Medium-term follow-up on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures

Medium-term follow-up on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures
August 2004
Received: 8 November 2002 Accepted: 3 March 2003 Published online: 14 May 2004
Mary Pat FitzGerald1 , S. Renee Edwards2 and Dee Fenner3
International Urogynecology Journal and Pelvic Floor Dysfunction
Issue: Volume 15, Number 4
SpringerLink
Abstract The aim of this study was to document longer-term follow-up of patients in a previously reported series who underwent either sacrocolpopexy (SCP) or suburethral sling procedures utilizing freeze-dried, irradiated donor fascia. Subjects from the initial series of 67 SCPs and 35 slings were included in this retrospective chart review of postoperative follow-up where surgical follow-up longer than 3 months from the procedure was available. Subjects undergoing SCP were examined at the time of any clinical visit and their pelvic organ support evaluated utilizing the POP-Q system. The SCP procedure was considered to be unsuccessful if any anterior vaginal wall point (Aa or Ba) was at the hymen or beyond, or if the vaginal apical point (C or D) descended to a point at least halfway to the hymen from a position of perfect apical support. Subjects who did not return for clinical examination after their 3-month postoperative visit but who had been in telephone contact with the clinic stating that they had experienced symptomatic recurrence of their POP were also included as having unsuccessful SCP procedures. Those similarly in contact with the office by telephone, but not clinically examined, who indicated no subjective return of their POP, were coded as successful. The outcome of the sling procedure was primarily evaluated subjectively, with the patient indicating that stress incontinence symptoms were present or absent. Follow-up was available for 75 patients, who had undergone 54 SCP and 27 sling procedures (6 patients had undergone both SCP and sling procedures). When failure was defined according to any of the criteria listed in the methods section, 45 (83%) patients experienced SCP failure at a median of 12 months after surgery. A total of 14 (52%) sling procedures were failures, with recurrent SUI symptoms experienced from 2 weeks to 24 months (median 3 months) after the procedure. One year after surgery, 23 (43%) SCPs were known to be failures, and 11 (41%) slings were known to be failures. The remaining 13 (48%) slings were subjectively successful when last seen 7?51 months after surgery. We reoperated on 21 (40%) patients. At the time of repeat SCP (chosen by 16 patients) we found graft between the sacrum and vagina in just 3 patients (19%). The use of freeze-dried, irradiated donor fascia for both SCP and sling procedures was associated with an unacceptably high failure rate in our series.
Keywords Donor fascia - Sacrocolpopexy - Sling procedure
Abbreviations SCP Sacrocolpopexy
Editorial Comment: In this paper the authors present the follow-up results of 67 sacrocolpopexy and 35 sling procedures. Follow-up was available in 73% of cases and ranged between 3 and 54 months, with an average of 17 months. The cases are identical to those presented in an earlier work entitled Functional failure of fascia lata allografts, published in the American Journal of Obstetrics and Gynecology in 1999, in which the focus was on 12 reoperations done for failures encountered up to that point. The histologic and gross appearances of utilized allografts were the focus of that earlier work. In the latest manuscript 21 patients from the same original pool of 102 cases had undergone reoperation. The focus of this article is on their failure rate over the aforementioned time period.
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