Application of a Mixed Material Graft to Posterior Intravaginal Slingoplasty Procedure: Preliminary Pilot Series

Abstract

Good anatomic outcomes have been achieved with transvaginal synthetic materials in pelvic organ prolapse, but mesh-related complications are a major health concern. Therefore, developing new synthetic or biological materials with increased tissue strength and decreased complications are major challenges. This paper presents preliminary pilot series of Posterior Intravaginal Slingoplasty (PIVS) procedure performed with mixed material graft containing both autologous tissue and a synthetic material. Six women with symptomatic Utero-Vaginal Prolapse (UVP) ≥ stage 2 underwent the PIVS procedure. Pelvic floor symptoms were assessed with the Pelvic Organ Prolapse Quantification (POP-Q) system, Pelvic Floor Distress Inventory (PFDI), and the Pelvic Floor Impact Questionnaire (PFIQ) both before the procedure and 36 months after the surgery. There were no mesh-related complications or recurrence and all the patients had good functional and anatomic outcomes. These preliminary results are promising, but further long-term studies with a larger series are needed.

Keywords: Autologous graft; Polypropylene mesh; Utero-vaginal prolapsed.

[Table/Fig-2]:

Preperation of mixed material graft containing both autologous vaginal tissue and a synthetic material. a) The extraction of excess vaginal tissue of ~5 cm from each side during the cystocele operation, b) Preparation of the vaginal tissue, showing the outer surface of the vaginal epithelium being scraped with a scalpel, c) The integration of the full-thickness vaginal tissue into the polypropylene tape (The polypropylene tapes were sutured with No. 3/0 polypropylene to the newly formed (~10 cm) vaginal tissue on each side). (Images up to down)

[Table/Fig-3]:

The application of mixed material graft in the PIVS procedure. a) Suturing the mixed material graft from the center of the vaginal tissue to the utero-sacral ligaments, b) The vaginal tissue-based tape with the polypropylene mesh arms was then pulled through the buttock incisions. (Images up to down) (PM: polypropylene mesh, C: cervix, VT: vaginal tissue, SU: sacrouterine ligament).