Original Article
Anatomic and Functional Outcomes with the Prolift Procedure in Elderly Women with Advanced Pelvic Organ Prolapse Who Desire Uterine Preservation

https://doi.org/10.1016/j.jmig.2011.12.014Get rights and content

Abstract

Study Objective

To assess the clinical outcomes of total mesh repair with the Prolift technique as treatment of advanced pelvic organ prolapse in elderly patients who desire uterine preservation.

Design

Case control series study (Canadian Task Force classification II-2).

Setting

Medical school–affiliated hospital.

Patients

Sixty-eight patients over the age of 70 years with advanced pelvic organ prolapse, Pelvic Organ Prolapse Quantification stage III (n = 59) or IV (n = 9), underwent a total Prolift procedure and were followed up for a minimum of 2 years.

Interventions

Transvaginal pelvic floor repairs were performed with a total Prolift system. The concurrent pelvic surgery included midurethral sling operation with a TVT-O, if indicated. The assessment included intraoperative and postoperative complications, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores.

Measurements and Main Results

Objective and subjective data were available for 68 patients. The anatomic success rate was 97.1% after 2 years. Complications included bladder perforation in 1 patient (1.5%), de novo stress urinary incontinence in 20 patients (29.4%), dyspareunia in 4 patients (22.2%), and vaginal erosion in 1 patient (1.5%). The Pelvic Organ Prolapse Quantification stages, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores all improved significantly after surgery.

Conclusions

The total Prolift procedure is an alternative surgical option that uses a minimally invasive transvaginal approach to surgically treat elderly patients with advanced pelvic organ prolapse.

Section snippets

Materials and Methods

In this study, we reviewed the outcomes of women more than 70 years of age with advanced POP who underwent transvaginal pelvic floor repair with a total Prolift (Ethicon, Inc., Somerville, NJ) procedure at the Chonnam National University Hospital, Gwangju, South Korea. Sixty-eight women with a minimum of 2 years of follow-up were included. This is a single-center case series with data, including age, body mass index, personal history, POP staging, and perioperative surgical complications,

Results

The preoperative patient characteristics are presented in Table 1. The mean age was 74.9 ± 3.10 (95% CI, 73.91–75.89), and the mean parity was 4.2 ± 1.60 (95% CI, 3.69–4.71). Sixty-three women (92.6%) had no previous hormonal treatment. The preoperative POP-Q stage was III in 59 (86.8%) and IV in 9 (13.2%). The length of follow-up ranged from 24 to 34 months. All of the patients underwent a total Prolift procedure. The mean operative time was 74.8 ± 14.94 (95% CI, 70.02–79.58) minutes. General

Discussion

Surgical treatment of POP in elderly women is troublesome because of their frequent comorbidities. Therefore, the ideal operative treatment for elderly women is likely to be a method with a short operation time, minimal invasiveness, a low recurrence rate, and fewer complications. Although colpocleisis or the Lefort operation may be more appropriate, these operations are only used in a limited subset of patients.

The traditional surgical treatment for POP has been vaginal hysterectomy. This

References (25)

  • X. Jia et al.

    Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis

    BJOG

    (2008)
  • M. Cervigni et al.

    Transvaginal cystocele repair with polypropylene mesh using a tension-free technique

    Int Urogynecol J Pelvic Floor Dysfunct

    (2008)

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    The authors declare that they have no conflict of interest.

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    Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.