Seth Jai, Toia Bogdan, Ecclestone Hazel, Pakzad Mahreen, Hamid Rizwan, Greenwell Tamsin, Ockrim Jeremy
Department of Urology, University College London Hospital, London, England, UK.
Urol Ann. 2019 Apr-Jun;11(2):193-197. doi: 10.4103/UA.UA_85_18.
About 40% of women suffer pelvic organ prolapse (POP) in a lifetime. The current standard intervention for vault prolapse is a mesh sacrocolpopexy or sacrohysteropexy. However, patients and surgeons are increasingly hesitant to use mesh given recent the UK and Food and Drug Administration warnings and litigation. A possible alternative is to use autologous tissue to support the vault, as a mesh-free solution. We report the outcomes from an initial series of autologous rectus fascia sheath (RFS) sacrocolpopexy and sacrohysteropexy in patients with complex pelvic floor dysfunction.
All patients had previous, multiple urological/gynecological surgery and declined standard mesh repairs. All had preoperative videourodynamics and defecating magnetic resonance imaging evaluation. The autologous POP repair was performed using 10-18 cm of rectus sheath with a similar technique to that employing mesh to support the anterior-posterior vaginal walls or encircle the cervix and secured to the sacral promontory.
Seven patients with a mean age of 52 (33-64) years underwent autologous RFS POP repair between 2014 and 2017. Mean follow-up is 16 (range 2-33) months. All patients have durable result at last follow-up. No significant complications are reported.
This is the first report of patients with complex pelvic floor dysfunction and apical POP being managed with autologous RFS sacrocolpopexy/sacrohysteropexy, and only the second report of a free graft being utilized with success. Autologous RFS sacrocolpopexy/sacrohysteropexy avoids the 10%-15% risks of mesh-related complications. Further studies of long-term durability are needed.
约40%的女性一生中会患盆腔器官脱垂（POP）。目前治疗穹窿脱垂的标准干预方法是网片骶骨阴道固定术或骶骨子宫固定术。然而，鉴于近期英国和美国食品药品监督管理局的警告及诉讼，患者和外科医生对使用网片越来越犹豫。一种可能的替代方法是使用自体组织来支撑穹窿，作为无网片解决方案。我们报告了一系列最初采用自体腹直肌筋膜鞘（RFS）骶骨阴道固定术和骶骨子宫固定术治疗复杂盆底功能障碍患者的结果。
所有患者既往均接受过多次泌尿外科/妇科手术，且拒绝标准的网片修复。所有患者术前行视频尿动力学检查和排粪磁共振成像评估。自体POP修复采用10 - 18厘米的腹直肌鞘，技术与使用网片支撑阴道前后壁或环绕宫颈并固定于骶骨岬的技术相似。
2014年至2017年间，7例平均年龄为52岁（33 - 64岁）的患者接受了自体RFS POP修复。平均随访时间为16个月（范围2 - 33个月）。所有患者在末次随访时效果持久。未报告严重并发症。
这是首例关于采用自体RFS骶骨阴道固定术/骶骨子宫固定术治疗复杂盆底功能障碍和顶端POP患者的报告，也是第二例成功使用游离移植物的报告。自体RFS骶骨阴道固定术/骶骨子宫固定术避免了10% - 15%与网片相关的并发症风险。需要进一步进行长期耐久性研究。
