Mesh Implants for Pelvic Floor Reconstruction: Complications and early follow-up with 232 ProLift operations
 

Menahem NEUMAN and Yuval LAVY, Israel and Walter ARTIBANI, Italy

Objectives: To evaluate the preliminary data of a Prolift patients' series, for curing pelvic organ prolapse with intact uterus or after hysterectomy.

 

Methods: Patients with pelvic organ prolapse grater than +2 for A,B,C or D points of the ICS standardised POP-Q method had
ProLift operations. Peri-operative data was prospectively collected.

 

Results: 232 ProLift operations were performed. Ninety three (40.1%) patients elected conservation of prolapsed uterus. Forty nine patients (21.1%) had concomitant urodynamic urinary stress incontinence and had An additive TVTO . Anterior (149) and posterior (83) Prolift operations (52 patients had both) were performed under general (66.4%) or regional (33.6%) anesthesia. Intra and immediate post operative recorded complications included 3 patients with para-vesical and one patient with para-rectal self resumed pelvic hematomas, not affecting the Hematocrit level. Three patients had bladder perforations that were immediately vaginaly corrected, one patient needed laparotomy for bladder tear repair with no morbid sequela. All these complications, except for one bladder wall injury, occurred with the first 50 patients sub-group.

 

Forty seven patients were eligible for 12 months evaluation including physical evaluation and subjective report on QoL, bladder, bowel and sexual functions with validated questioners (UDI6 and IIQ7). Two patients (4.3%) with vaginal pain due to mesh retraction needed surgical mesh release and three patients (6.4%) had tape protrusion that was removed successfully at the outpatient clinic. Hospitalization period was 24 to 48 hours. All patients but 4 (91.5%) reported high satisfaction (>80%) with the overall therapeutic consequences, on the twelve month follow up appointment. This refers to the improvement with general QoL, bladder, sexual and bowel functions and the genital prolapse. Clinical evaluation of the anatomical surgical correction of the pelvic organ prolapse revealed two patients with minor recurrent cystocele and three patients with recurrent minor rectocele, reporting high satisfaction, and two patients (4.3%) with recurrent vaginal vault prolapse. One had a further abdominal sacral fixation while the other had a repeated Prolift.

 

Conclusions: The Prolift operations dose not requires laparotomy, yet they involve rather large para-vesical and/or para-rectal dissections. Hence, previous familiarisation with deep pelvic anatomy and ability to deal with potential complications are mandatory. This series results shows early efficacy, safety and short rehabilitation period of this procedure. Longterm data is required for drawing solid conclusion concerning the benefits of on of the discussed operative technique.

 

Source: European Urology Association, Annual meeting, 2008, Milan, Italy of P-864


 

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