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- Title
The autologous rectus fascia sheath sacrocolpopexy and sacrohysteropexy, a mesh free alternative in patients with recurrent uterine and vault prolapse: A contemporary series and literature review.
- Authors
Seth, Jai; Toia, Bogdan; Ecclestone, Hazel; Pakzad, Mahreen; Hamid, Rizwan; Greenwell, Tamsin; Ockrim, Jeremy
- Abstract
Introduction: About 40% of women suffer pelvic organ prolapse (POP) in a lifetime. The current standard intervention for vault prolapse is a mesh sacrocolpopexy or sacrohysteropexy. However, patients and surgeons are increasingly hesitant to use mesh given recent the UK and Food and Drug Administration warnings and litigation. A possible alternative is to use autologous tissue to support the vault, as a mesh-free solution. We report the outcomes from an initial series of autologous rectus fascia sheath (RFS) sacrocolpopexy and sacrohysteropexy in patients with complex pelvic floor dysfunction. Patients and Methods: All patients had previous, multiple urological/gynecological surgery and declined standard mesh repairs. All had preoperative videourodynamics and defecating magnetic resonance imaging evaluation. The autologous POP repair was performed using 10-18 cm of rectus sheath with a similar technique to that employing mesh to support the anterior-posterior vaginal walls or encircle the cervix and secured to the sacral promontory. Results: Seven patients with a mean age of 52 (33-64) years underwent autologous RFS POP repair between 2014 and 2017. Mean follow-up is 16 (range 2-33) months. All patients have durable result at last follow-up. No significant complications are reported. Conclusions: This is the first report of patients with complex pelvic floor dysfunction and apical POP being managed with autologous RFS sacrocolpopexy/sacrohysteropexy, and only the second report of a free graft being utilized with success. Autologous RFS sacrocolpopexy/sacrohysteropexy avoids the 10%-15% risks of mesh-related complications. Further studies of long-term durability are needed.
- Subjects
UNITED Kingdom; COLPORRHAPHY; UNITED States. Food &; Drug Administration; LITERATURE reviews; UTERINE prolapse; PELVIC organ prolapse; PELVIC floor; MAGNETIC resonance imaging
- Publication
Urology Annals, 2019, Vol 11, Issue 2, p193
- ISSN
0974-7796
- Publication type
Article
- DOI
10.4103/UA.UA_85_18