Trans-Obturator Approach and the Native Tissue in the Treatment of High Stage Prolapse of the Anterior Vaginal Wall: Midterm Results of a New Surgical Technique
Vol. 18 No. 01 (2021),
17 March 2021
Purpose: Pelvic organ prolapse is a common condition as a consequence of the pelvic floor support weakness. This study evaluated the clinical results of treating the high stage prolapse of the anterior vaginal wall using a trans-obturator approach and the native vaginal wall tissue.
Methods: This was a prospective analysis of 94 patients with anterior vaginal wall prolapse stage ≥ Ⅲ. They underwent surgery with the trans-obturator approach using the native vaginal wall tissue. The objective primary outcome was evaluated according to the pelvic organ prolapse staging system (POP-Q). The subjective primary outcome was evaluated with pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) questionnaires. The secondary outcomes were post-surgery complications.
Results: Totally, 85 of 94 patients were followed up for a mean of 38.2 ± 4 months. The objective anatomical success rate was 90.58%. PDFI-20 and PFIQ-7 scores had improved (P = 0.001). The complications were minor (G1) according to the Clavien-Dindo classification (8.2 %). At one year follow up 3 out of 8 patients with clinical SUI underwent transvaginal repair with the Poly propylene mini sling mesh.
Conclusion: The midterm results of the surgical repair of the high stage anterior vaginal wall prolapse are promising with a new surgical technique by trans-obturator approach and native vaginal wall as the supportive layer.
- high stage; anterior vaginal wall prolapse; trans Obturator
How to Cite
Samuelsson, E. C., Victor, F. T., Tibblin, G. et al.: Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol, 180: 299, 1999
Moore, R. D., Beyer, R. D., Jacoby, K. et al.: Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up. Int Urogynecol J, 21: 545, 2010
Smith, F. J., Holman, C. D., Moorin, R. E. et al.: Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol, 116: 1096, 2010
Olsen, A. L., Smith, V. J., Bergstrom, J. O. et al.: Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol, 89: 501, 1997
Rane, A., Iyer, J., Kannan, K. et al.: Prospective study of the Perigee system for treatment of cystocele - our five-year experience. Aust N Z J Obstet Gynaecol, 52: 28, 2012
Handel, L. N., Frenkl, T. L., Kim, Y. H.: Results of cystocele repair: a comparison of traditional anterior colporrhaphy, polypropylene mesh and porcine dermis. J Urol, 178: 153, 2007
Porges, R. F., Smilen, S. W.: Long-term analysis of the surgical management of pelvic support defects. Am J Obstet Gynecol, 171: 1518, 1994
S., W., P., O. K., T., H. et al.: Urodynamic Evaluation after Vaginal Repair and Colposuspension. British Journal of Urology, 54: 377, 1982
White, G. R.: AN ANATOMICAL OPERATION FOR THE CURE OF CYSTOCELE. Transactions of the American Association of Obstetricians and Gynecologists for the Year... 24: 323, 1912
Young, S. B., Daman, J. J., Bony, L. G.: Vaginal paravaginal repair: one-year outcomes. American journal of obstetrics and gynecology, 185: 1360, 2001
Mallipeddi, P. K., Steele, A. C., Kohli, N. et al.: Anatomic and functional outcome of vaginal paravaginal repair in the correction of anterior vaginal wall prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 12: 83, 2001
Fatton, B., Amblard, J., Debodinance, P. et al.: Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)--a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct, 18: 743, 2007
de Tayrac, R., Devoldere, G., Renaudie, J. et al.: Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct, 18: 251, 2007
Bump, R. C., Mattiasson, A., Bo, K. et al.: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 175: 10, 1996
Lemack GE, Anger JT: Urinary incontinence and pelvic prolapse: epidemiology and pathophysiology. Campbell-Walsh Urology, 11th edition. Wein AJ, Kavoussi LR, Partin AW, et al. Philadelphia, PA . Elsevier. 3: 1743- 1760, 2016.
Chapple, C., Milsom, I.: Urinary incontinence and pelvic prolapse: epidemiology and pathophysiology. Campbell-Walsh Urology, 10th edition. Wein AJ, Kavoussi LR, Novick AC, et al. Philadelphia, PA . Saunders. 3: 1871- 1895, 2012.
Sharifiaghdas, F., Daneshpajooh, A., Mirzaei, M.: Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh. Korean J Urol, 56: 811, 2015
Parker, M. C., Phillips, R. K.: Repair of rectocoele using Marlex mesh. Annals of The Royal College of Surgeons of England, 75: 193, 1993
Maher, C., Baessler, K., Glazener, C. M. et al.: Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn, 27: 3, 2008
Maher, C., Feiner, B., Baessler, K. et al.: Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev, 11: Cd004014, 2016
Barski, D., Otto, T., Gerullis, H.: Systematic review and classification of complications after anterior, posterior, apical, and total vaginal mesh implantation for prolapse repair. Surgical technology international, 24: 217, 2014
Raz S,Klutke CG,Golomb J.Four corner bladder and urethral suspension for moderate cystocele.J Urol 1989;142;712-5
Ferrari A,Frigerio L. The triangular vaginal patch sling for stress urinary incontinence and hypermoblie urethra.Am J Obstet Gynecol 1997;177:1426-31.
Cosson, M., Collinet, P., Occelli, B. et al.: The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Eur J Obstet Gynecol Reprod Biol, 95: 73, 2001
Shah, H. N., Badlani, G. H.: Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review. Indian Journal of Urology : IJU : Journal of the Urological Society of India, 28: 129, 2012
A Minassian, V., Parekh, M., Poplawsky, D. et al.: Randomized Controlled Trial Comparing Two Procedures for Anterior Vaginal Wall Prolapse, p. 0, 2014
Balzarro, M., Rubilotta, E., Porcaro, A. B. et al.: Long-term follow-up of anterior vaginal repair: A comparison among colporrhaphy, colporrhaphy with reinforcement by xenograft, and mesh. Neurourol Urodyn, 37: 278, 2018
Durnea,CM,Pergialiotis, V,Duffy JM N,et al :a systematic review of outcome and outcome- measure reporting in randomised trials evaluating surgical interventions for anterior -compartment vaginal prolapse:a call to action to develop a core outcome set.international urogynecology journal 29:1727-1745,2018
Lavelle RS,Christie AL,Alhalabi F,et al:Risk of prolapse recurrence after native tissue anterior vaginal suspension procedure with intermediate to long-term followup. J urol 195(4 Pt 1)1014-20 2016
Amin K,Lee U,:Surgery for Anterior Compartment vaginal prolapse: Suture-Based repair:Urol Clin N Am 46:61-70 2019
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