Pelvic magnetic resonance imaging for assessment of the efficacy of the Prolift system for pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to compare pre- and postoperative pelvic organ prolapse-quantification (POP-Q) and magnetic resonance imaging (MRI) measurements in patients who undergo total Prolift (Ethicon, Inc, Somerville, NJ) colpopexy. STUDY DESIGN: Pre- and postoperative MRI and POP-Q examinations were performed on patients with stage 2 or greater prolapse who underwent the Prolift procedure. MRI measurements were taken at maximum descent. Correlations between changes in MRI and POP-Q measurements were determined. RESULTS: Ten subjects were enrolled. On MRI, statistically significant changes were seen with cystocele, enterocele, and apex. Statistically significant changes were seen on POP-Q measurements for Aa, Ba, C, Ap, Bp, and GH. Positive correlations were demonstrated between POP-Q and MRI changes. Minimal tissue reaction was seen on MRI. CONCLUSION: The Prolift system is effective in the surgical management of pelvic organ prolapse as measured by POP-Q and MRI. Postoperative MRIs support the inert nature of polypropylene mesh.

Risk of mesh erosion after abdominal sacral colpoperineopexy with concomitant hysterectomy.

OBJECTIVE: The purpose of this study was to evaluate the effect of concomitant hysterectomy at the time of abdominal sacral colpoperineopexy on the risk of mesh erosion with the use of type 1 polypropylene mesh. STUDY DESIGN: This was a retrospective case control study. All cases of vaginal mesh erosion (n = 31) were compared with matched control cases (n = 93) in a 3:1 ratio. Demographic data, concomitant procedures, and postoperative complications were compared between groups with the use of 2-sample Student t test and Pearson chi(2) test. RESULTS: The odds ratio of a vaginal mesh erosion was no different for those who underwent a hysterectomy at the time of abdominal sacral colpoperineopexy (odds ratio, 0.95; 95% confidence interval, 0.41-2.18; P = .899) when potential confounders were similar between groups. CONCLUSION: Hysterectomy at the time of abdominal sacral colpoperineopexy is not a risk factor for vaginal mesh erosion with the use of type 1 polypropylene mesh.

Does the Prolift system cause dyspareunia?

OBJECTIVE: The purpose of this study was to determine the de novo dyspareunia rate with the Prolift procedure. STUDY DESIGN: All Prolift cases performed between August 2005 and August 2007 were evaluated. The rate of de novo dyspareunia was calculated by chart review. Type and degree of dyspareunia were assessed by self-administered questionnaire. Demographics, use of hormone therapy, failure rate, and willingness to have the surgery again were summarized using descriptive statistics. RESULTS: The rate of de novo dyspareunia was 16.7%. Over 75% of patients with de novo dyspareunia described the pain as mild or moderate. Most described dyspareunia with insertion. Eighty-three percent of respondents with de novo dyspareunia would have the procedure done again. CONCLUSION: The Prolift is associated with a 17% de novo dyspareunia rate. Despite this, most would have the surgery done again.

Tobacco use is a risk factor for mesh erosion after abdominal sacral colpoperineopexy.

OBJECTIVE: The purpose of this study was to evaluate the association between smoking and vaginal mesh erosion after abdominal sacral colpoperineopexy with the use of type 1 polypropylene mesh. STUDY DESIGN: All cases of mesh erosion (n = 27) that were diagnosed between October 2003 and June 2006 were identified and compared with matched control cases (n = 81). Control cases were matched for age, diabetes mellitus status, hypoestrogenic state (menopausal status, chronic steroid use, use of hormone therapy), abdominal-vaginal rectocele repair, culdoplasty, and concomitant hysterectomy. Demographic data, surgical characteristics, and postoperative complications were also compared between groups. Continuous data were compared using 2-sample Student t tests. Categoric data were compared with the use of Pearson Chi-square tests. RESULTS: The odds of experiencing mesh erosion was significantly greater in smokers than in nonsmokers (odds ratio, 4.4; 95% CI, 1.3, 14.4; P = .010) when potential confounders were similar between groups. CONCLUSION: Tobacco use is a risk factor for vaginal mesh erosion after abdominal sacral colpoperineopexy with the use of type 1 polypropylene mesh.

Tension-free vaginal tape sling with a porcine interposition graft in an irradiated patient with a past history of a urethrovaginal fistula and urethral mesh erosion: a case report.

BACKGROUND: Patients with previous irradiation are at high risk for complications following pelvic reconstructive surgery. The treatment of these complications and the patient's initial disorder can be complex and difficult, especially when the use of various graft materials, including mesh, is involved in the original complication. CASE: A 49-year-old woman with a history of anal and vulvar cancer treated with pelvic irradiation underwent a tension-free vaginal tape (TVT) sling for stress urinary incontinence (SUI) and experienced complications of urethral mesh erosion and urethrovaginal fistula (UVF). The mesh was removed and the urethra repaired, but the repair failed, and she continued to have a persistent UVF. The patient presented to our center, and the UVF was repaired successfully with a Martius flap. Secondary to persistent SUI with intrinsic sphincter deficiency (ISD), the patient underwent a repeat TVT sling with a porcine interposition graft between the mesh and urethra to help prevent urethral mesh erosion. The patient healed without complications and achieved 80% improvement in her symptoms at 3 months, with only occasional SUI. She was eventually able to achieve 100% cure with the addition of periurethral collagen injections. CONCLUSION: Porcine interposition grafts while constructing a TVT sling may help reduce urethral erosion rates in patients with previous irradiation.