Assessment of Collagen-Coated Anterior Mesh Through Morphology and Clinical Outcomes in Pelvic Reconstructive Surgery for Pelvic Organ Prolapse
Study Objective: To assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse. Design: Evidence obtained from several timed series with intervention (Canadian Task Force classification II-3). Setting: Chang Gung Memorial Hospital, Taoyuan, Taiwan, China. Patients: Between April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System). Intervention: Anterior armed transobturator collagen-coated mesh.Measurement and Main Results: Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p<.001), whereas the PISQ-12 score was significantly increased (p=.01). Conclusions: Ultrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1year. A substantially good clinical outcome was noted.