Factors determining the adoption of innovative needle suspension techniques with mesh to treat urogenital prolapse: a conjoint analysis study

Objectives: This study was undertaken to determine which characteristics of proposed innovative surgical procedures influence the choice of pelvic floor surgeons when considering the use of mesh prostheses in the surgical treatment of urogenital prolapse. Study design: The survey was conceived using conjoint analyses technique. Opinion leaders were consulted in order to define six characteristics that were considered most relevant when evaluating a new mesh technique to treat urogenital prolapse. These characteristics were: scientific evidence, postoperative pain, erosion risk, required surgical skill, duration of hospital stay and costs. In 2007 the questionnaire was sent to the members of the Flemish and Dutch Societies for Obstetrics and Gynecology. Participants were presented with scenarios in which several possible combinations of levels of characteristics of the treatment are compared. A seven-point Likert scale was used to rate the willingness to adopt the new technique. Mixed model analysis of variance was used to determine the relative effects of the six characteristics of the new mesh technique. Results: The level of scientific evidence emerged as the most important factor on willingness to adopt the new technique, with an estimated effect (beta coefficient) of +1.59, followed by the risk to develop erosion, with an estimated effect of +1.53. The decision whether to perform a novel needle suspension technique with mesh was further, but less, influenced by pain (beta = +0.82), costs (beta = +0.41), and required surgical skill (beta = +0.26) and least by the duration of the patient's hospital admission (beta = +0.18). Conclusions: The results of our study underscore the idea that physicians consider it highly relevant that there exists scientific evidence that supports the use of innovative surgical techniques. In urogynecology, the surgeons seem to consider research in the properties of the mesh to be very significant. This observation implies a responsibility for both the manufacturers of these devices, who will have to invest in gathering evidence and delay widespread introduction of them before clinical data are available, as well as for the physicians, who should either participate in clinical trials or await the results of these studies before adopting a new technique. (C) 2010 Elsevier Ireland Ltd. All rights reserve

Surgical management of urinary stress incontinence in women: a historical and clinical overview

Urinary incontinence is a highly prevalent condition that has a significant impact on the affected patients' quality of life. Approximately one in three women suffers from some degree of urinary incontinence. Six to ten percent of them are severely affected. Cure or significant improvement can often be achieved after making the right diagnosis, tailoring the treatment accordingly and realistically counseling the patient on the expected outcome. This article focuses on the pathophysiology of genuine or urodynamic stress incontinence (USI) and its surgical management. Until now more than 200 surgical techniques have been described for the treatment of USI. An overview of the historically most important and most commonly used procedures is included. In view of the level I data and the long-term observational studies available on the TVT procedure, it can be considered to be the new gold standard for the treatment of US

A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair

The objective of this study was to estimate the anatomical and functional outcome of Prolift Anterior C. All patients presenting with symptomatic stage II or greater anterior vaginal wall prolapse were considered to enter this prospective observational study. Patient characteristics and surgical parameters were prospectively documented. Anatomical outcome, as measured by the Pelvic Organ Prolapse Quantification (POP-Q) score, and functional outcome, as assessed by the King's College Health Questionnaire, was considered primary outcome measures. Complications constituted the secondary outcome measures. Fifty-one patients met the inclusion criteria, and 48 underwent a transobturator anterior vaginal wall mesh. Objective cure was realized in 46 out of 48 (95.8%) patients. Postoperatively, 5 out of 48 (10.4%) patients developed an erosion which required surgical intervention in 2 (4.3%) patients. Subjective cure was achieved in 40 out of 42 (95.2%) patients. Urgency symptoms persisted in 3 out of 21 (14%). De novo urgency and frequency developed in only 1 patient. De novo stress incontinence developed in 4 out of 30 (13%). In 9 out of 29 (31%) of sexually active patients, dyspareunia due to the prolapse was present before surgery and disappeared in all; 3 out of 20 (15%) reported de novo dyspareunia. In conclusion, we state that transobturator anterior vaginal wall mesh kits provide a surgical tool with an acceptable but real morbidity to treat anterior vaginal wall prolapse with a favorable objective and subjective outcom