Strengths and limitations
By aiming to elucidate the impact of TVM specifically on bladder compliance, only the trajectory of the filling stage was analyzed in this study. Nevertheless, plotting a complete loop of the voiding cycle would provide more information other than the compliance. For example, compared with the pre-operative PVA, the right border of the loop was marked shifted to the left after TVM, indicated a post-operatively depressed voiding pressure; moreover, the distance between the top and bottom borders remained relatively constant after the procedure, revealing TVM barely affected the voided volume. In addition, recent animal15,18 and clinical16 studies have demonstrated the loop enclosed area in the PAV represents the thermodynamic workload of each voiding cycle. Hence, more studies analyzing entire loop trajectory in PVA will clarify detailed impacts of TVM on both storage and voiding functions of POP patients; and thereby benefit to clinicians in making therapeutic decisions.
Though TVM offers a successful anatomical reconstruction14 and results in this study consistently support its therapeutic benefits, TVM possibly causes bladder damage, post-operative lower urinary tract symptoms, pelvic pain, dyspareunia, and mesh erosion34,35 as side effects. Particularly, because mesh erosion is a potential complication36,37, the US Food and Drug Administration has issued a public health notification regarding the long-term safety and complications with the TVM10. Considering a long-term analysis has reported a 3.7% risks of erosions at 7 years after the TVM reconstruction38, a longer follow-up is needed to approve the lasting effect of the benefits presented in this study because we have measured the outcome at a mean of 112.27±5.38 days after the procedure in this study.