Reuters Health Information (2014-03-13): Vaginal mesh superior to native tissue repair for prolapse related to levator ani avulsion

Clinical

Vaginal mesh superior to native tissue repair for prolapse related to levator ani avulsion

Last Updated: 2014-03-13 11:40:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Women with post-hysterectomy prolapse with levator ani avulsion experience lower anatomic failure rates after vaginal mesh repair than after native tissue sacrospinous fixation, researchers from the Czech Republic report.

"We should definitively not favor native tissue repair in this group of patients, that is, patients with prolapse and major levator ani defect," Dr. Kamil Svabik from Charles University in Prague told Reuters Health via email. "The likelihood of failure is high."

Women with levator avulsion defects are about twice as likely to show pelvic organ prolapse of stage II or higher as women without such defects, and the recurrence risk seems to be three to four times higher in women with levator avulsion injury than in women without.

Dr. Svabik and colleagues compared 1-year outcomes after vaginal mesh repair using the Prolift Total system versus unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair (SSF) in 70 women with prolapse in association with levator ani avulsion injury.

After 1 year, there was one clinical anatomic failure among the 36 women in the Prolift group (3%), compared with 22 failures among the 34 women in the SSF group (65%; P<0.001), according to the March 11 Ultrasound in Obstetrics & Gynecology online report.

Based on the Pelvic Organ Prolapse Quantification (POP-Q) system's grade II criteria, there were six failures in the Prolift group (17%) versus 30 failures in the SSF group (88%; P<0.001).

Finally, using ultrasound criteria, there was one failure in the Prolift group (3%) versus 21 failures in the SSF group (62%; P<0.001).

Subjective outcomes at 1 year, as measured by the Pelvic Organ Prolapse Distress Inventory, and sexual activity did not differ significantly between the groups.

Although similar percentages of women reported stress incontinence at the 1-year follow-up, significantly more women in the Prolift group (n=13) than in the SSF group (n=3) had de novo incontinence (P=0.023).

"All prolapse patients are not the same," Dr. Svabik said. "The levator ani defects play a very important role. This knowledge should affect our choice of surgical technique. And we have a quite simple tool to diagnose such defects - ultrasound - and as gynecologists and obstetricians, we have enough skills to routinely use it."

Dr. Colleen McDermott from St. Michael's Hospital, University of Toronto in Ontario, Canada told Reuters Health by email, "Whenever you are considering a tissue versus mesh repair for prolapse you have to extensively counsel your patients with regards to risks of each. Tissue repair (i.e., SSF) has more recurrences, but mesh has its own set of issues, i.e., mesh erosion and pain complications."

"I personally don't think SSF is a good repair, so I would never recommend it," Dr. McDermott said. "For a native tissue repair, I use uterosacral suspensions for vault. They are better as far as I am concerned."

"Prolift is not on the market anymore, so it's hard to take anything away from this report," Dr. McDermott added. "None of the vaginal mesh kits that are still around are available as total kits; they are all only just anterior or posterior systems."

SOURCE: http://bit.ly/1gsSClR

Ultrasound Obstet Gynecol 2014.