Lauren E Giugale1, Molly M Hansbarger2, Amy L Askew3, Anthony G Visco4, Jonathan P Shepherd5, Megan S Bradley6. 1. Urogynecology and Pelvic Floor Reconstructive Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, 300 Halket Street, PA, 15213, Pittsburgh, USA. giugalele@upmc.edu. 2. University of Pittsburgh, Pittsburgh, PA, USA. 3. Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC, USA. 4. Duke University Medical Center, Durham, NC, USA. 5. Trinity Health Of New England, Hartford, CT, USA. 6. Urogynecology and Pelvic Floor Reconstructive Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, 300 Halket Street, PA, 15213, Pittsburgh, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: There has been a trend toward the use of ultra-lightweight mesh types for minimally invasive sacrocolpopexy. We hypothesized that ultra-lightweight mesh would have a greater proportion of composite anatomical pelvic organ prolapse recurrence than lightweight mesh. METHODS: Retrospective cohort study of minimally invasive sacrocolpopexies at two academic institutions from 2009 to 2016. Our primary outcome was composite anatomical prolapse recurrence, defined as prolapse beyond the hymen or retreatment with pessary or surgery, compared between ultra-lightweight (≤21 g/m2 [range 19-21]) and lightweight (>21 g/m2 [range 35-50]) mesh types. We assessed time to prolapse recurrence using Kaplan-Meier and Cox regression. RESULTS: The cohort consisted of 1,272 laparoscopic (n = 530, 41.7%) and robotic-assisted sacrocolpopexies (n = 742, 58.4%). Lightweight mesh was used in 745 procedures (58.6%) and ultra-lightweight mesh in 527 (41.4%). The lightweight mesh had longer median follow-up than the ultra-lightweight group (344 [IQR 50-670] vs 143 days [IQR 44-379], p < 0.01). There was no difference in composite anatomical prolapse recurrence between lightweight and ultra-lightweight mesh (54 [7.2%] vs 35 [6.6%], p = 0.68). Ultra-lightweight mesh demonstrated a shorter time to prolapse recurrence (p < 0.01), which remained significant on multivariate Cox regression (HR 2.38 [95% CI 1.47-3.87]). The lightweight mesh had significantly more mesh complications (43 [5.8%] vs 7 [1.3%], p < 0.01). CONCLUSIONS: Ultra-lightweight mesh for minimally invasive sacrocolpopexy was not associated with a higher proportion of composite anatomical prolapse recurrence; however, it was associated with a shorter time to recurrence. Longer follow-up is needed to assess the clinical importance of this finding, particularly given the trade-off of more complications with lightweight mesh.
INTRODUCTION AND HYPOTHESIS: There has been a trend toward the use of ultra-lightweight mesh types for minimally invasive sacrocolpopexy. We hypothesized that ultra-lightweight mesh would have a greater proportion of composite anatomical pelvic organ prolapse recurrence than lightweight mesh. METHODS: Retrospective cohort study of minimally invasive sacrocolpopexies at two academic institutions from 2009 to 2016. Our primary outcome was composite anatomical prolapse recurrence, defined as prolapse beyond the hymen or retreatment with pessary or surgery, compared between ultra-lightweight (≤21 g/m2 [range 19-21]) and lightweight (>21 g/m2 [range 35-50]) mesh types. We assessed time to prolapse recurrence using Kaplan-Meier and Cox regression. RESULTS: The cohort consisted of 1,272 laparoscopic (n = 530, 41.7%) and robotic-assisted sacrocolpopexies (n = 742, 58.4%). Lightweight mesh was used in 745 procedures (58.6%) and ultra-lightweight mesh in 527 (41.4%). The lightweight mesh had longer median follow-up than the ultra-lightweight group (344 [IQR 50-670] vs 143 days [IQR 44-379], p < 0.01). There was no difference in composite anatomical prolapse recurrence between lightweight and ultra-lightweight mesh (54 [7.2%] vs 35 [6.6%], p = 0.68). Ultra-lightweight mesh demonstrated a shorter time to prolapse recurrence (p < 0.01), which remained significant on multivariate Cox regression (HR 2.38 [95% CI 1.47-3.87]). The lightweight mesh had significantly more mesh complications (43 [5.8%] vs 7 [1.3%], p < 0.01). CONCLUSIONS: Ultra-lightweight mesh for minimally invasive sacrocolpopexy was not associated with a higher proportion of composite anatomical prolapse recurrence; however, it was associated with a shorter time to recurrence. Longer follow-up is needed to assess the clinical importance of this finding, particularly given the trade-off of more complications with lightweight mesh.
Authors: Margaret G Mueller; Kristin M Jacobs; Elizabeth R Mueller; Melinda G Abernethy; Kimberly S Kenton Journal: Female Pelvic Med Reconstr Surg Date: 2016 Jul-Aug Impact factor: 2.091
Authors: Lindsay Turner; Erin Lavelle; Jerry L Lowder; Jonathan P Shepherd Journal: Female Pelvic Med Reconstr Surg Date: 2016 Sep-Oct Impact factor: 2.091
Authors: Kimberly Kenton; Elizabeth R Mueller; Christopher Tarney; Catherine Bresee; Jennifer T Anger Journal: Female Pelvic Med Reconstr Surg Date: 2016 Sep-Oct Impact factor: 2.091
Authors: Marie Fidela R Paraiso; J Eric Jelovsek; Anna Frick; Chi Chung Grace Chen; Matthew D Barber Journal: Obstet Gynecol Date: 2011-11 Impact factor: 7.661
Authors: Linda Brubaker; Geoffrey W Cundiff; Paul Fine; Ingrid Nygaard; Holly E Richter; Anthony G Visco; Halina Zyczynski; Morton B Brown; Anne M Weber Journal: N Engl J Med Date: 2006-04-13 Impact factor: 91.245
Authors: Jennifer T Anger; Elizabeth R Mueller; Christopher Tarnay; Bridget Smith; Kevin Stroupe; Amy Rosenman; Linda Brubaker; Catherine Bresee; Kimberly Kenton Journal: Obstet Gynecol Date: 2014-01 Impact factor: 7.661
Authors: Ingrid Nygaard; Linda Brubaker; Halina M Zyczynski; Geoffrey Cundiff; Holly Richter; Marie Gantz; Paul Fine; Shawn Menefee; Beri Ridgeway; Anthony Visco; Lauren Klein Warren; Min Zhang; Susan Meikle Journal: JAMA Date: 2013-05-15 Impact factor: 56.272