Efficacy/Safety of Urogynecology Synthetic Mesh Surgery

NCT ID: NCT05682989

Last Updated: 2023-04-05

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

Total Enrollment

150 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-08-01

Study Completion Date

2027-12-31

Brief Summary

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This is a retrospective cohort study, aiming at analyzing the efficacy and safety of mesh surgery in pelvic organ prolapse. The synthetic mesh for pelvic organ prolapse include transvaginal mesh or laparotomy, laparoscope, or robotic-assisted laparoscopic sacrocolpopexy with mesh augmentation. The investigators would like to evaluate the efficacy and safety, such as recurrence rates and complication rates for women who underwent urogynecology mesh surgery.

Detailed Description

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Gynecologic mesh, including transvaginal mesh and mesh used in abdominal or laparoscopic sacrocolpopexy, has been used for pelvic organ prolapse since its debut in the US in 2005. It provides higher success and satisfaction rate than traditional colporrhaphy, but mesh-related complications, such as pain, mesh exposure and bleeding, have been reported. U.S. Food and Drug Administration issued a Safety Update in 2011 to inform the public that serious complications associated with synthetic mesh for the transvaginal repair of POP were common. Taiwan FDA and associated committees decided that the use of gynecologic mesh should be regulated. Thorough study and evaluation are needed.

Conditions

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Pelvic Organ Prolapse Stage III and IV High Grade Pelvic Organ Prolapse

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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mesh surgery

Data obtained before the operation

Urodynamic investigations before and after a mesh surgery protocol.

Intervention Type PROCEDURE

Urodynamic investigations (The urodynamic study included free uroflowmetry, postvoid residual, filling and voiding cystometry, and a urethral pressure profile. The filling cystometry and urethral pressure profile were performed with 37 degrees C normal saline similar to body temperature at an infusion rate of 80 ml/min.

Robotic-assisted sacrocolpopexy

Data obtained before the operation

Urodynamic investigations before and after a robotic-assisted sacrocolpopexy protocol.

Intervention Type PROCEDURE

All surgeries were performed using a DaVinci robotic system (Intuitive® Surgical Inc., Sunnyvale, California,US) with standardized technique and materials. Patients were positioned in dorsal lithotomy and steep Trendelenburg position. Trocars were placed bilaterally, and an assistant port was placed laterally. The peritoneum was opened medial to the ureter to develop an avascular space. The mesh was placed on the posterior and anterior vaginal wall and fixed at the level of anterior longitudinal ligaments S1/S2 by sutures. An intraoperative clinical examination was performed to ensure the mesh was in a tension-free position.

a hysterectomy with trans-vaginal mesh repair (Surelift®, Neomedic International, Barcelona, Spain)

Data obtained before the operation

Urodynamic investigations before and after a hysterectomy with trans-vaginal mesh repair

Intervention Type PROCEDURE

In summary, a vertical incision was made in the anterior vaginal wall to access the vesicovaginal space. The sacrospinous ligament was dissected, and an applicator was inserted and positioned over the SSL. The anchor was fixed to the SSL and the thread was attached to the mesh. The mesh was then adjusted in a tension-free manner, excess mesh was cut, and the incision was closed with suture.

Interventions

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Urodynamic investigations before and after a mesh surgery protocol.

Urodynamic investigations (The urodynamic study included free uroflowmetry, postvoid residual, filling and voiding cystometry, and a urethral pressure profile. The filling cystometry and urethral pressure profile were performed with 37 degrees C normal saline similar to body temperature at an infusion rate of 80 ml/min.

Intervention Type PROCEDURE

Urodynamic investigations before and after a robotic-assisted sacrocolpopexy protocol.

All surgeries were performed using a DaVinci robotic system (Intuitive® Surgical Inc., Sunnyvale, California,US) with standardized technique and materials. Patients were positioned in dorsal lithotomy and steep Trendelenburg position. Trocars were placed bilaterally, and an assistant port was placed laterally. The peritoneum was opened medial to the ureter to develop an avascular space. The mesh was placed on the posterior and anterior vaginal wall and fixed at the level of anterior longitudinal ligaments S1/S2 by sutures. An intraoperative clinical examination was performed to ensure the mesh was in a tension-free position.

Intervention Type PROCEDURE

Urodynamic investigations before and after a hysterectomy with trans-vaginal mesh repair

In summary, a vertical incision was made in the anterior vaginal wall to access the vesicovaginal space. The sacrospinous ligament was dissected, and an applicator was inserted and positioned over the SSL. The anchor was fixed to the SSL and the thread was attached to the mesh. The mesh was then adjusted in a tension-free manner, excess mesh was cut, and the incision was closed with suture.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Pelvic organ prolapse patients with objective / subjective voiding dysfunctions
* Underwent surgery for symptomatic POP ≥ stage II (POP-Q system)

Exclusion Criteria

* Patients with a history of pelvic radiation.
* Patients with a history of vesico-/recto-/urethra-vaginal fistula
* Patients unable to be followed up.
Minimum Eligible Age

30 Years

Maximum Eligible Age

100 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Mackay Medical College

OTHER

Sponsor Role lead

Responsible Party

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Chin-Tsung Shen

The Office of Research and Development

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hui-Hsuan Lau, M.D.

