Pelvic organ prolapse (POP) constitutes a significant clinical and social problem. The symptoms worsen when intra-abdominal pressure increases, for instance during physical activity or coughing. The number of patients suffering from pelvic organ prolapse is not exactly known due to different definitions of the disorder and various systems of classification. According to the latest European data, the ailment concerns approximately 6-11% of women. American data suggest that the disorder is found in about 24% of women. The incidence of the problem increases with the age of female patients up to 80 years of age. In such cases, the need to perform surgery is determined in 20% of women [1,2,3].
Currently, the basic indication for surgical treatment is the occurrence of symptoms and ineffective conservative treatment. and the lack of consent of the patient for conservative treatment or ineffective conservative treatment. Surgery may be warranted if if there are symptoms associated with prolapse such as:
- strain and/or pain in the lower abdomen;
- urinary and/or faecal incontinence;
- recurrent bladder ailments (urinary urgency or pollakiuria);
- difficulty urinating and/or defecating;
- the need to change body position in order to urinate;
- limited sexual activity [4].
Due to various methods of procedural treatment, eligibility for surgery should be carefully discussed with the patient. Ideally, the surgery should be effective and with the least possible number of complications.
In 1990, A. Wattiez [5] performed the first laparoscopic sacrocolpopexy, which is a gold standard for treating pelvic floor static disorders. The surgery involves the reconstruction of pelvic fascia using an implant. The Y-shaped posterior mesh is attached to the puborectalis muscles and above, to the vaginal stump or the uterine cervix. While the front mesh is attached to the vagina to the level of the bladder trigone, pubovaginal fascia or vesicovaginal fascia Both mesh implants are joined and after opening the peritoneum they are stitched to the longitudinal ligament of the vertebral column. Then, the peritoneum is closed over the mesh [6].
The surgery gives very good treatment results in the absence of complications typical for vaginal mesh implants. Unfortunately, due to the fact that the patient is in the Trendelenburg position during surgery and on account of the long surgery time of approximately 180 minutes [7], laparoscopic sacrocolpopexy is not a solution that can be performed on every patient.
Therefore, new solutions have appeared, such as Noe's [8] pectopexy (the suspension of the Cooper's ligament) and the Dubuisson's laparoscopic lateral suspension [9].
Nevertheless, it seems that in the case of older patients with a history of internal diseases, for whom laparoscopic or abdominal surgeries under general anaesthesia may pose too high risks, the only alternative is transvaginal surgery. Afterwards, the vaginal suspension to the sacrospinous ligament, developed by Amreich in 1951 [10], and then modified by Sederl and Richter, [11] should be considered. This method involves putting stitches on the sacrospinous ligaments visualising them. According to the latest scientific reports, this method is as effective as any other vaginal approach for prolapse repair, but have a higher reoperation rate than sacrocolpopopexy [12]. Therefore, it is necessary to find a method which would combine low invasiveness of transvaginal surgery with high efficiency.
Transvaginal surgeries performed under block anaesthesia, with the use of synthetic materials, giving good results in most studies [13], seemed to be a good solution.
However, due to the possibility of complications, such as mesh erosion and pain associated with its implantation, in 2011, the U.S. Food and Drug Administration (FDA) issued a warning, and in 2019 withdrew the vaginal mesh implants from the US market [14].
Complications related to the use of the mesh include the possibility of its erosion. The incidence or risk of mesh erosion is likely to be decreased by the use of small mesh implants with a monoporous texture that reduce the burden of biomaterials. What is more, mesh should be lightweight and macroporous. As a consequence of the preparation and attachment of the mesh near the pudendal nerve and pudendal vessels, the possibility of damage to the above structures, including neuralgia or haemorrhage may arise [15]. Pelvic organ prolapse significantly reduces the quality of life for women. The most common problems include incomplete bladder voiding, chronic urine retention, interrupted or impeded urination, as well as the need to support urination by engaging the abdominal prelum or the need to change body position in order to urinate [16,17]. Nowadays, doctors not only focus on extending the life of their patients, but also on improving its quality. Contemporary medicine aims to improve the quality of life of the patient to the condition from before the disease. Therefore, researchers are increasingly interested in assessing quality of life of people affected by various diseases [18,19].
The objective of this study was to assess the quality of life of patients before and after performing the surgery of an isolated apical defect using BSC synthetic mesh.