Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy.
Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy.
Urol Int. 2022;106(3):282-290. doi: 10.1159/000519818. Epub 2021 Nov 26.
Sacrocolpopexy (SC) is the main treatment option for the repair of anterior and apical pelvic organ prolapse (POP). Indications and technical aspects are not standardized, and the question remains whether it is necessary to place a mesh on both anterior and posterior vaginal walls, particularly in cases with only minor or no posterior compartment prolapse. The present study aimed to compare the anatomical and functional outcomes of single anterior mesh only versus anterior and posterior mesh procedures in SC.
Our prospectively maintained database on POP was used to identify patients who had undergone either abdominal or mini-invasive SC from January 2006 to October 2019. Patients with symptomatic or unmasked stress urinary incontinence (SUI) were not included in the study and were treated using the pubo-vaginal cystocele sling procedure. Objective outcomes included clinical evaluation of pre-existing or de novo POP by the halfway system and POP-q classifications, as well as the development of de novo SUI. Subjective outcomes were assessed using the Pelvic Floor Impact Questionnaire (PFIQ-7) with questions on bladder, bowel, and vaginal functions. Persistent or de novo constipation and overactive bladder were defined as bowel symptoms and urinary urgency/frequency/urinary incontinence after surgery.
Ninety-five women with symptomatic anterior and apical POP underwent SC. Forty-one patients were treated with only anterior vaginal mesh (group A), and 54 with anterior and posterior mesh (group B). There were no differences between the pre- and post-operative characteristics of the 2 groups. In group B, there were 2 blood transfusions, 1 wound dehiscence, and 3 mesh erosions/extrusion after abdominal SC (Clavien-Dindo II), and in group A, there was 1 ileal lesion after laparoscopic SC (Clavien-Dindo III). There were no differences between the 2 groups in either anatomical or functional outcomes during 3 years of follow-up.
SC with single anterior vaginal mesh has similar results to SC with combined anterior/posterior mesh, regardless of the surgical approach. The single anterior mesh may reduce the risk of complications (mesh erosion/extrusion), and offers better subjective outcomes with improved quality of life. Anterior/posterior mesh may be justified in the presence of clinically significant posterior POP.
经阴道骶骨固定术（SC）是修复前盆腔和中盆腔器官脱垂（POP）的主要治疗方法。适应证和技术方面尚未标准化，仍存在争议，即是否有必要在阴道前壁和后壁都放置网片，特别是在仅有轻微或无后盆腔器官脱垂的情况下。本研究旨在比较单纯前路网片与前路和后路网片在 SC 中的解剖和功能结果。
我们使用前瞻性维持的 POP 数据库，确定 2006 年 1 月至 2019 年 10 月期间接受过经腹或微创 SC 的患者。患有症状性或未显露的压力性尿失禁（SUI）的患者未纳入研究，采用耻骨阴道膀胱膨出吊带术治疗。客观结果包括采用 halfway 系统和 POP-q 分类对术前或新发性 POP 进行临床评估，以及新发性 SUI 的发生。主观结果采用盆腔器官脱垂影响问卷（PFIQ-7）进行评估，问题涉及膀胱、肠道和阴道功能。术后持续性或新发便秘和膀胱过度活动症被定义为肠症状和尿急/尿频/尿失禁。
95 例有症状的前盆腔和中盆腔 POP 患者接受了 SC。41 例患者仅接受阴道前壁网片治疗（A 组），54 例患者接受阴道前壁和后壁网片治疗（B 组）。2 组患者的术前和术后特征无差异。B 组中，5 例患者经腹 SC 后发生 2 例输血、1 例伤口裂开和 3 例网片侵蚀/脱出（Clavien-Dindo II 级），A 组中，1 例患者经腹腔镜 SC 后发生回肠损伤（Clavien-Dindo III 级）。3 年随访期间，2 组在解剖和功能结果方面无差异。
经阴道骶骨固定术联合单纯阴道前壁网片与联合阴道前壁/后壁网片的结果相似，无论手术方式如何。单纯阴道前壁网片可降低并发症（网片侵蚀/脱出）风险，并提供更好的主观结果，提高生活质量。在存在临床显著的后盆腔 POP 时，可考虑阴道前壁/后壁网片。
