الفهرس 
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Abstract
Uterine preservation is increasingly common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. Objective was to compare between using polyproline mesh and mersilene tape in abdominal sacrohysteropexy repairing apical prolapse stage ӀӀ or more. Using mersilene tape would attain the same efficacy as polyproline mesh without their complications.
The eligible population included women planned sacrohysteropexy for uterine prolapse stage 2, 3, or 4 with or without urinary incontinence, aged between 25 to 45. Patient had no uterine pathology necessitate hysterectomy and patient wished to retain her uterus. Exclusion criteria includes unfitness for anesthesia, present pelvic inflammatory disease at time of randomization, previous history or suspected massive adhesions between sigmoid and pre-sacral peritoneum, history of pelvic operations, or previous sling operation trial.
Women were randomly and equally assigned to two groups: the mesh group (n = 37), who underwent abdominal sacrohysteropexy with poly proline mesh, and the tape group (n = 35), who underwent abdominal sacrohysteropexy using mersilene tape. Due to Covid 19 crisis, one patient in mesh group, three patients in mersilene group didn’t have their long-term follow up and were excluded from the study. The computer‑generated randomization method was used, and allocation was done through consecutively numbered, sealed, opaque envelopes. Short term follow up was completed for both group candidates.
All participants were provided a full personal and medical history and underwent both general, abdominal, and pelvic examinations. Baseline preoperative clinical evaluation were done. Fitness for spinal and general anesthesia was confirmed. Prolapse was staged with the use of the pelvic organ prolapse quantification (POP-Q) system. Sexual function of the woman with prolapse was assessed. Urinary incontinence diagnosed and confirmed by history, examination, and urodynamic study.
Results of the current study could be summarized as follow:
Mesh and tape groups were comparable with respect to demographic characteristics (age, BMI, parity, prior miscarriage, and cesarean delivery). No significant differences were found among women in both groups with respect to symptoms, results of urodynamic study, degree of uterine prolapse, and sexual dysfunction.
Mesh sacrohysteropexy was more significantly successful than tape one (94.6% Vs. 80%) in surgical correction of apical vaginal (uterine prolapse). Moreover, prolapse recurrence at one-year post-operative was significantly lower in mesh (5.4%) than in tape (20%) groups. In contrast, tape group had shorter sacrohysteropexy operative time (mean 50.4 Vs. 90.6 min: p-value <0.001), also less need for post-operative analgesia (p-value <0.005). Tape group patients had shorter stay period than mesh group as mean hospital stay “in days” was (2.8 Vs. 5.2 day with p-value <0.001), while the rest of data were insignificant.
Our procedure was relatively safe with a low morbidity (seven women had blood transfusion, four women had wound infection and five women had mild pyrexia), but it is more invasive than the vaginal approach indeed.
There was no statistically significant difference between mesh and tape groups according to sexual function, quality of life and De novo urinary incontinence at one year (p>0.05). Both groups showed significant improvement regarding sexual function and quality of life after surgery with either mesh or tape (P<0.001).