title: Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes.
abstract: OBJECTIVE
  Here we describe anatomic and quality of life (QOL) outcomes of an anterior and apical compartment prolapse repair involving a reduced mesh implant size and apex-only fixation.
  
  
  METHODS
  One hundred and fifteen patients undergoing the repair at a single urogynecology center were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) and inpatient chart reviews. A horizontal incision eliminated overlap with the mesh, and each sacrospinous ligament was approached anteriorly by blunt dissection. Recurrence was defined as apical (C), or anterior (Aa or Ba) ≥0, and secondary analyses were performed using POP-Q ≥ -1 as the anatomic threshold. Pelvic Floor Distress Inventory (PFDI), Surgical Satisfaction Questionnaires (SSQ) and a dyspareunia symptom scale were analyzed pre- and postoperatively.
  
  
  RESULTS
  Fifty-three women with uterus in situ demonstrated a combined anterior-apical recurrence rate of 1.89 %, including no anterior (Ba ≥ -1) and one apical (C ≥ -1) recurrence. Forty-seven women undergoing repair for vault prolapse had recurrence rates ranging from 0 % in those with prior hysterectomy to 4.2 % in those undergoing concurrent hysterectomy. The rate of mesh exposure was 3/115 (2.6 %), including two in women with concurrent hysterectomy. Self-reported dyspareunia was more common preoperatively (13.4 %) than postoperatively (9.3 %). PFDI scores improved in all domains, and 93 % completing the SSQ reported they were satisfied and would choose the surgery again.
  
  
  CONCLUSIONS
  This technique resulted in successful outcomes within both anterior and apical compartments with a low rate of mesh complication, and no cases required mesh removal or hospital readmission. High rates of satisfaction and improved condition-specific QOL were observed.
authors.affiliation: University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem Division of Urogynecology, Evanston, IL, USA, avu817@gmail.com
authors.forename: Manhan K
authors.initials: MK
authors.lastname: Vu
authors.forename: Juraj
authors.initials: J
authors.lastname: Letko
authors.forename: Kelly
authors.initials: K
authors.lastname: Jirschele
authors.forename: Adam
authors.initials: A
authors.lastname: Gafni-Kane
authors.forename: Aimee
authors.initials: A
authors.lastname: Nguyen
authors.forename: Honyan
authors.initials: H
authors.lastname: Du
authors.forename: Roger P
authors.initials: RP
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011788:Quality of Life; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000601:surgery*