Pelvic Organ ProlapseNCT04139083
The Clinical Outcome of TVM or LSC Mesh Suspension for POP
An observational study of Pelvic Organ Prolapse, run by Kaohsiung Medical University Chung-Ho Memorial Hospital at 1 site in Taiwan.
Trial summary
The investigators aim to assess the surgical outcomes of transvaginal mesh (TVM) and laparoscopic (LSC) mesh suspension. During the study period, all women with main uterine prolapse stage II or greater defined by the POP quantification staging system receiving TVM or LSC mesh suspension were retrospectively… Read more about this study
- Who is it for?
- Ages 20 to 85 years, women only
- Conditions the study is for
- Pelvic Organ Prolapse
- What is being tested?
- LSC mesh suspension and TVM
- Type of treatment
- Surgery or procedure
- How many people
- 466 participants
- Where
- 1 siteTaiwan
- Study dates
- 1 Jan 2012to 31 Dec 2018
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 85 years
- Women only
- No healthy volunteers
- Adult, Older adult
Study population: Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system
Who may be able to join
- Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system
Who cannot join
- A hypertrophic uterus, huge fibroids
- History of cervical dysplasia or endometrial pathology
- History of postmenopausal bleeding in the past 12 months
- Unwilling to preserve their uterus
Trial locations and contacts
1 site in 1 country.
Taiwan1 site
Kaohsiung Medical University Chung-Ho Memorial Hospital
Kaohsiung City, 807
About this study
Official title: The Clinical and Urodynamic Effects of Transvaginal or Laparoscopic Mesh Suspension for the Treatment of Pelvic Organ Prolapse
The investigators aim to assess the surgical outcomes of transvaginal mesh (TVM) and laparoscopic (LSC) mesh suspension. During the study period, all women with main uterine prolapse stage II or greater defined by the POP quantification staging system receiving TVM or LSC mesh suspension were retrospectively recruited. Clinical evaluations before and 6 months after surgery included pelvic examination, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms using questionnaires.
Read the detailed description
All women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system receiving TVM or LSC mesh suspension surgeries at a tertiary referral center in Taiwan were included. The investigators excluded women with a hypertrophic uterus, huge fibroids, history of cervical dysplasia or endometrial pathology, history of postmenopausal bleeding in the past 12 months, and those unwilling to preserve their uterus. Concomitant mid-urethral sling operations were performed in women with current urodynamic stress incontinence unless the participants did not prefer a concomitant surgery. Cervical amputation was performed if the corpus/cervix ratio was less than 1 on the ultrasound. Concomitant anterior and posterior colporrhaphy were performed as needs.
The clinical evaluations consisted of a detailed history before and 6 months after surgery, including urinary analysis, pelvic examination using POP-Q system, urodynamic studies (UDS), transabdominal ultrasound, and personal interview to identify urinary and sexual symptoms with the Overactive Bladder Symptom Score (OABSS), the short forms of Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI) questionnaire, and the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Urinary symptoms with the standardized questionnaire taking into account the 2002 ICS definitions. The participants were asked to fill out the visual analog scale (VAS) scores during the postoperative day 1 round. Urodynamic studies, including non-instrumented uroflowmetry, filling and voiding cystometry, and urethral pressure profilometry, were performed according to the recommendations by the International Continence Society with a 6-channel urodynamic monitor (MMS; UD2000, Enschede, Netherlands). Any uninhibited detrusor contraction during filling cystometry was deemed positive for detrusor overactivity (DO).
As a follow-up, postoperative outpatient visits were at 1, 2, 3, 6, and 12 months and then semiannually beyond one year. Pelvic examination was performed routinely in every visit to clinics. Recurrence was defined as the most dependent portion of POP stage II or greater. The Clavien-Dindo grading was used for the classification of the intraoperative and postoperative complications of Long mesh surgery.
- Conditions
- Pelvic Organ Prolapse
- Being tested
- LSC mesh suspension, TVM
- Keywords
- Pelvic organ prolapse, Transvaginal mesh, Laparoscopic mesh suspension
- Medical subject headings
- Pelvic Organ Prolapse
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
LSC mesh suspensionProcedure or surgery
Long mesh, a synthetic T-shaped mesh (Gynemsh, Ethicon, San Lorenzo, Puerto Rico), is delivered into the pelvic cavity. Bilateral mesh arms are extracted outside trocar wounds bilaterally to stabilize mesh position. The center piece is fixed to the cervix with 5mm ProTack screws (Covidien, New Haven, Connecticut). Fixation is strengthened with Stratafix 2-0 sutures (Ethicon, Norderstedt, Germany), followed by Tisseel fibrin sealant (Baxter, Deerfield, Illinois) for better hemostasis among surrounding tissues. An extraperitoneal tunnel is created along the left round ligament until reaching 2cm medial to the anterior superior iliac spine (ASIS). One arm of the long mesh is pulled out along the tunnel underneath round ligament and fixed with the fascia of oblique abdominis. The same procedure is repeated for the contralateral side. Bilateral round ligaments and the mesh arms are sutured continuously with Stratafix 2-0.
