Melissa Fischer

Exploring Predictors of Mesh Exposure After Vaginal Prolapse Repair

Objectives To evaluate clinical, demographic, and surgical factors that may be associated with mesh exposure after vaginal repair of pelvic organ prolapse (POP). Methods Records of women who underwent POP repair with Elevate or Prolift were retrospectively reviewed. Body mass index (BMI), prolapse grade, smoking history, diabetes, steroid and estrogen use, parity, compartment repaired, concurrent hysterectomy, operative time, postoperative pain, change in hemoglobin (&Dgr;Hgb) and other characteristics were evaluated for associations with mesh exposure. Categorical variables were examined using Pearson &khgr;2 test where appropriate, or the Fisher exact test was used. The continuous variables were examined using Wilcoxon rank tests. A multivariable logistic regression analysis was completed to examine predictors of mesh exposure. All analyses used SAS for Windows version 9.2 (Cary, NC). Results Three hundred thirty-five women underwent repair from 2006 to 2011. Vaginal mesh exposure was identified in 27 (8.1%) of the 335 women. Patients with exposure had longer median follow-up than the group with no exposure (357 vs 145 days; P = 0.0003). The median time to exposure was 96 days (15–1129 days). Mesh exposure was associated with lower BMI (25.2 ± 2.5 vs 27.4 ± 5.1; P = 0.020) and greater &Dgr;Hgb (−3.7 ± 1.7 mg/dL vs −2.5 ±1.3; P = 0.0011). Change in hemoglobin decreased over time (P = 0.0005). Exposure rates also decreased over time (17% in 2005 to 12% in 2006, then 5%–8% in 2006–2011) but were not statistically significant (P = 0.49). Conclusions In this study, vaginal mesh exposure was only associated with &Dgr;Hgb and lower BMI.

Anatomy of Pelvic Support

Female pelvic anatomy can be a conceptual challenge. To understand the function of the pelvis, one must understand the basic anatomy and then the dynamic nature of the structures that allow for urinary and bowel continence in a variety of circumstances. An understanding of normal anatomy and function provides the clinician with a framework for understanding the pathophysiology of pelvic organ prolapse and female urinary incontinence. The evaluation of female urinary incontinence often involves the recognition and treatment of concurrent pelvic abnormalities, such as cystocele, uterine prolapse, enterocele, rectocele, or perineal laxity. The factors responsible for pelvic floor relaxation rarely affect isolated anatomic areas. This chapter provides a detailed description of normal female pelvic anatomy, and an emphasis is placed on key surgical landmarks for reestablishing normal anatomy.