Transvaginal Mesh For Treatment Of Advanced Pelvic Organ Prolapse:a Long-term Clinical Analysis

ObjectiveThis study is to discuss the long-term clinical effects of pelvic reconstructive operations.MethodsTo study retrospectively in 105 women with stage ?-? prolapsed according to pelvic organ prolapse quantification(POP-Q),who have received TVM pelvic reconstructive surgeries in Qilu hospital during January,2008 to December 2015.The success rate of follow-up was 90.5%(95/105).Among the 95 patients,the rate of patients who have completed 5-year follow-up was 53.7%(51/95),the rate of patients who have completed 3-year follow-up was 73.7%(70/95),the rate of patients who have finished 1-year follow-up was 100%(95/95).Through analysis of clinical data,we estimate relative variants of pelvic reconstructive operations and perioperative complications.Through physical examination post-operationally,we compare the POP-Q scores preoperatively and postoperatively to analyze objective clinical results of pelvic reconstructive operations.We perform quality-of-life questionnaires(PFIQ-7 and PSIQ-12)and sexual life questionnaires(PSIQ-12),we compared the scores preoperative and postoperative to analyze subjective results of transvaginal pelvic reconstructive operations.By performing follow-up regularly,we'd like to follow the tracks of long-term recurrence and complications postoperatively.SPSS version 16.0 was used for analyze statistical data.Count data was presented as mean± standard deviation,frequency or rate was presented to describe measurement data,and comparative analyses were obtained using t test for comparison of preoperative and postoperative continuous data.A value of p<0.05 was considered statistically significant.Results:1.Cure rate of transvaginal pelvic reconstructive operations:1.1 For ICS standard of cure rate,1-year,3-year,5-year cure rate was 94.7%,87.1%,80.4%respectively,1.2 For the standard of complicated standards of cure rate,1-year,3-year,5-year cure rate was 94.7%,91.4%,88.2%respectively.2.Post-operational complications of pelvic reconstructive operations:urinary injury rate was 1.1%(1/95),urinary tract infection rate was 2.1%(2/95),and urinary retention rate was 3.2%(3/95),VTE postoperative rate was 3.2%(3/95).3.Clinical effects of reansvaginal pelvic reconstructive operations:3.1 Objective clinical effects:POP-Q measurements of Aa,Ba,Ap,Ba,Bp and C points taken 1 year postoperatively were statistically significant improved compared with those at baseline(P<0.005),total vagina length compared preoperatively and 1-year follow up shows statistically insignificant(P=0.012).3.2 Subjective clinical effects:the quality-of-life scores compared preoperatively and postoperatively showed a statistically significant improvement(P<0.005),which indicated an improvement in quality of life;the sexual satisfaction compared preoperatively and postoperatively showed a statistically significant improvement(P<0.005),which indicated an improvement in sexual satisfaction postoperatively.4.Long-term follow-up shows recurrence rate of transvaginal pelvic reconstructive operations was 5.3%(5/95),among which 3 recurrent patients had received TVM pelvic reconstruction preserving uterus,among totally 5 patients in total had ever received the same procedures,the recurrence of this procedure was 60%(3/5);5.Late complications:mesh exposure rate was 4.2%(4/95),mesh erosion rate was 1.1%(1/95),vaginal ulcer(without exposure)rate was 1.1%(1/95),vaginal granuloma(without exposure)rate was 2.1%(2/95),De novo incontinence rate was 3.2%(3/95),groin pain rate was 1.1%(1/95).Re-intervention rate for recurrence was 3.2%(3/95),re-intervention rate for complication was 7.4%(7/95).Conclusion:1 The efficiency TVM pelvic floor reconstruction in the treatment of anatomical restoration,subjective satisfactory and patients' life quality can be affirmed;2 For advanced POP patients,pelvic reconstructive operations with hysterectomy were more effective in preventing recurrence.