Mesh kit for prolapse yields high satisfaction rates

The experience of one center with vaginal mesh kits for prolapse repair shows that morbidity can be acceptable and patient satisfaction rates high-in the hands of very experienced surgeons.

Royal Oak, MI-Urologists have had a lot of experience with kits for stress urinary incontinence repair, but vaginal mesh kits for prolapse repair are still relatively new. Are the kits making these repairs any easier and less prone to complications?

It's still early, but the experience of one center shows that morbidity can be acceptable and patient satisfaction rates high-in the hands of very experienced surgeons. Despite the availability of the kits, the procedures themselves are still very technically demanding.

That was the take-home message from the experience of three fellowship-trained urologists at Beaumont Hospital in Royal Oak, MI with the Gynecare Prolift pelvic organ prolapse repair kit (Ethicon Inc., Somerville, NJ). In a presentation at the AUA annual meeting in San Francisco, first author Larry Sirls, MD, detailed the procedure's perioperative and short-term complications as well as outcomes of the 269 patients he and his team operated on from October 2006 to April 2009.

A little more than half the procedures these surgeons performed used mesh only anteriorly, "recognizing the concurrent apical and anterior prolapse that we tend to see," said Dr. Sirls, director of female urology at Beaumont Hospital. For more than half of these repairs, the surgeons modified the procedure to connect mesh to the sacrospinous ligament to achieve both anterior and apical support.

One-third of the patients (32%) had mesh placed in all compartments, and only 15% had it placed in the posterior compartment alone. One-fourth of the patients had concurrent hysterectomy performed, and nearly three-fourths (73%) had a midurethral sling placed concurrently. During the procedure, the surgeons' aggressive approach to anterior and apical repair meant passing the trocar through the ischiorectal fossa to the sacrospinous ligaments twice, Dr. Sirls said.

Among operative and short-term postoperative complications, incontinence and voiding dysfunction were the most troublesome, Dr. Sirls noted. Fourteen patients required catheterization, 15 required treatment for stress urinary incontinence (seven received slings and eight underwent injection therapy), and the sling had to be revised in 27. Five patients had operative bladder injuries, which were repaired, and one had a rectal injury with initial dissection. There were no erosions into the urinary tract or mesh contractures.