LAparoscopic Preventive PRErectal Mesh

NCT ID: NCT03766048

Last Updated: 2023-02-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

834 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-11

Study Completion Date

2025-12-31

Brief Summary

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Urogenital prolapse is a frequent and invalidating pathology in women, involving the anterior vaginal wall and the uterus in most cases. Posterior vaginal wall prolapse is present in only 50% of cases. Surgery is an option for women with troublesome prolapse. A woman's lifetime risk of undergoing surgery for pelvic organ prolapse (POP) surgery by the age of 80 is around 19%. Laparoscopic sacrocolpopexy (LS) with synthetic non-absorbable mesh is considered the gold standard, with a composite success rate of 85% at one year (Prospere study). Based on early experience and historical habits, a prerectal mesh was used to be systematically placed in the rectovaginal space, in addition to the anterior and apical mesh placed in the vesicovaginal space, in order to prevent de-novo posterior prolapse (reported rates up to 33%).

The benefit of preventive prerectal mesh is questionned on the basis of a single retrospective study comparing 68 LS with double-mesh (anterior \& posterior, DM) to 32 LS with a single anterior mesh (SAM): posterior recurrence rates were respectively 5.9 vs. 31.3% (p\<0,01), and total recurrence rates 16.2 vs. 43.8% (p\<0.01). However, as this difference was not significant in the subgroup of patients without associated cervicocystopexy, the authors concluded that the risk of posterior failure was only due to the cervicocystopexy itself (anti-urinary incontinence procedure which has been abandoned since).

On the other hand, a prerectal mesh increases the risk for specific complications: rectal injury (up to 3%), anal pain (up to 25%), mesh exposition (up to 2%). Furthermore the posterior mesh increases the procedure by a minimum of 30 minutes (Robolaps study, unpublished data). The rate of de-novo obstructed defecation after LS with prerectal mesh is reported up to 25%. It could be explained by the mesh itself, but also by nerve injuries during the dissection of the rectovaginal space and rectal stalks.

Detailed Description

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Conditions

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Urogenital Prolapse

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Single-Anterior-Mesh, SAM

Group Type EXPERIMENTAL

Single-Anterior-Mesh, SAM

Intervention Type PROCEDURE

laparoscopic sacropexy is only performed with the anterior mes

Double-Mesh, DM

Group Type SHAM_COMPARATOR

Double-Mesh, DM

Intervention Type PROCEDURE

laparoscopic sacropexy is performed using two synthetic non-absorbable meshes, both sutured to the promontory (Double-Mesh, DM): one mesh is placed in the vesicovaginal space and sutured to the uterine cervix or vaginal apex, and one mesh is placed in the rectovaginal space

Interventions

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Single-Anterior-Mesh, SAM

laparoscopic sacropexy is only performed with the anterior mes

Intervention Type PROCEDURE

Double-Mesh, DM

laparoscopic sacropexy is performed using two synthetic non-absorbable meshes, both sutured to the promontory (Double-Mesh, DM): one mesh is placed in the vesicovaginal space and sutured to the uterine cervix or vaginal apex, and one mesh is placed in the rectovaginal space

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Women with a urogenital prolapse (anterior wall and/or uterus or vaginal apex) stage = 2 (Ba and/or C points ≥ - 1 cm using the POP-Q system),
* without significant posterior vaginal wall prolapse (Bp \< -1 cm when apical prolapse is reduced using a retractor leaving the posterior vaginal wall free),

Exclusion Criteria

* Previous surgical repair for Pelvic Organ Prolapse
* Any associated prolapse requiring any non-authorized additional surgical repair (Authorized additional surgical procedures are hysterectomy, ovariectomy, adnexectomy, salpingectomy, myomectomy, or suburethral vaginal tape.)
* Wish for future pregnancy
* Lack of health insurance
* Woman not reading French or unable to consent
* Woman under law protection
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Ministry of Health, France

OTHER_GOV

Sponsor Role collaborator

University Hospital, Lille

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jean-Philippe LUCOT, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Lille

Locations

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Hopital Estaing

Clermont-Ferrand, , France

Site Status RECRUITING

Ch Dunkerque

Dunkirk, , France

Site Status RECRUITING

Hopital Saint-Louis - La Rochelle

La Rochelle, , France

Site Status RECRUITING

Clinique Du Pre

Le Mans, , France

Site Status RECRUITING

Hop Jeanne de Flandre Chu Lille

Lille, , France

Site Status RECRUITING

Hopital Saint Vincent - Saint Antoine

Lille, , France

Site Status RECRUITING

Chu de Nice Hopital de L'Archet

Nice, , France

Site Status RECRUITING

Chu Nimes - Nimes

Nîmes, , France

Site Status RECRUITING

Chi Poissy St Germain Site de Poissy

Poissy, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Jean-Philippe LUCOT, MD,PhD

Role: CONTACT

(0)3 21 45 62 ext. +33

Facility Contacts

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Role: primary

0320445962

Role: primary

0320445962

Other Identifiers

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2018-A01487-48

Identifier Type: OTHER

Identifier Source: secondary_id

PHRCN-17-0226

Identifier Type: OTHER

Identifier Source: secondary_id

2017_74

Identifier Type: -

Identifier Source: org_study_id

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