Overholt Tyler L, Velet Liliya, Xu Mark, Dutta Rahul, Matthews Catherine A
Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, 27157, USA.
Division of Female Pelvic Medicine, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston Salem, NC, 27157, USA.
Int Urogynecol J. 2023 Oct;34(10):2603-2609. doi: 10.1007/s00192-023-05589-z. Epub 2023 Jul 13.
Anterior sacrospinous hysteropexy (SSH) was popularized by transvaginal mesh kits. Following mesh-kit market withdrawal, we hypothesized similar efficacy through native-tissue reattachment of the pubocervical fascia with fixation of the anterior cervix to the sacrospinous ligament. Few analyses for anterior native-tissue versus mesh-augmented SSH exist.
A retrospective analysis of women who underwent transvaginal anterior SSH between 01 January 2016 and 31 December 2022 was performed. Women who underwent a mesh-augmented (Uphold Lite Vaginal Support System™) versus native-tissue repair were compared. Composite success was defined as no bulge symptoms, no retreatment, and no recurrence beyond the hymen with apex nondescended > one third of the total vaginal length. Descriptive and bivariate statistics were obtained as indicated.
Of 223 women screened, inclusion criteria were met by 124 (40 mesh-augmented; 84 native-tissue). There was no difference in pre-operative characteristics between groups. Composite success was demonstrated in 95.2% of women with a median follow-up of 224 days (range: 30-988). Two women in the mesh-augmented group reported bulge symptoms and underwent re-treatment with a pessary. Four women in the native-tissue group reported bulge symptoms; 3 underwent re-treatment (2 pessary, 1 surgery). There were no differences in composite success rates between groups (p=0.954). There were additionally no differences in intra-operative (p=0.752) or post-operative (p=0.292) complication rates between the groups. There were no mesh-related complications, including exposure or chronic pelvic pain.
Ninety-five percent of women achieved surgical success and the use of mesh augmentation did not confer added benefit in terms of efficacy or complications when compared with native tissue. Further long-term data are needed to continue our assessment of native-tissue anterior SSH.
经阴道网片套件使骶棘肌前固定术（SSH）得到推广。在网片套件退出市场后，我们推测通过耻骨宫颈筋膜的自体组织重新附着并将子宫颈前部固定于骶棘韧带，可获得相似的疗效。目前针对自体组织与网片增强型SSH的比较分析较少。
对2016年1月1日至2022年12月31日期间接受经阴道前侧SSH手术的女性进行回顾性分析。比较接受网片增强修复（Uphold Lite阴道支撑系统™）与自体组织修复的女性。综合成功定义为无膨出症状、无需再次治疗且处女膜以上无复发，顶端下降未超过阴道总长度的三分之一。按要求获取描述性和双变量统计数据。
在筛查的223名女性中，124名符合纳入标准（40名接受网片增强修复；84名接受自体组织修复）。两组术前特征无差异。中位随访224天（范围：30 - 988天），95.2%的女性获得综合成功。网片增强组有两名女性报告有膨出症状并接受子宫托再次治疗。自体组织组有四名女性报告有膨出症状；3名接受再次治疗（2名使用子宫托，1名接受手术）。两组综合成功率无差异（p = 0.954）。两组术中（p = 0.752）或术后（p = 0.292）并发症发生率也无差异。未出现与网片相关的并发症，包括暴露或慢性盆腔疼痛。
95%的女性手术成功，与自体组织相比，使用网片增强在疗效或并发症方面未带来额外益处。需要进一步的长期数据来继续评估自体组织前侧SSH。
