1392 EFFECTS OF ESTROGEN TREATMENT ON MESH-AUGMENTED VAGINAL PROLAPSE REPAIR

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20101392 EFFECTS OF ESTROGEN TREATMENT ON MESH-AUGMENTED VAGINAL PROLAPSE REPAIR Colin Goudelocke, Matthew McIntyre, Brett Lebed, Walker Nickles, and Eric Rovner Colin GoudelockeColin Goudelocke Mount Pleasant, SC More articles by this author , Matthew McIntyreMatthew McIntyre Charleston, SC More articles by this author , Brett LebedBrett Lebed Charleston, SC More articles by this author , Walker NicklesWalker Nickles Charleston, SC More articles by this author , and Eric RovnerEric Rovner Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The surgical treatment of pelvic organ prolapse may be associated with failure and need for recurrent surgery. The use of synthetic mesh augmentation may improve failure rates in prolapse surgery, but may introduce added risks of dyspareunia, mesh erosion or mesh extrusion. It is unclear whether the presence of estrogen preoperatively effects short term outcomes in these cases. We sought to determine if pre-operative oral or topical estrogen influences the rates of success or complications associated with prolapse repair with synthetic mesh. METHODS A retrospective chart review was conducted for 134 consecutive patients undergoing mesh-supplemented anterior or posterior repair at the Medical University of South Carolina by two surgeons from March 2005 through October 2009. Of those, status of topical or oral estrogen treatment could be determined for 120 patients, who were included in the analysis. All patients received complete preoperative evaluation including history, physical exam and urinalysis. Video urodynamic evaluations were performed as indicated by symptoms or physical exam. Preoperative status was determined by a combination of patient self-report, visit notes and computerized medication record. Postoperative evaluation included history and physical exam with mean follow-up of 7.3 months for the entire population. RESULTS Of patients undergoing mesh prolapse repair, 16 (13%) received topical estrogen, 24 (20%) received oral estrogen and 80 (66%) received no estrogen therapy prior to surgery. Mean blood loss was not significantly different between those treated with estrogen (168 ml) and those not treated (173 ml; p = 0.41). There were no urethral, bladder or rectal injuries, nor were any subsequent erosions into the bladder or urethra detected in either group. Rates of anterior and posterior recurrence were not significantly different between the groups: 16% anterior and 3% posterior in the estrogen group versus 11% anterior and 9% posterior in the non-estrogen group (p=0.20 and p=0.11). Rates of vaginal extrusion were found to be significantly higher in the non-estrogen group (6%) versus the estrogen group (0%; p=0.05), though subsequent mesh excision was not found to be significantly different. CONCLUSIONS Preoperative presence of estrogen, oral or topical, prior to vaginal prolapse repair using synthetic mesh, was shown to be associated with lower rates of vaginal extrusion, though rates of mesh excision were similar. The use of estrogen did not significantly affect recurrence of prolapse. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e538 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Colin Goudelocke Mount Pleasant, SC More articles by this author Matthew McIntyre Charleston, SC More articles by this author Brett Lebed Charleston, SC More articles by this author Walker Nickles Charleston, SC More articles by this author Eric Rovner Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...