title: Transvaginal single-incision mesh reconstruction for recurrent or advanced anterior vaginal wall prolapse.
abstract: OBJECTIVE
  Single-incision transvaginal mesh for reconstruction of Level I and II prolapses in women with recurrent or advanced prolapse. We evaluated functional, anatomical, sonomorphological and quality-of-life outcome.
  
  
  METHODS
  Data were collected retrospectively for preoperative parameters and at follow-up visits. Anatomical cure was assessed with vaginal examination using the ICS-POP-Q system; introital-ultrasound scan for postvoidal residual and description of mesh characteristics was performed. We applied a visual analogue scale (VAS) and the German Pelvic Floor Questionnaire to assess quality-of-life.
  
  
  RESULTS
  Seventy women with cystocele (III: 61.3%/IV: 16%), all post-hysterectomy and in majority (81.4%) after previous cystocele repair, were operated using a single-incision transvaginal technique. Overall anatomical success rate was 95.7% with significant improvement in quality-of-life (p < 0.0001). Mesh erosion occurred in 5.7%, one patient presented symptomatic vaginal vault prolapse. Postvoidal residual declined significantly (58 vs. 2.9%). Sonographic mesh length was 55.7% of implanted mesh with a wide range of mesh position, but no signs of mesh dislocation. There was no de novo dyspareunia reported, one case of preoperative existing dyspareunia worsened. No severe adverse event was observed.
  
  
  CONCLUSIONS
  We hereby present a trial of a high-risk group of patients requiring reconstruction of anterior and apical vaginal wall in mostly recurrent prolapse situation. Our data support the hypothesis of improved anatomical and functional results and less mesh shrinkage caused by the single-incision technique with fixation in sacrospinous ligament in combination with modification in mesh quality compared to former multi-incision techniques.
authors.affiliation: Department of Urogynecology, German Pelvic Floor Centre, St. Hedwig Hospital, Große Hamburger Str. 5-11, 10115, Berlin, Germany, j.marschke@alexius.de.
authors.forename: J
authors.initials: J
authors.lastname: Marschke
authors.forename: L
authors.initials: L
authors.lastname: Hengst
authors.forename: N
authors.initials: N
authors.lastname: Schwertner-Tiepelmann
authors.forename: K
authors.initials: K
authors.lastname: Beilecke
authors.forename: R
authors.initials: R
authors.lastname: Tunn
mesh_terms: D000328:Adult; D000368:Aged; D052858:Cystocele / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse; D011183:Postoperative Complications / Q000601:surgery; D019736:Prostheses and Implants; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*