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Int Urogynecol J (2012) 23:715722 DOI 10.1007/s00192-012-1667-5
ORIGINAL ARTICLE
New approach in vaginal prolapse repair: mini-invasive surgery associated with application of platelet-rich fibrin
Franco Gorlero & Matilde Glorio & Paola Lorenzi &
Massimiliano Bruno-Franco & Clemente Mazzei
Received: 18 July 2011 /Accepted: 6 January 2012 /Published online: 25 January 2012 # The International Urogynecological Association 2012
AbstractIntroduction and hypothesis Platelet-rich fibrin (PRF) matrix is an autologous leukocyte and PRF biomaterial. PRF is a fibrin matrix polymerized in a tetramolecular structure with the incorporation of platelets, leukocytes, cytokines, and circulating stem cells. The three-dimensional structure of PRF is optimal for migration of endothelial cells and fibroblasts. It permits rapid angiogenesis and easier remodeling of fibrin in a more resistant connective matrix. In vaginal surgery, PRF may act as a graft material with better healing and better functional outcome.
Methods We performed a prospective observational study on ten consecutive women requiring surgery for prolapse recurrence (stage II or higher). These women had high risks for recurrence, erosion with graft materials, and intraoperative and postoperative complications with traditional pelvic reconstructive surgical procedures. ICS score and P-QoL Questionnaire results were assessed preoperatively and postoperatively. Surgery consisted of anterior, posterior, or apical repair plus PRF. Follow-up was performed at 1, 6, 12, 18, and 24 months.
Results Anatomically, the success rate was 80%. Prolapse symptoms improved by 100%. Sexual activity increased by 20% without dyspareunia. The surgical time was satisfactory (mean, 38.5 min). There were no intraoperative or postoperative complications.
Conclusions The use of PRF for site-specific prolapse repair is associated with a good functional outcome because of the healing and mechanical properties of PRF.
Keywords Dyspareunia . Pelvic organ prolapse (POP) . Platelet-rich fibrin (PRF) . Quality of life . Recurrence . Site-specific repair
Introduction
Over the years, several surgical procedures have been described to correct pelvic organ prolapse (POP). Despite improvement in the knowledge of pelvic anatomy and advances in surgical techniques, the success rates of traditional pelvic reconstructive surgical procedures are variable and sometimes disappointing with an overall recurrence rate of 30% [13].
There is significant risk of reoperation after pelvic reconstructive surgery. The need to improve the outcome of traditional surgical treatment has led to increased use of graft materials in pelvic reconstructive surgery [3]....