ABSTRACT
Objectives:
Both laparoscopic sacrocolpopexy (LSC) and transvaginal mesh surgery (TVM) result in favorable outcomes for patients undergoing pelvic organ prolapse (POP) repair. However, their effects on postoperative quality of life (QOL) are yet unknown, particularly when performed on patient groups with similar backgrounds. This study aimed to compare the postoperative POP-related symptoms between patient groups without statistically significant preoperative differences.
Materials and Methods:
We retrospectively evaluated 245 patients with POP who underwent LSC or TVM. In our hospital, 97 patients were treated by LSC, whereas 148 were treated by TVM. The postoperative QOL between the matched 68 LSC-treated patients and 68 TVM-treated patients were compared using the nearest-neighbor propensity score matching. The Japanese version of the prolapse QOL questionnaire (P-QOL) was administered to assess POP-related conditions. The rates of urinary incontinence (UI), mesh exposure, and prolapse recurrence were also calculated.
Results:
The nearest-neighbor propensity score matching showed no statistically significant differences between the matched LSC and TVM groups. In the matched patients, compared with the preoperative scores, the 3–12-month postoperative P-QOL component scores decreased significantly. When comparing the 1-year postoperative values with the preoperative values, differences in the presence of UI, mesh exposure, prolapse recurrence rates, and the P-QOL component scores were not statistically significant between the two matched groups.
Conclusion:
Using nearest-neighbor propensity score matched analysis, this study suggested TVM as a favorable option to treat POP, given the postoperative improvement in P-QOL scores in addition to the shorter operative time and lower complication rates.
KEYWORDS: Laparoscopic sacrocolpopexy, nearest-neighbor propensity score matching, pelvic organ prolapse, transvaginal mesh surgery
INTRODUCTION
Pelvic organ prolapse (POP), a significant health concern for women, is characterized by the protrusion of pelvic organs, including the uterus, bladder, and rectum, along with the vaginal wall because of the weakening of supporting tissues, resulting in bladder and bowel dysfunction.[1,2] Symptomatic POP severely affects quality of life (QOL), resulting in pain, discomfort, and humiliation. The condition is present in 6%–10% of women aged >20 years and 30%–40% of postmenopausal women;[3] therefore, POP is a very common condition in women, with 11.1% having a lifetime risk of surgical treatment and 38% experiencing stress urinary incontinence (SUI).[4] The increasing prevalence of POP necessitates different therapeutic options as life expectancy has increased in society. Considering the limited effects of conservative therapy such as pessary placement in the vagina, early surgical correction seems more feasible for many patients with POP.
Recently, robot-assisted sacrocolpopexy (RSC) has been recognized as the leading approach for sacrocolpopexy globally, whereas in Japan, patients with POP have been treated with laparoscopic sacrocolpopexy (LSC) or transvaginal mesh surgery (TVM). Both the surgical approaches for POP treatment have demonstrated favorable outcomes.[5,6] TVM has been reported to be a suitable option for high-risk women, including older adult patients,[7,8] whereas LSC is generally designated for younger patients participating in more frequent sexual activity.[9,10] However, in our experience, using various strategies based on the body mass index (BMI), POP stage, and number of prior laparotomies rather than age is more pragmatic. Although LSC was linked to a lower recurrence rate when treating stage 4 POP,[11] our experience showed that the postoperative outcomes were not significantly different among patients with stage ≤3 POP.[12,13,14] However, their effects on postoperative QOL still remain unknown, particularly when performed on similar patient groups.
In our previous research, we used the following variables to assess the QOL changes following POP surgery: International Prostate Symptom Score plus QOL score, Overactive Bladder Symptom Score, residual urine volume, 60-min pad weight testing, and the International Consultation on Incontinence Questionnaire-Short Form.[12,13,14] However, due to insufficient data, we did not incorporate the results of the prolapse QOL questionnaire (P-QOL), which is widely used to assess improvement in POP-related conditions in patients with POP.[15] In this study, we included both the pre- and postoperative P-QOL component scores to compare the postoperative outcomes in patients treated with LSC or TVM after eliminating significant differences in key factors as much as possible.
