Conventional fascial technique versus mesh repair for advanced pelvic organ prolapse: Analysis of recurrences in treated and untreated compartments.
117 women with severe pelvic organ prolapse (POP; stage > 2) were enrolled to elucidate a 24-month outcome of POP surgery, using conventional or mesh repair with 3 techniques. 59 patients underwent conventional repair and 58 underwent mesh repair. Two types of mesh were used: a trocar-guided transobturator polypropylene (Avaulta, Bard Inc.) and a porcine dermis mesh (Pelvisoft, Bard Inc.). Women with recurrences, who underwent previous unsuccessful conventional repair, were randomised. Primary outcome was the evaluation of anatomic failures (prolapse stage > 1) in treated and untreated compartments. Anatomic failure was observed in 11 of 58 patients (19%; CI 8.9-29) in the mesh group and in 16 of 59 patients (27.1%; p value = 0.3) in the conventional group. 9 of 11 failures in the mesh group (15.5%; CI 6.2-24.8) were observed in the untreated compartment (de novo recurrences), 14.3% in Pelvisoft and 16.7% in Avaulta arm, while only 1 recurrence in the untreated compartment (1.7%) was observed in the conventional group (odds ratio 10.6, p = 0.03).
a Department of Obstetrics and Gynecology , Manzoni Hospital , Lecco , Italy.|b Department of Obstetrics and Gynecology , University of Bari Aldo Moro , Policlinico, Bari , Italy.|c Department of Obstetrics and Gynecology , Azienda Ospedaliera di Lodi , Italy.|d Ospedale Manzoni Lecco , via dell' eremo 9/11 Lecco, Lecco , Italy.
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Damiani
e Department of Obstetrics and Gynecology , Cantu'-Sant Anna Hospital , Como , Italy.
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Riva
a Department of Obstetrics and Gynecology , Manzoni Hospital , Lecco , Italy.
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Pellegrino
b Department of Obstetrics and Gynecology , University of Bari Aldo Moro , Policlinico, Bari , Italy.
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Gaetani
f Department of Biomedical Sciences , Hygiene Section, University of Bari Aldo Moro , Policlinico, Bari , Italy.
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Tafuri
a Department of Obstetrics and Gynecology , Manzoni Hospital , Lecco , Italy.
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Turoli
g Department of Obstetrics and Gynecology , Azienda Ospedaliera di Lodi , Italy.
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Croce
b Department of Obstetrics and Gynecology , University of Bari Aldo Moro , Policlinico, Bari , Italy.
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Loverro
D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012008:Recurrence; D013526:Surgical Mesh
Biological mesh; de novo prolapse; pelvic organ prolapse; severe prolapse; synthetic mesh; untreated compartments