Reconstruction of the posterior and central compartment with the Prolift Posterior: cohort study with a 5-year follow-up
Abstract
Objective: To analyse the results of the long-term prospective follow-up study of vaginal prolapse reconstructed using a Prolift Posterior. Study design: Prospective, cohort study.
Setting: Institute for the Care of Mother and Child, Prague. Methods: Over a 5-year period (I/2006 - XII/2011) we prospectively followed a cohort of patients with posterior vaginal wall defect who underwent surgical reconstruction using a monofilament polypropylene implant Prolift Posterior (TM) (Gynecare, Ethicon, Inc., Piscataway, NJ, USA).
Patients were invited for review at six weeks, three months, six months, 12 months and then yearly up to five years. Postoperative follow-up included the clinical examination and subjective evaluation using VAS, PISQ 12 and ICIQ SF.
Results: One hundred twenty-four women were included in the study, of which 14 (11.3%) had no prolapse surgery in their health history. There were no concomitant vaginal procedures such as hysterectomy or another implant surgery.
The average operation time and blood loss were 64.25 min (min. 10, max. 205 min) and 115 ml (min. 10 ml, max. 1000 ml), respectively. Only one patient had a blood loss 1000 ml.
There were no injuries of the urinary bladder or intestines during the needle insertion of the mesh. In the five-year period, the recurrence of posterior vaginal wall defect was observed in 4 cases (3.3%).
The average time to the posterior vaginal wall recurrence prolapse was 19.5 months (min. 6, max. 36). De novo prolapse in the anterior compartment was observed in 25 patients (20.5%).
Conclusion: In this prospective single centre study, we observed anatomical improvement in the implanted compartment with low recurrence rate. During five years follow-up period there was de novo anterior vaginal wall defect observed in 20.5% cases.
The question of implant employment in urogynecology remain to be answered, however, our results show that implants have their position in reconstructive surgery.