So far, we performed LSC or TVM based on the BMI, POP stage, and previous history of laparotomy; however, age and presence of diabetes mellitus (DM) should also be considered when comparing the postoperative QOL between these two techniques. Therefore, in this study, we aimed to applied propensity score matching analysis (nearest-neighbor propensity score matching) to reduce the possible selection bias caused by the aforementioned factors and compare the differences in QOL after LSC and TVM.
MATERIALS AND METHODS
Patients
We retrospectively reviewed and analyzed clinicopathological data from the medical records of 245 patients with POP who underwent LSC or TVM at our hospital between September 2014 and April 2024. Ninety-seven patients underwent LSC, and 148 patients received TVM. We examined patients who underwent either surgery within the aforementioned period and followed them for at least 1 year postoperatively at our institution. Indications for surgery included vaginal prolapse symptoms, which meant the POP staging system of ≥2.[11] All procedures performed in this study were in accordance with the tenets of the 2013 revision of the Declaration of Helsinki. The study protocol (Saitama, Japan; ID 4219) was accepted on August 21, 2020, by our institutional ethics committee, and all patients who participated in this study provided written informed consent forms. This study included patients who underwent LSC or TVM for POP within the aforementioned period, and excluded those who declined to participate.
The median follow-up period after surgery was 13.3 months (interquartile range, 12.3–20.4 months). We recorded types of surgery, age, BMI, the presence of DM, POP stage, previous laparotomy, blood loss, operating time, mesh products used and intraoperative complications.
Surgical procedure
One urologist performed LSC in accordance with the method of Wattiez et al.[16] and our technique: After port placement, the patient was positioned in a 15° Trendelenburg position to view the pelvic cavity by shifting the bowel cranially. The key steps were as follows:
The space between the anterior vaginal wall and bladder was dissected, and anterior wall mesh – either Polyform™ (Boston Scientific Japan, Tokyo, Japan) or ORIHIME® (Kono Seisakusho, Tokyo, Japan) – was fixed. The mesh was suture-fixed to the back of the vaginal wall behind the bladder neck, approximately 2 cm proximal to the urethral meatus
Subtotal hysterectomy and bilateral adnexectomy were performed if the uterus and the adnexa were present
The posterior vaginal wall was separated from the rectum, and posterior wall mesh – either Polyform™ or ORIHIME® – was fixed. The mesh was anchored to the bilateral puborectal fascia
The anterior and posterior meshes were fixed to the cervical stump, and the pelvic peritoneum was partially closed
The peritoneum was completely closed after the mesh was suture-fixed to the anterior longitudinal ligament at the promontory level.
Three urologists performed TVM according to the methods described in our previous paper.[12,13,14] The procedure was initiated with hydrodissection beneath the vaginal wall, where the incision was planned. Subsequently, the anterior vaginal wall was incised vertically, and the pubocervical fascia was fully dissected laterally using a blunt technique to expose the sacrospinous ligaments. Next, a skin incision was made 4 cm lateral and 3 cm posterior to the anal center. Targeting a position of one or two finger breadths medial to the ischial spine, a Shimada needle threaded with 1-0 nylon monofilament sutures was then used to further penetrate the sacrospinous ligaments through the skin incision. The arms of the Polyform™ or ORIHIME® mesh were then removed with nylon monofilament loops; the meshes were shaped, spread, and secured under the bladder appropriately before they were cut to fit the stencil paper with two arms in advance. In the Polyform™ group, the mesh arm width was approximately 3 cm, while in the ORIHIME® group, the initial arm width was cut to 4.5–6 cm, which was later increased to approximately 7.5–8 cm.[13,14] Finally, traction was applied over the externalized arms to ensure proper alignment, and the vaginal wound was closed using 2-0 Vicryl (Johnson and Johnson, Japan, Tokyo) sutures.
