Preliminary retrospective case series study of the outcome of Prolift technique in thirty women with pelvic organ prolapse including its effect on stress urinary incontinence

Pelvic organ prolapse (POP) and associated stress urinary incontinence (SUI) is a major health care problem. It is estimated that 50% of parous women lose pelvic support 1 and an American woman has a 11.1% lifetime risk of undergoing an operation for pelvic floor support.2 An ageing population is likely to increase the prevelance of POP and DeLancey describes this anticipated increasing health burden as a “hidden epidemic”.3 Current methods of pelvic reconstructive surgery for treating POP are suboptimal. The Olson study found that 29% of the patients requiring one operation for pelvic floor support will have an organ prolapse recurrence (OPR) sufficiently severe as to require at least one re-operation.2 Even when the conventional procedure of anterior and posterior repair is supplemented with other procedures such as sacrospinous ligament fixation, transvaginal needle suspension and enterocele repair, the recurrence rate is still high at 20-30%.4 Shull et al. reported an incidence of 30% cystocele following vaginal vault suspension with half of these noted within the six weeks postoperative period. The same group reported a 24% cystocele recurrence rate after vaginal and paravaginal repair.5 Paraiso et al. reported their long term follow-up data after sacrospinous ligament fixation of the vaginal vault prolapse: the recurrence rate was 37% for cystocele and 14% for rectocele.6 The utilisation of the weak native tissues may be the contributing factor in the high recurrence rate. These classical pelvic reconstructive techniques can only restore 50% of the pre-operative tissue strength.7 Synthetic material has been used to reconstruct pelvic floor anatomy and restore function and has been shown to reduce the OPR rate.4 Its effectiveness has however been marred by the occurence of adverse effects such as granuloma formation (GF), vaginal erosion and mesh shrinkage. The increased use of Tension-free Vaginal Tape (TVT) has created evidence that polypropylene mesh is better tolerated and the new Prolift mesh (Ethicon, USA) is now being used in an attempt to treat POP. Preliminary studies give cause for cautious optimism. The TVM Group from France first described the procedure in 687 patients.8 A subsequent study has looked at the optimal anatomical positioning of the mesh,9 but there have also been reported cases of serious adverse effects.10-11 In this retrospective case series analysis of Prolift procedures we describe specific aspects of the surgical technique that developed during operating on these thirty patients. Intraoperative complications, immediate and medium term post procedure outcomes with particular analysis on its effect on urodynamic stress incontinence (UDSI) are also described. The results shall be compared with those of the retrospective study of the TVM Group reported in 2005 International Meeting of the ICS 8 and the Fatton et al. case series multicentre study.12