Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Department of Obstetrics and Gynecology, Horsens Regional Hospital, Aarhus, Denmark.
Acta Obstet Gynecol Scand. 2022 Jun;101(6):589-596. doi: 10.1111/aogs.14322. Epub 2022 Feb 12.
To evaluate patient-reported outcomes and clinical findings after surgery for apical prolapse with the transvaginal Uphold mesh technique. Moreover, to evaluate the rate of mesh-related complications.
A historical cohort study of patients who underwent surgery from January 1, 2012 to April 30, 2019, at Aarhus University Hospital, Denmark. Pelvic examination and patient completion of questionnaires were performed in 2018-2019. Information on adverse events and reoperations was obtained from medical records.
A total of 240 patients were operated on using the Uphold mesh, 89% due to recurrent prolapse. Follow-up was attended by 192 patients (80%). Median follow-up time was 30 months, interquartile range 19-52. During follow-up, 29 patients (15%) underwent reoperation due to prolapse and are considered failures. Among the remaining, patient satisfaction was high. Thus, average score for pelvic symptoms affecting daily life was 2, on a scale of 0-10, where 0 represents no symptoms. The Patient Global Impression of Improvement (PGI-I) had an average score of 6.4 (1: very much worse; 7 very much better). Preoperatively, 89.5% of the women had grade 2 or more apical prolapse, whereas at follow-up, this was only 6.1%. Perioperative heavy bleeding needing embolization was observed in one patient (0.5%). Two patients had serious constriction of the ureter and needed re-operation. Postoperative complications, primarily temporary voiding problems, were observed in 15 patients (8%). Complications during the follow-up period were registered in 23 patients (12%); eight of these were mesh erosions. Due to complications, 11 patients (6%) needed re-operation.
The study confirms that the Uphold procedure in a centralized set-up is a procedure with high patient-reported satisfaction even in a population characterized by a high proportion of recurrent prolapse. Moreover, the procedure seems safe with acceptable complication rates.
评估经阴道 Uphold 网片技术治疗 apical prolapse 的患者报告结局和临床发现。此外，评估网片相关并发症的发生率。
这是一项在丹麦奥胡斯大学医院进行的回顾性队列研究，纳入了 2012 年 1 月 1 日至 2019 年 4 月 30 日期间接受手术的患者。2018-2019 年期间对患者进行了盆腔检查和问卷调查。从病历中获取不良事件和再次手术的信息。
共有 240 例患者接受了 Uphold 网片手术，89%因复发性脱垂而手术。192 例患者（80%）接受了随访。中位随访时间为 30 个月，四分位间距为 19-52 个月。随访期间，29 例（15%）因脱垂再次手术，被视为失败。其余患者的满意度较高。因此，对日常生活有影响的盆腔症状平均评分为 2 分（0-10 分，0 分表示无症状）。患者整体改善印象（PGI-I）平均评分为 6.4（1 分：差很多；7 分：好很多）。术前，89.5%的患者有 2 级或更高级别的 apical prolapse，而随访时仅为 6.1%。术中观察到 1 例（0.5%）严重大出血需要栓塞。2 例患者输尿管严重狭窄，需要再次手术。术后并发症，主要是暂时的排尿问题，在 15 例患者（8%）中观察到。在随访期间，23 例患者（12%）发生了并发症；其中 8 例为网片侵蚀。由于并发症，11 例患者（6%）需要再次手术。
该研究证实，在集中式设置中，Uphold 手术是一种患者报告满意度高的手术，即使在以高复发脱垂为特征的人群中也是如此。此外，该手术似乎是安全的，并发症发生率可接受。
