Research from Taiwan suggests that combining trocar-guided transvaginal mesh surgery with a midurethral sling in the treatment of women with advanced pelvic organ prolapse could be an effective way to manage associated stress urinary incontinence (SUI).
The researchers followed up 89 patients who underwent both procedures at the same time for a median of 35 months. Overall, 17 (19.1%) had a concurrent vaginal hysterectomy, 20 (22.5%) underwent vault suspension and 52 (58.4%) underwent uterine suspension.
Overall, all parameters in the Pelvic Organ Prolapse Quantification improved significantly from baseline to 6 months. And, the 69 patients who underwent urodynamics at 6 months had significantly higher maximum flow rate and mean flow rate and lower post-void residual urine volume and maximum urethral closure pressure compared with baseline, as well as a significantly improved 1-hour pad test result.
The researchers, led by Ming-Ping Wu (Chi Mei Foundation Hospital, Tainan), note that the 29 patients with postoperative persistent of de novo overactive bladder symptoms were all successfully treated with antimuscarinic treatment. And, 55 (96.5%) of 57 patients with preoperative voiding difficulty were cured. However, there were 20 (22.5%) patients with postoperative SUI.
Other peri- and postoperative complications included two cases of haematoma, requiring blood transfusion in one patient, and five patients with vaginal apical mesh exposure. The researchers also report that patients undergoing vaginal hysterectomy had a significantly longer operation time and blood loss than patients undergoing vault and uterine suspension. Mesh erosion was also significantly less likely in patients undergoing uterine suspension group than the other patients.
Writing in the Taiwanese Journal of Obstetrics & Gynecology, the authors say that their findings suggest that the technique offers good efficacy for treating women with pelvic organ prolapse and SUI.
“However, concerns should be raised regarding potential harmful consequences due to such an intervention, particularly technique-related morbidity (bleeding, organ injury, and mesh exposure),” they caution.
“One single treatment strategy cannot fit every woman. Certainly, patient input should be taken into account as well, and a frank discussion of the pros and cons of concomitant surgery should occur between the surgeon and patient prior to surgery.”
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