Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Endourol. 2021 Jun;35(6):801-807. doi: 10.1089/end.2020.0537. Epub 2020 Nov 26.
The objective is to compare robotic sacral colpopexy (RSC) utilizing autologous fascia lata with RSC with synthetic mesh in the treatment of pelvic organ prolapse (POP). We performed a prospective nonrandomized case comparison trial at a single institution. We compared RSC utilizing either synthetic mesh or autologous fascia lata in women with symptomatic POP, stages II through IV. The primary outcome was anatomic prolapse recurrence determined by the Pelvic Organ Prolapse Quantification (POP-Q) examination. Secondary outcomes included patient-reported outcomes such as the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Complications were also recorded and categorized using the Clavien-Dindo (CD) system. The hypothesis is that autologous fascia lata would provide equivalent anatomic and patient-reported outcomes compared with mesh while eliminating mesh-related complications. Sixty-four women underwent RSC with 19 (29.7%) receiving fascia lata graft. The overall operative time was greater in the fascia lata group with mean fascia lata harvest time of 24.8 ± 7.4 minutes. Intragroup comparisons of the fascia and mesh groups demonstrated significant improvement in pelvic measurements as well as patient-reported outcomes. Intergroup comparison demonstrated equivalent success rates at 12.1 ± 8.7 months follow-up. There was one apical failure in the fascia lata RSC group; however, the difference was not statistically significant ( = 0.30). Significant complications in the fascia lata harvest group included two CD-II and one CD-IIIb. In the mesh group there was one mesh erosion requiring surgical excision (CD-IIIb). This is the first comparison between RSC with autologous fascia lata and mesh. Short-term anatomic outcomes were similar with autologous fascia lata use without the risk of mesh erosion. Morbidity from graft harvest site was not trivial. These results emphasize the need for a randomized controlled trial.
目的是比较机器人骶骨阴道固定术（RSC）使用自体阔筋膜与 RSC 联合合成网片治疗盆腔器官脱垂（POP）的效果。我们在一家机构进行了一项前瞻性非随机病例对照试验。我们比较了 RSC 分别使用合成网片或自体阔筋膜治疗 II 至 IV 期有症状的 POP 女性患者的效果。主要结局是通过盆腔器官脱垂定量（POP-Q）检查确定的解剖复发。次要结局包括尿生殖窘迫量表-6（UDI-6）和尿失禁影响问卷-7（IIQ-7）等患者报告的结局。还记录并使用 Clavien-Dindo（CD）系统对并发症进行分类。假设自体阔筋膜与网片相比，在消除网片相关并发症的同时，提供等效的解剖和患者报告的结局。 64 名女性接受了 RSC 手术，其中 19 名（29.7%）接受了阔筋膜移植。阔筋膜组的总体手术时间较长，平均阔筋膜采集时间为 24.8±7.4 分钟。阔筋膜组和网片组的组内比较显示，盆腔测量和患者报告的结局均有显著改善。组间比较显示，12.1±8.7 个月随访时的成功率相当。在阔筋膜 RSC 组中有 1 例穹隆部失败，但差异无统计学意义（ = 0.30）。阔筋膜采集组有 2 例 CD-II 级和 1 例 CD-IIIb 级并发症。在网片组中有 1 例网片侵蚀需手术切除（CD-IIIb 级）。 这是 RSC 联合自体阔筋膜与网片的首次比较。使用自体阔筋膜短期解剖结局相似，且无网片侵蚀风险。移植物采集部位的发病率不容忽视。这些结果强调了需要进行随机对照试验。
