[Vaginal reconstruction for the remedy of pelvic organ prolapse: the effect, influence on urinary and sexual function and quality of life in two-years follow-upPart I. Vaginal status and complications].

Objective: To evaluate the effect, risks and benefits of vaginal reconstruction surgery for pelvic organ prolapse (POP). This article (part I of the study) focuses on the vagina - POP-Q status, complications, re-operations.

Design: Clinical prospective non-randomized trial, two years follow-up.

Setting: Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.

Materials and Methods: The cohort consisted of 410 women who underwent anterior and/or posterior vaginal repair (with or without hysterectomy or anti-incontinence procedure) in our hospital in the two years period (1. 3. 2012 - 28. 2. 2014). From among the total, 297 women received transvaginal mesh (TVM group), 113 women underwent "native tissue reconstruction" - NT group. Vaginal status was evaluated pre-operative, in the early postoperative period and 2 - 6 - 12 and 24 month after the surgery.

Results: The number of women that had come to the vaginal investigation at 2 - 6 - 12 - 24 month in NT group: 96 - 49 - 58 - 65, in TVM group: 277 - 218 - 228 - 222. All percentage relates then to the number of vaginally checked cases in the appropriate time. The most distal point of vagina: NT group - preoperative mean 1,12 (median +1), after two years mean -1,30 (median -1). Vaginal wall reaching hymen or 1 cm under it found in 24 women (36.9%), POP stage III, IV, i.e. decrease 2 cm, was in two women (3.1%). TVM group: preoperative mean 2.93 (median +2), after two years mean -1.73 (median -2). Prolapse 0-1 cm under hymen developed in 39 women (17.6%), POP stage III, IV found in five women (2.3%). Clinically significant complications (symptomatic and/or dehiscence >1 cm) in the hospital period and after 2 - 6 - 12 - 24 month in NT group: 3.5% - 12.5% - 2% - 0 - 0 of the checked women, in TVM group these numbers were 3.5% - 12.3% - 8.7% - 6.1% - 3.2%. Reoperation for recurrent POP: in NT group once (0.9%), in TVM group three times (1.0%). Reoperation for vaginal complication after NT operation: six times (5.3%), after TVM procedure 15 times (5.1%). Protrusion resection from the above done in nine cases (three times resection itself, six times in combination with another indication).

Conclusion: The vaginal reconstruction of POP has a good effect with acceptable rate of complications. The NT procedure had the higher percentage of POP recurrence (40% vs 19.9%), the TVM surgery had more late vaginal complications (6...3% vs 0 after NT). Number of re-operations for vaginal complications was similar in both groups (about 5%).