The following is a summary of “Martius labial fat pad use in the treatment of complications associated with prior surgery for urinary incontinence or pelvic organ prolapse,” published in the September 2024 issue of Urology by Guerin et al.

This study aimed to assess the outcomes of the Martius Labial Fat Pad (MLFP) procedure in managing complications following surgery for urinary incontinence (UI) and pelvic organ prolapse (POP), with a particular focus on the influence of mesh usage. The MLFP is a well-known surgical technique used to address complex complications in pelvic surgeries, yet its outcomes, especially about prior mesh repairs, remain underexplored.

Following institutional review board approval (n° STU 2023 1280), a comprehensive review was conducted on women who underwent MLFP procedures at a tertiary center after UI or POP repair between 2006 and 2022—an independent investigator-assessed outcome, with the primary endpoint being post-operative complications classified according to the Clavien-Dindo classification. Secondary endpoints included indications for the procedure and functional outcomes. A subgroup analysis compared outcomes between patients with prior mesh repairs versus those with native tissue repairs.

A total of 26 patients were included in the study, with a median follow-up period of 30 months (range: 12–67.5 months). Bladder outlet obstruction and fistulae were the most common indications for the MLFP procedure. Post-operative complications were observed in 15 patients (58%), with the majority classified as minor: grade I in 6 patients (43%) and grade II in 3 patients (21%). However, major complications (grades ≥ 3) were seen in 5 patients (29%), with 4 of these cases occurring in the mesh group. The median operative time was significantly longer in the mesh group, averaging 200 minutes (range: 177.5–229.5) compared to 146 minutes (range: 128–190) in the non-mesh group (p = 0.03). Additionally, the success rate was lower in the mesh group (61%) compared to the native tissue group (85%), though this difference approached but did not reach statistical significance (p = 0.06). The MLFP procedure was deemed successful in 19 patients (73.8%).

In conclusion, the Martius Labial Fat Pad is a reliable surgical option for managing complications after UI or POP repair, particularly in complex cases. However, patients with prior mesh repairs face a higher risk of significant complications and have lower success rates. These findings highlight the importance of careful patient selection and the need for specialized management in cases involving mesh. Further studies are warranted to validate these results and optimize treatment strategies.

Source: sciencedirect.com/science/article/abs/pii/S0090429524008227