Study design, materials and methods
A prospective cohort study design was conducted in women who underwent Uphold Mesh Surgery for treatment of pelvic organ prolapse (POP). From September 2015 through August 2017, two hundred and five women with symptomatic POP stages ranging from II to IV defined by the POP quantification (POP-Q) staging system were treated with TVM with Uphold™ Lite mesh at our hospitals performed by two skilled and experienced urogynecologic physicians. Concomitant operations included posterior colporrhaphy, vaginal total hysterectomy, midurethral sling surgery in women with stress urinary incontinence or occult urodynamic stress incontinence (USI), unless they did not desire additional surgery. Thirty women were included because they were sexually active and had complete follow-up. “Sexually active” was defined as having vaginal intercourse within the 6 months. Preoperative and postoperative assessments included pelvic examination using the POP-Q system and a personal interview to evaluate their urinary and sexual symptoms by using the short forms of Urogenital Distress Inventory（UDI-6 ),Incontinence Impact Questionnaire(IIQ-7) and Female Sexual Function Index(FSFI) before and 6 months after operation. Anatomical restoration was evaluated by pelvic examination based on POP-Q system postoperatively and surgical failure was defined as the most distal portion being POP stage II or greater, regardless of a primary or a new site.
Results
As for the POP-Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, Bp and tvl (p <0.001) after operation, and a 96.7 % of success rate for POP correction was noted. With respect to the changes in quality of life (QoL), there were statistically significant improvement in both UDI-6 and IIQ-7 questionnaires. We assessed female sexual function with FSFI questionnaire, and the total score and all domains except for lubrication domain showed significant improvement. Subgroup analysis of FSFI comparing women with and without concomitant sling procedures revealed both group showed significant improvement in all domains except for sexual desire. Statistical analysis was performed using Paired t-test or Wilcoxon signed-rank test for continuous variables. A difference was considered statistically significant when P < 0.05.
Interpretation of results
Uphold™ Mesh surgery has less influence on sexual function after prolapse repair due to its unique characteristic of single incision mesh which involves anterior and/or apical compartment ,causing less vaginal stiffness and scar formation with less condom-like effect. It is made up of less dense, monofilament macroporous Polypropylene Mesh that could decrease biomaterial load to avoid mesh-related complications, such as mesh erosion and promote better mesh attachment and wound healing. The results of our study indicated that the Uphold TVM surgery was effective in anatomical restoration of POP and was favorable for sexual function. We found significant improvements on all domains of FSFI after single-incision Uphold mesh surgery, except for the lubrication domain. This may be due to the evolution of new TVM, such as smaller size, lighter, less dense texture, and single-incision design. No mesh extrusion was found. The other reason for favorable sexual function may be the limited involvement of only the anterior compartment in the new Uphold TVM procedure. Twelve (40%) women underwent concomitant TVM with mid-urethral sling with not only for anatomical restoration but also vesicourethral function. The significant improvement in UDI-6, IIQ-7, and POP-Q measurements implies that our surgical managements can successfully treat POP and concomitant stress urinary incontinence. Moreover, there is no detrimental effect on sexual function in women treated with Uphold plus sling surgery