TVMProcedure or surgery
Transvaginal mesh kit is delivered into the pelvis via vagina route.
| Study group | Role | What they receive |
|---|---|---|
| TVM group | Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system treated with TVM Receives: Procedure: TVM | |
| LSC mesh suspension group | Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system treated with LSC mesh suspension Receives: Procedure: LSC mesh suspension |
What is being measured
The primary outcome is the main question the study is designed to answer.
Recurrence
The POP-Q stage measurement after the operation
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Oct 2019
- Study start1 Jan 2012
- Primary completion31 Dec 2018
- Study completion31 Dec 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Pelvic Organ ProlapseStudies of the same condition, open and under way.
- More trials run by Kaohsiung Medical University Chung-Ho Memorial HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 466 participants (actual)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Cheng-Yu Long, PhD, Principal investigator, Kaohsiung Municipal University Chung-Ho Memorial Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04139083
- Sponsor's protocol ID
- KMUHIRB-E(I)-20190015
- Status last verified
- Jan 2019
- First submitted
- 23 Oct 2019
- Last updated
- 28 Oct 2019
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen MI. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016 Apr;27(4):655-84. doi: 10.1007/s00192-016-3003-y.
PubMed 26984443Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Lopes VV, Harvie HS, Sung VW. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013 Nov;209(5):470.e1-6. doi: 10.1016/j.ajog.2013.08.003. Epub 2013 Aug 3.
PubMed 23921090Wu MP, Long CY, Huang KH, Chu CC, Liang CC, Tang CH. Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study. Int Urogynecol J. 2012 Jul;23(7):865-72. doi: 10.1007/s00192-011-1647-1. Epub 2012 Jan 24.
PubMed 22270728Long CY, Wang CL, Ker CR, Juan YS, Tsai EM, Lin KL. Laparoscopic Organopexy with Non-mesh Genital (LONG) Suspension: A Novel Uterine Preservation Procedure for the Treatment of Apical Prolapse. Sci Rep. 2018 Mar 20;8(1):4872. doi: 10.1038/s41598-018-23285-7.
PubMed 29559709Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016 Oct 1;10(10):CD012376. doi: 10.1002/14651858.CD012376.
PubMed 27696355Long CY, Hsu CS, Wu CH, Liu CM, Wang CL, Tsai EM. Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2012 Mar;161(1):105-8. doi: 10.1016/j.ejogrb.2011.12.007. Epub 2012 Jan 9.
PubMed 22226537Ker CR, Lin KL, Loo ZX, Juan YS, Long CY. Comparison of UpholdTM Vaginal Mesh Procedure with Hysterectomy or Uterine Preservation for the Treatment of Pelvic Organ Prolapse. Sci Rep. 2018 Jun 21;8(1):9438. doi: 10.1038/s41598-018-27765-8.
PubMed 29930249
Study at a glance
From the registry record, last updated by the sponsor on 28 Oct 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Clinical and Urodynamic Effects of Transvaginal or Laparoscopic Mesh Suspension for the Treatment of Pelvic Organ Prolapse
- ClinicalTrials.gov ID
- NCT04139083
- Acronym / sponsor ID
- KMUHIRB-E(I)-20190015
- Conditions
- Pelvic Organ Prolapse
- Keywords
- Pelvic organ prolapse, Transvaginal mesh, Laparoscopic mesh suspension
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 466 participants (actual)
- Lead sponsor
- Kaohsiung Medical University Chung-Ho Memorial HospitalUniversity, hospital or other
- Study start
- 1 Jan 2012 (actual)
- Primary completion
- 31 Dec 2018 (actual)
- Study completion
- 31 Dec 2018 (actual)
- First posted
- 25 Oct 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators aim to assess the surgical outcomes of transvaginal mesh (TVM) and laparoscopic (LSC) mesh suspension. During the study period, all women with main uterine prolapse stage II or greater defined by the POP quantification staging system receiving TVM or LSC mesh suspension were retrospectively recruited. Clinical evaluations before and 6 months after surgery included pelvic examination, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms using questionnaires.
Detailed description
All women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system receiving TVM or LSC mesh suspension surgeries at a tertiary referral center in Taiwan were included. The investigators excluded women with a hypertrophic uterus, huge fibroids, history of cervical dysplasia or endometrial pathology, history of postmenopausal bleeding in the past 12 months, and those unwilling to preserve their uterus. Concomitant mid-urethral sling operations were performed in women with current urodynamic stress incontinence unless the participants did not prefer a concomitant surgery. Cervical amputation was performed if the corpus/cervix ratio was less than 1 on the ultrasound. Concomitant anterior and posterior colporrhaphy were performed as needs.
