Presentation Authors: Fahad Chaus*, Jayce Pangilinan, Joel Funk, Christian Twiss, Tucson, AZ
Introduction: Since the reclassification of transvaginal mesh as a high-risk device, there is renewed interest in non-mesh pelvic organ prolapse (POP) repair. Our goal was to develop a transvaginal repair for anterior and apical vaginal prolapse with the use of only autologous fascia lata graft. We report our experience in our first 33 patients.
Methods: Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair utilizes a 4 cm x 14 cm piece of fascia lata harvested through a single 3-4 inch lateral upper thigh incision. The graft is cut into 3 strips approximately 1.3 cm x 14 cm which are reconfigured to provide apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia at the level of the bladder neck. Patients were followed by history, SEAPI scores, POP-Q scores, and symptoms related to thigh harvest including visual analog pain (VAP) scores. Treatment failure was defined as symptomatic anterior and/or apical POP.
Results: The AAA-POP procedure was performed on 33 patients with a mean age of 62. Mean follow-up was 8 months (range 1-25 months), with 10 patients having 12 or more months of follow-up. 13 patients had prior vaginal mesh removal. POP symptoms resolved in 32 patients, and there was one treatment failure (Stage II uterine POP). Ten patients developed post-operative retention, 9 of whom had undergone concurrent pubovaginal sling. Four of the retention patients required urethral dilation, and five underwent sling lysis. The overwhelming majority of harvest site issues were minor and managed expectantly. Mean VAP score at the harvest site was 0.24. Five patients developed non-bothersome thigh bulges, all of which were managed expectantly. Harvest site seroma occurred in 4 patients and all resolved with 2 requiring simple aspiration. Eight patients reported mild, non-bothersome harvest site paresthesia. No thromboembolic events occurred.
Conclusions: AAA-POP repair is an efficacious treatment for the mesh-injured and other patients who desire non-mesh POP repair. Patients should be counseled regarding harvest site issues, which typically resolve with expectant management alone. Patients undergoing concurrent pubovaginal sling should be counseled regarding the risk of urinary retention. Continued follow-up of this series is ongoing to determine long-term success of AAA-POP repair.