Assessment methods for the preoperative and postoperative parameters
The Japanese P-QOL was administered preoperatively and 3–12 months postoperatively to assess POP-related conditions. The questionnaire contains eight multi-item domains, namely, general health perceptions, prolapse impacts, role limitations, physical/social limitations, personal relationships, emotions, sleep/energy, and severity measures.[17] Possible P-QOL scores range from 0 (best health perception) to 100 (worst health perception), based on the original version reported by Digesu et al.[15] Urinary incontinence (UI) was defined by a daily life disturbance with incontinence regardless of the type of SUI, urge UI, or mixed UI. Mesh exposure was vaginally and/or visually examined using a vaginal scope. Prolapse recurrence was defined as the most dependent portion being at POP stage 2 or further according to Takazawa et al.[9]
Statistical analysis
To perform nearest-neighbor propensity score matching, we used age, presence of DM, BMI, the POP stage, and the number of laparotomies as explanatory variables, which are considered key factors when examining changes in the status of POP-related symptoms. The propensity score for each patient was determined by multiplying each variable (age, DM, BMI, POP stage, the number of laparotomy) by a coefficient that was computed using logistic regression analysis as shown in our previous study.[18]
The Kruskal–Wallis test or the unpaired Student’s t-test was used to compare the differences in the variable data between the LSC and TVM groups before and after propensity score matching. The Pearson’s Chi-square test was used to determine differences in the presence of DM, POP stage, mesh used, and the rate of intraoperative complication rates before and after propensity score matching.
After performing nearest-neighbor propensity score matching, we used the Pearson’s Chi-square to compare the surgical outcomes (rate of UI, mesh exposure, and prolapse recurrence as well as 1-year postoperative P-QOL changes) between the matched 68 LSC-treated patients and 68 TVM-treated patients. The Wilcoxon signed-rank test was used to compare the preoperative and 3–12-month postoperative P-QOL component scores within each group. Statistical analysis was performed using JMP PRO (version 17; SAS Institute, Cary, NC, USA). A P < 0.05 was considered statistically significant.
RESULTS
Patient parameters
Before nearest-neighbor propensity score matching, the median age (LSC: 74 years, TVM: 76 years; P = 0.0379) and BMI (LSC: 22.6 kg/m2, TVM: 24.6 kg/m2; P < 0.0001) of the two groups showed a significant difference. Furthermore, the proportion of patients with stage 4 POP (LSC: N = 21, TVM: N = 13; P = 0.0002), number of previous laparotomies (P = 0.0192), blood loss (P < 0.0001), and operating time (P < 0.0001) were significantly different between the LSC and TVM groups. The usage ratio of ORIHIME® and Polyform™ was not significantly different between the two groups (P = 0.71). Statistically significant differences were observed in the rate of intraoperative complications (P = 0.0004) [Table 1]; LSC: Anterior vaginal wall injuries (n = 8), posterior vaginal wall injuries (n = 1), and bladder injuries (n = 4); TVM: Peritoneal injuries (n = 2) and bladder injuries (n = 1). However, no serious postoperative complications were observed. All of them were rated as Clavien–Dindo classification grade 1.[19]
Table 1.
