2026, Number 2
Next >>
Rev Mex Urol 2026; 86 (2)
Treatment of genital prolapse by placing a TOT apical sling. Technique of Dr. Mauro Valentini
Sebastián VMO, Palafox-Rodríguez MH
Language: Spanish
References: 12
Page: 1-11
PDF size: 1057.14 Kb.
ABSTRACT
Introduction: retrospective and descriptive study of a new alternative
technique in patients with genital prolapse; combining anterior
prolapse repair technique with the placement of a trans-obturator
sling in the apical component.
Objective: demonstrate the steps to perform the new technique in
patients with genital prolapse and share the results.
Method: during the period between December 2020 and December
2024, a total of 150 women with genital prolapse were selected, who
were treated with anterior prolapse repair techniques plus placement
of a TOT sling through the lower part of the obturator orifice
anchored to the apical component, the average age was 63 years, all
had previous urological and gynecological studies. The patients had
varying degrees of prolapse, with GIII being the most common. The
hospital stay was 24 hours. Upon discharge, they were allowed to
perform light tasks after 15 days, and heavy tasks and sexual intercourse
after 45 days.
Results: after an average follow-up of 24 months, no complications
related to the technique or the sling were observed, and the patients
presented a high level of compliance and satisfaction. The overall
rate of patients reported that they did not regret the procedure.
Conclusions: in our experience during this period, we see that this
technique is reproducible with a rapid learning curve and provides
adequate support for patients, resulting in highly satisfactory results
for their quality of life.
REFERENCES
Hendrix SL, Clark A, Nygaard I, Aragaki A,Barnabei V, McTiernan A. Pelvic organ prolapsein the Women’s Health Initiative: gravity andgravidity. American Journal of Obstetrics andGynecology. 2002;186(6): 1160–1166. https://doi.org/10.1067/mob.2002.123819.
Resel Folkersma L, Vozmediano ChicharroR, González López R, Jiménez Calvo J,Escribano Patiño G, Conde Santos G, etal. Consenso de la Asociación Española deUrología sobre el uso de mallas en la cirugía delprolapso de órganos pélvicos. Actas UrológicasEspañolas. 2020;44(8): 529–534. https://doi.org/10.1016/j.acuro.2020.04.007.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC,Clark AL. Epidemiology of surgically managedpelvic organ prolapse and urinary incontinence.Obstetrics and Gynecology. 1997;89(4):501–506. https://doi.org/10.1016/S0029-7844(97)00058-6.
Scientific Committee on Emerging and NewlyIdentified Health Risks. Opinion on The safetyof surgical meshes used in urogynecologicalsurgery. 2015.
Hugele F, Panel L, Farache C, Kashef A,Cornille A, Courtieu C. Two years followup of 270 patients treated by transvaginalmesh for anterior and/or apical prolapse.European Journal of Obstetrics, Gynecology, andReproductive Biology. 2017;208: 16–22. https://doi.org/10.1016/j.ejogrb.2016.10.015.
Alas AN, Pereira I, Chandrasekaran N,Devakumar H, Espaillat L, Hurtado E, et al.Apical sling: an approach to posthysterectomyvault prolapse. International UrogynecologyJournal. 2016;27(9): 1433–1436. https://doi.org/10.1007/s00192-016-3010-z.
Altman D, Mikkola TS, Bek KM, Rahkola-Soisalo P, Gunnarsson J, Engh ME, et al. Pelvicorgan prolapse repair using the UpholdTM VaginalSupport System: a 1-year multicenter study.International Urogynecology Journal. 2016;27(9):1337–1345. https://doi.org/10.1007/s00192-016-2973-0.
Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for womenwith apical vaginal prolapse. The CochraneDatabase of Systematic Reviews. 2016;10(10):CD012376. https://doi.org/10.1002/14651858.CD012376.
Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginalmesh or grafts compared with native tissuerepair for vaginal prolapse. The CochraneDatabase of Systematic Reviews. 2016;2(2):CD012079. https://doi.org/10.1002/14651858.CD012079.
Torras Caral I, Ros Cerro C, Espuña Pons M.Tratamiento quirúrgico del prolapso apical. SueloPélvico. 2022;15(2). https://revistasuelopelvico.com/wp-content/uploads/2022/09/105570-SUELO-PELVICO-152-revision.pdf
Larouche M, Belzile E, Geoffrion R. SurgicalManagement of Symptomatic Apical PelvicOrgan Prolapse: A Systematic Review and Metaanalysis.Obstetrics and Gynecology. 2021;137(6):1061–1073. https://doi.org/10.1097/AOG.0000000000004393.
Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M, et al. Uterinepreservation vs hysterectomy in pelvic organprolapse surgery: a systematic review withmeta-analysis and clinical practice guidelines.American Journal of Obstetrics and Gynecology.2018;219(2): 129-146.e2. https://doi.org/10.1016/j.ajog.2018.01.018.