Department of Urology and Pediatric Urology, University Hospital Mainz, Mainz, Germany.
Department of Urology and Pediatric Urology, University Hospital Mainz, Mainz, Germany.
Int J Surg. 2016 Sep;33 Pt A:36-41. doi: 10.1016/j.ijsu.2016.07.062. Epub 2016 Jul 25.
Transvaginal mesh repair has been discredited due to high complications rates in the past years. Therefore, we evaluated the quality of life (QoL) and complication rates after transvaginal mesh (TVM) repair for pelvic organ prolapse (POP).
A total of 148 women who underwent TVM repair for symptomatic POP were retrospectively enrolled. Complication rates and functional outcomes were retrospectively assessed and validated, standardised questionnaires were used prospectively for evaluation of QoL. Univariate analysis by the chi(2)-test as well as a multivariate Cox regression analysis was conducted to predict mesh exposure using various variables as predictors.
Intraoperative complications with bowel or bladder injury appeared in 3.4%. Mesh exposure occurred in 2.7% whereas surgical revision was necessary only in 1.4%. No predictor for mesh exposure could be identified. Postoperative complications according to Clavien-Dindo classification ≥ III occurred in only 2.8%. An improvement of POP-symptoms was reported by 84.6% according the "patients' global impression of improvement" (PGI-I) and 88.2% women would repeat the surgery. The results of the "prolapse-quality of life"-questionnaire were comparable to asymptomatic women. Only 33% reported vaginal pain with a mean vaginal pain score of 0.6 according the international index of pain. Of sexually active women, 29% reported sexual impairments and mean score of sexual impairment was 1.52.
Low complication rates and a quality of life comparable to asymptomatic women following TVM repair could be achieved in our cohort. However, a high number of sexual impairments was identified although the impact of impairment was marginal.
由于过去几年中并发症发生率较高，经阴道网片修补术已不再被认可。因此，我们评估了经阴道网片（TVM）修补治疗盆腔器官脱垂（POP）后的生活质量（QoL）和并发症发生率。
回顾性纳入了 148 例因症状性 POP 而行 TVM 修补术的女性。回顾性评估并验证了并发症发生率和功能结果，并前瞻性使用标准问卷评估 QoL。使用卡方检验进行单变量分析，使用多元 Cox 回归分析预测各种变量作为预测因素的网片暴露情况。
术中发生肠或膀胱损伤等并发症的比例为 3.4%。网片暴露的发生率为 2.7%，而仅 1.4%需要再次手术。无法确定网片暴露的预测因素。根据 Clavien-Dindo 分类≥III 级的术后并发症仅占 2.8%。84.6%的患者根据“患者总体改善印象”（PGI-I）报告 POP 症状有所改善，88.2%的女性会再次接受手术。“脱垂生活质量”问卷的结果与无症状女性相当。仅 33%的患者报告阴道疼痛，阴道疼痛评分平均为 0.6 分。在有性生活的女性中，29%报告存在性障碍，性障碍的平均评分是 1.52。
在我们的队列中，经 TVM 修补后可获得较低的并发症发生率和与无症状女性相当的生活质量。然而，尽管性障碍的影响较小，但仍发现了大量的性障碍。