Clinical characteristics of the enrolled patients before matching
| LSC (n=97), n (%) | TVM (n=148), n (%) | P | |
|---|---|---|---|
| Age (year), median (IQR) | 74 (70–78) | 76 (71.3–81) | 0.0379 |
| BMI (kg/m2), mean±SD or median (IQR) | 22.6±2.4 | 24.6 (22.2–27.0) | <0.0001 |
| DM | |||
| Present | 14 (14.4) | 31 (20.9) | 0.1979 |
| Absent | 83 (85.6) | 117 (79.1) | |
| POP stage | |||
| Stage 2 | 5 (5.2) | 0 | 0.0002 |
| Stage 3 | 71 (73.2) | 135 (91.2) | |
| Stage 4 | 21 (21.6) | 13 (8.8) | |
| Number of previous laparotomies, median (IQR) | 0 (0–1) | 0 (0–1) | 0.0192 |
| Blood loss (mL), median (IQR) | 1.0 (0–7.0) | 32 (20–63) | <0.0001 |
| Operating time (min), median (IQR) | 180.6 (151.2–243.6) | 66 (55.8–79.2) | <0.0001 |
| Mesh used | |||
| ORIHIME® | 68 (70.1) | 107 (72.3) | 0.71 |
| Polyform™ | 29 (29.9) | 41 (27.7) | |
| Preoperative voiding dysfunction (PVR ≥100 mL) | |||
| Present | 36 (37.1) | 61 (41.2) | 0.5207 |
| Absent | 61 (62.9) | 87 (58.8) | |
| Preoperative urinary incontinence | |||
| Present | 55 (56.7) | 93 (43.3) | 0.3368 |
| Absent | 42 (62.8) | 55 (37.2) | |
| Intraoperative complications | |||
| Present | 13 | 3 | 0.0004 |
| AVW injury - 8 | Peritoneal injury - 2 | ||
| PVW injury - 1 | |||
| Bladder injury - 4 | Bladder injury - 1 | ||
| Absent | 84 | 145 |
Clinical characteristics of the patients before matching are shown. Values for normally distributed measurements are expressed as mean±SD, and values for nonnormally distributed values are expressed as median variables (IQR). The Kruskal–Wallis test was used to determine significant differences in age, BMI, number of previous laparotomies, blood loss, and operating time. Pearson’s Chi-square test was used to determine the difference in the presence of DM, the POP stage, mesh used, preoperative voiding dysfunction, preoperative UI, intraoperative complications between the LSC and TVM groups. UI: Urinary incontinence, LSC: Laparoscopic sacrocolpopexy, TVM: Transvaginal mesh surgery, IQR: Interquartile range, BMI: Body mass index, SD: Standard deviation, DM: Diabetes mellitus, POP: Pelvic organ prolapse, PVR: Postvoid residual urine volume, AVW: Anterior vaginal wall, PVW: Posterior vaginal wall
Nearest-neighbor propensity score matching
Using multiple logistic regression analysis, we calculated the predicted probability as a propensity score for age, BMI, the presence of DM, the number of previous laparotomies, and POP stage. The nearest-neighbor matching resulted in 68 pairs between the LSC and TVM groups. After nearest-neighbor propensity score matching, age, BMI, the presence of DM, POP stage, and number of previous laparotomies were not significantly different between the matched LSC and TVM groups, whereas differences remained significant in blood loss, operating time, mesh usage ratio, and intraoperative complication rates between the two groups [Table 2].
Table 2.
Clinical characteristics of the matched patients
| LSC (n=68), n (%) | TVM (n=68), n (%) | P | |
|---|---|---|---|
| Age (year), mean±SD | 74.8±6.9 | 74.6±7.4 | 0.8576 |
| BMI (kg/m2), mean±SD | 23.1±2.3 | 23.4±3.3 | 0.5742 |
| DM | |||
| Present | 11 (16.2) | 12 (17.6) | 0.8191 |
| Absent | 57 (83.8) | 56 (82.4) | |
| POP stage | |||
| Stage 3 | 57 (83.8) | 58 (85.3) | 0.8124 |
| Stage 4 | 11 (16.2) | 10 (14.7) | |
| Number of previous laparotomies, median (IQR) | 0 (0–1) | 0 (0–1) | 0.7118 |
| Blood loss (mL), median (IQR) | 1 (0–8.3) | 26.5 (16.3–55.5) | <0.0001 |
| Operating time (min), median (IQR) | 184.2 (151.8–267) | 60.0 (55.8–73.2) | <0.0001 |
| Mesh used | |||
| ORIHIME® | 45 (66.2) | 58 (85.3) | 0.0093 |
| Polyform™ | 23 (33.8) | 10 (14.7) | |
| Preoperative voiding dysfunction (PVR ≥100 mL) | |||
| Present | 24 (35.3) | 25 (36.8) | 0.8582 |
| Absent | 44 (64.7) | 43 (63.2) | |
| Preoperative urinary incontinence | |||
| Present | 40 (58.8) | 41 (60.3) | 0.944 |
| Absent | 28 (41.2) | 27 (39.7) | |
| Intraoperative complications | |||
| Present | 11 | 1 | 0.0025 |
| AVW injury 7 | Peritoneal injury 1 | ||
| Bladder injury 4 | |||
| Absent | 57 | 67 |
Clinical characteristics of the matched patients are shown. Values for normally distributed measurements are expressed as mean±SD, and values for non-normally distributed values are expressed as median variables (IQR). The Kruskal–Wallis test was used to determine significant difference in number of previous laparotomies, blood loss, and operating time. Student’s t-test was used to test for significant differences in age and BMI. Pearson’s Chi-square test was used to determine the difference in the presence of DM, the POP stage, mesh used, preoperative voiding dysfunction, preoperative UI, intraoperative complications between the matched LSC and TVM groups. LSC: Laparoscopic sacrocolpopexy, TVM: Transvaginal mesh surgery, IQR: Interquartile range, BMI: Body mass index, SD: Standard deviation, DM: Diabetes mellitus, POP: Pelvic organ prolapse, PVR: Postvoid residual urine volume, AVW: Anterior vaginal wall, UI: Urinary incontinence
All P-QOL component scores were significantly lower during the 3–12-month postoperative period than the preoperative period in the matched LSC and TVM groups [Figures 1 and 2].
