Pelvic Floor Unit, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, Germany.
World J Urol. 2012 Aug;30(4):479-86. doi: 10.1007/s00345-011-0794-9. Epub 2011 Nov 16.
Transvaginally placed mesh in pelvic reconstructive surgery for women with pelvic organ prolapse has gained popularity because of excellent anatomical outcomes, but postoperative mesh-related complications have lead to a number of cautious reviews and warnings. This review focuses on functional outcomes after synthetic transvaginal mesh placement.
MEDLINE database was searched from 2010 to August 2011 for original articles on transvaginal mesh surgery for pelvic organ prolapse not included in recent reviews. The following search terms were used: pelvic organ prolapse, genital prolapse, cystocele, rectocele and mesh, synthetic graft, and repair. Studies were assessed and appropriate data extracted and tabularized. Studies were excluded if the follow-up time was less than 12 months and if studies did not contain original data or data on subjective outcome.
Eleven studies irregularly reported functional outcomes. After trocar-guided transobturator vaginal mesh surgery, symptomatic recurrence of pelvic organ prolapse was reported between 7 and 33%. If analyzed cumulatively, 76 of 370 patients (21%) complained of prolapse symptoms postoperatively. De novo stress urinary incontinence occurred in 12-17% and persisted in up to 68% after trocar-guided mesh surgery. De novo dyspareunia was present between 2 and 15%, worsened or de novo dyspareunia between 25 and 44%. Deteriorating coital incontinence was described in 6 of 16 women after anterior Prolift in one trial.
When counseling women for pelvic reconstructive surgery, we should provide them with evidence-based information on functional outcomes and subsequently take the patient's concerns and preferences into account. Pelvic floor symptoms were scarcely reported in reviewed trials, but demonstrated a worse scenario than anatomical outcomes.
经阴道放置网片在女性盆腔器官脱垂重建术中的应用因具有极佳的解剖学效果而受到广泛欢迎，但术后与网片相关的并发症导致了许多谨慎的回顾和警告。本综述聚焦于合成经阴道网片置入后的功能性结果。
2010 年至 2011 年 8 月，我们在 MEDLINE 数据库中检索了关于经阴道网片治疗盆腔器官脱垂的原始文章，这些文章未包含在近期的综述中。使用了以下搜索词：盆腔器官脱垂、生殖器脱垂、膀胱膨出、直肠膨出和网片、合成移植物、修复。评估了研究，并提取了适当的数据并制成表格。如果随访时间少于 12 个月，如果研究没有包含原始数据或主观结果数据，则排除研究。
11 项研究不规则地报告了功能性结果。在经阴道穿刺引导的经闭孔网片手术后，盆腔器官脱垂的症状复发率为 7%至 33%。如果累积分析，370 例患者中有 76 例（21%）术后出现脱垂症状。新发生的压力性尿失禁发生率为 12-17%，经阴道穿刺引导网片手术后持续存在 68%。新发生的性交困难为 2-15%，恶化或新发性交困难为 25-44%。在一项试验中，16 名女性中有 6 名在接受 Prolift 前位修复后出现了恶化的性交时尿失禁。
在为盆腔重建手术提供咨询时，我们应向女性提供基于证据的功能性结果信息，并随后考虑患者的关注和偏好。在综述研究中很少报告盆底症状，但结果比解剖学结果更差。
