Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.
Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.
Eur J Obstet Gynecol Reprod Biol. 2014 Jan;172:131-5. doi: 10.1016/j.ejogrb.2013.11.001. Epub 2013 Nov 9.
Mesh reinforcement in cystocele repair has become popular in recent years, with some evidence of reduced recurrence rates. In this retrospective cohort series, we aimed to assess subjective and objective outcomes, including ultrasound quantification of prolapse, following anterior colporrhaphy with and without mesh use for anterior compartment prolapse.
We assessed anatomical and functional outcomes of patients after cystocele repair in three tertiary urogynecology units. Outcome measures included either objective prolapse recurrence (defined as cystocele≥Stage 2 ICS POP-Q or bladder descent ≥10mm below the symphysis pubis on ultrasound) or subjective prolapse recurrence (defined as symptoms of vaginal lump, bulge or dragging sensation post-operatively). Comparisons between mesh use and anterior colporrhaphy-only groups were undertaken, adjusting for potential confounders (age, BMI, vaginal parity, previous prolapse repair, levator avulsion and length of follow-up) using multiple linear regression and logistic regression methods.
183 patients were assessed at an average follow-up of 4 years. Eight-three patients had anterior colporrhaphy between January 2002 and December 2005, and 100 had an anterior mesh repair between March 2004 and October 2008. Forty-six (55%) patients in the anterior colporrhaphy group compared to 33 (33%) in the mesh use group were diagnosed with a recurrent cystocele (≥stage 2) (p=0.002). After adjustment for age, BMI, previous vaginal delivery, previous vaginal repair surgery, and length of follow-up, the benefit of mesh on prolapse recurrence was principally experienced by women with major levator trauma.
At a mean of four years' follow-up, mesh augmentation was associated with reduced cystocele recurrence, but this effect was limited to patients with levator avulsion.
近年来，网片在膀胱膨出修补术中的应用越来越受欢迎，一些证据表明其复发率降低。在这项回顾性队列研究中，我们旨在评估前阴道壁修补术联合或不联合网片应用于前阴道壁膨出的主观和客观结局，包括脱垂的超声量化。
我们在三个三级泌尿妇科单位评估了膀胱膨出修复患者的解剖和功能结局。结局测量包括客观的脱垂复发（定义为膀胱膨出≥国际尿控协会膀胱膨出问卷[ICS POP-Q]分期 2 级或膀胱下降 10mm 以上低于耻骨联合的超声）或主观的脱垂复发（定义为术后阴道肿块、膨出或牵拉感症状）。使用多元线性回归和逻辑回归方法，调整潜在混杂因素（年龄、BMI、阴道分娩次数、既往脱垂修补术、肛提肌撕裂和随访时间）后，比较了网片使用组和前阴道壁修补术组。
在平均 4 年的随访中，共评估了 183 例患者。83 例患者在 2002 年 1 月至 2005 年 12 月期间行前阴道壁修补术，100 例患者在 2004 年 3 月至 2008 年 10 月期间行前阴道网片修补术。与网片使用组（33%）相比，前阴道壁修补术组有 46（55%）例患者被诊断为复发性膀胱膨出（≥2 级）（p=0.002）。在调整年龄、BMI、既往阴道分娩、既往阴道修复手术和随访时间后，网片在脱垂复发方面的获益主要见于有严重肛提肌损伤的女性。
在平均 4 年的随访中，网片增强与膀胱膨出复发减少相关，但这种效果仅限于有肛提肌撕裂的患者。
