A Systematic Review Study:the Effect Of Native Tissue Repair And The Transvaginal Mesh In The Treatment Of Anterior Compartment And The Related Problems Of Recurrence

Background&Objective The pelvic organ prolapse is one of the common diseases in elderly women,which is related to the pelvic floor tissue flabby.Anterior compartment is the most common in clinical.Native tissue repair is one of the most traditional methods to correct anterior compartment prolapse.Because of its obvious effect to reinforcing pelvic fascia,the transvaginal mesh is used widely in recent years.However,the complications caused by the use of the transvaginal mesh make the doctors more cautiously in the clinical treatment with mesh,and the comparison of the effect and safety of native tissue repair and transvaginal mesh implantation has attracted more and more attention.In addition,with the extension of the follow-up time,more and more recurrent POP were found in the clinic.The purpose of this research is to summarize the safety and efficacy between native tissue repair and transvaginal mesh in the treatment of anterior compartment prolapse.At the same time,we attempted to discuss the advantages of native ti'ssue repair and transvaginal mesh in recurrent POP through the analysis,in order to provide reference for application in clinical practice.Methods Computer searched Pubmed database,Cochrane library database,Holland Medical Abstracts(EMBASE)and Web of science database,OVID database,and the deadline is to December 2016.Evaluating and extracting data if the RCTs were under the requirements,and then performing Meta-analysis.Results There were no significant differences in the average hospital stay,the subjective questionnaires and the de novo stress urinary incontinence between the native tissue repair and the transvaginal mesh.The Operating time is shorter(P<0.00001,MD=-17.89 minutes,95%CI[-25.81,-9.98])and the injury to bladder is rare(P=0.025,RR 0.21,95%CI[0.06,0.82])in NT group.The POP-Q assessment is worse(P=0.000013,average MD 0.55 cm,95%CI[0.30,0.80])and the awareness of prolapse is more obvious(P=0.000010,RR 1.77,95%CI[1.37,2.28])in NT group.Transvaginal mesh resulted in lower rates of recurrence of anterior compartment prolapse and repeat surgery for prolapse.For the second surgery after recurrent prolapse,the anatomic recurrence rate of native tissue repair was higher than that of transvaginal mesh,and the subjective improvement rate was similar.Conclusions The operation time is short in native tissue repair,and there are advantages in bladder injury,mesh exposure and other adverse events.The application of transvaginal mesh can significantly reduce the recurrence rate of anterior compartment prolapse and improve the subjective feeling of prolapse.The effect of transvaginal mesh was more obvious in the second surgery after recurrence prolapse.There were no significant differences between the two groups in the average hospital stay,the subjective questionnaire score and the de novo stress urinary incontinence.Correction of apical defects during operation is of great significance to improve the recurrence of anterior compartment prolapse.Physicians should pay attention to the accumulation of surgical experience and the improvement of surgical skills,clinical treatment should be individualized.The imaging methods represented by MRI and ultrasonography are of important significance for the evaluation of the surgical outcome and the study of the mechanism of recurrence...