title: Concomitant trocar-guided transvaginal mesh surgery with a midurethral sling in treating advanced pelvic organ prolapse associated with stress or occult stress urinary incontinence.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy and feasibility of concomitant trocar-guided transvaginal mesh (TVM) surgery with a midurethral sling (MUS) for treating women with advanced pelvic organ prolapse (POP) and stress urinary incontinence (SUI) or occult SUI (OSUI).
  
  
  METHODS
  Eighty-nine women with advanced POP and SUI or OSUI were retrospectively enrolled. The Total Prolift and Tension-free Vaginal Tape-Obturator Systems were used for trocar-guided TVM surgery and MUS. Patients received regular follow-up at 1 week, and 1 month, 3 months, 6 months, and 12 months postoperatively, and then annually thereafter. The endpoints were the success rate for POP, and perioperative and postoperative complications. Functional outcomes were the presence of voiding difficulty, persistent or de novo overactive bladder symptoms, postoperative SUI, and paresthesia.
  
  
  RESULTS
  The median follow-up period was 35 months (range, 12-50 months). Within the follow-up period, 84 patients (94.4%) were objectively cured, five patients (5.6%) had vaginal apical mesh exposure, 29 individuals (32.6%) had persistent or de novo overactive bladder symptoms, six individuals (22.5%) had de novo SUI (two were found by urodynamics), and nine individuals (10.1%) had voiding difficulties (two were found by urodynamics). In addition, the vaginal hysterectomy group had greater blood loss, longer operation times, and a higher mesh erosion rate compared to the uterine suspension group.
  
  
  CONCLUSIONS
  Concomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chia Yi, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Fei-Chi
authors.initials: FC
authors.lastname: Chuang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chia Yi, Taiwan.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Chu
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: gynh2436@adm.chmh.org.tw.
authors.forename: Kuan-Hui
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. Electronic address: mpwu@mail.chimei.org.tw.
authors.forename: Ming-Ping
authors.initials: MP
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D010535:Laparoscopy; D008875:Middle Aged; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects; D053201:Urinary Bladder, Overactive / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics
keywords: midurethral sling; occult stress urinary incontinence; pelvic organ prolapse; stress urinary incontinence; transvaginal mesh