| Objective The incidence of pelvic organ prolapse (POP) is increaseing with aging.Transvaginal mesh repair has significantly improved the clinical outcome,but recurrent cystoceles and complications of mesh are a major challenge in pelvic reconstructive surgery (RPS),especially for the cystoceles.To understand the mechanism of recurrence can provide better operation concept and may help to improve the outcome of operation.Mesh contraction is one of the reasons for the pop recurrence,and also the reason for pain and dyspareunia.Clinical examination,as a subjective method,can measure and assess the length, elasticity and rigidity of vagina after mesh contraction.The ultrasound scanning(US) can quantify the degree of mesh contraction with good reproducibility, and also has the advantages of noninvasion and more precisian.The aim of this study was to examine the postoperative size of the mesh implant,to investigate whether mesh is shortten with time,to analyze the role and complications of transvaginal mesh in RPS.Method Part 1:During July 2010 to Februry 2011,20 patients with severe POP had undergone operation for anterior wall prolapse with the Prosima pelvic repair system plus high uterosacral ligment suspension (HUS)in first affilicated hospital of PLA general hospital.One months after surgery we performed an introital two-dimensional ultrasound examination to measure mesh length in midsagittal plane.The same measurment by US was performed in 2 to 3 months after surgery.After comparing the results with the initial length of the mesh, contraction rate was calculated. Part 2:To investigate the results and complications of TVH plus transvaginal mesh repair of anterior vaginal wall puls HUS in first affilicated hospital of PLA general hospital..A toal of 87 patients with severe POP in our hospital from Feb.2006 to Feb.2011 were recruited in this study.Result the results of part 1:The mesh of 20 cases were found lying on the middle and upper segment of the vagina, one month after operation,the average length of the mesh was 3.71(3.08-5.20) cm and it shrinked to 2.96(2.0-4.80) cm at the second examination.The contraction rate was 38.2% vs.50.7%,respectively (P>0.05). There was no difference in the shrinkage rate of the mesh along time.The results of part 2:All the 87 patients were followed at a mean time of 19 (1-57) months with no recurrence according to the physical examination.The definition of prolapse recurrence we adopted to is equal to or severe than POPQ II.The average operation time was 191.39±55.33 (90-405) minutes.The estimated blood loss was 245.54±139.90 (100-1000) ml. After operation the TVL,GH,PB was 8.08±1.11cm,3-24±0.66cm,4.33±0.79 cm,respectively.Two months later,the PFIQ-7 and PFIQ-20 was improved from 83.36±59.82,5.03±47.46 to 22.30±3 2.06,20.65±23.29,respectively(P<0.05).Six months after operation,the scores were28.20±35.41分,26.52±29.68,respectively. Eighty-five cases(97.7%) were followed up at 2 to 3 months after operation.Four cases of sling erosion occured in TVT/TOT cases (25%), fifteen cases of mesh erosion(17.24%) and 2 cases of mesh expousure(2.29%) were found in anterior vaginal wall.There were no de novo SUI and pain.Conclusion:The objective cure rates of Prosima puls HUS for treatment of advanced POP were very high,but the long term results need to follow up. Prolapse will not recur when the lenth of anterior vaginal mesh is as short as 2cm. Transvaginal mesh repair in anterior vaginal wall puls HUS is a safe and effective method to restore the pelvic floor function.Mesh erosion is the main complication and need to futher study.
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