4) 腟壁と膀胱・尿道間の微小交感神経束を温存する合成メッシュ骨盤底再建手術(シンポジウム1:女性ヘルスケア「中高年に対する女性医学の展開」,第64回日本産科婦人科学会・学術講演会)

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It has been recognized that successful aging of elderly people is an important issue in the aging society. Japan Society of Obstetrics and Gynecology has established women's health care committee since 2010 to contribute to QOL improvement of postmenopausal women. Supporting abnormality of a pelvic floor develops pelvic organ prolapse (POP) such as uterine prolapse, cystocele, rectocele, lower urinary tract symptoms through childbirth and estrogen depletion. Surgical cure of pelvic organ prolapse must be aimed for not only anatomical reconstruction of pelvic floor organs but functional recovery of these organs. The conventional operations for POP (vaginal hysterectomy and anterior colporrhaphy) apply wide dissection of anterior vaginal tissue and cause urinary dysfunctions by nerve injury around urethra. I identified novel nerve fibers located in the anterior vagina associated with the pathogenesis of incontinence and pelvic organ prolapse using specimens from cadavers and operations. Descending nerves 50〜200(im in thickness were identified between the urethra and vagina. They locate more than 10mm away from a cluster of nerves found almost along the lateral edge of the vagina and stained with S100 and tyrosine hydroxylase (TH) antibody, originated from the cranial part of the pelvic plexus, and appeared to terminate at the urethral smooth muscles. They are different from those of the common nervous system or the pelvic floor and are associated with the pathogenesis of cystocele and urinary incontinence. When performing surgical placation of the anterior vaginal wall for anterior colporrhaphy, nerve injury may contribute to the subsequent development of stress urinary incontinence. Based on the anatomical investigation, tension-free vaginal mesh (TVM) operation has been applied for POP. Surgical procedure consists of the same basic concepts originated by French TVM group. Original hand-made trocars were inserted through obturator membrane and sacrospinous ligaments. Synthetic proline soft mesh was inserted into behind of the vagina. Severe mesh infection occurred in only one case and postoperative hematomas were observed in three cases. No fistula formation was observed. Mesh exposure occurred in only four patients (1.6%). Anatomical recurrences were observed in 8 patients (3.2%) and additional surgical treatments were necessary in four patients. In conclusion, TVM repair with tailor-made trimmed mesh is well tolerated and anatomically and functionally highly effective and safe.
2012-10-01

4) 腟壁と膀胱・尿道間の微小交感神経束を温存する合成メッシュ骨盤底再建手術(シンポジウム1:女性ヘルスケア「中高年に対する女性医学の展開」,第64回日本産科婦人科学会・学術講演会)

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