The safety and early efficacy of a new technique to treat cystocele and/or concomitant apical prolapse through a single vaginal incision with a lightweight mesh anchored apically bilaterally to the sacrospinous ligaments is reported.
Women with anterior compartment and/or apical prolapse ≥stage II underwent repair through a single anterior vaginal wall incision with the Anterior Elevate System (AES). The technique utilizes a lightweight (24 g/m2) type I mesh anchored to the sacrospinous ligaments via two mesh arms with small self-fixating tips. The bladder neck portion of the graft is anchored to the obturator internus with similar self-fixating tips. The apical portion of the graft is adjustable to vaginal length prior to locking in place. Outcome measures included prolapse degree at last follow-up visit, intra/post-operative complications, and QOL assessments.
Sixty patients were implanted with average follow-up of 13.4 months (range 3–24 months). Mean pre-op Ba was +2.04 ± 1.3 and C −2.7 ± 2.9. Average blood loss was 47 cc and average hospital stay was 23 h. Sixty-two percent of patients had concomitant sling for SUI. Mean post-op Ba is −2.45 ± 0.9 and C −8.3 ± 0.9. There was no statistical difference in pre- to post-op TVL. Objective cure rate at current follow-up is 91.7% (≤stage 1). To date, there have been no mesh extrusions. No patients have reported significant buttock or leg pain. No patients have required surgical revision for any reason.
The AES is a minimally invasive technique to treat anterior compartment and/or apical prolapse through a single vaginal incision. Initial results show the procedure to be safe and early efficacy is promising. Longer-term follow-up is ongoing.
Olsen AL, Smith VJ, Bergstrom JO et al (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 8:501–506 CrossRef
Maher C, Feiner B, Baessler K, Glazener CMA. Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD004014. doi: 10.1002/14651858.CD004014.pub4
Moore RD, Beyer RD, Jacoby K, Freedman SJ, McCammon KA, Gambla MT (2010) Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct 21(5):545–552 CrossRef
Moore RD, Miklos JR (2009) Vaginal mesh kits for pelvic organ prolapse, friend or foe: a comprehensive review. Scientific World Journal 9:163–189 PubMed
Sung VW, Rogers RG, Schaffer JI, Balk EM, Uhlig K, Lau J, Abed H, Wheeler TL 2nd, Morrill MY, Clemons JL, Rahn DD, Lukban JC, Lowenstein L, Kenton K, Young SB, Society of Gynecologic Surgeons Systematic Review Group (2008) Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol 112(5):1131–1142 PubMedCrossRef
Margulies RU, Lewicky-Gaupp C, Fenner DE, McGuire EJ, Delancy JO (2008) Complications requiring reoperation following vaginal mesh kit procedures for prolapse. Am J Obstet Gynecol 199:678.e1–678.e4 CrossRef
Ridgeway B, Walters MD, Paraiso MF, Barber MD, McAchran SE, Goldman HB, Jelovsek (2008) Early experience with mesh excision for adverse outcomes after transvaginal mesh placement using prolapse kits. Am J Obstet Gynecol 199:703.e1–703.e7 CrossRef
Moore RD, Mikos JR. Vaginal repair of cystocele with anterior wall mesh via transobturator route:efficacy and complications with up to 3-year follow-up. Adv Urol. 2009:743831. 2009 Aug 24 (in press)
Milani AL, Hinoul P, Gauld JM, Sikirica V, van Drie D, Cosson M, Prolift + M Investigators (2011) Trocar-guided mesh repair of vaginal prolapse using partially absorbable mesh: 1 year outcomes. Am J Obstet Gynecol 204(1):74.e 1–74.e8 CrossRef
- Single-incision vaginal approach to treat cystocele and vault prolapse with an anterior wall mesh anchored apically to the sacrospinous ligaments
Robert D. Moore
Gretchen K. Mitchell
John R. Miklos
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
e.Med Kampagnen-Visual, Mail Icon II