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Christopher G Maher - One of the best experts on this subject based on the ideXlab platform.
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transvaginal mesh or grafts compared with Native Tissue repair for vaginal prolapse
Cochrane Database of Systematic Reviews, 2016Co-Authors: Christopher G Maher, Benjamin Feiner, Kaven Baessler, Corina Christmannschmid, Nir Haya, Jane MarjoribanksAbstract:Background A wide variety of grafts have been introduced with the aim of improving the outcomes of traditional Native Tissue repair (colporrhaphy) for vaginal prolapse. Objectives To determine the safety and effectiveness of transvaginal mesh or biological grafts compared to Native Tissue repair for vaginal prolapse. Search methods We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ongoing trials registers, and handsearching of journals and conference proceedings (6 July 2015). We also contacted researchers in the field. Selection criteria Randomised controlled trials (RCTs) comparing different types of vaginal repair (mesh, biological graft, or Native Tissue). Data collection and analysis Two review authors independently selected trials, assessed risk of bias, and extracted data. The primary outcomes were awareness of prolapse, repeat surgery, and recurrent prolapse on examination. Main results We included 37 RCTs (4023 women). The quality of the evidence ranged from very low to moderate. The main limitations were poor reporting of study methods, inconsistency, and imprecision. Permanent mesh versus Native Tissue repair Awareness of prolapse at one to three years was less likely after mesh repair (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.54 to 0.81, 12 RCTs, n = 1614, I2 = 3%, moderate-quality evidence). This suggests that if 19% of women are aware of prolapse after Native Tissue repair, between 10% and 15% will be aware of prolapse after permanent mesh repair. Rates of repeat surgery for prolapse were lower in the mesh group (RR 0.53, 95% CI 0.31 to 0.88, 12 RCTs, n = 1675, I2 = 0%, moderate-quality evidence). There was no evidence of a difference between the groups in rates of repeat surgery for continence (RR 1.07, 95% CI 0.62 to 1.83, 9 RCTs, n = 1284, I2 = 21%, low-quality evidence). More women in the mesh group required repeat surgery for the combined outcome of prolapse, stress incontinence, or mesh exposure (RR 2.40, 95% CI 1.51 to 3.81, 7 RCTs, n = 867, I2 = 0%, moderate-quality evidence). This suggests that if 5% of women require repeat surgery after Native Tissue repair, between 7% and 18% in the permanent mesh group will do so. Eight per cent of women in the mesh group required repeat surgery for mesh exposure. Recurrent prolapse on examination was less likely after mesh repair (RR 0.40, 95% CI 0.30 to 0.53, 21 RCTs, n = 2494, I2 = 73%, low-quality evidence). This suggests that if 38% of women have recurrent prolapse after Native Tissue repair, between 11% and 20% will do so after mesh repair. Permanent mesh was associated with higher rates of de novo stress incontinence (RR 1.39, 95% CI 1.06 to 1.82, 12 RCTs, 1512 women, I2 = 0%, low-quality evidence) and bladder injury (RR 3.92, 95% CI 1.62 to 9.50, 11 RCTs, n = 1514, I2 = 0%, moderate-quality evidence). There was no evidence of a difference between the groups in rates of de novo dyspareunia (RR 0.92, 95% CI 0.58 to 1.47, 11 RCTs, n = 764, I2 = 21%, low-quality evidence). Effects on quality of life were uncertain due to the very low-quality evidence. Absorbable mesh versus Native Tissue repair There was very low-quality evidence for the effectiveness of either form of repair at two years on the rate of awareness of prolapse (RR 1.05, 95% CI 0.77 to 1.44, 1 RCT, n = 54). There was very low-quality evidence for the effectiveness of either form of repair on the rate of repeat surgery for prolapse (RR 0.47, 95% CI 0.09 to 2.40, 1 RCT, n = 66). Recurrent prolapse on examination was less likely in the mesh group (RR 0.71, 95% CI 0.52 to 0.96, 3 RCTs, n = 292, I2 = 21%, low-quality evidence) The effect of either form of repair was uncertain for urinary