title: Assessment of collagen-coated anterior mesh through morphology and clinical outcomes in pelvic reconstructive surgery for pelvic organ prolapse.
abstract: OBJECTIVE
  To assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse.
  
  
  METHODS
  Evidence obtained from several timed series with intervention (Canadian Task Force classification II-3).
  
  
  METHODS
  Chang Gung Memorial Hospital, Taoyuan, Taiwan, China.
  
  
  METHODS
  Between April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System).
  
  
  METHODS
  Anterior armed transobturator collagen-coated mesh.
  
  
  RESULTS
  Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01).
  
  
  CONCLUSIONS
  Ultrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China. Electronic address: 2378@cgmh.org.tw.
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; Sarawak General Hospital, Kuching, Sarawak, Malaysia.
authors.forename: Yiap Loong
authors.initials: YL
authors.lastname: Tan
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; Prince of Songkla University, Hatyai, Songkhla, Thailand.
authors.forename: Siwatchaya
authors.initials: S
authors.lastname: Khanuengkitkong
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; Penang Hospital, Penang, Malaysia.
authors.forename: Anil Krishna
authors.initials: AK
authors.lastname: Dass
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; De La Salle University Medical Center, Dasmariñas Cavite, Philippines.
authors.forename: Eileen Feliz M
authors.initials: EF
authors.lastname: Cortes
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China.
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D020099:Coated Materials, Biocompatible / Q000737:chemistry; D003094:Collagen / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D011126:Polypropylenes / Q000737:chemistry; D011184:Postoperative Period; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D053825:Suburethral Slings; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D014621:Vagina / Q000601:surgery*
chemical_list: D020099:Coated Materials, Biocompatible; D011126:Polypropylenes; D003094:Collagen
keywords: Anterior vaginal mesh; Collagen-coated mesh; Morphology; Outcome; Pelvic organ prolapse