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02 October 2020, Volume 36 Issue 10 Previous Issue    Next Issue

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Prudent cognition of FDA announcement on the transvaginal surgical mesh treatment for pelvic organ prolapse. XIE Bing，WANG Jian-liu 2020, 36(10): 917-920.  DOI: 10.19538/j.fk2020100102 Abstract ( )   Since 2008，the U.S. Food and Drug Administration（FDA）had published a series of notifications and announcements concerning transvaginal surgical mesh for pelvic organ prolapse in the USA.Since more than ten ysears ago，the transvaginal placement of mesh and the native tissue repair have aroused widespread concern in the urogynecology domain all over the world.Based on the existing scientific literature and input from clinical trials，the authorities from the United States，Canada，the United Kingdom，Australia and a few of other countries have released the ban on the use of TVM.The above series of measures have a tremendous impact on the urogynecologic field in China，so it is necessary to pay attention to it，and to make a more prudent and objective response to the FDA announcement on the transvaginal surgical mesh treatment for pelvic organ prolapse.

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Understanding and recognition of complications of transvaginal mesh surgery. ZHAO Ying，XIA Zhi-jun 2020, 36(10): 920-924.  DOI: 10.19538/j.fk2020100103 Abstract ( )   Transvaginal mesh（TVM）is a surgical procedure widely used in the treatment of pelvic organ prolapse（POP）.In order to effectively prevent the occurrence of complications，it is important to understand and recognize the complications of TVM surgery，which is good for improving the safety of surgery and reducing the negative prognosis.Reducing the incidence of TVM surgical complications requires that the surgeons not only have a correct understanding of pelvic floor disease and accurate diagnosis for getting an accurate assessment before operation，but also have perfect surgical operation skills and rich clinical experience of pelvic floor surgery such as separation and puncture and other techniques.At the same time，perioperative care and postoperative maintenance are also issues that should be paid attention to in order to prevent postoperative complications.

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How to understand the expert consensus on transvaginal mesh surgery. SONG Yan-feng 2020, 36(10): 924-927.  DOI: 10.19538/j.fk2020100104 Abstract ( )   In recent years，the clinical application value of transvaginal mesh（TVM）surgery has caused widespread controversy in the international academic community.At the end of 2019，experts from the Gynecology and Pelvic Floor Group，Chinese Medical Association Obstetrics and Gynecology Branch，discussed，updated and improved the original pelvic organ prolapse（POP）diagnosis and treatment draft，and formed a new guideline for diagnosis and treatment of POP.A comprehensive understanding of the background and connotation of the development of this guideline，especially the improvement of the awareness of key issues，such as the origin of the mesh problem，the clinical problems of TVM surgery，and the prospects and challenges of its application，will help clinical surgeons to make reasonable clinical decisions in POP management.

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Application prospect in substitute for the treatment of pelvic floor dysfunction. LIU Juan，CHEN Shuo-zhen 2020, 36(10): 927-930.  DOI: 10.19538/j.fk2020100105 Abstract ( )   The substitute for the treatment of pelvic floor dysfunction mainly refer to "mesh"，which can be divided into synthetic mesh，biological mesh and tissue-engineered mesh according to the materials.Surgical managements with mesh for moderate and severe pelvic organ prolapse（POP）and stress urinary incontinence（SUI）include transvaginal mesh（TVM），sacrocolpopexy（SC），and mid-urethralslings（MUS）.Complications related to mesh have caused controversy in the application of the mesh.The application of mesh in PFD is discussed based on the current status of mesh operation，the improvement in mesh material and operation，biomechanics development and the establishment of supervision and follow-up mechanism.

