A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse / 中华医学杂志(英文版)

BACKGROUND@#It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.@*METHODS@#A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).@*RESULTS@#The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).@*CONCLUSIONS@#The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.@*TRIAL REGISTRATION NUMBER@#NCT03620565, https://register.clinicaltrials.gov.

Subjective and objective evaluation of second-generation total pelvic floor reconstruction with six-arm mesh in patients with severe pelvic organ prolapse / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effect of total pelvic floor reconstruction with 6-arm mesh in the treatment of pelvic organ prolapse.METHODS: The patients who received different surgical procedures for the anterior and middle pelvic organ prolapse between October 2016 and December 2017 in Gynecological Department of Shengjing Hospital of China Medical University,were divided into two groups.There were 78 cases in observation group who used six-arm mesh,and 82 patients in control group who underwent total pelvic floor reconstruction with anterior and posterior unabsorbable polypropylene mesh. All patients were reviewed at 3,6,and 12 months after surgery.OBJECTIVE: and subjective evaluations were used to compare the postoperative recovery between the two groups.RESULTS:(1)OBJECTIVE: evaluation:there was no recurrence in the two groups within 12 months after the operation;the POP-Q score showed that all indication points returned to normal position;the length of vagina at the 12 th month after the operation was longer than that of the control group;the difference was statistically significant(P<0.05).(2)Subjective symptom score:PFDI-20 score at 6 months and 12 months after surgery in observation group was 22.66±5.34 and 16.23±5.12,while in control group it was 30.87±5.32 and 21.86±5.28,observation group lower than control group,the difference being statistically significant(P<0.05).Among them,the CRADI-8 score was lower than that of the control group in 6 months and 12 months after surgery,and the differences were statistically significant(P<0.05).Compared with FSFI,the observation group was superior to the control group in 6 months and 12 months after operation,and the difference was statistically significant(P<0.05).(3)Postoperative complications: the observation group was lower than the control group in terms of the incidence of mesh exposure and sex pain,the difference being statistically significant(P<0.05).CONCLUSION: The total pelvic floor reconstruction with six-arm mesh has the same healing rate as traditional pelvic floor reconstruction surgery,and it is better than traditional pelvic floor reconstruction surgery in improving subjective symptoms and reducing postoperative complications.