University of Twente Student Theses


Functional outcome of vaginal mesh for pelvic organ prolapse in Gelre hospital Apeldoorn

Scheltes, Milou (2012) Functional outcome of vaginal mesh for pelvic organ prolapse in Gelre hospital Apeldoorn.

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Abstract:Objective Evaluation of the performances of Gelre Hospital Apeldoorn on Prolift™ treatment for prolapse. With these results a benchmark between providers of this treatment will be possible. Background Transvaginal mesh in pelvic prolapse surgery has been introduced in 2005 (1). In recent years, it became clear that mesh can increase the success rate but also can cause serious complications, leading to FDA warnings to protect over courageous patients and doctors (1-3). Materials and methods A prospective cohort research was done. It used descriptive statistics to describe patient characteristics, complications and symptoms. Analyzes were done to see whether there were relations between preoperative data with follow-up at six weeks and eleven months or later postoperative follow-up outcomes in women treated with transvaginal mesh (Prolift™) between 2006 and 2010. The importance of all different kind of symptoms were valued by the use of the Analytic Hierarchy Program. Data was collected by the use of Pelvic Organ Prolapse Quantification measurements, IUGA/ICS complication qualification, Urogenital Distress Inventory, Defecation Distress Inventory and several separate questions. Besides general patient characteristics several performance indicators were measured like: complications, reoperations, anatomical outcomes, symptoms and quality of life. Results Of the 107 selected women eventually 105 women received a mesh implant. Women could receive three different types of mesh implants: 21% (N = 22) received an anterior implant; 29% (N = 30) a posterior implant and 51% (N = 53) a total implant. The anatomical success rate of this research group was 72% (N = 58). 38% (N = 32) of the women had some kind of complication, of whom 8,3% (N = 7) presented with erosion. The Analytic Hierarchy Program showed that bowel problems are the most preferred group of symptoms to be solved. Individually, visible or tangible genital prolapse and fecal incontinence are the most preferred symptoms to be solved by treatment. Genital prolapse symptoms decreased significantly after surgery and 74% (N = 66) of these problems were solved. None of the women suffered from aggravated or de novo genital prolapse problems. Fecal incontinence problems decreased, but not significantly, after surgery. 35% (N = 10) of these problems were solved; 12% (N = 10) got aggravated and 8,6% (N = 7) of the women suffered from de novo fecal incontinence problems. 90% (N = 84) of all women in this research improved on their quality of life experience in some extend. Conclusion In some areas the outcomes of this treatment in Gelre hospital Apeldoorn are comparable to other known numbers. These are areas like erosion and de novo incontinence. On de novo dyspareunia the hospital scores extremely well with no cases found in this study. There are also areas that could be improved. These are anatomical success; resolution of visible or a tangible prolapse and fecal incontinence symptoms. Despite these improvement points, nearly all women feel improved after mesh treatment for prolapse.
Item Type:Essay (Master)
Gelre hospital Apeldoorn
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:88 social and public administration
Programme:Health Sciences MSc (66851)
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