**3.3 Results of the study**

We retrospectively analyzed 78 patients operated on at our center with a mean age of 64.2 years (48–78). The comorbidities evaluated were diabetes mellitus (DM) (21%), arterial hypertension (48%), with a body mass index (BMI) of 27.5 kg/m2 and a mean parity of 2.2 births (1–5). 36% of our patients had a history of gynecological surgical, the most prevalent being hysterectomy in up to 50% of the operated patients. The most frequently treated prolapse was anterior (72%), followed by posterior (12%) and mixed anterior–posterior (12%), with only one case of apical and posterior prolapse. Of these, 4 were recurrent prolapses. The most common grade of prolapse was III and IV with a frequency of 54% and 42%, respectively (**Table 2**).

Regarding the functional and clinical results, 50% of the sexually active patients had preoperative dyspareunia, which persisted after the intervention in two


#### **Table 2.**

*Demographic variables and clinical characteristics before surgery.*


#### **Table 3.**

*Results and complications during follow-up.*

patients. Preoperative UI (urinary incontinence) was present in 48%, with urgency, stress UI and mixed UI in 37%, 31% and 19% respectively. 18% of these patients resolved their UI and 12% had postoperative UI (**Table 3**). We obtained a success rate of 92%, understood as absence of extrusion (6%), pain (3%) or functional recurrence (3%) 6 months after surgery. The anatomic recurrence rate was 9%. The total Clavien-Dindo IIIa complication rate was the most prevalent with 6.4% (extrusion), followed by grade II (3.8%). There were none in group IV or V. Cases of extrusion were resolved on an outpatient basis with local anesthesia. The mean follow-up time was 13.5 months. In general, the patients were satisfied (57.7%) or very satisfied (36%), and only 6.4% of the patients were dissatisfied and none were very dissatisfied.

## **4. Discussion**

Surgical techniques can be performed using an abdominal or vaginal approach, depending on the medical history, physical examination, and experience of the surgeon. Laparoscopic sacrocolpopexy is an adequate therapeutic option with a high success rate in 80–100% of cases [33, 34]. However, this technique is not always appropriate, especially for patients who are at high risk for anesthesia, a multi-operated abdomen, or in recurrent prolapse. In these cases, a vaginal approach offers an interesting surgical alternative. Transvaginal mesh was developed to maintain the advantage of a vaginal procedure, while reducing the risk of recurrent prolapse compared to native tissue repair.

In the short and medium term, our results are similar to the articles published in relation to the success rate of studies with the same device and implantation route (92% in our series vs. 80.3%) [22] and different prosthetic devices but with the same implantation route (91.3%) [35], although its comparison is difficult due to the existence of different follow-up times. In our series, the minimum follow-up time was 6 months, while in studies such as the one published by Ferry et al. [22] they only had 3 months of follow-up. We could say that our success rate is slightly higher, despite a longer follow-up. Our good results may be due to the fact that all surgeries were performed by a single surgeon with extensive experience in vaginal

#### *Surgical Treatment of Pelvic Organ Prolapse DOI: http://dx.doi.org/10.5772/intechopen.100232*

POP correction surgery with mesh interposition. If we compare other techniques with a recent boom, such as laparoscopic or robotic sacrocolpopexy [27, 28], there are also no great differences with respect to the success rate, 92% in our series versus 80–100% in those mentioned.

Our anatomical correction rate at 6 months of follow-up was 91%, similar to that found in other studies with this same device, 87.9% [22] or other light weight devices with the same implantation route, which oscillates between 79 and 96.5% [35–37], although their comparison is equally difficult due to different follow-up times. This same mesh surgery with the same anatomical correction rate criterion was 98.7% at 36 months for De Tayrac et al. [21] and 93.7% for Denance´ et al. [38]. Most of the published studies are retrospective [39], and those that are prospective have a follow-up period that is too short. If we compare other techniques such as robotic sacrocolpopexy [27], we find similar rates of absence of anatomic recurrence (95%).

Regarding the complications observed, the mesh extrusion rate in our series was 6.4% compared to 1.3–11.5% published in other studies with lightweight vaginal mesh (28 g / m2) [19, 21]. In a study published with the Restorelle® device, an extrusion rate of 2.8% was observed, lower than that obtained at our center. Again, this difference can be justified because the postsurgical follow-up at our center was more than double that of the referenced study [22]. Furthermore, in general, we can affirm that it is difficult to compare our data with the literature, as there is great diversity of previously available prosthetic products.

The functional results obtained are similar to those published to date. We can find postoperative dyspareunia in 1.76% of patients in some existing studies after the use of transvaginal mesh [36, 40], a rate very similar to that of our study with only two existing cases. In the case of laparoscopic sacrocolpopexy, there seems to be a lower risk of dyspareunia compared to the transvaginal implantation device (RR 0.39, 95% CI 0.18) [41, 42]. Incontinence rates were lower after correction of the prolapse, mainly, stress urinary incontinence improved [40, 43] and 12% of new cases appeared. On the other hand, the appearance of de novo stress urinary incontinence is common in the treatment of prolapse with the use of prosthetic material (RR 1.55, 95% CI 1.02 to 2.35 - anterior colporrhaphy versus use of transvaginal mesh), a fact that patients undergoing this surgery should always be advised of. However, our rate of de novo urinary incontinence with the use of transvaginal mesh is similar to that published with the laparoscopic colposacropexy technique (12%) [41].

Summarizing, we can state that transvaginal single incision-mesh have several advantages compared to classical approaches like colposacropexy or other mesh devices. It avoids the peritoneal cavity, truly important in patients with previous abdominal surgeries, reducing the risk of paralytic ileus and making possible a shorten recovery. As we have shown in our cases study, it can be done under locoregional anesthesia, allowing to perform this surgery almost without hospital stay. And finally, the esthetic results are obviously better, as we can avoid any abdominal scar, a fact that is especially transcendent in young women.

Our study presents several limitations. The first of these is the retrospective and non-randomized nature of our study. Furthermore, all the interventions were carried out by the same surgeon with great experience, which makes it difficult to reproduce these results in other centers and makes it difficult to compare them with other studies. On the other hand, the results of the treatments of non-oncological pathologies usually respond to very high expectations on behalf of the patients, so we can consider a limitation of our study the absence of quality of life questionnaires that assess the impact of success obtained after surgery and possible complications during follow-up.
