The aim of this study was to compare long-term effects of high-volume surgery at a single-center to multicenter use when using a mesh-capturing device for pelvic organ prolapse (POP) repair.
Five years after surgery 101 (88%) at the single center were compared with 164 (81. 2%) in the multicenter trial. Outcome measurements included clinical examination, prolapse-specific symptom questionnaires [Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire-short form (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] and pain estimation by VAS (0-10).
Optimal apical segment outcome was 95% in the single- compared to 83.3% in the multicenter study (p < 0.001). POP recurrence in the anterior and posterior walls (POP-Q, Ba and Bp ≥ 0) was more common at the multicenter as compared to the single center [(19.8% vs 5.4%) and (26% vs 2.7%), (p < 0.001)]. Reoperations for POP and mesh-related complications were more frequent in the multicenter study [31/202 (15.3%) vs 7/116 (6.1%), p < 0.001]. Total PFDI-20, PFIQ-7 and PISQ-12 scores were comparable between the cohorts. There were no significant differences in overall pain scores in-between the cohorts during follow-up. At the single center, 1/81 patients (1.2%) had VAS 7/10, i.e. severe pain, as compared to 3/131 (2.3%) in the multicenter study (p = 0.277).
Despite the high objective and subjective long-term effectiveness of the procedure in both regular use, and at a high-volume center, centralizing the use of a standardized capturing-device guided transvaginal mesh for POP repair reduced secondary interventions by more than half.
Archives of gynecology and obstetrics. 2020 Sep 11 [Epub ahead of print]
Christian Falconer, Daniel Altman, Georgios Poutakidis, Päivi Rahkola-Soisalo, Tomi Mikkola, Edward Morcos
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 171 77, Stockholm, Sweden., Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 171 77, Stockholm, Sweden. .