outcomes, dyspareunia, and quality of life. Biological graft versus Native Tissue repair There was no evidence of a difference between the groups at one to three years for the outcome awareness of prolapse (RR 0.97, 95% CI 0.65 to 1.43, 7 RCTs, n = 777, low-quality evidence). There was no evidence of a difference between the groups for the outcome repeat surgery for prolapse (RR 1.22, 95% CI 0.61 to 2.44, 5 RCTs, n = 306, I2 = 8%, low-quality evidence). The effect of either approach was very uncertain for recurrent prolapse (RR 0.94, 95% CI 0.60 to 1.47, 7 RCTs, n = 587, I2 = 59%, very low-quality evidence). There was no evidence of a difference between the groups for dyspareunia or quality of life outcomes (very low-quality evidence). Authors' conclusions While transvaginal permanent mesh is associated with lower rates of awareness of prolapse, repeat surgery for prolapse, and prolapse on examination than Native Tissue repair, it is also associated with higher rates of repeat surgery for prolapse or stress urinary incontinence or mesh exposure (as a composite outcome), and with higher rates of bladder injury at surgery and de novo stress urinary incontinence. The risk-benefit profile means that transvaginal mesh has limited utility in primary surgery. While it is possible that in women with higher risk of recurrence the benefits may outweigh the risks, there is currently no evidence to support this position. Limited evidence suggests that absorbable mesh may reduce rates of recurrent prolapse on examination compared to Native Tissue repair, but there was insufficient evidence on absorbable mesh for us to draw any conclusions for other outcomes. There was also insufficient evidence for us to draw any conclusions regarding biological grafts compared to Native Tissue repair. In 2011, many transvaginal permanent meshes were voluntarily withdrawn from the market, and the newer, lightweight transvaginal permanent meshes still available have not been evaluated within a RCT. In the meantime, these newer transvaginal meshes should be utilised under the discretion of the ethics committee.
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an international urogynecological association iuga international continence society ics joint terminology and classification of the complications related to Native Tissue female pelvic floor surgery
International Urogynecology Journal, 2012Co-Authors: Bernard T Haylen, Robert Freeman, Joseph Lee, Steven Swift, Michel Cosson, Jan Deprest, Peter L Dwyer, B Fatton, Ervin Kocjancic, Christopher G MaherAbstract:Introduction and hypothesis A terminology and standardized classification has yet to be developed for those complications related to Native Tissue female pelvic floor surgery.
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international urogynecological association iuga international continence society ics joint terminology and classification of the complications related to Native Tissue female pelvic floor surgery
Neurourology and Urodynamics, 2012Co-Authors: Bernard T Haylen, Robert Freeman, Joseph Lee, Steven Swift, Michel Cosson, Jan Deprest, Peter L Dwyer, B Fatton, Ervin Kocjancic, Christopher G MaherAbstract:Introduction and Hypothesis A terminology and standardized classification has yet to be developed for those complications related to Native Tissue female pelvic floor surgery. Methods: This report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision- making by collective opinion (consensus). Results: A terminology and classification of complications related to Native Tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions, that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure- specific. Users of the classification have been assisted by case examples, color charts, and online aids (www. icsoffice. org/ ntcomplication). Conclusions: A consensus- based terminology and classification report for complications in Native Tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research. Neurourol. Urodynam. 31: 406-414, 2012. (C) 2012 Wiley Periodicals, Inc.
Stefano Manodoro - One of the best experts on this subject based on the ideXlab platform.
