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.