1. LONG-TERM FOLLOW-UP OF ANTERIOR VAGINAL REPAIR:
A COMPARISON AMONG COLPORRHAPHY, COLPORRHAPHY WITH REINFORCEMENT BY XENOGRAFT, AND MESH.
M. Balzarro§, E. Rubilotta§, A.B. Porcaro§, N. Trabacchin*, A. Sarti§, M.A. Cerruto*, S. Siracusano*, W. Artibani*
U.O.C. Urology, A.O.U.I. of Verona§, University of Verona*, Verona, Italy
PURPOSE
Long-term objective and subjective outcomes in women underwent anterior vaginal wall repair with:
Anterior Colporrhaphy (AC)
AC with reinforcement by porcine Xenograft, Pelvisoft® biomesh, (AC-P)
AC with reinforcement by polypropylene mesh, Prolene mesh Ethicon, (AC-M)
MATERIALS AND METHODS
Retrospective evaluation of 109/123 underwent anterior POP repair with:
AC: 42 pts.
AC-P: 19 pts.
AC-M: 48 pts.
Statistical analysis: Chi-square or Fisher’s exact test. p values were considered statistically significant when <0.05.
Objective evaluation by two independent observers:
POP-Q
Baden-Walker Halfway Scoring System
Objective failure:
POP-Q > 2 stage
HWS >2° grade
Subjective evaluation:
Patient Perception of Bladder Condition (PPBC) – Italian
Global Impression of Improvement (PGI-I)
“Are you satisfied with the surgical procedure?”
“Would you confirm the same surgical choice at the time of the counseling before surgery?”
AC (n=42)
65.4 (9.8)
30 (71.4)
3 (7.2)
9 (21.4)
AC-P (n=19)
67.1 (6.6)
14 (73.6)
5 (26.4) -
AC-M (n=48)
64.5 (8.6)
31 (64.6)
4 (8.4)
13 (27.0)
Age, yrs mean (± sd)
III / 3
IV / 4
II / 2
POP-Q / HWS, n (%)
2/II POP-Q/HWS
3/III POP-Q/HWS
4/IV POP-Q/HWS AC
AC-P
AC-M AC
(n=42) 7 18 6
AC-P
(n=19) 2 9 3
AC-M
(n=48) 4 -
Associated Surgical
Procedures, n
Posterior vaginal wall repair
TVT / TVT-O
Sacrospinous suspension
Hysterectomy
Other procedures 14 AC
(n=42)
AC-P
(n=19)
AC-M
(n=48)
Overall mean follow-up time:
87,7 ± months
Range (12-184)
85.4
(29.5)
76.7
(61.2)
Follow-up, months mean
(± sd)
101.5
(44.9) AC
2 (4.7) 1 -
AC-P
AC-M 3*
Pts. Complicated, n (%)
Severe vaginal adhesions
Dyspareunia
Pain
Complications
Extrusion
8*§
Hematoma
Urinary retention 4§
3 (15.7)
14 (29.1)
P value
0.0095
Two patients (* & §) developed both the complications. Chi-square statistical analysis. AC
(n=42)
AC-P
(n=19)
AC-M
(n=48)
P value
40 (95.2)
19 (100)
40 (83.3)
0.370
Personal patient satisfaction, n (%)
39 (92.8)
45 (93.7)
0.503
Pts that would repeat the surgery, n (%)
1.38 (1-5)
1.15 (1-5)
1.45 (1-5)
PPBC
1.42 (1-5)
1.21 (1-5)
1.56 (1-5)
PGI-I
34 (80.9)
17 (89.4)
0.572
POP-Q / HWS < II/2, n (%)
Objective success
Subjective success
Anatomical Success (%) Complications (%)
Anatomical Success vs Complications AC
AC-P
AC-M
Pre-Operative Stage
Follow-up Stage
CONCLUSIONS
AC has objective and subjective good results in a very long-term follow-up
The additional support given by a mesh, or a xenograft, does not increase with statistically significance the anatomic cure rate
The use of mesh leads to a statistically significant increase of complications
AC-P