Ann-Sophie Page

SCP Mesh weight 73 Patients who underwent surgery initially presented with symptomatic and anatomical prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage 2 or greater) with involvement of the apical compartment.5 In our unit, patients are followed up 1.5-3 months postoperatively, and thereafter yearly, using a standardized subjective and objective assessment.28,151,154 Patients not attending these visits are for audit purposes invited by mail or telephone at given intervals for audit purposes. The last one was in January 2021. In case of non-response, we obtain follow-up information from their general practitioner as well as through the national electronical medical record (https://www.ehealth.fgov.be), which permits the identification of any reintervention following the index procedure (possible from 2015). The clinical assessment and standardized interview were done by an independent assessor, i.e. a subspecialty trainee in urogynecology who was not involved in the surgery or clinical management of the study participants (SP, ASP). The assessors were, however, aware of the type of mesh implanted. Data were entered and validated by the same assessor. For this study, an additional criterion was that follow-up was at least 18 months by January 2021 (date of last audit). The primary outcome was the occurrence and nature of graft-related complications, categorized using the International Urogynecology Association/International Continence Society standardized terminology.33 Secondary outcomes included, first, reinterventions for graft-related complications and prolapse, which are reported on all patients operated, as all can be identified through the national electronic health records. Additional secondary outcomes were the PGIC (Patient Global Impression of Change) score to measure subjective outcome. This is a patientcentered, validated, 5-point response scale comparing the postoperative with the preoperative state, ranging from 1=much worse to 5=much better.155,156 A PGIC score of 4 or higher is considered success.28,151 In addition, we did a functional assessment by a 24 question standardized interview related to prolapse and bladder, bowel, and sexual function, as used in an earlier audit (Appendix 1, available online at http://links.lww.com/AOG/C959).31 Questions can be answered either by “never,” “rarely,” “sometimes,” or “often.” Patients were considered as symptomatic when they answered “sometimes” or “often” to one or more questions in each domain. We asked patients about the occurrence and time point of any complications, co-morbidities or interval treatments for pelvic floor disorders since the index operation. In patients who could not or did not want to be physically examined, the standardized interview and Patient Global Impression of Change score were obtained by telephone or mail. In participants presenting for clinical examination, the degree of prolapse was quantified using the POP-Q system.5 Anatomical failure was defined as POP-Q stage 2 or greater or -1 cm or greater at the apex at any point during follow-up.45 Statistical analyses were performed with SPSS version 27 for Windows (SPSS Inc, Chicago, IL) and GraphPad Prism 9.0. Data are reported as mean (SD), median(interquartile range), number, and %, as appropriate. Distribution was tested with the Shapiro-Wilk test. Comparison between groups was performed by parametric two-sample t test or nonparametric Mann-Whitney U test, χ2 test and Fisher exact test, as appropriate. We designed survival curves for graft-related

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