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transvaginal Native Tissue repair of vaginal vault prolapse
Minerva ginecologica, 2018Co-Authors: Rodolfo Milani, Matteo Frigerio, Francesca Letizia Vellucci, Stefania Palmieri, Federico Spelzini, Stefano ManodoroAbstract:BACKGROUND Posthysterectomy vaginal vault prolapse repair is a challenge for pelvic floor surgeons. Native-Tissue repair procedures imply lower costs and reduced morbidity. Our study aims to evaluate operative data, complications, objective, subjective and functional outcomes of transvaginal Native-Tissue repair for posthysterectomy vaginal vault prolapse. We also investigated differences among available techniques. METHODS Retrospective study including patients with symptomatic vaginal vault prolapse (≥stage 2), previously treated with transvaginal vault suspension through Native-Tissue repair. Objective recurrence was defined as the descent of at least one compartment ≥II stage according to Pelvic Organ Prolapse Quantification (POP-Q) system or need of reoperation. Subjective recurrence was defined as the presence of bulging symptoms. Patients satisfaction was evaluated with PGI-I Score. RESULTS The study included 111 patients. Apical suspension was achieved either by uterosacral ligament suspension (16), levator myorrhaphy (17), iliococcygeus fascia fixation (65) or sacrospinous ligament fixation (13). No intraoperative complications were observed. Perioperative/postoperative complications occurred in 8 patients (7.2%). Mean follow-up was 24.5±12.1 months. Objective recurrence was observed in 28 patients (25.2%). Reintervention was required by 3 patients (2.7%). Subjective recurrence was referred by 6 patients (5.4%). Mean satisfaction evaluated with PGI-I Score was 1.2±0.6. No differences in terms of operative data, overall complications, objective, subjective cure rate and perceived satisfaction were found among different techniques. CONCLUSIONS Transvaginal repair with Native-Tissue procedures is safe and effective in correcting posthysterectomy vaginal vault prolapse and represents a valid alterNative to prosthetic procedures for vaginal vault prolapse treatment.
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risk factors for recurrence after hysterectomy plus Native Tissue repair as primary treatment for genital prolapse
International Urogynecology Journal, 2018Co-Authors: Stefano Manodoro, Federico Spelzini, Matteo Frigerio, Alice Cola, Rodolfo MilaniAbstract:Identification of risk factors for pelvic organ prolapse (POP) recurrence is crucial to provide adequate preoperative counselling and tailor surgical treatment. The aim of this retrospective study was to identify risk factors for recurrence in a large series of patients with POP treated with primary transvaginal Native-Tissue repair involving high uterosacral ligament suspension. Postoperative descent of POP-Q stage 2 or higher in any compartment was considered as recurrence. Global recurrence (GR) was defined as any recurrence in any compartment irrespective of the surgical procedures performed during primary prolapse surgery. True recurrence (TR) was defined as recurrence in a compartment repaired during primary prolapse surgery. Of a total of 533 eligible women, 519 were available for follow-up. Univariate analysis showed that age ≤50 years, premenopausal status, obesity (BMI >30 kg/m2), history of severe macrosomia (>4,500 g), preoperative POP stage 3 or higher and absence of anterior repair at the time of POP surgery were risk factors for GR. Multivariate analysis confirmed lack of posterior repair (odds ratio, OR, 1.8), severe macrosomia (OR 2.7), premenopausal status (OR 3.9), obesity (OR 2.2) and preoperative stage 3 or higher (OR 2.6) as risk factors for GR. Univariate analysis showed that premenopausal status and preoperative POP stage 3 or higher were risk factors for TR. Multivariate analysis confirmed premenopausal status (OR 4.0) and preoperative stage 3 or higher (OR 4.5) as risk factors for TR. This study confirmed preoperative stage 3 or higher as a risk factor for prolapse recurrence. The study also identified additional risk factors for surgical failure including lack of posterior repair, severe macrosomia, premenopausal status and obesity.
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transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Federico Spelzini, Stefano ManodoroAbstract:Introduction and hypothesis Posthysterectomy vaginal vault prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with Native Tissue using a vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.
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transvaginal sacrospinous ligament fixation for posthysterectomy vaginal vault prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Stefano ManodoroAbstract:Introduction and hypothesis Posthysterectomy vaginal vault prolapse repair is a challenge for urogynecologists. Surgical management can be successful with Native Tissue by the vaginal approach with sacrospinous ligament fixation. However, severe complications have been described, including nerve injury and life-threatening hemorrhage.
Rodolfo Milani - One of the best experts on this subject based on the ideXlab platform.
