Clinical Study Of Pelvic Floor Reconstruction In Treatment Of Pelvic Organ Prolapse

Background:Pelvic Organ Prolapse (POP) is a complex condition that is result from the defectiveness of the vaginal supportive tissue.It has important personal and public significance due to their great harm to women.There are diverse treatments with the increasing incidence.Surgery is the treatment of choice for women with POP if conservative treatment like pelvic floor muscle exercises and vaginal pessary therapy have failed.Due to high recurrence rate of traditional surgery such as transvaginal hysterectomy(TVH) plus anterior and posterior wall repair of vagina, the first trasvaginal mesh delivery system became available for the correction of pelvic organ prolapse in2002,that device was intended to provide the surgeon with an reproducible,safe,effective method.From then on, A varity of tension-free vaginal mesh (TVM) systems soon followed available for surgical treatment of POP.These include improved TVM, prolift, prosima and Avaulta.Objective:To research the outcomes of reconstructive pelvic surgeries (Avaulta, prosima, prolift, improved TVM) and TVH plus anterior and posterior wall repair of vagina on the treatment of POP.Materials and Methods:Subjects:227patients who received one of the following surgical treatment were selected from408cases with POP treated at Qilu Hospital of Shandong University from January2005to December2012:(1)Avaulta;(2) prosima;(3)prolift;(4) improved TVM;(5) TVH plus anterior and posterior wall repair.The patients were divided into5groups:the study group one with20cases had Avaulta pelvic floor reconstruction,the study group two with8cases had Prosima pevic floor reconstruction, the study group three with53cases had Prolift pelvic floor reconstruction, the study group four with35cases had improved TVM pelvic floor reconsrction,and the study group five with111cases had TVH+anterior and posterior wall repair of vagina.Methods:1. Surgical indication:1.1Reconstructive pelvic surgery (Avaulta, prolift, improved TVM):(1) POP-Q were Ⅲ-Ⅳ level;(2) Older patients or patients with recurrence.1.2Prosima reconstructive pelvic surgery:POP-Q stages were Ⅱ-Ⅳ level.1.3TVH+anterior and posterior wall repair of vagina:POP-Q stages were Ⅱ-Ⅳ level.2. Surgical methods:the study group one with20cases had Avaulta pelvic floor reconstruction, the study group two with8cases had Prosima pevic floor reconstrction, the study group three with53cases had Prolift pelvic floor reconstruction, the study group four with35cases had improved TVM pelvic floor reconsrction, the study group five with111cases had TVH+anterior and posterior wall repair of vagina.3.Analysis:Collect general clinical data,intraoperative data and postoperative data,use SPSS13.0to analyse.(1) The related data were measured by mean±standard deviation and analysis of variance(ANOVA) was used.(2) The result like POP-Q stages,cure rate,ecurrence rate and incidence of complications was compared by chi-square test.Data analysis is based on standard P=0.05.Results:1.General data:Among five groups.no significant difference was found in the general data such as age,BMI,parity,menopause and POP-Q stages.(P>0.05).2.Intraoperative and postoperative data:Operation time:the average operation time of study group one was79.50±19.60minutes, the study group two was96.88±17.72minutes, the study group three was 86.98±32.85minutes, the study group four was77.14±35.92minutes, and the study group five was85.76±32.22minutes.Statistical difference was found between study group one and the study group five (P<0.05), and there was no signifigant defference between other groups (P>0.05).Amount of intraoperative bleeding:the average amount of intraoperative bleeding of study group one was67.50±27.12ml, the study group two was103.75±33.35ml, the study group three67.36±37.53ml, the study group four was64.57±99.75ml, the study group five was91.53±72.83ml.There were statistical differences between study group one and study group two,study group one and study group five, study group two and study group three, study group three and study group five (P<0.05).There was no signifigant defference between other groups (P>0.05).Time of indwelling catheter:the average time of postoperative indwelling catheter of study group one was5.65±2.37d, the study group two was6.13±1.25d, the study group three was5.09±1.86d, the study group four was4.41±1.33d and the study group five was4.61±1.43d. There were statistical differences between study group one and the study group four,study group one and the study group five, the study group two and the study group four, the study group two and the study group five (P＜0.05).There was no signifigant defference between other groups (P>0.05).Postoperative hospitalization days:the average of postoperative hospitalization days of study group one was7.85±3.41d, the study group two was8.00±1.77d, the study group three was7.34±2.19d, the study group four was6.80±1.64d, the study group five was7.01±3.20d.There was no significant difference among five groups (P>0.05).Complications:There were one case of urinary incontinence and one case of hip infection in study group one,the complication rate was10%,in study group two,there were one case of mesh erosion and the rate was12.5%.In study group three,there were one case of post-operative mobidity,two case of SUI,one case of urinary retention,three cases of mesh erosion and the rate was13.2%.In study group four, there were one case of rectocele,one case of SUI,one case of urinary retention, two cases of mesh erosion and the rate was14.3%.In study group five, there were eleven cases of post-operative mobidity.one case of SUI,one case of urinary retention,one case of obdominal pain.one case of infection,and the rate was13.5%. No significant statistical difference was found among five groups.3. Analysis of clinical evaluations:Anatomical outcome:All patients reach the anatomical cure criteria with the POP-Q stages were0or Ⅰ level.Vaginal length comparison:The average preoperative and postoperative vaginal length of study group one were8.21±0.95cm,7.76±0.95cm, study group two were8.04±1.05cm,7.59±1.01cm, the study group three were8.04±0.60cm,7.62±0.62cm. the study group four were8.02±0.69cm,7.62±0.68cm,the study group five were7.90±0.57cm,7.50±0.56cm.There were no significant statistical differences among the five groups pre and post operation.And the postoperative vaginal length of five groups were shorter than pre-operation.but there were no statistical differences among fives groups on shortens.4.Follow-up:The time of follow up varies between2months and7years,and the follow-up rate was100%.The recurrence rate of study group one was0. the study group two was12.5%with1case of recurrence, the study group three was1.9%with1case of recurrence, the study group four was2.9%with1case of recurrence, the study group five was9.9%with11cases of recurrence.The recurrence rate of study group one was significantly lower, but there were no significant difference among control groups.Conclusion:1. Pelvic floor reconstruction (Avaulta, Prosima, Prolift, improved TVM) and TVH plus anterior and posterior wall repair of vagina are all safe and effective treatment for pelvic organ prolapse.2. Surgical experience of surgeon is important to outcomes of operation.