[Vaginal access pelvic organ prolapse repair at the high-volume center: evolution of implants from XL to XS].

Introduction: The use of large vaginal meshes for the treatment of pelvic organ prolapse (POP) combined with insufficient surgeon experience are the important risk factors for serious postoperative complications.

Aim: To find the most safe and effective method of surgical treatment of POP.

Materials And Methods: To evaluate the efficiency of surgical techniques, a retrospective study of 5031 medical records from an electronic database was carried out. As the primary endpoint, we assessed the duration of the procedure, the volume of blood loss and the length of stay. As a secondary endpoint, the number of intra- and postoperative complications was assessed. In addition to objective data, we assessed subjective measures using the validated PFDI20 and PISQ12 questionnaires.

Results: The best results in terms of blood loss were shown by unilateral hybrid pelvic floor reconstruction and three-level hybrid reconstruction (33+/-15 ml and 36+/-17 ml, respectively). Patients who underwent the three-level hybrid pelvic floor reconstruction technique had the highest result: 33+/-15 points of the PISQ12 questionnaire, 50+/-28 points of the PFDI20 questionnaire, which was significant in comparison with other techniques (p<0.001). The number of postoperative complications was also significantly lower for this procedure.

Conclusion: Three-level hybrid pelvic floor reconstruction is a safe and effective technique for the treatment of pelvic organ prolapse. In addition, this procedure can be done in a specialized hospital with the appropriate skills of surgeons.