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| Effect of transvaginal implantation of TiLOOP mesh in the treatment of anterior pelvic organ prolapse#br# |
| ZHU Xiaodan XU Lan ZHANG Xinpei LIN Yan QIN Caifang HU Jiazhen XU Wenjuan FAN Bozhen▲ |
| Department of Obstetrics and Gynecology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China |
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Abstract Objective To evaluate the short-term efficacy of transvaginal implantation of lightweight titanium polypropylene TiLOOP anterior pelvic floor repair system (TiLOOP Total 4) in the treatment of anterior pelvic organ prolapse. Methods Sixty patients with severe anterior pelvic organ prolapse who underwent anterior pelvic floor reconstruction in Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from April 2018 to May 2020 were selected as the research subjects. All patients underwent anterior vaginal wall mesh repair using TiLOOP Total 4. Perioperative indicators such as operative time, bleeding, incidence of postoperative diseases, and time to recover spontaneous urination were recorded; subjective satisfactive with surgery was assessed by patient global impression of change scale (PGI-C); pelvic organ prolapse quantitation (POP-Q) degree was used to evaluate the therapeutic effect. The reduction of indicator points was compared before surgery and 12 months after surgery; the quality of life of patients before surgery and 12 months after surgery was assessed by using pelvic floor impact questionnaire 7 (PFIQ-7); pelvic organ prolapse / urinary incontinence sexual function questionnaire short form 12 (PISQ-12) was used to evaluate the effect of surgery on sexual quality before surgery and 12 months after surgery. The occurrence of complications was recorded. Results All 60 patients were successfully operated without the occurrence of peripheral organ injury, pelvic vulvar hematoma or infection. The average operative time was (54.4±14.1) min, and the intraoperative blood loss was (65.2±22.5) ml. After surgery, two cases developed upper respiratory tract infection and one case developed urinary tract infection, which were cured after anti-infection treatment; the catheter was removed three days after surgery. One patient was found to have anterior vaginal wall bulge nine months after surgery, and the POP-Q degrees of the other 59 patients were ≤ Ⅰ degree. The PGI-C scores of 60 patients were ≥4 points. The midline of the anterior wall of the vagina 3 cm from the hymen (Aa), the furthest point in the upper segment of the anterior wall between the apex of the vagina or anterior fornix and Aa, and the furthest point of the apex of the vagina after cervical or hysterectomy were significantly improved 12 months after surgery, with highly statistically significant differences (P < 0.01). There were highly significantly differents in PFIQ-7 total score and the simple list scores before surgery and 12 months after surgery (P < 0.01). A total of 28 patients resumed sexual life three months after surgery, there were highly significantly differents in PISQ-12 scores before surgery and 12 months after surgery (P < 0.01). Up to 12 months after surgery, the incidence of vaginal anterior wall mesh exposure was 5%, and the incidence of mild acid distension pain in thigh root and lumbosacral region was 6.7%. Conclusion TiLOOP Total 4 has positive short-term efficacy in patients with anterior pelvic organ prolapse, with fewer postoperative complications, and the long-term efficacy needs further follow-up.
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