Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

• Published in: BMC urology 2018-05, Vol.18 (1), p.53-53, Article 53
• Main Authors: Fekete, Zoltán, Kőrösi, Szilvia, Pajor, László, Bajory, Zoltán, Németh, Gábor, Kozinszky, Zoltan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anterior colporrhaphy; Care and treatment; Clavien–Dindo classification; Cohort Studies; Complications; Data processing; Female; Humans; Implants, Artificial; Longitudinal Studies; Middle Aged; Modified transvaginal mesh; Patients; Pelvic Organ Prolapse - complications; Pelvic Organ Prolapse - diagnosis; Pelvic Organ Prolapse - surgery; Prolapse; Prospective Studies; Prostheses; Prosthesis; SUI with POP–Q II; Surgery; Surgical Mesh - utilization; Surgical outcomes; Suture Techniques - utilization; Transobturator tape; Treatment Outcome; Urethra; Urinary Incontinence, Stress - diagnosis; Urinary Incontinence, Stress - etiology; Urinary Incontinence, Stress - surgery; Urine; Urology; Vagina; Vagina - pathology; Vagina - surgery
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-018-0363-2

This study aims to explore the feasibility of anchoring a four-arm transvaginal mesh (TVM) to the mid-urethra to correct an anterior compartment POP-Quantification stage II-III (Q II-III) and concomitant genuine SUI. We analysed clinical data from 248 patients with stage II-III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2008 and June 2010. One hundred and twenty-four women treated with anterior colporrhaphy and 62 patients implanted with a conventional permanent TVM were selected as historical matched controls. Sixty-two patients received a modified permanent TVM, where the mesh was fixed to the mid-urethra with two stitches for the purpose of potentially correcting SUI. Surgical complications were classified using the Clavien-Dindo (CD) classification system. The anti-SUI efficacy was minimally higher in the mTVM group than in the original TVM group (p = 0.44, 96.8% vs 91.9%, respectively), while prosthesis surgery was more effective than anterior colporrhaphy in improving the anterior compartment POP-Q status (96.8, 90.3% vs 64.5%, respectively). Anchoring the mesh did not increase the extrusion rate (p = 0.11). The de novo urge symptoms were not more prevalent among those who had received additional periurethral stitches (p = 1.00, 11.3% vs 12.9%). The incidence of reoperation observed in the mTVM group was non-significantly lower than that in the TVM group (p = 0.15, 6.5% vs 16.1%); however, the difference did not reach the level of significance. The early postoperative complication profile was more favourable among the mTVM patients (classified as CD I: 8.1%; CD II: 1.6%; and CD IIIb: 1.6%) as compared to the TVM group (p = 0.013). The new, modified mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications.