Milani Alfredo L, Heidema Wieteke M, van der Vloedt Wanda S, Kluivers Kirsten B, Withagen Mariella I J, Vierhout Mark E
Department of Obstetrics and Gynaecology, Reinier de Graaf Group, Delft, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2008 Jun;138(2):232-8. doi: 10.1016/j.ejogrb.2007.12.014. Epub 2008 Mar 4.
To determine the safety and efficacy of ultra lightweight titanium coated polypropylene mesh to augment conventional vaginal prolapse repair in women with recurrent symptomatic prolapse stage II or more or primary prolapse stage III or more.
A prospective observational cohort study was performed at two urogynecological centres in The Netherlands. Women with recurrent symptomatic prolapse at least stage II or primary vaginal prolapse ICS POP stage III or more participated in the study. POP-Q and validated urogynecological questionnaires were used pre- and post-operatively. Outcome measures were mesh-related morbidity and prolapse recurrence, defined as ICS POP stage II, as well as changes in domain scores on urogenital distress- and defaecatory distress inventory (UDI and DDI), incontinence impact questionnaire (IIQ) as well as sexual functioning. Wilcoxon's signed ranks test for paired variables and 95% confidence intervals, respectively were used to analyse these data.
The study group comprised 71 patients with a median follow-up of 9 months (6-14). Mesh erosions were detected in four patients (5.6%), all on the posterior vaginal wall. After Ti-mesh((R)) augmentation in 14 patients (36%) the anterior vaginal wall and in 7 patients (18%) the posterior vaginal wall, was categorised as ICS POP stage II and were thus considered failures. UDI and DDI domain scores all improved significantly, except for the domains of incontinence and pain, respectively. Three out of five domains of the IIQ showed significant improvement. Surgery did not have any significant negative impact on sexual functioning.
Ultra lightweight titanized polypropylene mesh to augment conventional vaginal prolapse repair surgery showed minimal morbidity, but no additional value compared to conventional surgery at short-term follow-up.
