Wang Lily C, Al Hussein Al Awamlh Bashir, Hu Jim C, Laudano Melissa A, Davison Wesley L, Schulster Michael L, Zhao Fujun, Chughtai Bilal, Lee Richard K
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
Urology. 2015 Nov;86(5):885-91. doi: 10.1016/j.urology.2015.08.022. Epub 2015 Sep 4.
To investigate recent trends in mesh use for pelvic organ prolapse (POP)-related reconstruction procedures.
Using the 2001-2011 5% Medicare claims database, we identified POP diagnoses and related procedures. Transvaginal mesh use and sacrocolpopexy were first reported in 2005 and 2004, respectively.
A total of 613,160 cases of vaginal and abdominal POP repair procedures were identified. The majority of procedures involved multiple compartments. The rate of mesh use increased dramatically from 2% of repairs in 2005 to 35% by 2008. After the Food and Drug Administration warning in 2008, mesh use plateaued and then decreased in 2011. Mesh was used more commonly in younger (odds ratio [OR] 0.722, P < .001), white (OR 0.712-0.791 for other races, P < .001) women in the South (OR 0.741-0.848 for non-South regions, P < .001). Starting in 2008, the rate of sacrocolpopexy procedures almost doubled yearly until 2011. Sacrocolpopexy was more common in younger patients (49% in women <70 years) and in white women (88%); the majority of sacrocolpopexies were performed in the South (60%) and laparoscopically (83%-98%).
The treatment of POP has changed over time. The use of mesh increased significantly until 2008, after which it plateaued following the Food and Drug Administration warning regarding mesh-related complications. Concurrently, the number of sacrocolpopexy procedures increased significantly starting in 2008 as the use of laparoscopic and/or robotic technique and concern regarding transvaginal mesh increased.
探讨盆腔器官脱垂（POP）相关重建手术中补片使用的近期趋势。
利用2001 - 2011年5%的医疗保险索赔数据库，我们确定了POP诊断及相关手术。经阴道补片的使用和骶骨阴道固定术分别于2005年和2004年首次报告。
共确定613,160例阴道和腹部POP修复手术。大多数手术涉及多个腔室。补片使用率从2005年修复手术的2%急剧上升至2008年的35%。2008年美国食品药品监督管理局发出警告后，补片使用率趋于平稳，随后在2011年下降。补片在南方年轻女性（优势比[OR]0.722，P <.001）、白人女性（其他种族的OR为0.712 - 0.791，P <.001）中使用更为普遍。从2008年开始，骶骨阴道固定术的手术率几乎每年翻倍，直至2011年。骶骨阴道固定术在年轻患者（<70岁女性中占49%）和白人女性（88%）中更为常见；大多数骶骨阴道固定术在南方进行（60%），且采用腹腔镜手术（83% - 98%）。
POP的治疗随时间发生了变化。补片的使用在2008年之前显著增加，之后在美国食品药品监督管理局就补片相关并发症发出警告后趋于平稳。同时，从2008年开始，随着腹腔镜和/或机器人技术的使用以及对经阴道补片关注度的增加，骶骨阴道固定术的手术数量显著增加。