Figure 1.
Preoperative (a), 3-month postoperative (b), 6-month postoperative (c), and 12-month postoperative (d) prolapse quality of life (P-QOL) domain scores in matched laparoscopic sacrocolpopexy-treated patients. They are expressed as a percentage of the full score. Each P-QOL domain score was significantly lower at 3, 6, and 12 months postoperatively than preoperatively (all P < 0.01)
Figure 2.
Preoperative (a), 3-month postoperative (b), 6-month postoperative (c), and 12-month postoperative (d) prolapse quality of life (P-QOL) domain scores in matched transvaginal mesh surgery-treated patients. They are expressed as a percentage of the full score. Each P-QOL domain score was significantly lower at 3, 6, and 12 months postoperatively than preoperatively (all P < 0.01)
The preoperative and 1-year postoperative differences in the presence of UI, mesh exposure, prolapse recurrence, and all the P-QOL component scores were not statistically significant between the matched LSC and TVM groups [Table 3].
Table 3.
Association between surgical methods and the rate of incontinence, mesh exposure, prolapse recurrence, the prolapse Quality of Life Questionnaire score at 12 months after surgery after matching (all patients)
| LSC (n=68), n (%) | TVM (n=68), n (%) | P | |
|---|---|---|---|
| Incontinence | |||
| Present | 8 (11.8) | 7 (10.3) | 0.7843 |
| Absent | 60 (88.2) | 61 (89.7) | |
| Mesh exposure | |||
| Present | 1 (1.5) | 1 (1.5) | 1.0000 |
| Absent | 67 (98.5) | 67 (98.5) | |
| Prolapse recurrence | |||
| Present | 5 (7.4) | 4 (5.9) | 0.7301 |
| Absent | 63 (92.6) | 64 (94.1) | |
|
| |||
| P-QOL | LSC, median (IQR) | TVM, median (IQR) | P |
|
| |||
| General health perceptions | 2 (0–2) | 2 (1–3) | 0.0770 |
| Prolapse impact | 11 (4–16) | 13 (6–18) | 0.1585 |
| Role limitations | 0 (0–1) | 0 (0–1) | 0.7241 |
| Physical/Social limitations | 0 (0–2) | 0 (0–2) | 0.4377 |
| Personal relationships | 0 (0–0) | 0 (0–0) | 0.9614 |
| Emotions | 0 (0–2) | 0 (0–3) | 0.1854 |
| Sleep/Energy | 0 (0–0) | 0 (0–1) | 0.4017 |
| Severity measures | 0 (0–2) | 1 (0–3) | 0.0738 |
The rate of incontinence, mesh exposure, prolapse recurrence, the P-QOL score at 12 months after surgery in the matched LSC-treated and TVM-treated patients are shown. Pearson’s Chi-square test was used to determine the difference in the rate of incontinence, mesh exposure, prolapse recurrence. The Kruskal–Wallis test was used to determine significant difference in P-QOL component scores. LSC: Laparoscopic sacrocolpopexy, TVM: Transvaginal mesh surgery, IQR: Interquartile range, P-QOL: Prolapse quality of life questionnaire
DISCUSSION
This study showed that the nearest-neighbor propensity score matching analysis eliminated the significant differences observed in age, BMI, the presence of DM, POP stage, and number of previous laparotomies between the LSC and TVM groups, while differences in blood loss, operating time, mesh product ratio, and the rate of intraoperative complications remained significant between the groups. After propensity score matching, the 3–12-month postoperative P-QOL component scores were significantly lower than the preoperative scores in the matched LSC and TVM groups. In addition, differences in the rates of UI, mesh exposure, or prolapse recurrence were not statistically significant between the matched LSC and TVM groups, and all the 1-year postoperative P-QOL component scores also did not differ significantly between the two matched groups.
