Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.
Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Shanghai, China.
Low Urin Tract Symptoms. 2021 Oct;13(4):456-462. doi: 10.1111/luts.12392. Epub 2021 Jun 8.
To compare the outcomes of transvaginal mesh (TVM) and native-tissue repair (NTR) for the repair of anterior compartment prolapse.
This retrospective study involved 90 patients with anterior compartment prolapse who underwent pelvic organ prolapse surgery between January 2018 and October 2020. A TVM was used to treat 53 patients and 37 underwent NTR. All patients underwent a standardized interview, clinical examination, and four-dimensional pelvic floor ultrasound (PFUS) before and after the surgery. The primary outcome was anatomic recurrence evaluated by ultrasonic parameters. The secondary outcomes were subjective recurrence and complications.
Subjective recurrence was 9.43% (5/53) for TVM and 16.22% (6/37) for NTR (P = .522). Significant recurrence of prolapse on ultrasound occurred in five patients (9.43%) after TVM and 12 (32.43%) after NTR; there was a significant difference between the TVM and NTR groups (P = .006). In the TVM group, the mesh was visible on ultrasound in each patient. The mesh exposure rate was 1.89% (1/53). The postoperative hiatal area reduction in the TVM group, compared with the NTR group, was statistically significant (5.55 ± 4.71 cm vs 3.09 ± 5.61 cm , P = .027). The incidence of de novo stress urinary incontinence was higher in the TVM group (20.75% vs 2.70%, P = .03). After surgery, there were significant differences between the two groups based on bladder descent (12.02 ± 8.64 mm vs 22.41 ± 13.95 mm, P = .000) and urethral rotation angle (25.26 ± 13.92° vs 40.27 ± 23.72°, P = .001).
PFUS is effective for evaluating postoperative outcomes. TVM facilitates a better anatomic cure than NTR for anterior compartment prolapse.
比较经阴道网片（TVM）和固有组织修复（NTR）治疗前盆腔器官脱垂患者前盆腔器官脱垂的疗效。
本回顾性研究纳入了 2018 年 1 月至 2020 年 10 月间接受盆腔器官脱垂手术的 90 例前盆腔器官脱垂患者。53 例患者接受 TVM 治疗，37 例患者接受 NTR。所有患者在手术前后均接受标准化访谈、临床检查和四维盆底超声（PFUS）检查。主要结局为超声参数评估的解剖学复发。次要结局为主观复发和并发症。
TVM 组的主观复发率为 9.43%（5/53），NTR 组为 16.22%（6/37）（P=0.522）。TVM 组 5 例（9.43%）和 NTR 组 12 例（32.43%）患者发生显著的超声下脱垂复发，两组之间差异有统计学意义（P=0.006）。TVM 组 53 例患者的网片在超声下均可见。网片暴露率为 1.89%（1/53）。与 NTR 组相比，TVM 组术后疝孔面积减少有统计学意义（5.55±4.71 cm 比 3.09±5.61 cm，P=0.027）。TVM 组新发压力性尿失禁发生率高于 NTR 组（20.75%比 2.70%，P=0.03）。术后两组间膀胱下降程度（12.02±8.64 mm 比 22.41±13.95 mm，P=0.000）和尿道旋转角度（25.26±13.92°比 40.27±23.72°，P=0.001）差异均有统计学意义。
PFUS 可有效评估术后疗效。对于前盆腔器官脱垂，TVM 比 NTR 更有利于解剖学治愈。
