 +/- 7 years. The 20 women with cystocele underwent repair by means of anterior transobturator mesh implantation; the initial mesh length was 6.8 +/- 1.1 cm versus 2.9 +/- 0.6 cm postoperatively. The 20 women with rectocele underwent repair by posterior transischioanal mesh implantation; the initial mesh length was 9.9 +/- 0.8 cm versus 3.3 +/- 0.5 cm postoperatively. The mesh supported 43.4% of the length of the anterior vaginal wall and this value was 53.7% for the posterior wall (P = 0.016). CONCLUSION: Sonography is recommended for postoperative evaluation of the anterior and posterior mesh positions after prolapse surgery. There is a considerable discrepancy between the implanted mesh size and the length measured 6 weeks later by postoperative ultrasound. Published by John Wiley & Sons, Ltd. (+info)
Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms.
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OBJECTIVE: At present little information is available to help define whether a certain degree of pelvic organ prolapse is clinically relevant. We performed a retrospective study to define cut-offs for significant pelvic organ descent on the basis of prolapse symptoms. METHODS: At a tertiary urogynecological center, 735 women with symptoms of lower urinary tract dysfunction and prolapse were seen for interview, clinical examination, multi-channel urodynamics and ultrasound imaging, while supine and after voiding, for prolapse quantification. Women with multi-compartment prolapse, i.e. those in whom no compartment was clearly dominant were excluded. Receiver-operator statistics were used to test pelvic organ descent as a predictor of prolapse symptoms. RESULTS: Mean age was 55.1 years, mean parity 2.8 (range, 0-12). Symptoms of prolapse were reported by 188 women (25.6%). Seventy-four showed a symptomatic multi-compartment prolapse and were excluded, 56 symptomatic women had cystoceles and 48 had rectoceles. Symptomatic cystoceles descended on average to 23.8 mm below the symphysis pubis and symptomatic rectoceles to 21.4 mm below the symphysis pubis. Descent was strongly associated with symptoms of prolapse (both, P < 0.001). Receiver-operating characteristics (ROC) statistics suggested a cut-off of 10 mm below the symphysis pubis for cystocele, and 15 mm below the symphysis pubis for rectocele. ROC curves were similar for both compartments (area under the curve, 0.857 and 0.821, respectively). CONCLUSIONS: Descent of the bladder to > or = 10 mm and of the rectum to > or = 15 mm below the symphysis pubis are strongly associated with symptoms, and these values are proposed as cut-offs for the diagnosis of significant prolapse on the basis of ROC statistics. (+info)
Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI.
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The objective of the study was to determine the relationship between midsagittal vaginal wall geometric parameters and the degree of anterior vaginal prolapse. We have previously presented data indicating that about half of anterior wall descent can be explained by the degree of apical descent present (Summers et al., Am J Obstet Gynecol, 194:1438-1443, 2006). This led us to examine whether other midsagittal vaginal geometric parameters are associated with anterior wall descent. Magnetic resonance (MR) scans of 145 women from the prior study were suitable for analysis after eight were excluded because of inadequate visibility of the anterior vaginal wall. Subjects had been selected from a study of pelvic organ prolapse that included women with and without prolapse. All patients underwent supine dynamic MR scans in the midsagittal plane. Anterior vaginal wall length, location of distal vaginal wall point, and the area under the midsagittal profile of the anterior vaginal wall were measured during maximal Valsalva. A linear regression model was used to examine how much of the variance in cystocele size could be explained by these vaginal parameters. When both apical descent and vaginal length were considered in the linear regression model, 77% (R (2) = 0.77, p < 0.001) of the variation in anterior wall descent was explained. Distal vaginal point and a measure anterior wall shape, the area under the profile of the anterior vaginal wall, added little to the model. Increasing vaginal length was positively correlated with greater degrees of anterior vaginal prolapse during maximal Valsalva (R (2) = 0.30, p < 0.01) determining 30% of the variation in anterior wall decent. Greater degrees of anterior vaginal prolapse are associated with a longer vaginal wall. Linear regression modeling suggests that 77% of anterior wall descent can be explained by apical descent and midsagittal anterior vaginal wall length. (+info)
LOXL1 deficiency negatively impacts the biomechanical properties of the mouse vagina and supportive tissues.
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