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transvaginal Native Tissue repair of vaginal vault prolapse
Minerva ginecologica, 2018Co-Authors: Rodolfo Milani, Matteo Frigerio, Francesca Letizia Vellucci, Stefania Palmieri, Federico Spelzini, Stefano ManodoroAbstract:BACKGROUND Posthysterectomy vaginal vault prolapse repair is a challenge for pelvic floor surgeons. Native-Tissue repair procedures imply lower costs and reduced morbidity. Our study aims to evaluate operative data, complications, objective, subjective and functional outcomes of transvaginal Native-Tissue repair for posthysterectomy vaginal vault prolapse. We also investigated differences among available techniques. METHODS Retrospective study including patients with symptomatic vaginal vault prolapse (≥stage 2), previously treated with transvaginal vault suspension through Native-Tissue repair. Objective recurrence was defined as the descent of at least one compartment ≥II stage according to Pelvic Organ Prolapse Quantification (POP-Q) system or need of reoperation. Subjective recurrence was defined as the presence of bulging symptoms. Patients satisfaction was evaluated with PGI-I Score. RESULTS The study included 111 patients. Apical suspension was achieved either by uterosacral ligament suspension (16), levator myorrhaphy (17), iliococcygeus fascia fixation (65) or sacrospinous ligament fixation (13). No intraoperative complications were observed. Perioperative/postoperative complications occurred in 8 patients (7.2%). Mean follow-up was 24.5±12.1 months. Objective recurrence was observed in 28 patients (25.2%). Reintervention was required by 3 patients (2.7%). Subjective recurrence was referred by 6 patients (5.4%). Mean satisfaction evaluated with PGI-I Score was 1.2±0.6. No differences in terms of operative data, overall complications, objective, subjective cure rate and perceived satisfaction were found among different techniques. CONCLUSIONS Transvaginal repair with Native-Tissue procedures is safe and effective in correcting posthysterectomy vaginal vault prolapse and represents a valid alterNative to prosthetic procedures for vaginal vault prolapse treatment.
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risk factors for recurrence after hysterectomy plus Native Tissue repair as primary treatment for genital prolapse
International Urogynecology Journal, 2018Co-Authors: Stefano Manodoro, Federico Spelzini, Matteo Frigerio, Alice Cola, Rodolfo MilaniAbstract:Identification of risk factors for pelvic organ prolapse (POP) recurrence is crucial to provide adequate preoperative counselling and tailor surgical treatment. The aim of this retrospective study was to identify risk factors for recurrence in a large series of patients with POP treated with primary transvaginal Native-Tissue repair involving high uterosacral ligament suspension. Postoperative descent of POP-Q stage 2 or higher in any compartment was considered as recurrence. Global recurrence (GR) was defined as any recurrence in any compartment irrespective of the surgical procedures performed during primary prolapse surgery. True recurrence (TR) was defined as recurrence in a compartment repaired during primary prolapse surgery. Of a total of 533 eligible women, 519 were available for follow-up. Univariate analysis showed that age ≤50 years, premenopausal status, obesity (BMI >30 kg/m2), history of severe macrosomia (>4,500 g), preoperative POP stage 3 or higher and absence of anterior repair at the time of POP surgery were risk factors for GR. Multivariate analysis confirmed lack of posterior repair (odds ratio, OR, 1.8), severe macrosomia (OR 2.7), premenopausal status (OR 3.9), obesity (OR 2.2) and preoperative stage 3 or higher (OR 2.6) as risk factors for GR. Univariate analysis showed that premenopausal status and preoperative POP stage 3 or higher were risk factors for TR. Multivariate analysis confirmed premenopausal status (OR 4.0) and preoperative stage 3 or higher (OR 4.5) as risk factors for TR. This study confirmed preoperative stage 3 or higher as a risk factor for prolapse recurrence. The study also identified additional risk factors for surgical failure including lack of posterior repair, severe macrosomia, premenopausal status and obesity.
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transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Federico Spelzini, Stefano ManodoroAbstract:Introduction and hypothesis Posthysterectomy vaginal vault prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with Native Tissue using a vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.
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transvaginal sacrospinous ligament fixation for posthysterectomy vaginal vault prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Stefano ManodoroAbstract:Introduction and hypothesis Posthysterectomy vaginal vault prolapse repair is a challenge for urogynecologists. Surgical management can be successful with Native Tissue by the vaginal approach with sacrospinous ligament fixation. However, severe complications have been described, including nerve injury and life-threatening hemorrhage.
Huihsuan Lau - One of the best experts on this subject based on the ideXlab platform.
