One-Year Anatomical and Functional Outcomes of 302 Elevate Posterior and Apical Mesh Repairs

Abstract

Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prolapse often have global support defects causing difficulty in identification and repair. Fascial plication and levatorplasty in rectocele repair can cause over-narrowing of vagina and introitus leading to dyspareunia. Mesh reinforcement is used to correct multiple defects while avoiding vaginal narrowing. Although literatures have reported encouraging results of vaginal mesh repair, the use of mesh in posterior compartment is still controversial. Elevate system® has been developed as a minimally invasive method for mesh augmentation. Our objective is to evaluate outcomes of Elevate Posterior and Apical mesh in the posterior and apical prolapse repair. Methods: We conducted a prospective study of 302 women undergoing Elevate Posterior mesh reconstruction between 2009 and 2015. Demographic and peri-operative information were recorded. Pre- and post-operative evaluation included symptom, quality of life and POP-Q assessment. Differences in quality-of-life and POP-Q scores were demonstrated using paired t test. Objective cure rates, symptom resolution, quality-of-life measures and peri-operative morbidities were evaluated. Results: Three-hundred women had posterior vaginal prolapse while 131 had apical descent. Mean operative time was 87±21 minutes. Bleeding complication occurred in 9 while mesh extrusion occurred in 3 women. Significant symptom and quality-of-life improvement were demonstrated at one year. Objective cure rates of Elevate Posterior mesh in the treatment of posterior vaginal and apical prolapse were 93.7% and 92.4% respectively. Conclusion: Elevate Posterior and Apical mesh reconstruction has delivered impressive clinical outcomes for the treatment of posterior vaginal and apical prolapse.

Keywords

• Complications
• Elevate Posterior and Apical mesh
• objective cure
• pelvic organ prolapse
• recurrence rates
• success rate
• surgical outcomes
• (Siriraj Med J 2018;70: 131-138)