A preliminary evaluation of the TOPAS system for the treatment of fecal incontinence in women.
OBJECTIVE
The TOPAS AMS pelvic floor repair system is a self-fixating polypropylene mesh intended for use to reinforce soft tissues where weakness exists in the gynecological and gastroenterological anatomy. It is not available commercially in any country. This was a preliminary study conducted to obtain initial clinical experience with the TOPAS system for the treatment of fecal incontinence (FI) in women.


METHODS
This was a prospective study conducted at 5 centers in the United States. Women with FI who failed 1 or more conservative therapies were candidates for the study. Fecal incontinence was assessed with a bowel diary, Cleveland Clinic incontinence scores (CCISs), and Fecal Incontinence Quality of Life (FIQOL) questionnaires, and patients were followed prospectively up to 24 months. Treatment success was defined as a reduction in number of FI episodes of 50% or more compared with baseline.


RESULTS
A total of 29 women (mean age, 60.6 years) were implanted with the TOPAS system. Mean number of FI episodes per 14 days decreased from 6.9 at baseline to 3.5 at 24 months of follow-up, and the reduction was significant for the entire follow-up period compared with baseline (P < 0.001). A total of 55.6% of the subjects reported treatment success. The CCIS and FIQOL scores for all domains were significantly improved during the overall follow-up period compared with baseline (P < 0.001). The most common procedure and/or device-related adverse events were de novo urinary incontinence, including bladder spasms (n = 6), worsening FI (n = 2), and constipation (n = 2). No device-related erosions or extrusions were reported.


CONCLUSIONS
Initial experience of the TOPAS system demonstrated a significant improvement in FI episodes, CCIS and FIQOL scores, and a benign safety profile. These results indicate that the TOPAS system has potential as a new therapeutic option for FI, but it needs to be confirmed in a larger study.
From the *Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA; †American Medical Systems, Minnetonka, MN; ‡Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA; §Sacred Heart Medical Center, Spokane, WA; ∥Division of Colon and Rectal Surgery, The Christ Hospital, Cincinnati, OH; and ¶Colon & Rectal Surgery Associates, Ltd, Minneapolis, MN.
Peter
P
Rosenblatt
Joshua
J
Schumacher
Vincent
V
Lucente
Shane
S
McNevin
Janice
J
Rafferty
Anders
A
Mellgren
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D061646:Operative Time; D017773:Pelvic Floor / Q000601:surgery*; D011126:Polypropylenes / Q000627:therapeutic use; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D011788:Quality of Life; D013526:Surgical Mesh; D016896:Treatment Outcome
D011126:Polypropylenes