Delu Ava A, Funk Joel T, Twiss Christian O
Department of Urology, University of Arizona College of Medicine, Tucson, Arizona, USA.
Neurourol Urodyn. 2025 Jun;44(5):1163-1169. doi: 10.1002/nau.70042. Epub 2025 Mar 26.
The recognition of synthetic vaginal mesh as a high-risk device in pelvic organ prolapse (POP) repair has led to a resurgence in the utilization of autologous graft and emphasizes the need for long-term studies into the use of autologous materials. In a 33-patient cohort, we highlighted our earliest results of a transvaginal repair for apical and anterior prolapse using a graft harvest of autologous fascia lata. In an updated cohort of 63 patients with up to 5 years of follow-up, we report our current findings.
The Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair begins with a solitary, lateral 7-10 cm thigh incision, through which, a 4 × 14 cm segment of fascia lata is harvested. Transvaginal reconfiguration of the graft results in apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Concurrent procedures, including autologous pubovaginal sling, were performed as indicated. Several patient parameters were monitored including medical history, Visual Analog Pain (VAP) Score, SEAPI scores, POP-Q scores, and Baden-Walker grading. We defined a successful repair as absent symptomatic apical or anterior POP.
A total of 63 patients with an average age of 64 years underwent AAA-POP repair. Mean follow-up was 17 months (range 1-65); 18 patients had 24 months or more of follow-up. Complete POP symptom resolution was reported in 49 (78%) patients. In total, 11 patients (17%) experienced treatment failure; 5 of this subgroup (45%) underwent a uterine sparing procedure. Urinary retention postoperatively occurred in 20 patients and pubovaginal sling was concurrently performed in 18 of the patients in this subgroup (90%). Minor harvest site issues occurred and were managed expectantly. Nonbothersome thigh bulges occurred in 15 patients. Nine patients experienced a seroma at the harvest site, and five underwent aspiration. Mild paresthesia was reported by 37 patients. Mean VAP score of the fascia lata harvest site was 0.37.
The AAA-POP repair medium-term follow-up results reaffirm the procedure's efficacy as a transvaginal and nonmesh repair of POP. Patients should be advised of several precautions including the higher frequency of treatment failure with the uterine sparing approach, potential for urinary retention if pubovaginal sling placement is performed concurrently, and morbidities associated with the harvest site. Our results continue to uphold the AAA-POP repair and its role as a treatment option for patients desiring a nonmesh approach to POP repair.
人工合成阴道网片在盆腔器官脱垂（POP）修复中被视为高风险器械，这使得自体移植物的使用再度兴起，并强调了对自体材料使用进行长期研究的必要性。在一个33例患者的队列中，我们突出展示了使用自体阔筋膜移植进行经阴道修复顶端和前部脱垂的早期结果。在一个更新的63例患者队列中，随访时间长达5年，我们报告了目前的研究结果。
自体前部和顶端盆腔器官脱垂（AAA-POP）修复始于大腿外侧一个单独的7-10厘米切口，通过该切口获取一段4×14厘米的阔筋膜。经阴道对移植物进行重新塑形，使其顶端固定于骶棘韧带，远端固定于闭孔筋膜。根据需要进行同期手术，包括自体耻骨后阴道吊带术。监测了多个患者参数，包括病史、视觉模拟疼痛（VAP）评分、SEAPI评分、POP-Q评分和巴登-沃克分级。我们将成功修复定义为无症状性顶端或前部POP。
共有63例平均年龄64岁的患者接受了AAA-POP修复。平均随访时间为17个月（范围1-65个月）；18例患者的随访时间为24个月或更长。49例（78%）患者报告POP症状完全缓解。总共有11例患者（17%）治疗失败；该亚组中有5例（45%）接受了保留子宫的手术。术后20例患者发生尿潴留，该亚组中有18例患者（90%）同期进行了耻骨后阴道吊带术。出现了轻微的取材部位问题，采用观察等待的方式处理。15例患者出现了不引起困扰的大腿膨出。9例患者取材部位出现血清肿，并对其中5例进行了抽吸。37例患者报告有轻度感觉异常。阔筋膜取材部位的平均VAP评分为0.37。
AAA-POP修复的中期随访结果再次证实了该手术作为经阴道非网片修复POP的有效性。应告知患者一些注意事项，包括保留子宫手术治疗失败的频率较高、如果同期进行耻骨后阴道吊带术有发生尿潴留的可能性以及与取材部位相关的并发症。我们的结果继续支持AAA-POP修复及其作为希望采用非网片方法修复POP的患者的一种治疗选择的作用。