In April 2019, the Food and Drug Administration mandated that all the transvaginal mesh producers discontinue the sale of synthetic mesh used for anterior compartment prolapse repair because of inadequate safety and efficacy.[20] Previous studies indicate that the prevalence of SUI is higher in TVM-treated patients than in LSC- and RSC-treated patients.[8,21] Nevertheless, TVM has showed favorable outcomes for patients in Japan, with minimal occurrence of mesh-related complications such as UI and a low rate of postoperative prolapse recurrence.[9,12,13,14] Although a minimal mesh procedure has been previously advocated for POP management,[9] our prior research suggested placing ORIHIME® with wide arms and adjusted length beneath the bladder for POP repair.[12,13,14] The increased incidence of postoperative UI in the cohort with unadjusted mesh length beneath the bladder was consistent with that reported in several studies, indicating that SUI was caused by excessive correction of the bladder neck because of the defects in urethral support and neural denervation.[22,23,24]
In our prior investigations, LSC-or TVM-treated patients exhibited satisfactory surgical results.[12,13,14] The postoperative results in TVM-treated patients with stage ≤3 POP were similar to those in LSC-treated patients. The favorable postoperative outcomes in both groups are comparable, with both TVM[12,13,14] and LSC being effective in reducing symptoms of overactive bladder and urinary difficulties.[25,26] Based on our experience and earlier reports, both surgical approaches are quite successful in treating POP and POP-related symptoms. However, the postoperative outcomes after either of the methods in patients with similar background conditions have not been analyzed yet.
The degree of symptoms and its impact on the QOL of women with POP must be considered before selecting the most suitable clinical intervention in each situation (surgical or conservative) to evaluate its effectiveness.[15] The main objective of any prolapse treatment is enhancing the patient’s QOL. Because women find clinical evaluations uncomfortable, the P-QOL questionnaire is an easy, nonintrusive assessment that is used in both clinical and research settings. The questionnaire has been validated in languages other than English after translation.[27] This study used the Japanese P-QOL, as reported by Fukumoto et al.[17] The study participants did not report having difficulty understanding the Japanese P-QOL because the questions and responses were straightforward. The Japanese version did not require cultural adaptation because it was deemed relevant in all QOL component questions. Although the original P-QOL questionnaire was created for the European population, the Japanese translation almost perfectly captured the original’s content, goal, and structure.
Using nearest-neighbor propensity score matching analysis, we compared the postoperative outcomes of LSC and TVM in patients with similar preoperative characteristics. At our facility, BMI, the number of previous laparotomies, and the POP stage are considered for surgical treatment decision-making to achieve satisfactory performance status. However, to compare the postoperative P-QOL scores between the two treatment groups, potential statistical biases, including age and the presence of DM, should be included in the nearest-neighbor propensity score matched analysis as explanatory factors.
This study has several limitations. We performed statistical analysis while paying attention to the power of the study and type 1 error, but this is a retrospective study conducted at a single center, and the small sample size may limit the generalizability of the findings. The relatively small cohort could have the possibility of reducing the power to detect subtle differences. We also had a lack of correction for multiple comparisons. The median postoperative follow-up period was also relatively short, as a postoperative follow-up period of at least >1 year is necessary for benign diseases such as POP. Multicenter studies with larger sample sizes and longer follow-up duration are required to validate our findings and strengthen the evidence.
