Subjective and Objective Evaluation of Total Pelvic Floor Reconstruction with Six-Arm Mesh in Patients with Severe Pelvic Organ Prolapse: A 1-Year Retrospective Study

Figures & data

Figure 1 Schematic diagram of the position of anteroposterior approach mesh.

Notes: A: Mesh in the vaginal bladder space. P: Mesh in the rectovaginal space. B: Bladder. V: Vagina. R: Rectum.

Figure 2 (A) The puncture points of the posterior arm of the mesh in sacrospinous ligament. (B) The puncture points of the anterior and middle arm of the mesh in the obturator.

Figure 3 Schematic diagram of the position of six-arm mesh.

Notes: c: The position of the six arms of the mesh. The yellow area: No mesh is inserted in the rectovaginal space.

Table 1 Comparison of Patient Clinical Characteristics Between the Two Groups

	Six-Arm Mesh Group (n=176)	Anteroposterior Approach Group (n=192)	P
Age (year)	66.23±9.15	67.87±8.62	0.419
BMI	26.76±0.63	26.82±0.85	0.445
P	2.51±1.43	2.32±1.21	0.168
Prolapse stage (%)
III	96 (54.55)	105 (54.69)
IV	80 (45.45)	87 (45.31)
Prolapse position (N)
Anterior prolapse	64	71
Apical prolapse	24	20
Anterior and apical prolapse combined	88	101
Posterior prolapse	-	-
Instantaneous surgery for hysterectomy	21	23
Instantaneous surgery for urinary incontinence (N)	26	29

Abbreviations: BMI, body mass index; P, parity.

Table 2 Comparison of Intraoperative Conditions and Postoperative Recovery Between the Two Groups

	Six-Arm Mesh Group (n=176)	Anteroposterior Approach Group (n=192)	P value
Mesh insertion time (min)	31.35±5.14	40.12±7.35	<0.0001*
Intraoperative bleeding volume (mL)	60.26±15.53	65.46±20.34	<0.0001*
Postoperative urinary catheter removal time (d)	3.65±0.96	3.76±0.35	0.14
Residual urine volume after urinary extraction (mL)	57.67±47.53	67.35±62.46	0.09
Postoperative hospital stay (d)	5.43±1.37	5.54±1.03	0.38

Notes: The two groups were compared by t test, significance level α = 0.05. *The difference was statistically significant at a significance level of 0.05.

Table 3 Comparison of POP-Q Score in Both Groups Before and at 3, 6, and 12 Months After Surgery

		Six-Arm Mesh Group (n=176)	Anteroposterior Approach Group (n=192)	P value
Before operation	Ba	+2.21±0.34	+2.30±0.53	0.051
	Bp	+0.54±0.12	+0.56±0.15	0.157
	C	−0.22±0.33	−0.28±0.42	0.132
	TVL (cm)	6.65±1.01	6.44±1.45	0.106
3 months after operation	Ba	−2.57±0.24	−2.54±0.40	0.778
	Bp	−2.74±0.19	−2.76±0.22	0.350
	C	−5.46±0.45	−5.56±0.56	0.059
	TVL (cm)	6.63±0.86	6.68±0.82	0.569
6 months after operation	Ba	−2.54±0.34	−2.59±0.33	0.153
	Bp	−2.68±0.09	−2.70±0.18	0.173
	C	−5.85±0.11	−5.83±0.52	0.603
	TVL (cm)	7.45±0.46	6.83±0.16	<0.0001^a
12 months after operation	Ba	−2.68±0.21	−2.65±0.26	0.181
	Bp	−2.83±0.15	−2.81±0.14	0.188
	C	−5.64±0.28	−5.48±0.56	<0.0001^b
	TVL (cm)	7.73±0.58	6.85±0.23	<0.0001^a

Notes: Ba the most dependent position of the anterior wall, Bp the most dependent position of the posterior wall, C Cervix or cuff, TVL Total Vaginal Length. The two groups were compared by t test, significance level α < 0.05. ^aTVL in two groups was prolonged after surgery, there were significant differences between the two groups at 6 and 12 months after surgery (P < 0.05). ^bThere were significant differences in C (cervical position) between the two groups at 12 months after surgery (P < 0.05).

Table 4 Pre- and Postoperative Comparison of PFDI-20 and FSFI Scores Between the Two Groups

		Six-Arm Mesh Group (n=176)	Anteroposterior Approach Group (n=192)	P value
Before operation	PFDI-20	128.32±37.70	133.5±42.12	0.216
	POPDI-6	64.26±16.96	66.37±10.82	0.152
	CRADI-8	56.78±14.79	59.68±17.88	0.092
	UDI-6	36.53±12.39	38.47±12.32	0.133
	FSFI	2.33±1.51	2.57±1.61	0.142
3 months after operation	PFDI-20	26.45±9.36	27.63±10.24	0.251
	POPDI-6	2.34±1.93	2.65±1.64	0.692
	CRADI-8	14.36±5.68	15.36±5.34	0.082
	UDI-6	14.65±3.62	15.14±3.44	0.184
	FSFI	–	–	–
6 months after operation	PFDI-20	23.78±5.25	28.26±5.97	<0.0001^a
	POPDI-6	2.38±1.41	2.53±1.05	0.245
	CRADI-8	7.46±3.01	12.17±5.02	<0.0001^b
	UDI-6	11.06±3.32	11.73±3.82	0.075
	FSFI	24.03±7.66	20.23±5.31	<0.0001^c
12 months after operation	PFDI-20	16.23±5.12	21.86±5.28	<0.0001^a
	POPDI-6	1.35±1.21	1.28±1.14	0.568
	CRADI-8	5.52±1.87	8.89±1.65	<0.0001^b
	UDI-6	8.96±2.03	9.28±2.16	0.145
	FSFI	35.63±13.64	23.76±8.48	<0.0001^c

Notes: The two groups were compared by t test, significance level α = 0.05. ^aThere were significant differences in the PFDI-20 score between the two groups at 6 and 12 months after surgery (P < 0.05). ^bThere were significant differences in the CRADI-8 score between the two groups at 6 and 12 months after surgery (P < 0.05). ^cThere were significant differences in the FSFI score between the two groups at 6 and 12 months after surgery (P < 0.05).

Table 5 Comparison of Postoperative Complications Between the Two Groups

	Six-Arm Mesh Group (n=176)	Anteroposterior Approach Group (n=192)	P
POP recurrence	0	0	-
Mesh exposure	3 (1.70%)	13 (6.77%)	0.02
Vaginal foreign body sensation	0	8 (4.17%)	0.008
Defecation pain	0	6 (3.13%)	0.031
Dysuria or dyschezia	0	0	-
Dyspareunia	1/98 (1.02%)	15/103 (14.56%)	<0.001