Role: STUDY_CHAIR

Department of Ear, Nose, and Throat, MacKay Memorial Hospital, Taipei, Taiwan

Locations

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Department of Obstetrics and Gynecology

New Taipei City, , Taiwan

Site Status RECRUITING

Countries

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Taiwan

Central Contacts

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Hui-Hsuan Lau, M.D.

Role: CONTACT

+886-975-835928

Facility Contacts

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Hui-Hsuan Lau, PhD

Role: primary

+886 975-835928

References

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Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, Drake M, Dubeau C, Fry C, Hanno P, Smith JH, Herschorn S, Hosker G, Kelleher C, Koelbl H, Khoury S, Madoff R, Milsom I, Moore K, Newman D, Nitti V, Norton C, Nygaard I, Payne C, Smith A, Staskin D, Tekgul S, Thuroff J, Tubaro A, Vodusek D, Wein A, Wyndaele JJ; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40. doi: 10.1002/nau.20870. No abstract available.

Reference Type BACKGROUND
PMID: 20025020 (View on PubMed)

GREEN TH Jr. Development of a plan for the diagnosis and treatment of urinary stress incontinence. Am J Obstet Gynecol. 1962 Mar 1;83:632-48. doi: 10.1016/s0002-9378(16)35894-x. No abstract available.

Reference Type BACKGROUND
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McGuire EJ, Lytton B, Kohorn EI, Pepe V. The value of urodynamic testing in stress urinary incontinence. J Urol. 1980 Aug;124(2):256-8. doi: 10.1016/s0022-5347(17)55396-3.

Reference Type BACKGROUND
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Ulmsten U, Johnson P, Rezapour M. A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence. Br J Obstet Gynaecol. 1999 Apr;106(4):345-50. doi: 10.1111/j.1471-0528.1999.tb08272.x.

Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 28479203 (View on PubMed)

Jiao B, Lai S, Xu X, Zhang M, Diao T, Zhang G. A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence. Medicine (Baltimore). 2018 Apr;97(14):e0283. doi: 10.1097/MD.0000000000010283.

Reference Type BACKGROUND
PMID: 29620645 (View on PubMed)

Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Lee J. Risk factors of treatment failure of midurethral sling procedures for women with urinary stress incontinence. Int Urogynecol J. 2010 Feb;21(2):149-55. doi: 10.1007/s00192-009-1020-9. Epub 2009 Oct 24.

Reference Type BACKGROUND
PMID: 19855914 (View on PubMed)

Ford AA, Ogah JA. Retropubic or transobturator mid-urethral slings for intrinsic sphincter deficiency-related stress urinary incontinence in women: a systematic review and meta-analysis. Int Urogynecol J. 2016 Jan;27(1):19-28. doi: 10.1007/s00192-015-2797-3. Epub 2015 Jul 29.

Reference Type BACKGROUND
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Sand PK, Bowen LW, Panganiban R, Ostergard DR. The low pressure urethra as a factor in failed retropubic urethropexy. Obstet Gynecol. 1987 Mar;69(3 Pt 1):399-402.

Reference Type BACKGROUND
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McGuire EJ, Fitzpatrick CC, Wan J, Bloom D, Sanvordenker J, Ritchey M, Gormley EA. Clinical assessment of urethral sphincter function. J Urol. 1993 Nov;150(5 Pt 1):1452-4. doi: 10.1016/s0022-5347(17)35806-8.

Reference Type BACKGROUND
PMID: 8411422 (View on PubMed)

Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14(2):131-9. doi: 10.1002/nau.1930140206.

Reference Type BACKGROUND
PMID: 7780440 (View on PubMed)

Kenton K, Stoddard AM, Zyczynski H, Albo M, Rickey L, Norton P, Wai C, Kraus SR, Sirls LT, Kusek JW, Litman HJ, Chang RP, Richter HE. 5-year longitudinal followup after retropubic and transobturator mid urethral slings. J Urol. 2015 Jan;193(1):203-10. doi: 10.1016/j.juro.2014.08.089. Epub 2014 Aug 23.

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Foss Hansen M, Lose G, Kesmodel US, Gradel KO. Reoperation for urinary incontinence: a nationwide cohort study, 1998-2007. Am J Obstet Gynecol. 2016 Feb;214(2):263.e1-263.e8. doi: 10.1016/j.ajog.2015.08.069. Epub 2015 Sep 5.

Reference Type BACKGROUND
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Sun MJ, Chuang YL, Lau HH, Lo TS, Su TH. The efficacy and complications of using transvaginal mesh to treat pelvic organ prolapse in Taiwan: A 10-year review. Taiwan J Obstet Gynecol. 2021 Mar;60(2):187-192. doi: 10.1016/j.tjog.2021.01.031.

Reference Type BACKGROUND
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Lau HH, Lai CY, Hsieh MC, Peng HY, Chou D, Su TH, Lee JJ, Lin TB. Pressure-volume analysis of thermodynamic workload of voiding - an application in pelvic organ prolapse patients subjected to robotic-assisted sacrocolpopexy. Biomed Eng Lett. 2024 Dec 30;15(2):357-365. doi: 10.1007/s13534-024-00453-5. eCollection 2025 Mar.

Reference Type DERIVED
PMID: 40026886 (View on PubMed)

Other Identifiers

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22MMHIS361e

Identifier Type: -

Identifier Source: org_study_id

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