Kuroda Kenji, Hamamoto Koetsu, Kawamura Kazuki, Masunaga Ayako, Kobayashi Hiroaki, Horiguchi Akio, Ito Keiichi
Department of Urology, National Defense Medical College, Tokorozawa, JPN.
Cureus. 2024 Feb 1;16(2):e53388. doi: 10.7759/cureus.53388. eCollection 2024 Feb.
Introduction Transvaginal mesh surgery (TVM) is an effective treatment option for pelvic organ prolapse (POP). Although ORIHIME®, the only available mesh product, is thin, soft, and easy to handle, it has the disadvantages of sliding off or mildly adhering to the surrounding tissues. The current study compared the efficacy of using wide-arm ORIHIME (Kono Seisakusho, Japan, Tokyo), non-wide arm ORIHIME, Gynemesh PS (Johnson and Johnson, Japan, Tokyo), and Polyform (Boston Scientific Japan, Japan, Tokyo) meshes for TVM. Methods The study included 116 patients who underwent TVM (Prolift with Gynemesh PS (n = 14); Elevate with Polyform (n = 43); Uphold with non-wide-arm ORIHIME(n = 24); Uphold with wide-arm ORIHIME(n = 35)) at our hospital. Pre- and post-surgical changes in symptoms were measured using questionnaires and 60-minute pad weight testing and compared by mesh type and surgical methods used. Results The residual urine volume, 60-minute pad weight testing, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), and international consultation on incontinence questionnaire-short form score (ICIQ-SF) significantly improved one year postoperatively in the TVM with the wide-arm ORIHIME group. Comparison of pre and one-year postoperative findings by mesh type and surgical methods used showed no significant differences in the 60-minute pad test, IPSS, Quality of Life (QOL), OABSS, and urinary incontinence in daily life scores, and improvement in residual urine volume, ICIQ-SF, and mesh exposure and POP recurrence rates in the TVM with the wide-arm ORIHIME group. Conclusion TVM with wide-arm ORIHIME had better postoperative outcomes compared to TVM with other mesh products.
引言 经阴道网状物手术（TVM）是治疗盆腔器官脱垂（POP）的有效方法。尽管唯一可用的网状物产品ORIHIME®薄、柔软且易于操作，但它存在滑落或与周围组织轻度粘连的缺点。本研究比较了使用宽臂ORIHIME（日本东京的Kono Seisakusho公司）、非宽臂ORIHIME、Gynemesh PS（日本东京的强生公司）和Polyform（日本东京的波士顿科学日本公司）网状物进行TVM的疗效。
方法 本研究纳入了116例在我院接受TVM的患者（使用Gynemesh PS进行Prolift手术（n = 14）；使用Polyform进行Elevate手术（n = 43）；使用非宽臂ORIHIME进行Uphold手术（n = 24）；使用宽臂ORIHIME进行Uphold手术（n = 35））。术前和术后症状的变化通过问卷调查和60分钟护垫重量测试进行测量，并按网状物类型和所使用的手术方法进行比较。
结果 宽臂ORIHIME组TVM术后一年，残余尿量、60分钟护垫重量测试、国际前列腺症状评分（IPSS）、膀胱过度活动症症状评分（OABSS）和国际尿失禁咨询问卷简表评分（ICIQ-SF）均有显著改善。按网状物类型和所使用的手术方法对术前和术后一年的结果进行比较，结果显示，在60分钟护垫测试、IPSS、生活质量（QOL）、OABSS和日常生活中尿失禁评分方面，宽臂ORIHIME组TVM与其他组无显著差异；在残余尿量改善、ICIQ-SF以及网状物暴露和POP复发率方面，宽臂ORIHIME组TVM有改善。
结论 与使用其他网状物产品的TVM相比，使用宽臂ORIHIME的TVM术后效果更好。
