| Background:Transvaginal mesh(TVM)is a minimally invasive but effective treatment for pelvic organ prolapsed(POP).Pelvic organ prolapse happens in up to 50%of women who have given birth.This can happen at different sites within the vagina;prolapse of the anterior compartment is most difficult to repair,and rates of recurrence are little bit higher among of other vaginal sites.This challenge has resulted in the use of a variety of surgical techniques and mesh implant to improve outcomes of anterior compartment prolapse surgery.We aimed to appraisement surgical interventions for anterior compartment prolapse.The anterior vaginal wall is the most common segment of the vagina to prolapse and that segment is most likely to fail long-term after surgical correction.We aimed to appraisement surgical interventions for anterior compartment prolapse.Anterior vaginal prolapse occurs commonly and cohabit with disorders of micturition.AVP is defined as pathological descent of the anterior vaginal wall toward the pelvic floor and overlying bladder base due to the weakness of pelvic floor tissues as a result of various anatomical or physiological conditions which contrariwise affects organ function.A large cystocele can often cause or be associated with urinary symptoms such as urinary leakage,urinary urgency(strong and sudden desire to pass urine),having to go frequently,difficulty passing urine or a sensation of incomplete emptying.Pelvic organ defect and POP are common conditions for women as they age,but many women won't discuss their symptoms-not even with their doctors.In the United States 24%of women have Pelvic Organ Prolapse(POP)where one or more organs in the pelvis,such as the uterus,bladder or rectum,have shifted downward after the pelvic floor wall was injured or hurt.Treatment of a woman with prolapse depends on the severity of the prolapse,its symptoms,the woman's general health and surgeon preference and capabilities.Options for treatment include conservative,mechanical and surgical interventions.The choice of operation depends on several factors,which include the nature,site and severity of the prolapse;whether additional symptoms are affecting urinary,bowel or sexual function;the general health of the woman;and surgeon preference and capability.Concomitant procedures are often performed to treat or prevent urinary incontinence at the same time.Generally,conservative or mechanical treatments are considered for women with a mild degree of prolapse,those who wish to have more children,frail women and those unwilling to undergo surgery.Initial marketing of synthetic vaginal mesh was aimed at improved success rates for POP surgery and time efficient,minimally invasive procedures.Conventional surgery for the treatment of AVP is anterior colporrhaphy.However,up to 70%of individuals have recurrent prolapse after anterior conventional surgery.Dissatisfaction with the outcomes of conventional surgery for AVP has resulted in the increased use of mesh repair,which has been reported to have higher success rates in the treatment of AVP.Moreover,mesh repair has become exoteric in many countries as it is associated with less risk of complications.However,the advantages and disadvantages of mesh repair still require further investigation.Anterior vaginal wall operation has been performed for a long time.There is a high recurrence rate(symptoms returning)but the operation can be repeated.Because this prolapse involves the bladder,a test of bladder function(urodynamics)is sometimes required prior to the operation,especially if the prolapse is large or if patients already have urinary symptoms(frequency,urgency or incontinence).The benefits are that patients are likely to feel more comfortable,intercourse may be more satisfactory and patient may empty her bladder more effectively.Objective:Vaginal prolapse of the vagina is one of the most common causes that plague women's lives,and research on its treatment has been a hot topic and a problem that people hope to break through.The purpose of this paper is to evaluate the relationship between 7 different LUTS symptoms and 8 different complications at 3 different follow-up time points within 6 months after the new and old groups of mesh.Recognizing that these complications should help us conduct appropriate patient counseling and facilitate further research on lower-level mechanisms.Methods:It was a hospital based prospective study conducted between January 2014 to June 2018 and after receiving approval from the local ethics committee,informed consent was obtained from all patients.All methods in this study were performed in accordance with the relevant guidelines and regulations.Select the patients who during Aweta mesh January 2014 to August 2017 and Heme mesh September 2017 to June 2018 see a doctor in the Third Affiliated Hospital of Zhengzhou University,Henan,China.Total 109 female patients,61 cases in group A and 48 cases in group B with POP undergoing vaginal reconstructive surgery for anterior vaginal wall prolapse by TVM procedure with or without posterior vaginal wall repair,vaginal hysterectomy,anti-incontinence surgery.The 2 types of meshes Prolift anterior leaf fixation had the same pore size,the same texture(monofilament polypropylene meshes).Record two groups of patients including age,menopause status,body mass index(BMI),gravidity and parity,stage of the POP,TVM types,concomitant procedures,operation time,blood loss,postoperative morbidity,and postoperative complication.Only patients with a least 6 months of follow up time were included.All patients went through the same preoperativet protocol,which covered a urogynecologic history,a