Perioperative experience of pelvic organ prolapse repair with the Prolift and Elevate vaginal mesh procedures.
OBJECTIVE
We compared the operative and immediate postoperative experience of the trocar-based Prolift and non-trocar-based Elevate techniques used to repair vaginal prolapse.


METHODS
A retrospective review of Prolift and Elevate repairs was performed. Baseline characteristics and operative and postoperative variables evaluated included compartment(s) repaired, adjacent organ injury, operative time (OT), change in hemoglobin (ΔH), pain score, narcotic use, length of stay (LOS), and short-term complications. Categorical variables were assessed as counts and percent frequency. Data were compared using chi-squared analysis and paired t test.


RESULTS
Prolift (n = 143) and Elevate (n = 77) patients were similar in age (p = 0.19). Concurrent hysterectomy was done in 22 (15.4 %) and 24 (31.2 %), respectively, and concurrent midurethral sling placed in 100 (70 %) and 50 (65 %), respectively. LOS (median, 25th,75th) after anterior/apical compartment repairs was shorter with Elevate, whether with (1.0; 1.0,1.5 vs. 2.0 days;1.0, 2.0; p = 0.003) or without (2.0; 1.0, 2.0 vs. 2.0 days; 2.0, 3.0; p = 0.024) hysterectomy, but no differences in OT, ΔH, pain score, or narcotic use occurred. Posterior compartment mean pain scores were lower with Prolift (3.6 ± 2.2 vs. 1.7 ± 1.5, p = 0.035), and three-compartment-repair pain scores were lower with Elevate (0.6 ± 1.3 vs 2.5 ± 1.9; p = 0.013). Three bladder injuries occurred with Prolift but none with Elevate.


CONCLUSIONS
Operative and postoperative experiences were similar between groups; however, Elevate anterior/apical repairs had shorter LOS, which might reflect more aggressive discharge planning. There were no bowel or major vascular injuries, and the Prolift trocar bladder injuries did not alter the surgical procedure.
Department of Urology, Oakland University William Beaumont Hospital, 3535 West 13 Mile Road Suite 438, Royal Oak, MI 48073, USA. grmc15@gmail.com
Gregory P
GP
McLennan
Larry T
LT
Sirls
Kim A
KA
Killinger
Dmitriy
D
Nikolavsky
Judith A
JA
Boura
Melissa C
MC
Fischer
Kenneth M
KM
Peters
D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D059035:Perioperative Period; D012189:Retrospective Studies; D013525:Surgical Instruments; D013526:Surgical Mesh; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*