Factors influencing success of pelvic organ prolapse repair using porcine dermal implant Pelvicol.

OBJECTIVE: To evaluate factors influencing pelvic organ prolapse (POP) recurrence after repair surgery with a porcine dermal collagen implant (Pelvicol). STUDY DESIGN: From December 2003 to August 2005, 78 patients with mainly stage 3 pelvic organ prolapse by the Pelvic Organ Prolapse Quantification (POP-Q) system underwent vaginal repair using porcine dermal implant. Assessments were made preoperatively and at 6 weeks and one year follow-up. These included physical examination with POP-Q, Incontinence Impact Questionnaire, Urogenital Distress Inventory and the Defaecatory Distress Inventory and questions from the Patient Global Impression of Improvement. Data were recorded on changes in functional status, mesh erosion and adverse events. Procedural success was defined as POP-Q stage 0/1. RESULTS: 71 patients returned for one year follow-up. The overall cure rate was 74.6%. The chance of a successful operation in the younger group was significantly higher than in the older group (OR: 7.5; 95% CI 1.38, 40.69), but this effect is lower and no longer significant after adjusting for compartment (post, anterior, post+anterior) (adjusted OR: 5.5; 95% CI 0.92, 32.6). CONCLUSIONS: A low complication rate and satisfactory overall results were observed in a group of women after POP repair surgery with Pelvicol. Whether these results are better or worse than with conventional surgery or non-resorbable mesh implantation is unclear and can only be determined in a randomized controlled trial. There was a strong tendency towards better results in the younger women than in the older women, but the reason for this phenomenon is unclear.

Discrepancies between physician interview and a patient self-assessment questionnaire after surgery for pelvic organ prolapse.

The objective of this article was to investigate whether there were discrepancies between the physician interview and a patient's self-assessment questionnaire on the functional results after surgery for pelvic organ prolapse. Before their follow-up appointment, 79 patients were sent a validated urogynaecological questionnaire. At the follow-up visit, the physician interviewed the patients using a checklist with ten symptoms and scored the items as present or absent. Seventy-two patients (91.1%) attended the follow-up visit and had completed the questionnaire. There was poor to slight agreement between the interview score and the self-reported responses to the questionnaire on all items. This was illustrated by low kappa coefficients. The physician was more optimistic about the outcome of the operation than was justified according to the answers to a patient self-assessment questionnaire. We therefore recommend the use of validated questionnaires to evaluate surgical outcome because they provide a more realistic (objective) view of the functional results.