The Clinical Outcome of TVM or LSC Mesh Suspension for POP
Condition: Pelvic Organ Prolapse
MeSH terms: Prolapse; Pelvic Organ Prolapse
Study type: Observational

Summary: 
      The investigators aim to assess the surgical outcomes of transvaginal mesh (TVM) and
      laparoscopic (LSC) mesh suspension. During the study period, all women with main uterine
      prolapse stage II or greater defined by the POP quantification staging system receiving TVM
      or LSC mesh suspension were retrospectively recruited. Clinical evaluations before and 6
      months after surgery included pelvic examination, urodynamic study, and a personal interview
      to evaluate urinary and sexual symptoms using questionnaires.
    

Detailed description: 
      All women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging
      system receiving TVM or LSC mesh suspension surgeries at a tertiary referral center in Taiwan
      were included. The investigators excluded women with a hypertrophic uterus, huge fibroids,
      history of cervical dysplasia or endometrial pathology, history of postmenopausal bleeding in
      the past 12 months, and those unwilling to preserve their uterus. Concomitant mid-urethral
      sling operations were performed in women with current urodynamic stress incontinence unless
      the participants did not prefer a concomitant surgery. Cervical amputation was performed if
      the corpus/cervix ratio was less than 1 on the ultrasound. Concomitant anterior and posterior
      colporrhaphy were performed as needs.

      The clinical evaluations consisted of a detailed history before and 6 months after surgery,
      including urinary analysis, pelvic examination using POP-Q system, urodynamic studies (UDS),
      transabdominal ultrasound, and personal interview to identify urinary and sexual symptoms
      with the Overactive Bladder Symptom Score (OABSS), the short forms of Urogenital Distress
      Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function
      Index (FSFI) questionnaire, and the Pelvic Organ Prolapse Distress Inventory (POPDI-6).
      Urinary symptoms with the standardized questionnaire taking into account the 2002 ICS
      definitions. The participants were asked to fill out the visual analog scale (VAS) scores
      during the postoperative day 1 round. Urodynamic studies, including non-instrumented
      uroflowmetry, filling and voiding cystometry, and urethral pressure profilometry, were
      performed according to the recommendations by the International Continence Society with a
      6-channel urodynamic monitor (MMS; UD2000, Enschede, Netherlands). Any uninhibited detrusor
      contraction during filling cystometry was deemed positive for detrusor overactivity (DO).

      As a follow-up, postoperative outpatient visits were at 1, 2, 3, 6, and 12 months and then
      semiannually beyond one year. Pelvic examination was performed routinely in every visit to
      clinics. Recurrence was defined as the most dependent portion of POP stage II or greater. The
      Clavien-Dindo grading was used for the classification of the intraoperative and postoperative
      complications of Long mesh surgery.
    

Intervention name(s): LSC mesh suspension; TVM
Intervention type(s): Procedure; Procedure
Intervention description(s): Long mesh, a synthetic T-shaped mesh (Gynemsh, Ethicon, San Lorenzo, Puerto Rico), is delivered into the pelvic cavity. Bilateral mesh arms are extracted outside trocar wounds bilaterally to stabilize mesh position. The center piece is fixed to the cervix with 5mm ProTack screws (Covidien, New Haven, Connecticut). Fixation is strengthened with Stratafix 2-0 sutures (Ethicon, Norderstedt, Germany), followed by Tisseel fibrin sealant (Baxter, Deerfield, Illinois) for better hemostasis among surrounding tissues. An extraperitoneal tunnel is created along the left round ligament until reaching 2cm medial to the anterior superior iliac spine (ASIS). One arm of the long mesh is pulled out along the tunnel underneath round ligament and fixed with the fascia of oblique abdominis. The same procedure is repeated for the contralateral side. Bilateral round ligaments and the mesh arms are sutured continuously with Stratafix 2-0.; Transvaginal mesh kit is delivered into the pelvis via vagina route.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging
        system
      
Keywords: Pelvic organ prolapse; Transvaginal mesh; Laparoscopic mesh suspension