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changes in female sexual function after vaginal mesh repair versus Native Tissue repair for pelvic organ prolapse a meta analysis of randomized controlled trials
The Journal of Sexual Medicine, 2019Co-Authors: Saochun Liao, Wenchu Huang, Huihsuan LauAbstract:Abstract Aim To evaluate changes in female sexual function after transvaginal mesh (TVM) repair versus Native Tissue repair for pelvic organ prolapse. Methods Eligible studies, published through November 2017, were retrieved through searches of ClinicalTrials.gov , MEDLINE, Embase, and Cochrane Review databases and associated bibliographies. We included randomized control trials of transvaginal prolapse surgery with either mesh repair or Native Tissue repair regarding the outcomes of sexual function, de novo and postoperative dyspareunia with a minimum of 3 months of follow-up. Results Seventeen trials including 2,976 patients (1,488 with TVM repair and 1,488 with Native Tissue repair) were identified. There was no significant difference in postoperative dyspareunia after TVM repair versus Native Tissue repair (risk ratio [RR] = 1.07; 95% confidence interval [CI] = 0.76–1.50). Likewise, there was no significant difference in de novo dyspareunia after TVM repair versus Native Tissue repair (RR = 0.91; 95% CI = 0.52–1.61). There was also no significant difference in the short form Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score after TVM mesh repair versus Native Tissue repair (mean difference = 0.26; 95% CI = -1.34 to 1.85). Conclusion Sexual function and de novo and postoperative dyspareunia were similar between the patients who underwent TVM repair and those who underwent Native Tissue repair. Liao S-C, Huang W-C, Su T-H, et al. Changes in Female Sexual Function After Vaginal Mesh Repair Versus Native Tissue Repair for Pelvic Organ Prolapse: A Meta-Analysis of Randomized Controlled Trials. J Sex Med 2019;16:633–639.
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single incision mesh repair versus traditional Native Tissue repair for pelvic organ prolapse results of a cohort study
International Urogynecology Journal, 2014Co-Authors: Huihsuan Lau, Wenchu Huang, Chinghung Hsieh, Rhuchu ChangAbstract:Introduction and hypothesis To compare the efficacy and safety of the Elevate™ anterior and posterior prolapse repair system and traditional vaginal Native Tissue repair in the treatment of stage 2 or higher pelvic organ prolapse.
Bernard T Haylen - One of the best experts on this subject based on the ideXlab platform.
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anterior and posterior colporrhaphy Native Tissue versus mesh
2021Co-Authors: Bernard T HaylenAbstract:The efficacy of traditional Native Tissue anterior and posterior colporrhaphies has been subject to long-term concern. Much of the variability in anatomical and functional outcomes results from variability in techniques and a lack of understanding of the specific anatomical aims of the surgeries. The experiment with the use of mesh over the last 15 years to try and improve results has come to an abrupt end in many countries. The relatively high rate of prosthetic complications has created patient demand for action by administrators and legislators.
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an international urogynecological association iuga international continence society ics joint terminology and classification of the complications related to Native Tissue female pelvic floor surgery
International Urogynecology Journal, 2012Co-Authors: Bernard T Haylen, Robert Freeman, Joseph Lee, Steven Swift, Michel Cosson, Jan Deprest, Peter L Dwyer, B Fatton, Ervin Kocjancic, Christopher G MaherAbstract:Introduction and hypothesis A terminology and standardized classification has yet to be developed for those complications related to Native Tissue female pelvic floor surgery.
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international urogynecological association iuga international continence society ics joint terminology and classification of the complications related to Native Tissue female pelvic floor surgery
Neurourology and Urodynamics, 2012Co-Authors: Bernard T Haylen, Robert Freeman, Joseph Lee, Steven Swift, Michel Cosson, Jan Deprest, Peter L Dwyer, B Fatton, Ervin Kocjancic, Christopher G MaherAbstract:Introduction and Hypothesis A terminology and standardized classification has yet to be developed for those complications related to Native Tissue female pelvic floor surgery. Methods: This report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision- making by collective opinion (consensus). Results: A terminology and classification of complications related to Native Tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions, that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure- specific. Users of the classification have been assisted by case examples, color charts, and online aids (www. icsoffice. org/ ntcomplication). Conclusions: A consensus- based terminology and classification report for complications in Native Tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research. Neurourol. Urodynam. 31: 406-414, 2012. (C) 2012 Wiley Periodicals, Inc.