RESUMEN
Objective: This study examined gynaecologists' experience and views on the management of vaginal vault prolapse (VVP) using laproscopic sarcocolpopexy (LSCP) versus open sarcocolpopexy (OSCP). Methods: In a qualitative study conducted at the University of Surrey and Homerton University Hospital, UK, from 2016 to 2017, semi-structured interviews were conducted with 15 consultants experienced in minimal access surgery or urogynecology. Interviews were recorded and transcripts were analyzed using the qualitative description (QD) approach. Results: Eight broad themes emerged: VVP management, LSCP for management of VVP, OSCP and vaginal surgery with or without mesh use in VVP management, laparoscopic training and support as well as surgeons' attitude towards LSCP. All participants acknowledged the importance of LSCP in the management of post-hysterectomy VVP as benefits outweighed risks in their view. OSCP was considered suitable in very specific circumstances. Vaginal surgery could be an excellent alternative to OSCP bearing in mind long-term efficacy and sexual activity in young women. Most participants agreed with national recommendations to avoid use of mesh in vaginal surgery for VVP and expressed the view that it should be done in specialised centres by trained surgeons who do such operations. Conclusions: This study showed that the acceptability of LSCP was dependent on participants' experience and consideration of the balance between patient's goals and potential risks. It provides useful guidance for future large-scale projects.
RESUMEN
OBJECTIVE: The aim of our study was to report anatomic outcomes at 2 years in patients who underwent transvaginal mesh repair (Prolift™) for pelvic organ prolapse (POP). STUDY DESIGN: We conducted a prospective study of 60 women who underwent surgery between April 2005 and March 2008 and presented for 2 year follow-up visits. RESULTS: Median follow-up was 29 months, and mean age was 57.5 years. There were significant improvements in the Pelvic Organ Prolapse Quantification system (POP-Q) measurements of point C/D and the leading edge of the prolapse/most dependent part of the vagina (p<0.001). Overall anatomic success rate was 85%. Mesh exposure was seen in 15% of patients and there was recurrent prolapse in 10%. CONCLUSIONS: Women undergoing the Prolift™ procedure have a good anatomical success rate over the medium term. The higher mesh erosion rates seen in our study emphasises the need for long-term follow-up in these patients.