CONCLUSION
Both surgical methods seem to be effective for treating POP and POP-related symptoms based on the nearest-neighbor propensity score matched analysis. Given the shorter operative time, lower complication rates, and postoperative improvement in P-QOL scores, TVM may be preferred over LSC for treating patients with POP.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020;46:5–14. doi: 10.1590/S1677-5538.IBJU.2018.0581. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853. doi: 10.1136/bmj.i3853. [DOI] [PubMed] [Google Scholar]
- 3.Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24:1783–90. doi: 10.1007/s00192-013-2169-9. [DOI] [PubMed] [Google Scholar]
- 4.Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. doi: 10.1016/S0029-7844(97)00058-6. [DOI] [PubMed] [Google Scholar]
- 5.Wei D, Wang P, Niu X, Zhao X. Comparison between laparoscopic uterus/sacrocolpopexy and total pelvic floor reconstruction with vaginal mesh for the treatment of pelvic organ prolapse. J Obstet Gynaecol Res. 2019;45:915–22. doi: 10.1111/jog.13908. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Obinata D, Sugihara T, Yasunaga H, Mochida J, Yamaguchi K, Murata Y, et al. Tension-free vaginal mesh surgery versus laparoscopic sacrocolpopexy for pelvic organ prolapse: Analysis of perioperative outcomes using a Japanese national inpatient database. Int J Urol. 2018;25:655–9. doi: 10.1111/iju.13587. [DOI] [PubMed] [Google Scholar]
- 7.Park YH, Yang SC, Park ST, Park SH, Kim HB. Laparoscopic reconstructive surgery is superior to vaginal reconstruction in the pelvic organ prolapse. Int J Med Sci. 2014;11:1082–8. doi: 10.7150/ijms.9027. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Liu CK, Tsai CP, Chou MM, Shen PS, Chen GD, Hung YC, et al. Acomparative study of laparoscopic sacrocolpopexy and total vaginal mesh procedure using lightweight polypropylene meshes for prolapse repair. Taiwan J Obstet Gynecol. 2014;53:552–8. doi: 10.1016/j.tjog.2014.07.006. [DOI] [PubMed] [Google Scholar]
- 9.Takazawa N, Fujisaki A, Yoshimura Y, Tsujimura A, Horie S. Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse. Investig Clin Urol. 2018;59:133–40. doi: 10.4111/icu.2018.59.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Aubé M, Guérin M, Rheaume C, Tu LM. Efficacy and patient satisfaction of pelvic organ prolapse reduction using transvaginal mesh: A Canadian perspective. Can Urol Assoc J. 2018;12:E432–7. doi: 10.5489/cuaj.5095. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Bland DR, Earle BB, Vitolins MZ, Burke G. Use of the pelvic organ prolapse staging system of the international continence society, American Urogynecologic Society, and society of gynecologic surgeons in perimenopausal women. Am J Obstet Gynecol. 1999;181:1324–7. doi: 10.1016/s0002-9378(99)70371-6. [DOI] [PubMed] [Google Scholar]
- 12.Kuroda K, Hamamoto K, Kawamura K, Horiguchi A, Ito K. Comparison between the effect of transvaginal mesh surgery using ORIHIME(®) mesh and laparoscopic sacrocolpopexy at 1 year postoperatively -TVM has a favorable postoperative course compared to LSC in patients with pop scored ≤stage 3. Nihon Hinyokika Gakkai Zasshi. 2024;115:53–63. doi: 10.5980/jpnjurol.115.53. [DOI] [PubMed] [Google Scholar]
