title: A retrospective comparison of two vaginal mesh kits in the management of anterior and apical vaginal prolapse: long-term results for apical fixation and quality of life.
abstract: OBJECTIVE
  To compare apical correction in stage ≥3 cystocele between two mesh kits.
  
  
  METHODS
  This was a retrospective, nonrandomized study that compared two groups matched on anterior/apical POP-Q stage: 84 received Elevate Ant™ single-incision mesh (Elevate Ant group) and 42 Perigee™ transvaginal mesh (Perigee group). Follow-up at 1 and 2 years comprised objective (POP-Q) and subjective (PFDI-20, PFIQ-7, PISQ-12) assessments. The primary endpoint was objective success: 2-year apical POP-Q stage ≤1. Secondary endpoints were anterior POP-Q stage, subjective results and complications.
  
  
  RESULTS
  Groups were comparable in terms of age (66.6 and 64.7 years, respectively; p = 0.19), BMI (both 25.4 kg/m2; p = 0.93), and history of hysterectomy (7.2 % and 14.3 %; p = 0.21) or prolapse surgery (12 % and 14.3 %; p = 0.72). Operative time was shorter in the Elevate Ant group (54.1 vs. 62.5 min; p = 0.048), and the 2-year objective apical success rate was higher (92.9 % vs. 66.7 %; p < 0.0001), with better point C correction (-5 vs. -3.8; p = 0.006). Function improved in both groups, with significantly better PFIQ-7 (p = 0.03) and PFDI-20 (p = 0.02) scores in the Elevate Ant group at 2 years. Vaginal exposure was not seen in the Elevate Ant group but occurred in two patients in the Perigee group (p = 0.33). Factors associated with success were age >65 years (OR 7.16, 95 % CI 1.83 - 27.97) and treatment with Elevate Ant mesh (OR 10.16, 95 % CI 2.78 - 37.14). Postoperative stress urinary incontinence rate was greater with the Elevate Ant group (29.8 % and 16.7 %; p = 0.11).
  
  
  CONCLUSIONS
  The use of the Elevate Ant mesh was associated with significantly better apical correction at 2 years. Function improved in both groups, but with a significantly better PFDI-20 score in the Elevate Ant group at 1 and 2 years. The postoperative stress urinary incontinence rate, however, tended to be greater in the Elevate Ant group. The results need confirming with longer follow-up of these cohorts and in randomized studies.
authors.affiliation: Service de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Lyon-Bron, France. gery.lamblin@chu-lyon.fr.
authors.forename: Gery
authors.initials: G
authors.lastname: Lamblin
authors.affiliation: Clinique Beau Soleil, Service de Chirurgie Gynécologique, Montpellier, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Gouttenoire
authors.affiliation: Clinique Beau Soleil, Service de Chirurgie Gynécologique, Montpellier, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Panel
authors.affiliation: Service de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Lyon-Bron, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Moret
authors.affiliation: Service de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Lyon-Bron, France.
authors.forename: Gautier
authors.initials: G
authors.lastname: Chene
authors.affiliation: Clinique Beau Soleil, Service de Chirurgie Gynécologique, Montpellier, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Courtieu
mesh_terms: D000368:Aged; D052858:Cystocele / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Anterior vaginal wall; Apical descent; Cystocele; Elevate Ant™ anterior/apical mesh; Perigee™ mesh