Complications of pelvic organ prolapse surgery and methods of prevention

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• 作者：Renaud de Tayrac (1)
  Loic Sentilhes (2)
  
• 关键词：Genital prolapse ; Vaginal surgery ; Sacrocolpopexy ; Complications ; Methods of prevention
• 刊名：International Urogynecology Journal
• 出版年：2013
• 出版时间：November 2013
• 年：2013
• 卷：24
• 期：11
• 页码：1859-1872
• 全文大小：
• 作者单位：Renaud de Tayrac (1)
  Loic Sentilhes (2)
  
  1. Department of Obstetrics and Gynecology, Caremeau University Hospital, Place du Prof Robert Debr 30900, Nmes, France
  2. Department of Obstetrics and Gynecology, Angers University Hospital, 4, rue Larrey, 49000, Angers, France
  
• ISSN：1433-3023

文摘

Introduction and hypothesis The aim was to review complications associated with pelvic organ prolapse surgery. Methods Every 4years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or ajority evidencefrom RCTs. Grade C recommendation usually depends on level 4 studies or ajority evidence from level 2/3 studies or Delphi processed expert opinion. Grade D o recommendation possiblewould be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Results and conclusions Transvaginal mesh has a higher re-operation rate than native tissue vaginal repairs (grade A). If a synthetic mesh is placed via the vaginal route, it is recommended that a macroporous polypropylene monofilament mesh should be used. At sacral colpopexy mesh should not be introduced or sutured via the vaginal route and silicone-coated polyester, porcine dermis, fascia lata and polytetrafluoroethylene meshes are not recommended as grafts. Hysterectomy should also be avoided (grade B). There is no evidence to recommend routine local or systemic oestrogen therapy before or after prolapse surgery using mesh. The first cases should be undertaken with the guidance of an experienced surgeon in the relevant technique (grade C). Expert opinion suggests that by whatever the surgical route pre-operative urinary tract infections are treated, smoking is ceased and antibiotic prophylaxis is undertaken. It is recommended that a non-absorbable synthetic mesh should not be inserted into the rectovaginal septum when a rectal injury occurs. The placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after a bladder injury has been repaired, if the repair is considered to be satisfactory. It is possible to perform a hysterectomy in association with the introduction of a non-absorbable synthetic mesh inserted vaginally, but this is not recommended routinely.