LAPAROSCOPIC Y-SHAPED POLYPROPYLENE MESH FOR UTERINE AND VAGINAL VAULT PROLAPSE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Min , FENG Yichen , JIN Shaoyan , YU Danhua.

Minimally Invasive Ward, South Branch of Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 201400, P.R.China. Corresponding author: LI Min, E-mail: lm621113@163.com;

Corresponding author：

Keywords：

Laparoscope; Y-shaped polypropylene mesh; Uterine prolapse; Vaginal vault prolapse

DOI：

10.7507/1002-1892.20130242

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Objective To investigate the effectiveness of laparoscopic Y-shaped polypropylene mesh in the treatment of uterine and vaginal vault prolapse. Methods Between June 2010 and December 2012, 24 patients with uterine and vaginal vault prolapse were treated by laparoscopic pelvic reconstruction (vagina and uterus-sacral fixation) with Y-shaped polypropylene mesh. The age of patients was 35-60 years (mean, 48.6 years). The disease duration was 2-8 years (mean, 5 years). According to the pelvic organ prolapse quatitative (POP-Q) classification by International Continence Society (ICS), 16 cases were classified as uterine prolapsed degree II and 8 cases as degree III; 15 cases were classified as vaginal prolapse degree I, 7 cases as degree II, and 2 cases as degree III. All patients received postoperative follow-up regularly. Subjective evaluation was done based on prolapse quality of life questionnaire (P-QOL), and objective evaluation based on POP-Q classification. Results All the patients were operated successfully. The operation time was 22-68 minutes (mean, 33 minutes); the blood loss was 30-80 mL (mean, 51 mL); the indwelling urethral catheter remain was 3-7 days (mean, 4 days); and the hospitalization days were 4-9 days (mean, 6.8 days). Twenty-four patients were followed up 3-12 months (mean, 9 months), of whom, 2 were followed up less than 6 months. All patients had normal urination after withdrawal of urethral catheter, and the residual urine volume was in normal range. No patients had mesh erosion and discomfort during sex, vaginal and anal bearing down. The P-QOL scores at 3, 6, and 12 months after operation were significantly improved when compared with the preoperative value (P lt; 0.05); but there was no significant difference among 3, 6, and 12 months after operation (P gt; 0.05). The postoperative POP-Q classification was degree 0 in 19 cases and degree I in 3 cases, and the objective cure rate was 91.7%. No recurrence was found during follow-up. Conclusion Laparoscopic Y-shaped polypropylene mesh for treatment of uterine and vaginal vault prolapse is a safe and effective method, especially applicable to preserve the uterus, and higher requirements of sexual life of patients.

Citation： LI Min,FENG Yichen,JIN Shaoyan,YU Danhua.. LAPAROSCOPIC Y-SHAPED POLYPROPYLENE MESH FOR UTERINE AND VAGINAL VAULT PROLAPSE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(9): 1106-1109. doi: 10.7507/1002-1892.20130242 Copy

1.	Beer M, Kuhn A. Surgical technigues for vault prolapse: a review of the literature. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 144-155.
2.	Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn, 2008, 27(1): 3-12.
3.	Clark AL, Gregory T, Smith VJ, et al. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary in continence. Am J Obstet Gynecol, 2003, 189(5): 1261-1267.
4.	Jo H, Kim JW, Park NH, et al. Efficacy and outcome of anterior vaginal wall repair using polypropylene mesh (Gynemesh). J Obstet Gynaecol Res, 2007, 33(5): 700-704.
5.	Deffieux X, de Tayrac R, Huel C, et al. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(1): 73-79.
6.	Fatton B, Amblard J, Debodinance P, et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)—a case series multicentric study. Int Urogynecol J, 2007, 18(7): 743-752.
7.	Feiner B, Gietelink L, Maher C. Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 2010, 21(2): 203-208.
8.	Hinoul P, Ombelet WU, Burger MP, et al. A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair. J Minim Invasive Gynecol , 2008 , 15(5): 615-620.
9.	Feiner B, Maher C. Vaginal mesh contraction definition, clinical presentation, and management. Obstet Gynecol, 2010, 115(2 Pt 1): 325-330.
10.	Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol, 2006, 194(5): 1418-1422.
11.	Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic Review. Obstet Gynecol, 2008, 112(5): 1131-1142.
12.	Cespedes RD. Diagnosis and treatment of vaginal vault prolapse conditions. Urology, 2002, 60(1): 8-15.
13.	Serecchioli R, Hourcabie JA, Vianello F, et al. Laparoscopic treatment of pelvic floor defects in women of reproductive age. J Am Assoc Gynecol Laparosc, 2004, 11(3): 332-335.
14.	曾俐琴, Chou Danny, Wong Felix, 等. 腹腔镜网片骶骨阴道固定术治疗阴道穹窿脱垂. 中华妇产科杂志, 2012, 47(2): 154-157.
15.	Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol, 2006, 176(2): 655-659.

1. Beer M, Kuhn A. Surgical technigues for vault prolapse: a review of the literature. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 144-155.
2. Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn, 2008, 27(1): 3-12.
3. Clark AL, Gregory T, Smith VJ, et al. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary in continence. Am J Obstet Gynecol, 2003, 189(5): 1261-1267.
4. Jo H, Kim JW, Park NH, et al. Efficacy and outcome of anterior vaginal wall repair using polypropylene mesh (Gynemesh). J Obstet Gynaecol Res, 2007, 33(5): 700-704.
5. Deffieux X, de Tayrac R, Huel C, et al. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(1): 73-79.
6. Fatton B, Amblard J, Debodinance P, et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)—a case series multicentric study. Int Urogynecol J, 2007, 18(7): 743-752.
7. Feiner B, Gietelink L, Maher C. Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 2010, 21(2): 203-208.
8. Hinoul P, Ombelet WU, Burger MP, et al. A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair. J Minim Invasive Gynecol , 2008 , 15(5): 615-620.
9. Feiner B, Maher C. Vaginal mesh contraction definition, clinical presentation, and management. Obstet Gynecol, 2010, 115(2 Pt 1): 325-330.
10. Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol, 2006, 194(5): 1418-1422.
11. Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic Review. Obstet Gynecol, 2008, 112(5): 1131-1142.
12. Cespedes RD. Diagnosis and treatment of vaginal vault prolapse conditions. Urology, 2002, 60(1): 8-15.
13. Serecchioli R, Hourcabie JA, Vianello F, et al. Laparoscopic treatment of pelvic floor defects in women of reproductive age. J Am Assoc Gynecol Laparosc, 2004, 11(3): 332-335.
14. 曾俐琴, Chou Danny, Wong Felix, 等. 腹腔镜网片骶骨阴道固定术治疗阴道穹窿脱垂. 中华妇产科杂志, 2012, 47(2): 154-157.
15. Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol, 2006, 176(2): 655-659.

Chinese Journal of Reparative and Reconstructive Surgery

LAPAROSCOPIC Y-SHAPED POLYPROPYLENE MESH FOR UTERINE AND VAGINAL VAULT PROLAPSE

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