Effect Of Transvaginal Placement Of Surgical Mesh On Stress Urinary Incontinence

Objective: The purpose of this study is to investigate the influence of pelvic reconstruction surgery on urinary incontinence in the pelvic organ prolapse and to study the mechanism of improving urinary incontinence symptom and quality of life of patients from pelvic floor anatomical level after transvaginal placement of surgical mesh for pelvic organ and prolapse.It may provide new ideas and evidences for the treatment in POP complicated with urinary incontinence.Materials and Methods: 60 patients who underwent transvaginal placement of surgical mesh were enrolled in Dalian Municipal Women and Children’s Medical Center from September 2014 to June 2021.After obtaining the consent of the patients,basic data were collected,including age,weight,and BMI,etc.The patients were divided into two groups according to the results of preoperative urodynamic examination: group with stress urinary incontinence(30 cases)and group without stress urinary incontinence(30 cases).By measuring the preoperative and postoperative 3months in patients with pelvic ultrasound in bladder neck descent,the bottom of the bladder descent,urethral angle,retrovesical angle,urethral length and comparing the scores of pelvic floor dysfunction questionnaire and urinary incontinence questionnaire preoperative and postoperative 3 months,the effect of transvaginal placement of surgical mesh on urinary incontinence symptoms was determined,and the influence mechanism was analyzed.Results: 1.A total of 60 cases were collected,and there was no significant difference in general data between the two groups.2.Thirty patients in the urinary incontinence group received surgical treatment.Among them,17 patients had urinary incontinence symptoms disappeared after the operation,and the cure rate was 56.67%.11 patients had significant improvement in urinary incontinence symptoms after the operation and no more surgical treatment was required.The improvement rate was36.67%.Two patients had no significant improvement in their urinary incontinence symptoms after the operation,and they needed another operation to treat stress urinary incontinence.Thirty patients in the non-urinary incontinence group received surgical treatment,and all patients had no new symptoms of urinary incontinence after the operation.One of the 60 patients had symptoms of mesh exposure after surgery,and the symptoms disappeared after symptomatic treatment such as pruning and application of estrogen ointment in the clinic.Both groups of patients had prolapse of degree II and above,and there was no significant difference in the degree of prolapse.3.Comparison of preoperative conditions between the two groups: the urethral angle of the group without urinary incontinence in Valsalva state was higher than that of the group without urinary incontinence(76.62±26.33 vs 38.73±18.09,P=0.000),and the difference in the remaining measurements was not significant.4.Comparison of postoperative conditions between the two groups: in Valsalva state after surgery,the urethral length in the group without urinary incontinence was greater than that in the group with urinary incontinence(23.60±39.85 vs 22.07±11.42,P=0.032),and the retrovesical angle in the group without urinary incontinence was smaller than that in the group with urinary incontinence(131.23±16.25 vs 145.96±27.25,P=0.014),with no significant difference in the remaining measurements.5.Comparison of the postoperative situation of patients with urinary incontinence in the combined urinary incontinence group and those without urinary incontinence after the operation in the combined urinary incontinence group: Patients still with urinary incontinence after operation,the retrovesical angle in Valsalva state after operation is larger than those without urinary incontinence after operation(160.69±21.03 vs 134.69±26.51,P=0.007),and the difference of residual measurements was not significant.6.Comparison of postoperative conditions between patients still complicated with urinary incontinence and the group without urinary incontinence: The lurethral length in the Valsalva state after the operation is smaller than that of the group without urinary incontinence(24.41±4.12 vs 27.71±3.24,P=0.007),and retrovesical angle was larger than that of the group without urinary incontinence(160.69±21.03 vs 131.23±16.25,P=0.000),with no significant difference in residual measurements.7.There was no significant difference between preoperative patients with urinary incontinence and those without postoperative urinary incontinence.8.Comparison before and after operation in the group with urinary incontinence: postoperative pelvic floor dysfunction questionnaire scores significantly less than the preoperative(73.95±23.14 vs.22.54±12.94,P = 0.000),postoperative incontinence questionnaire scores significantly greater than preoperative(91.00±5.13 vs.98.30±3.04,P = 0.000),postoperative bladder neck descent,the bottom of the bladder descent,retrovesical angle in resting state,urethra angle in Valsalva state after the operation were significantly reduced compared with those before the operation(bladder neck descent: 26.33±12.71 vs 7.03±4.63,P=0.000;bottom of the bladder descent: 35.06±18.08 vs 6.62±3.95,P=0.000;retrovesical angle in resting state:149.47±37.75 vs 134.9±18.09,P=0.041;urethral angle in Valsalva state: 76.62±26.33 vs22.01±11.42,P=0.000),there was no significant difference between the remaining measured values.9.Comparison before and after operation in the group without urinary incontinence: the postoperative pelvic floor dysfunction questionnaire score was significantly lower than before(69.27±19.52 vs.21.49±8.58,P = 0.000).The bladder neck descent,the bottom of the bladder descent,urethral angle in Valsalva state,retrovesical angle in Valsalva state were significantly reduced after the operation,the urethral length in Valsalva state increases compared to before the operation(bladder neck descent: 26.38±12.05 vs.6.73±4.51,P = 0.000;bottom of the bladder descent:33.96±20.46 vs 7.28±3.97,P=0.000;urethral length in Valsalva state: 24.60±4.43 vs27.71±3.24,P=0.001;urethral angle in Valsalva state: 38.73±18.09 vs 23.60±9.85,P=0.000;retrovesical angle in Valsalva state: 147.17±37.49 vs 131.23±16.25,P=0.036).There was no significant difference between the remaining measured values.10.There was no significant difference in the improvement of bladder neck descent and the bottom of the bladder descent between the two groups before and after surgery(bladder neck descent: 19.30±11.74 vs 19.64±11.59,P=0.909;bottom of the bladder descent:28.43±15.14 vs 26.69±19.51,P=0.700).There was no significant correlation between the degree of improvement and the retrovesical angle.Conclusion: 1.The anterior pelvic reconstruction with transvaginal mesh implantation can improve the symptoms of urinary incontinence in patients with pelvic organ prolapse combined with stress urinary incontinence;2.The mechanism of improving urinary incontinence symptoms in patients with pelvic organ prolapse complicated with stress urinary incontinence by transvaginal mesh reconstruction is the reduction of bladder neck descent,bottom of the bladder descent,urethral Angle and posterior bladder Angle.