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Clinical challenges in the management of vaginal prolapse.

Siddiqui NY, Edenfield AL - Int J Womens Health (2014)

Bottom Line: Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques.In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse.Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.

View Article: PubMed Central - PubMed

Affiliation: Division of Urogynecology and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA.

ABSTRACT
Pelvic organ prolapse is highly prevalent, and negatively affects a woman's quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider. These may include the location(s) of anatomic defects, the severity of prolapse symptoms, the activity level of the woman, and concerns regarding the durability of the repair. In many instances, women and their surgeons are challenged to weigh the risks and benefits of native tissue versus mesh-augmented repairs. Though mesh-augmented repairs may offer better durability, they are also associated with unique complications, such as mesh erosion. Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques. Biologic grafts may also be considered to improve durability of a surgical repair, while avoiding potential complications of synthetic mesh. In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse. Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.

No MeSH data available.


Related in: MedlinePlus

Transvaginal mesh. Image of an anterior/apical transvaginal mesh. The body of the mesh lies over the anterior vaginal wall and apex of the vagina. The “arms” of the mesh are placed into the sacrospinous ligaments bilaterally. The ischial spine is depicted with the pudendal neurovascular bundle (nerve, artery, vein) in close proximity to the ischial spine.
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f4-ijwh-6-083: Transvaginal mesh. Image of an anterior/apical transvaginal mesh. The body of the mesh lies over the anterior vaginal wall and apex of the vagina. The “arms” of the mesh are placed into the sacrospinous ligaments bilaterally. The ischial spine is depicted with the pudendal neurovascular bundle (nerve, artery, vein) in close proximity to the ischial spine.

Mentions: Another way in which surgeons have tried to provide the benefits of a mesh-augmented repair with a less invasive approach is by offering transvaginal mesh repairs (Figure 4). A recent study of a large US health care claims database shows that from 2005 to 2010 the rate of all procedures for prolapse using mesh grafts increased, with vaginal mesh surgeries constituting the vast majority (approximately 75%).58 These typically involved permanent meshes that were placed with a vaginal approach using trocars to guide arms of mesh into place. However, the landscape of available transvaginal mesh products is rapidly changing, particularly following the 2011 US Food and Drug Administration (FDA) safety communication, which expressed concern regarding adverse events and complications associated with transvaginal mesh prolapse repairs.59 In this communication, an FDA-sponsored systematic review found that erosion of mesh through the vagina was the most consistent and common mesh-related complication, and that mesh contraction (shrinkage) was a previously unidentified risk of transvaginal mesh repairs.59,60 These complications may lead to pelvic pain, dyspareunia, or the inability to achieve vaginal intercourse. Notably, the FDA did not find conclusive evidence that transvaginally placed mesh improves outcomes any more than traditional prolapse repair without mesh, and may expose patients to greater risk.


Clinical challenges in the management of vaginal prolapse.

Siddiqui NY, Edenfield AL - Int J Womens Health (2014)

Transvaginal mesh. Image of an anterior/apical transvaginal mesh. The body of the mesh lies over the anterior vaginal wall and apex of the vagina. The “arms” of the mesh are placed into the sacrospinous ligaments bilaterally. The ischial spine is depicted with the pudendal neurovascular bundle (nerve, artery, vein) in close proximity to the ischial spine.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3897326&req=5

f4-ijwh-6-083: Transvaginal mesh. Image of an anterior/apical transvaginal mesh. The body of the mesh lies over the anterior vaginal wall and apex of the vagina. The “arms” of the mesh are placed into the sacrospinous ligaments bilaterally. The ischial spine is depicted with the pudendal neurovascular bundle (nerve, artery, vein) in close proximity to the ischial spine.
Mentions: Another way in which surgeons have tried to provide the benefits of a mesh-augmented repair with a less invasive approach is by offering transvaginal mesh repairs (Figure 4). A recent study of a large US health care claims database shows that from 2005 to 2010 the rate of all procedures for prolapse using mesh grafts increased, with vaginal mesh surgeries constituting the vast majority (approximately 75%).58 These typically involved permanent meshes that were placed with a vaginal approach using trocars to guide arms of mesh into place. However, the landscape of available transvaginal mesh products is rapidly changing, particularly following the 2011 US Food and Drug Administration (FDA) safety communication, which expressed concern regarding adverse events and complications associated with transvaginal mesh prolapse repairs.59 In this communication, an FDA-sponsored systematic review found that erosion of mesh through the vagina was the most consistent and common mesh-related complication, and that mesh contraction (shrinkage) was a previously unidentified risk of transvaginal mesh repairs.59,60 These complications may lead to pelvic pain, dyspareunia, or the inability to achieve vaginal intercourse. Notably, the FDA did not find conclusive evidence that transvaginally placed mesh improves outcomes any more than traditional prolapse repair without mesh, and may expose patients to greater risk.

Bottom Line: Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques.In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse.Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.

View Article: PubMed Central - PubMed

Affiliation: Division of Urogynecology and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA.

ABSTRACT
Pelvic organ prolapse is highly prevalent, and negatively affects a woman's quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider. These may include the location(s) of anatomic defects, the severity of prolapse symptoms, the activity level of the woman, and concerns regarding the durability of the repair. In many instances, women and their surgeons are challenged to weigh the risks and benefits of native tissue versus mesh-augmented repairs. Though mesh-augmented repairs may offer better durability, they are also associated with unique complications, such as mesh erosion. Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques. Biologic grafts may also be considered to improve durability of a surgical repair, while avoiding potential complications of synthetic mesh. In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse. Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.

No MeSH data available.


Related in: MedlinePlus