title: Anterior-apical single-incision mesh surgery (SIMS): surgical and functional outcomes at 1 year.
abstract: OBJECTIVE
  To study the surgical and functional outcomes of single-incision mesh surgery for treatment of advanced pelvic organ prolapse (POP).
  
  
  METHODS
  Case series (Canadian Task Force classification II-3).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Sixty-five patients who underwent surgery to treat symptomatic POP greater than stage II according to the Pelvic Organ Prolapse Quantification System (POP-Q).
  
  
  METHODS
  All patients underwent anterior-apical single-incision mesh surgery using the Elevate Anterior and Apical Prolapse Repair System.
  
  
  RESULTS
  The primary objectives were anatomical correction of anterior and apical prolapse of POP stage I or greater and absence of voiding dysfunction reported via multi-channel urodynamic study at 6 months after surgery. Subjective outcome was measured via patient feedback using questions 2 and 3 of the Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6). The secondary outcome was quality of life using the following: Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), POPDI-6, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Two-dimensional introital ultrasonography was performed in the first and third months after surgery and at 1-year follow-up. Descriptive statistics were used for demographic and perioperative data. The paired-samples t test was used for comparison of preoperative and postoperative continuous data. For all comparisons, a value of p < .05 was considered statistically significant. All statistical methods were performed using commercially available software (SPSS version 17). Postoperative data were available for 64 patients. The objective outcome was 96.9%, and the subjective outcome was 93.8%. All patients demonstrated significant improvement in anatomical outcomes after prolapse surgery (p < .05), and none experienced recurrence requiring further surgery. There was concomitant significant improvement in POPDI-6, UDI-6, IIQ-7, and PISQ-12 scores after surgery. A subanalysis of POP quantification measurements immediately after surgery and at 1-year postoperative follow-up demonstrated deepening of the C point and total vaginal length. Ultrasound evaluation demonstrated a significant increase in the length and thickness of mesh at 1-year follow-up. There has been no documented mesh extrusion to date. However, the number of patients with stress urinary incontinence has increased. Four patients received treatment, whereas in the remaining patients the condition was not severe enough to require surgical intervention.
  
  
  CONCLUSIONS
  Single-incision mesh surgery for treatment of advanced POP results in improvement in anatomical and quality-of-life outcomes. No mesh exposure was recorded in the first year after surgery; however, new onset of stress urinary incontinence may occur. Ultrasound evaluation demonstrated an increase in mesh length and thickness over time, with concurrent calculated lengthening of the C point and total vaginal length.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou, Taipei, Keelung Medical Center), Chang Gung University, School of Medicine, Taoyuan, Taiwan. 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 (Linkou, Taipei, Keelung Medical Center), Chang Gung University, School of Medicine, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Sarawak General Hospital & Kuching Specialist Hospital KPJ, 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 (Linkou, Taipei, Keelung Medical Center), Chang Gung University, School of Medicine, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, 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 (Linkou, Taipei, Keelung Medical Center), Chang Gung University, School of Medicine, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Hospital Serdang, Kajang, Selangor, Malaysia.
authors.forename: Leng Boi
authors.initials: LB
authors.lastname: Pue
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou, Taipei, Keelung Medical Center), Chang Gung University, School of Medicine, Taoyuan, Taiwan.
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou, Taipei, Keelung Medical Center), Chang Gung University, School of Medicine, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, King Abdullah University Hospital, University of Science and Technology, Irbid, Jordan.
authors.forename: Ahlam
authors.initials: A
authors.lastname: Al-Kharabsheh
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D011788:Quality of Life; D012725:Sexual Behavior; D053825:Suburethral Slings; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014621:Vagina / Q000601:surgery*
keywords: Anterior-apical single-incision mesh; Elevate; Pelvic organ prolapse; Stress urinary incontinence