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Vaginal Hysterectomy at the Time of Transvaginal Mesh Placement

Murphy, Miles MD, MSPH; Shrestha, Ruby MD; Haff, Robin RN; van Raalte, Heather MD; Devakumar, Hemikaa MD; Lucente, Vincent R. MD, MBA

Female Pelvic Medicine & Reconstructive Surgery: September-October 2010 - Volume 16 - Issue 5 - p 272-277
doi: 10.1097/SPV.0b013e3181ee6847
Original Articles
Journal Club

Introduction: Previous investigations have shown an increased risk of mesh erosion when concomitant vaginal hysterectomy is performed at the time of transvaginal reconstruction with mesh. We hypothesize that vaginal hysterectomy can be performed without a high risk of erosion.

Methods: This is a retrospective, repeated-measures study of women with uterovaginal prolapse who underwent vaginal hysterectomy and pelvic reconstruction with a transvaginal mesh technique using the Prolift system. Mesh was never placed behind the cuff closure and "T" incisions were not used. We compared preoperative quality-of-life and Pelvic Organ Prolapse Quantification values to postoperative values.

Results: Forty women met the study criteria. The median length of follow-up was 12 months (range 4-43 months). Thirty-two (80%) of the women had at least 1 year of follow-up. Significant improvements were found in all quality-of-life measures. Except for genital hiatus and perineal body length, a significant change was seen in all Pelvic Organ Prolapse Quantification measures. The greatest mean change found was for point "C" going from +2.4 to −6.8 cm (P < 0.001). There was 1 (2.5%) mesh erosion.

Conclusions: When incisions for mesh placement are kept separate from the vaginal cuff, transvaginal mesh reconstruction can be safely performed at the time of hysterectomy.

Vaginal hysterectomy can be performed without a high risk of mesh erosion by using a new technique of TVM placement.

From the *Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales; †Abington Memorial Hospital, Abington; and ‡St Luke's Hospital and Health Network, Allentown, PA.

Reprints: Miles Murphy, MD, MSPH, Institute for Female Pelvic Medicine and Reconstructive Surgery, 1010 Horsham Rd, Suite 205, North Wales, PA, 19454. E-mail: milesmurphy@comcast.net.

Dr Murphy, Ms Haff, Dr van Raalte, and Dr Lucente have consultant agreements with and have received research funding from Ethicon Women's Health and Urology, the company that markets the product that was used for the transvaginal colpopexies in this study. However, this company provided no funding for or intellectual input into this investigation.

Copyright © 2010 Wolters Kluwer Health, Inc. All rights reserved.