Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Aichi, Japan.
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Int J Urol. 2020 Nov;27(11):996-1000. doi: 10.1111/iju.14343. Epub 2020 Aug 9.
To investigate techniques of transvaginal mesh prolapse surgery in Japan, and compare complication rates by surgeons' specialty and experience with transvaginal mesh prolapse surgery.
We carried out an anonymous questionnaire survey for surgeons attending a national transvaginal mesh prolapse surgery meeting in 2010. The surgeons were asked to state their specialty, practice patterns, transvaginal mesh prolapse surgery techniques and the number of transvaginal mesh prolapse procedures carried out as an operator including the complications that occurred.
A total of 118 surgeons (59% of the attendees) responded to the questionnaire. The mean age was 44.0 ± 9.1 years, 54 (46%) were gynecologists and 64 (54%) were urologists. All urologists and 78% of gynecologists carried out anti-incontinence surgery (midurethral sling), whereas more gynecologists (93%) carried out native tissue repair than urologists (73%). Most of both specialties (each 98%) avoided prophylactic anti-incontinence surgery during prolapse surgery. Concomitant hysterectomy during transvaginal mesh prolapse surgery was generally avoided. Surgeons reached a consensus regarding the critical transvaginal mesh prolapse surgery techniques: hydrodissection (98%) and the full-thickness dissection (the "Lychee layer"; 69%). A total of 11 935 Prolift-type transvaginal mesh prolapse procedures were carried out and the following complications were reported: bladder injury (1.6%), rectal injury (0.3%), ureteral injury (0.1%), blood transfusion (0.2%), vaginal exposure (2.8%) and recurrence requiring reoperation (1.1%). Although complications did not differ between specialty, bladder injury, transfusion and vaginal exposure were less prevalent with experienced surgeons (≥50 transvaginal mesh prolapse surgery cases).
Over 10 000 transvaginal mesh prolapse surgery had been carried out in Japan with a relatively low complication rate until 2010. This survey shows that surgeons' experience could lead to a decrease in the amount of transvaginal mesh prolapse surgery complications.
研究日本经阴道网片修补手术的技术，并比较不同术者专业和经阴道网片修补手术经验与并发症发生率的关系。
我们对 2010 年参加全国经阴道网片修补手术会议的外科医生进行了匿名问卷调查。调查内容包括术者的专业、手术习惯、经阴道网片修补手术技术以及作为术者实施的经阴道网片修补手术例数（包括发生的并发症）。
共 118 名外科医生（出席会议人数的 59%）对问卷做出了回应。平均年龄为 44.0±9.1 岁，其中 54 名（46%）为妇科医生，64 名（54%）为泌尿科医生。所有泌尿科医生和 78%的妇科医生都开展了抗尿失禁手术（中段尿道悬吊术），而开展经阴道网片修补手术的妇科医生多于泌尿科医生（93%比 73%）。两个专业的大多数医生（各 98%）在进行阴道膨出手术时都避免预防性抗尿失禁手术。经阴道网片修补手术时一般不常规行子宫切除术。术者在经阴道网片修补手术的关键技术上达成了共识：包括水分离（98%）和全层分离（“荔枝层”；69%）。共开展了 11 935 例 Prolift 型经阴道网片修补术，报告的并发症包括：膀胱损伤（1.6%）、直肠损伤（0.3%）、输尿管损伤（0.1%）、输血（0.2%）、阴道暴露（2.8%）和需要再次手术的复发（1.1%）。尽管不同专业的并发症无差异，但有经验的外科医生（≥50 例经阴道网片修补术）膀胱损伤、输血和阴道暴露的发生率较低。
截至 2010 年，日本已开展了超过 10 000 例经阴道网片修补术，其并发症发生率相对较低。本调查显示，术者经验可能会降低经阴道网片修补术的并发症发生率。