The clinical evaluations consisted of a detailed history before and 6 months after surgery, including urinary analysis, pelvic examination using POP-Q system, urodynamic studies (UDS), transabdominal ultrasound, and personal interview to identify urinary and sexual symptoms with the Overactive Bladder Symptom Score (OABSS), the short forms of Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI) questionnaire, and the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Urinary symptoms with the standardized questionnaire taking into account the 2002 ICS definitions. The participants were asked to fill out the visual analog scale (VAS) scores during the postoperative day 1 round. Urodynamic studies, including non-instrumented uroflowmetry, filling and voiding cystometry, and urethral pressure profilometry, were performed according to the recommendations by the International Continence Society with a 6-channel urodynamic monitor (MMS; UD2000, Enschede, Netherlands). Any uninhibited detrusor contraction during filling cystometry was deemed positive for detrusor overactivity (DO).
As a follow-up, postoperative outpatient visits were at 1, 2, 3, 6, and 12 months and then semiannually beyond one year. Pelvic examination was performed routinely in every visit to clinics. Recurrence was defined as the most dependent portion of POP stage II or greater. The Clavien-Dindo grading was used for the classification of the intraoperative and postoperative complications of Long mesh surgery.
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| TVM group | – | Procedure: TVMWomen with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system treated with TVM |
| LSC mesh suspension group | – | Procedure: LSC mesh suspensionWomen with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system treated with LSC mesh suspension |
Who may qualify
- Ages
- 20 to 85 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system
Key inclusion criteria (1 listed)
- Women with mainly uterine prolapse stage II or greater as defined by the POP-Q staging system
Key exclusion criteria (4 listed)
- A hypertrophic uterus, huge fibroids
- History of cervical dysplasia or endometrial pathology
- History of postmenopausal bleeding in the past 12 months
- Unwilling to preserve their uterus
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| LSC mesh suspensionLong mesh, a synthetic T-shaped mesh (Gynemsh, Ethicon, San Lorenzo, Puerto Rico), is delivered into the pelvic cavity. Bilateral mesh arms are extracted outside trocar wounds bilaterally to stabilize mesh position. The center piece is fixed to the cervix with 5mm ProTack screws (Covidien, New Haven, Connecticut). Fixation is strengthened with Stratafix 2-0 sutures (Ethicon, Norderstedt, Germany), followed by Tisseel fibrin sealant (Baxter, Deerfield, Illinois) for better hemostasis among surrounding tissues. An extraperitoneal tunnel is created along the left round ligament until reaching 2cm medial to the anterior superior iliac spine (ASIS). One arm of the long mesh is pulled out along the tunnel underneath round ligament and fixed with the fascia of oblique abdominis. The same procedure is repeated for the contralateral side. Bilateral round ligaments and the mesh arms are sutured continuously with Stratafix 2-0. | Procedure or surgery | LSC mesh suspension group |
| TVMTransvaginal mesh kit is delivered into the pelvis via vagina route. | Procedure or surgery | TVM group |
Primary outcome
Recurrence
Time frame: 12 months
The POP-Q stage measurement after the operation
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Oct 2019.
- Background: PubMed 26984443Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen MI. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016 Apr;27(4):655-84. doi: 10.1007/s00192-016-3003-y.
- Background: PubMed 23921090Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Lopes VV, Harvie HS, Sung VW. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013 Nov;209(5):470.e1-6. doi: 10.1016/j.ajog.2013.08.003. Epub 2013 Aug 3.
- Background: PubMed 22270728Wu MP, Long CY, Huang KH, Chu CC, Liang CC, Tang CH. Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study. Int Urogynecol J. 2012 Jul;23(7):865-72. doi: 10.1007/s00192-011-1647-1. Epub 2012 Jan 24.
- Background: PubMed 29559709Long CY, Wang CL, Ker CR, Juan YS, Tsai EM, Lin KL. Laparoscopic Organopexy with Non-mesh Genital (LONG) Suspension: A Novel Uterine Preservation Procedure for the Treatment of Apical Prolapse. Sci Rep. 2018 Mar 20;8(1):4872. doi: 10.1038/s41598-018-23285-7.
- Background: PubMed 27696355Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016 Oct 1;10(10):CD012376. doi: 10.1002/14651858.CD012376.
- Background: PubMed 22226537Long CY, Hsu CS, Wu CH, Liu CM, Wang CL, Tsai EM. Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2012 Mar;161(1):105-8. doi: 10.1016/j.ejogrb.2011.12.007. Epub 2012 Jan 9.
- Background: PubMed 29930249Ker CR, Lin KL, Loo ZX, Juan YS, Long CY. Comparison of UpholdTM Vaginal Mesh Procedure with Hysterectomy or Uterine Preservation for the Treatment of Pelvic Organ Prolapse. Sci Rep. 2018 Jun 21;8(1):9438. doi: 10.1038/s41598-018-27765-8.
- U.S. Food and Drug Administration. Urogynecologic surgical mesh implants.Link provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Cheng-Yu Long, PhD principal investigator
Kaohsiung Municipal University Chung-Ho Memorial Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Pelvic Organ Prolapse, run by Kaohsiung Medical University Chung-Ho Memorial Hospital at 1 site in Taiwan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Oct 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Recurrence (time frame: 12 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04139083, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Oct 2019.