Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Acta Obstet Gynecol Scand. 2019 Apr;98(4):451-459. doi: 10.1111/aogs.13520. Epub 2019 Feb 3.
The management of pelvic organ prolapse (POP) varies significantly between countries. The objective of this study was to describe the methods used for POP surgery in Finland and to identify the factors that affect clinicians' choice to use either a native tissue repair (NTR) or a mesh repair method.
This prospective cohort study included 3535 surgeries covering 83% of all POP operations performed in Finland in 2015. The operative details and patient characteristics, including the Pelvic Floor Distress Inventory (PFDI-20), were compared between three selected surgical methods: NTR, transvaginal mesh (TVM) and abdominal mesh (AM). The predictive factors for the use of mesh augmentation were also studied with logistic regression analysis.
The most common method was NTR (n = 2855, 81%), followed by TVM (n = 429, 12%) and AM (n = 251, 7%). Approximately 92% of the patients who underwent primary prolapse surgery underwent NTR, and mesh surgery was used mainly for recurrent prolapse. The strongest predictor of mesh surgery was previous POP surgery for the same vaginal compartment (adjusted odds ratio [OR] = 56, 95% confidence interval [CI] = 38-84 for TVM; adjusted OR = 22, 95% CI = 14-34 for AM). Other predictive factors for mesh surgery were previous hysterectomy, healthcare district, severe bulge symptoms and advanced prolapse. TVM was associated with advanced anterior prolapse and older age. AM surgery was associated with advanced apical and/or posterior compartment prolapse. PFDI-20 scores were the highest in the AM group (108 vs 103 in the TVM group and 98 in the NTR group, P = 0.012), which indicates more bothersome symptoms than in the other groups.
The Finnish practices follow international guidelines that advocate NTR as the principal surgical method for POP. Synthetic mesh augmentation was mainly used in patients with recurrent and advanced prolapse with severe symptoms. The variation in the rates of mesh augmentation for POP surgery in different hospitals implies a lack of sufficient evidence of the most suitable treatment method and indicates a need for national guidelines.
盆腔器官脱垂（POP）的管理在各国之间差异很大。本研究的目的是描述芬兰 POP 手术的方法，并确定影响临床医生选择使用天然组织修复（NTR）或网片修复方法的因素。
本前瞻性队列研究纳入了 2015 年芬兰所有 POP 手术的 83%，共 3535 例手术。比较了三种选定手术方法（NTR、经阴道网片（TVM）和腹式网片（AM））之间的手术细节和患者特征，包括盆腔器官脱垂严重程度问卷（PFDI-20）。还使用逻辑回归分析研究了网片增强的预测因素。
最常见的方法是 NTR（n=2855，81%），其次是 TVM（n=429，12%）和 AM（n=251，7%）。大约 92%的初次脱垂手术患者接受了 NTR，而网片手术主要用于复发性脱垂。网片手术的最强预测因素是同一阴道隔的先前 POP 手术（TVM 的调整优势比[OR] = 56，95%置信区间[CI] = 38-84；AM 的调整 OR = 22，95%CI = 14-34）。网片手术的其他预测因素包括先前的子宫切除术、医疗保健区、严重膨出症状和高级脱垂。TVM 与高级前突脱垂和较年长有关。AM 手术与高级顶、后突脱垂有关。PFDI-20 评分在 AM 组最高（TVM 组为 108，NTR 组为 103，P=0.012），表明症状比其他组更麻烦。
芬兰的实践遵循国际指南，主张 NTR 作为 POP 的主要手术方法。合成网片增强主要用于有严重症状的复发性和高级脱垂患者。不同医院 POP 手术中网片增强率的差异表明缺乏最合适的治疗方法的充分证据，并表明需要国家指南。
