Transvaginal Mesh (TVM) Reconstruction with TVT / TOT Sling for Vaginal Prolapse Concurrent with Stress Urinary Incontinence

Abstract

We evaluated clinical efficacies of transvaginal mesh (TVM) reconstruction alone and those concomitant with a TVT / TOT sling for the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Between January 2006 and February 2007, 138 female patients with POP under­went TVM reconstruction. The mean age was 66.6 years (range: 52–84). Fourteen individuals were qualified as grade II in the POP quantification (POP-Q) system, 85 and 39 were grades III and IV, respectively. One hundred and seventeen of 138 (85 %) cases showed SUI. Twenty-one patients without SUI underwent TVM alone, and 117 cases with SUI underwent TVM concomitant with TVT / TOT sling. Mean operation time and intra­operative bleeding was 79 min (range: 25–177) and 74 ml (range: 10–429), respectively. Mean follow-up period is 5.3 months (range: 1–14). The vaginal prolapses were cured (grade 0) in 129 cases (93 %) after the surgery. Total inter­national prostate symptom score (IPSS), its QOL score, International Consultation on Incontinence Questionnaires Short Form (ICIQ-SF) significantly improved (from 12.6 to 3.9; p < 0.0001, from 5.0 to 1.0; p < 0.0001, and from 6.1 to 2.5; p < 0.01, respectively). Six of 21 cases (29 %) who underwent TVM alone showed postoperative de-novo SUI. In contrast, 116 cases (99 %) who underwent TVM concomitant with TVT / TOT, experienced a cure of SUI. Maximum flow rate did not change postoperatively in the both groups. In conclusion, the short-term efficacies of TVM reconstruction for POP are excellent, and a concomitant TVT / TOT sling prevents postoperative SUI.

Key words

pelvic organ prolapse - tension-free vaginal mesh - trans-obturator tape

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