Pelvic Organ Prolapse: Surgical Repair with Tailored Prolene Mesh

Abstract

Introduction:

The repair of pelvic organ prolapse (POP) with or without stress urinary incontinence (SUI) has evolved over time. The increasing prevalence of POP and SUI has led to the development of many commercial kits (CK). The downside of CK is their high cost. Off-the-shelf Prolene mesh can be tailored to any clinical need and has robust long-term outcomes. ^1,2 Surgeon-tailored Prolene mesh (STPM) for the treatment of SUI with or without POP has recently been found to be more cost effective than CK. ³ We aim to describe the repair of POP with SUI using STPM in a step-wise fashion in an 8-min video. Also, we compare the operative costs associated with the use of CK, with or without biomaterials, with STPM in the treatment of SUI with or without POP.

Methods:

The video shows our operative technique using STPM for the treatment of a patient with POP along with SUI. The technique entails a single vaginal incision, tailoring the mesh to a patient-specific defect, tension-free retropubic support of mid and proximal urethra, apical support at the level of the sacrospinalis using a Capio device, and posterior use of mesh as needed. A cost analysis was also performed by reviewing all operations at a single institution for uncomplicated SUI with or without POP from 2007 to 2008. Operative billing data, including operative time, hospital cost, and the insurance billing statement, were obtained and reviewed. Surgeon payment was not included in this analysis. Hospital stay was also compared between the two groups.

Results:

A total of 45 patients were identified and included in this analysis of which 20 had SUI alone (A), 16 had SUI and anterior compartment prolapse (B), and 9 had SUI and both anterior and posterior compartment prolapse (C). For group A, on average, the insurance billing statements for STPM were $2,220 less per case as compared with CK (p < 0.001). For group B, on average, the insurance billing statements for STPM were $4,770 less per case as compared with CK (p < 0.001). For group C, on average, the insurance billing statements for STPM were $5,600 less per case as compared with CK (p = 0.11). There was no significant difference in operative time or hospital stay.

Conclusions:

The use of STPM for the treatment of POP with SUI is feasible and has long-term durable results. STPM compared with CK is significantly less costly for the hospital and the patient and/or insurance company. STPM does not increase hospital stay or operative time compared with prefashioned kits. We demonstrate our technique in a step-wise fashion in this short video.

Accepted for presentation at the annual meeting of the American Urological Association, San Francisco, CA, May 29–June 3, 2010.

No competing financial interests exist.

Runtime of video: 8 min