title: Long-term follow-up of sacrocolpopexy mesh implants at two time intervals at least 1 year apart using 4D transperineal ultrasound.
abstract: OBJECTIVE
  To determine, using four-dimensional (4D) transperineal ultrasound, whether the appearance, position or dimensions of sacrocolpopexy mesh implants or the degree of tissue support change in the long term.
  
  
  METHODS
  Women who had undergone minimally invasive abdominal sacrocolpopexy for pelvic organ prolapse were invited for follow-up assessment at two consecutive visits at least 1 year apart. All participants completed a Pelvic Floor Distress Inventory questionnaire (PFDI-20) and underwent a pelvic examination by one examiner and had 4D ultrasound volumes obtained by a different examiner. Volumes were analyzed offline for mesh position with the woman at rest and on maximal Valsalva maneuver, and for mesh dimensions and characteristics on three-dimensional orthogonal planes and rendered views, with the operator blinded to the clinical data. Findings were compared between the two examinations.
  
  
  RESULTS
  Thirty women attended follow-up assessment at two time points, a median of 22 (range, 12-37) months apart. The median age at the latter visit was 60 (range, 46-72) years, median body mass index was 25.9 (range, 20.8-31.9) kg/m2, median parity was 3 (range, 1-7) and median time from surgery to first and second visit, respectively, was 11.2 (range, 6-26) months and 33.5 (range, 14-56) months. There were no significant differences between the two time points in symptom scores, reported satisfaction from surgery, pelvic examination findings or pelvic organ descent in any compartment according to ultrasound. While mesh dimensions of anterior and posterior arms did not change significantly over time, both arms descended less on Valsalva at the second follow-up compared with at the first (13.2 ± 6.7 mm vs 21.9 ± 10.0 mm and 9.1 ± 5.3 mm vs 16.1 ± 8.1 mm, respectively, both P < 0.001). There were no mesh erosions, but folding remained a consistent finding, occurring in 80% of women in each assessment.
  
  
  CONCLUSIONS
  Characteristics of tissue support and dimensions of sacrocolpopexy mesh implants remained constant over long-term follow-up, with no mesh shrinkage or erosion. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: V H
authors.initials: VH
authors.lastname: Eisenberg
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Weiner
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Schiff
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Lowenstein
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D058869:Gynecological Examination / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000295:instrumentation*; D014636:Valsalva Maneuver
keywords: 4D transperineal ultrasound; cystocele; mesh erosion; mesh folding; mesh shrinkage; pelvic organ prolapse; sacrocolpopexy mesh