Performance of the Transvaginal Mesh Surgery TVM-UPB Compared to the Laparoscopic Sacrocolpopexy Using a Polytetrafluoroethylene Mesh ORIHIME for Advanced Anterior Vaginal Prolapse.

Abstract

<h4>Objectives</h4>In the up-hold transvaginal mesh (TVM-UP) procedure, the barbs are shaped like arrowheads to prevent the mesh from slipping off the sacrospinous ligament. This modified procedure is termed TVM-UPB. This study examines the efficacy and safety of TVM-UPB surgery using polytetrafluoroethylene (PTFE) mesh ORIHIME for advanced anterior vaginal prolapse compared with laparoscopic sacrocolpopexy (LSC).<h4>Methods</h4>A cohort study was conducted involving patients who underwent TVM-UPB surgery and LSC with ORIHIME for Pelvic Organ Prolapse Quantification of stage III or IV anterior vaginal prolapse between January 2022 and August 2023. The primary outcome was the recurrence rate in the operated compartment. The secondary outcomes included recurrence in the other pelvic compartments and risk factors for recurrence in the operated compartment.<h4>Results</h4>Ninety-five patients underwent TVM-UPB, and 104 underwent LSC surgery during the study period. In a propensity-matched analysis of 199 patients, recurrence in the operated compartment was lower in the TVM-UPB group than in the LSC group. There was no significant difference in recurrence rates in the other compartments between the TVM-UPB and LSC groups. Age < 70 was associated with a higher risk of recurrence in the operated compartments (adjusted odds ratio: 6.32), while a preoperative Ba point score ≥ 2.5 was also associated with a higher risk of recurrence (adjusted odds ratio: 4.49).<h4>Conclusions</h4>The recurrence rate in the operated compartment after TVM-UPB for advanced anterior vaginal prolapse was 3.2%. TVM-UPB using ORIHIME may be an effective surgical option for treating anterior vaginal prolapse.