physical examination,urine analysis,a voiding diary,cough stress test,postvoid residual urine volume analysis,and transvaginal ultrasonography.The POP-Q system for prolapse staging was used according to the Pelvic Organ Prolapse Quantification(POP-Q)system.Patients having risk received antithrombotic prophylaxis with low-molecular-weight heparin.Antibiotic prophylaxis was administrated to all patients.The duration of the hospital stay was measured from the time of admission to discharge.Women having vaginal erosion were prescribed vaginal estrogen before the surgery for 2-3 weeks.The urethral catheter was removed on the first postoperative day.All patients returned for follow-up examinations at least three times during the 6-month period after the surgery and were assessed for subjective outcome in terms of pelvic floor dysfunction symptoms and for anatomical outcome by vaginal examination.All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS.Result:A total of 109 patients were recruited for this study from January 2014 to June 2018 only who completed their 6 months follow up.Patient mean age was(63.7±69)years in group A and(65.4±6.6)in group B.The average mean parity was(2.5±1.0)in group A and(2.6±1.1)in group B,among of them the post menopausal women was found 53(86.9%)in group A and 39(81.3%)in group B,within that sexually active women was 13(21.3%)in group a and 7(14.6%)in group B.The average mean BMI was 24.3±2.3kg/m2 in group a and 24.1±2.5 kg/m2 in group B.Mean operative time was 56.0±21.0 minutes in group A and 53.0±23.0 minutes in group B.Average blood loss was 98.0±75.0 ml in group A and 95.0±77.0 in group B and mean hospital stay was 5.0±1.2 days in group A and 5.5±2.1 days in group B.Most of the patients were discharge home within 7 days of surgery after spontaneous voiding(<100 ml).2 patients were discharge within 14 days due to physical illness.Regarding complications,the mesh related complications were identified in(1.6%)in group A and(2.1%)in group B at 3 months after which was treated conservatively with estrogen cream(Table VII&VIII).6 patients(9.8%)in group A and 2 patients(4.2%)in group B had denovo SUI,and we noticed that which was chronologically decreased in different follow up in group A but no difference were observed in group B.Dyspareunia was reported 7 days after surgery 3 patients(4.9%)in group A and 6 patients(12.5%)in group B.However dyspareunia was significantly decreased after 3rd month and 6th month follow up compared with before TVM surgery.Before surgery total patients of pelvic pain in group A was 17(27.9)and 15(31.3)in group B.Interestingly we observed that pelvic pain was decreased after surgery in different follow up and significantly decreased in at 6th month in both group(P value 0.001 in group A&0.004 in group B)Table ?&?.Based on urodynamic study,before surgery 8(13.11%)patients had incontinence in group A and 26(54.16%)patients in group B.After 6th month of surgery 56(91.80%)Patients reported the lack of incontinence episodes,5(8.19%)still had moderate to severe incontinence in group A and 46(95.8%)patients reported the lack of incontinence episodes,2(4.16%)still had moderate to severe incontinence in group B.All patients had moderate to severe anterior vaginal wall prolapse with 8(13.11%)in group A and 26(54.16%)in group B had moderate to severe incontinence prior to AVM surgery in both groups.After AVM surgery most commonly LUTS at first week were urgency(50.8%;3 times increased from baseline)in group A,frequency were(19.7%;3 times),splitting/spraying(42.6%;almost 8 fold increased),and post micturition feeling of incomplete bladder emptying(36.1%;3times increased).Nocturia was the least frequency symptom(13.1%).After 6th of surgery we noticed that,most annoying complaints splitting/sparing decreased 8.2%which remained twice as high in comparison in baseline and another annoying complaints urgency was decreased 4.9%after surgery at 6th month which also decreased 3 fold as comparison with baseline(P value 0.040)in group A and likely to similar in group B.Detailed data on what happened to LUTS and evaluation in the post operative period in table IX for group A&table X for group B.At the 6th month of follow up,patients were asked to evaluate satisfaction according to Likert's scale of seven grades 46 patients(75.4%)in group A&40 patients(83.3%)in group B indicate 7,which means they were fully satisfied.3(4.9%)in group A&1(2.0%)in group B declared little improvement and rated their satisfaction as 3.The most common LUTS after 6 months were hesitancy(13.1%)and terminal dribbling(9.8%)in group A and hesitancy(8.3%)in group B.Surprisingly,the incidence of all these symptoms was higher than preoperatively.Moreover we also noticed that a decreased of urgency>9 times in group A and>10 times in group B when compared with baseline visit.Conclusion:TVM surgery is used to treat anterior vaginal wall prolapse and provide benefits to patients,although the vast majority of patients experience different infections and complications early after surgery.However,most unwanted symptoms are spontaneously resolved within the first 6 months of surgery.Our goal was to report the preliminary results and investigate to perioperative complications and short-term post-operative outcomes of patients.So we have to understand the complications of these operations.Being aware of these complications should help us in the proper patient consultation,as well as stimulate further investigation of the subordinate mechanism.Reducing complications should be seen as an important outcome of future clinical studies. |
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