| BackgroundDue to degradation,trauma or other factors,the pelvic floor support tissue weakens,leading to the displacement of pelvic organs and adjacent vaginal wall that moving into or out of the vagina.POP includes both anatomical changes and clinical symptoms,but not all patients with POP have clinical symptoms.POP affects the life quality of nearly half of women over 50 years old.At present,the most effective and most major management of POP with clinical symptoms is surgical treatment.Surgical methods,including the traditional native tissue repair and mesh-augmented pelvic floor reconstruction,both have a certain recurrence rate.Recurrence implies the failure of the previous surgery,which can be detected in the pelvic examination and/or from the patients' subjective feelings.Recurrence may still occur in the previously treated compartments(direct recurrence)or other compartments(indirect recurrence).The International Urogynecological Association(IUGA)proposes that objective recurrent POP refers to recurrent,direct or indirect POP reaching or going below the level of the hymen,and subjective recurrent POP refers to having corresponding symptoms.Clinically,recurrent POP treatment is tricky.Conservative treatment is not good enough.Surgical treatment doesn't have standard surgical template,which makes it more difficult and the recurrence rate is higher than the previous surgery.Therefore,the choice of recurrent POP surgery should be more careful.ObjectiveTo investigate clinical significance and application of mesh-augmented pelvic floor reconstruction and traditional anterior/posterior colporrhaphy in the treatment of recurrent pelvic organ prolapse.MethodsTotally 73 with recurrent POP who had undergone operations at Qilu Hospital,Shandong University from January 2010 to December 2014 were selected.We divided these patients into two groups by operation methods:48 patients who were treated with mesh-augmented pelvic floor reconstruction were represented as the mesh group,where 21 patients treated with total vaginal mesh were represented as mesh group 1 and 27 patients treated with anterior vaginal mesh + posterior colporrhaphy were represented as mesh group 2;25 patients who were treated with anterior/posterior colporrhaphy were represented as the traditional operation group.The anatomical outcomes were evaluated by Pelvic Organ Prolapse Quantification(POP-Q);functional effectiveness was evaluated by Patient Global Impression of Change(PGI-C);the quality of life was evaluated by the comparison of Pelvic Floor Impact questionnaire short form 7(PFIQ-7)and Pelvic Floor Distress Inventory short form 20(PFDI-20)before and after operation;the quality of sexual life was evaluated by POP/Urinary Incontinence Sexual Questionnaire 12(PISQ-12);operation security were evaluated by surgical duration,intra-operative blood loss and complications.Results(1)Clinical characteristics:There were no significance differences between two groups among delivery way,parity,the first time of delivery,body mass index,preoperative menopausal rate and preoperative POP-Q(P>0.05).There were significant differences between two groups in age and morbidity rate of medical complications(P<0.05).There were no significance differences between mesh group 1 and mesh group 2 in terms of the above clinical characteristics(P>0.05).(2)Previous surgery:There were 3 patients who had undergone more than one operations for POP.The previous operation way of other 70 patients includes transvaginal hysterectomy + vaginal wall repair,anterior and posterior colporrhaphy,Manchester operation,hysterectomy.Recurrent time after operation was between three months to sixteen years,median time was fifty-four months.(3)This time surgery:There were significant differences between two groups as for mean surgical time(P<0.05).There were no significant differences among intra-operative blood loss,post-operative indwelling catheter time and hospital stay(P>0.05).There were no significance differences between mesh group 1 and mesh group 2 in terms of the above clinical characteristics(P>0.05).(4)Operation effect:There were significant differences between pre-and post-operative POP-Q degrees in both groups(P<0.05),objective cure rate was 100%.After follow-up 2 years,the patients' subjective satisfaction of mesh group was 89.58%(43/48),the patients' subjective satisfaction of traditional operation group was 84%(21/25),there were no significant differences about subjective satisfaction in both group(P>0.05).Post-operative PFIQ-7 scores and PFDI-20 scores were significantly lower than corresponding preoperative items in every group(P<0.001).There were significant differences as for post-operative PFIQ-7 scores between the mesh group and the traditional operation group(P<0.05),but there were no significant differences as for post-operative PFDI-20 scores(P>0.05).There were no significance differences between mesh group 1 and mesh group 2 in terms of the patients'subjective satisfaction,post-operative PFIQ-7 scores and PFDI-20 scores(P>0.05).(5)Complication and Recurrence:post-operative complication rate of mesh group was 14.58%(7/48).the rate of mesh exposure was 4.17%(2/48),post-operative complication rate of traditional operation group was 8%(2/25),there were no significant differences as for the rate of postoperative complications(P>0.05).There were no significant differences between mesh group]and mesh group 2 in terms of the post-operative complication rate.There was only one recurrence case after 18 months of the operation.Conclusions(1)Both surgeries are effective ways in the treatment of recurrent POP;(2)Mesh-augmented pelvic floor reconstruction possesses better subjective effectiveness,but the complications of mesh should be considered;(3)As for posterior pelvic floor deficiency,the effectiveness of the two surgeries has no difference;(4)Both surgeries possess affirmative effects from a short-term perspective for treating recurrent POP,but it deserves much attention regarding the long-term reliability. |
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