Year: 2018
Type: dissertation
Abstract: Female pelvic organ prolapse (FPOP) is a debilitating condition. In Australia, 19% of women require prolapse surgery in their lifetime and recurrence rates range as high as 40 – 60% in the anterior compartment. Given the high surgical failure rate, this thesis aimed to identify the use of mesh to improve surgical outcomes utilising translabial ultrasound as the principal study method. In a retrospective analysis of mesh use in vaginal repair, anterior mesh proved to have a lower recurrence rate compared to native tissue repair, and anterior anchored mesh such as the PerigeeTM was of maximum benefit only in women who had a levator avulsion, a risk factor for prolapse recurrence. Apical anchoring supports were also evaluated in this thesis. Vaginally, the anterior ElevateTM was found to be inferior compared to the PerigeeTM, highlighting the possible poorer load-bearing capability of the self-fixating anterior ElevateTM anchors, whilst abdominally, there was still a very high rate of cystocele recurrence (>80%) despite excellent apical support in those that had laparoscopic sacrocolpopexy. Regardless of anchoring methods, mesh repair did not seem to completely compensate for the effect of levator avulsion and it did not confer additional benefit in women with an enlarged levator hiatal area, another risk factor for prolapse recurrence. The Puborectalis sling was designed to prevent excessive levator hiatal enlargement and proof of concept was achieved in a phase II observational pilot study of 110 women. There was a mean reduction of the levator hiatal area by 12cm2 sustained for over two years. During the course of this work, the rise in reported mesh related complications had also led to heated debates over its use in urogynaecology. Prolapse repair with mesh shifted from being readily embraced to complete withdrawal of use in many countries. This work hopes to contribute to the evolving mesh literature and to outline an alternative operative approach in women at high risk of prolapse recurrence.
Author: Vivien Wong
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Astellas Pharma
OpenAlex ID: W3033015877