- 13.Kuroda K, Hamamoto K, Kawamura K, Kobayashi H, Horiguchi A, Ito K. Efficacy of transvaginal surgery using an ORIHIME mesh with wider arms and adjusted length. Cureus. 2024;16:e57106. doi: 10.7759/cureus.57106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kuroda K, Hamamoto K, Kawamura K, Masunaga A, Kobayashi H, Horiguchi A, et al. Favorable postoperative outcomes after transvaginal mesh surgery using a wide-arm ORIHIME®mesh. Cureus. 2024;16:e53388. doi: 10.7759/cureus.53388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S. P-QOL: A validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:176–81. doi: 10.1007/s00192-004-1225-x. [DOI] [PubMed] [Google Scholar]
- 16.Wattiez A, Boughizane S, Alexandre F, Canis M, Mage G, Pouly JL, et al. Laparoscopic procedures for stress incontinence and prolapse. Curr Opin Obstet Gynecol. 1995;7:317–21. [PubMed] [Google Scholar]
- 17.Fukumoto Y, Uesaka Y, Yamamoto K, Ito S, Yamanaka M, Takeyama M, et al. Assessment of quality of life in women with pelvic organ prolapse: Conditional translation and trial of P-QOL for use in Japan. Nihon Hinyokika Gakkai Zasshi. 2008;99:531–42. doi: 10.5980/jpnjurol1989.99.531. [DOI] [PubMed] [Google Scholar]
- 18.Kuroda K, Hamamoto K, Kawamura K, Masunaga A, Kobayashi H, Ito K. Comparison of postoperative urinary storage function following laparoscopic sacrocolpopexy and transvaginal mesh surgery using nearest-neighbor propensity score matching analysis. J Midlife Health. 2025;16:301–8. doi: 10.4103/jmh.jmh_106_25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250:187–96. doi: 10.1097/SLA.0b013e3181b13ca2. [DOI] [PubMed] [Google Scholar]
- 20.U.S. Food and Drug Administration. Urogynecologic Surgical Mesh Implants. [[Last accessed on 2024 Oct 01]]. Available from: https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants .
- 21.Kusuda M, Kagami K, Takahashi I, Nozaki T, Sakamoto I. Comparison of transvaginal mesh surgery and robot-assisted sacrocolpopexy for pelvic organ prolapse. BMC Surg. 2022;22:268. doi: 10.1186/s12893-022-01702-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Lo TS, Bt Karim N, Cortes EF, Wu PY, Lin YH, Tan YL. Comparison between elevate anterior/apical system and perigee system in pelvic organ prolapse surgery: Clinical and sonographic outcomes. Int Urogynecol J. 2015;26:391–400. doi: 10.1007/s00192-014-2492-9. [DOI] [PubMed] [Google Scholar]
- 23.Oride A, Kanasaki H, Hara T, Kyo S. Postoperative outcomes following tension-free vaginal mesh surgery for pelvic organ prolapse: A retrospective study. Urol J. 2019;16:581–5. doi: 10.22037/uj.v0i0.4631. [DOI] [PubMed] [Google Scholar]
- 24.Liang CC, Lin YH, Chang YL, Chang SD. Urodynamic and clinical effects of transvaginal mesh repair for severe cystocele with and without urinary incontinence. Int J Gynaecol Obstet. 2011;112:182–6. doi: 10.1016/j.ijgo.2010.09.011. [DOI] [PubMed] [Google Scholar]
- 25.Sawada Y, Kitagawa Y, Hayashi T, Tokiwa S, Nagae M, Cortes AR, et al. Clinical outcomes after laparoscopic sacrocolpopexy for pelvic organ prolapse: A 3-year follow-up study. Int J Urol. 2021;28:216–9. doi: 10.1111/iju.14436. [DOI] [PubMed] [Google Scholar]
- 26.Rozet F, Mandron E, Arroyo C, Andrews H, Cathelineau X, Mombet A, et al. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: Experience with 363 cases. Eur Urol. 2005;47:230–6. doi: 10.1016/j.eururo.2004.08.014. [DOI] [PubMed] [Google Scholar]
- 27.Belayneh T, Gebeyehu A, Adefris M, Rortveit G. A systematic review of the psychometric properties of the cross-cultural adaptations and translations of the prolapse quality of life (P-QoL) questionnaire. Int Urogynecol J. 2019;30:1989–2000. doi: 10.1007/s00192-019-03920-1. [DOI] [PubMed] [Google Scholar]