Amrute Kaytan V, Eisenberg Evan R, Rastinehad Ardeshir R, Kushner Leslie, Badlani Gopal H
North Shore-Long Island Jewish Medical Center, Department of Urology, New Hyde Park, New York 11040, USA.
Neurourol Urodyn. 2007;26(1):53-8. doi: 10.1002/nau.20362.
A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed.
After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat(R).
Seventy-six patients (79%) were available with a mean follow-up time of 30.7 +/- 1.7 months and mean age of 69.3 +/- 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n = 36), average pad use per day decreased significantly from 2.1 +/- 0.4 to 0.8 +/- 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 +/- 0.3 on a scale of 1 (least satisfied) to 10 (most satisfied).
Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable.
对接受单聚丙烯网片经阴道全盆腔器官脱垂修复术的患者进行了为期2.5年的结局分析。还回顾了使用无张力四点固定的修复技术描述。
在适当的阴道解剖后，放置一个特制的“H”形聚丙烯网片并在四点固定。使用单片网片，前臂提供尿道中段和膀胱颈支撑，网片中部纠正前间隙缺陷，后臂有助于阴道穹窿悬吊。最初，使用骨锚进行前路固定，但目前采用无张力方法。对2000年1月至2005年6月接受该手术的96例患者进行了回顾性分析，通过问卷调查电话随访收集额外信息。使用Sigma Stat®软件进行Student t检验统计分析。
76例患者（79%）可获得随访，平均随访时间为30.7±1.7个月，平均年龄为69.3±11.3岁。在有随访的患者中，36例（47.4%）同时接受了子宫切除术。4例患者（5.2%）报告脱垂复发。68例患者（89%）完全干燥或几乎干燥，定义为偶尔漏尿。对于术前有尿失禁的患者（n = 36），术后每天平均使用尿垫数量从2.1±0.4显著减少至0.8±0.2（P < 0.005）。12例患者（15.7%）报告新发尿急。6例患者需要再次手术，包括切除阴道网片侵蚀（2例）、解除尿道梗阻的尿道松解术（1例）、拆除可触及的阴道缝线（1例）和复发性压力性尿失禁（2例）。在21例有性生活的患者中，19例否认有任何性交困难（90.4%）。患者满意度较高，在1（最不满意）至10（最满意）的量表上平均值为7.9±0.3。
使用聚丙烯网片经阴道修复完全性盆腔脱垂是一种安全有效的选择，脱垂和压力性尿失禁的复发率极低。虽然有2例患者出现阴道侵蚀，但未发生尿道或膀胱侵蚀。总体而言，患者满意度良好。
