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Efficacy And Longterm Outcomes For The Transobturator Pelvic Floor Repairs: A Retrospective Review Of One Institutions Experience
Sophia Drinis, Mini Varghese
Geisinger Medical Center, Danville, PA
Introduction: Minimally invasive procedures (MIP) have played a role in stress urinary incontinence with reported success. Modifications have been applied to pelvic organ prolapse (POP). To define therapeutic potential and toxicity profile, we reviewed our experience and outcomes for the transobturator anterior prolapse repair system (Perigee; AMS Minnetonka, MN, USA) and the posterior repair system (Apogee) using polypropylene mesh.
Methods: A retrospective review of 73 patients over a 28 month period was done using a deidentified quality improvement clinical database. Patient/surgical parameters and clinical endpoints included, age, symptoms, grade, prior repairs, pad use and mesh erosion.
Results: The Perigee was used in 21 patients (mean age 66). 67% had POP > grade 3, 33% grade 2. Postop, all achieved grade < 1 support. The Apogee was used in 2 patients (mean age 70.5). All had POP > grade 2. Postop, all achieved grade 1 support. 50 (mean age 68.7) underwent Perigee/Apogee repairs. 65.8% had POP > grade 3, 34.2% grade 2. Postop, 90.9% were grade <1. 43 had prior repairs (range 1-9). Preop pad use (range 1-12/day) vs (0-2) postop. Mesh erosion occurred in 5/73 (6.8%): Perigee 2, Perigee/Apogee 3. No urethral, bladder or vascular injuries noted. All were observed overnight. 36.9% required recatheterization. 97.3% report subjective improvement in emptying, continence and quality of life. 89% have resumed full activities.
Conclusions: Our data on these MIP would indicate high efficacy rates with low patient toxicity for management of POP. Longterm data and larger patient sampling is required for definitive conclusions.
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