Treatment of Moderate and Severe Pelvic Organ Prolapse by Biomechanical Reconstruction: A Series of 135 patients

Abstract

Abstract Objective To evaluate the efficacy of pelvic floor biomechanical reconstruction surgery in patients with moderate and severe pelvic organ prolapse (POP). Materials and methods A retrospective analysis was conducted on 135 patients diagnosed with moderate and severe pelvic organ prolapse (POP) who underwent pelvic floor biomechanical reconstruction at the Urogynecology Department of The First Affiliated Hospital of Kunming Medical University from January 2021 to May 2022. The procedure included anterior compartment mesh inlay, posterior colporrhaphy, and reconstruction of perineal body. Follow-up examinations were systematically performed at 3 months, 6 months and annually after the surgery. The primary outcomes assessed were objective and subjective cure rates, while the secondary outcomes included recurrence rate, reoperation rate, and complications. Anatomic evaluation was conducted using the Pelvic Organ Prolapse Quantification System (POP-Q) and sonographic imaging of pelvic floor functional anatomy. Patient’s satisfaction was evaluated using the Patient Global Impression of Improvement Scale (PGI-I). Results All operations were successfully completed, with the exception of one case that experienced an intraoperative bladder injury. At a follow-up of 10.4 ± 3.3 months, out of the 135 patients evaluated, statistically significant improvements were observed in the POP-Q points compared to preoperative measurements at the 6-month, 1-year and 2-year time points (p < .001). Additionally, postoperatively, the Urethral Rotation Angle (URA), Restrovesical Angle (RVA), Levator Hiatus Area (LHA) at maximum Valsalva state, and Bladder Neck Descent (BND) were significantly lower than their preoperative values (p < .05). At 1 year 1.5% patients had mesh exposure, and the reoperation rate was 2.2%. More than 90% of patients expressed highly satisfaction with the surgical outcome. Conclusions Pelvic floor biomechanical reconstruction is a safe technique that has shown promising results and low complication rates. It may serve as a viable alternative to sacral hysteropexy for patients with POP.