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Comparison of clinical effect between transvaginal mesh and vaginal native tissue repair in the treatment of pelvic organ prolapse. LU Yong-xian 2020, 36(10): 930-935.  DOI: 10.19538/j.fk2020100106 Abstract ( )   The aim of this commentary is to compare the clinical outcomes between transvaginal mesh（TVM）and vaginal native tissue repair（VNTR）for pelvic organ prolapsed（POP）in the literatures published recently.The results are as follows：（1）Clavien-Dindo classifications to assess the perioperative and short-term  serious complications of TVM and VNTR groups have shown that the early serious complicatios are rare in TVM group and TVM is as safe as VNTR.（2）Comparing the objective and subjective outcomes，recurrence rates，mesh weight and changes in sexual function between two groups of TVM and VNTR in near and medium-term follow-up，except one study，most studies have shown that TVM group is lower than VNTR group in terms of awareness of prolapse after operation，recurrence rates of anterior prolapse and repeat surgery rates.The specific complications caused by TVM has increased the repeat surgery rates，but the overall repeat surgery rates were of no significant difference  between the two groups.The low weight mesh has shown less complication than the heavy mesh.Dysparenia could  result from both TVM and VNTR groups and there was no significant difference  between the two groups.（3）Comparing the long-term outcomes after POP repair between the two groups，TVM  group has better  objective and subjective outcomes and satisfaction rates in anterior and multicompartment prolapse than VNTR group，and the anatomical recurrence rates are reduced.The study results indicate TVM is a safe and efficient option for POP surgical management.Low rates of mesh conmplications can be achieved with appropriate indications and trained surgeons.

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Transvaginal mesh surgery and pain. GAO Lei，SUN Xiu-li 2020, 36(10): 935-938.  DOI: 10.19538/j.fk2020100107 Abstract ( )   Tranvaginal mesh（TVM）surgery has been widely used in surgical repair of pelvic organ prolapse.The recurrence rate proved to be lower than that of native tissue repair.However，due to the unique complications of transvaginal mesh for POP，the US Food and Drug Administration（FDA）has repeatedly restricted its use and banned the application from sale in the US in April 2019.As one of the main complications of TVM，pain seriously affects patients’ quality of life.This article focuses on the type of pelvic pain after TVM，and try to analyze the causes，the possible mechanism and management of it，and makes a prospect of the future development of TVM.

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Discussion on causes of erosion and exposure of transvaginal mesh. LIU Dong-xia，CHEN Fei 2020, 36(10): 938-942.  DOI: 10.19538/j.fk2020100108 Abstract ( )   Recently，the exposure and erosion of mesh have attracted more and more attention in pelvic floor reconstruction with transvaginal mesh implantation.The main risk factors include the patient's own factors，the mesh material，the location of the mesh implant，the surgeon's experience and skills，the surgical process，and postoperative management.There are many types of mesh，and their materials and pore size have different effects on the erosion and exposure of mesh.The operation skill and experience of doctors are the protective factors of mesh erosion and exposure.Standardized operation plays an important role in reducing the occurrence of complications.The age and diabetes history of the patients are significantly related to the mesh erosion and exposure.The influence of body mass index and the history of pelvic floor surgery on the mesh erosion and exposure is still controversial.Understanding the causes of mesh exposure and erosion is of great significance to the rational application of mesh，effective prevention and reduction of complications，treatment of complications and improvement of treatment effect.

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Clinical value of sacrocolpopexy. WANG Xiao-juan，HUA Ke-qin 2020, 36(10): 942-945.  DOI: 10.19538/j.fk2020100109 Abstract ( )   Sacrocolpopexy is the suspension of the vaginal vault or uterus on to the anterior longitudinal ligament at the level of the sacrum，using a prosthetic material or other grafts.Sacrocolpopexy is a classic surgical procedure for pelvic organ prolapse，being developed from abdominal sacrocolpopexy，to laparoscopic sacrocolpopexy，and to transvaginal single port laparoscopic sacrocolpopexy（VLSC）.The VLSC，as a newly-emerged minimally invasive surgical technique，combines the advantage of the vaginal surgery and laparoscopic surgery.This minimally invasive surgery has the following advantages，such as better cosmetic outcomes，less postoperative pain，faster recovery，higher subjective and objective cure rate，and less complications associated with mesh，which is expected to become a common surgery for POP in the near future.

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Advantage and disadvantage of the application of transvaginal mesh in the perspective of big data. SUN Zhi-jing，GUO Tao 2020, 36(10): 945-948.  DOI: 10.19538/j.fk2020100110 Abstract ( )   The application of transvaginal mesh（TVM）in pelvic floor diseases is controversial，and more evidence-based evidences are needed to guide clinical practice.In the era of big data，WITMED is getting new development.TVM surgery calls for establishing a management registration system for long-term standardized follow-up，establishing a diagnosis and treatment intelligent platform，improving special training，and developing new materials，etc，which injects new vitality in the diagnosis and treatment of pelvic floor diseases.