3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients

Abstract

ObjectivesTo evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles.Patients and methodsIn this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ⩾2 according to the Baden–Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh®, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. The patients’ characteristics and surgical variables were recorded prospectively. The anatomical outcome, as measured by a physical examination and postoperative stratification of prolapse, and functional outcome, as assessed by a questionnaire derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and the Pelvic Organ Prolapse–Urinary Incontinence-Sexual Questionnaire, were considered as the primary outcome measures. Peri- and postoperative complications constituted the secondary outcome measures.ResultsAt 36 months after surgery the anatomical success rate (stage 0 or 1) was 93%. On a functional level, all the scores of quality of life and sexuality were improved. The overall satisfaction score (visual analogue scale) was 71.4%. There were no perioperative adverse events. Mesh erosion was reported in 7.6% and mesh retraction in 5.7% of the patients.ConclusionsIf the guidelines and precautions are followed, vaginal prosthetic surgery for genitourinary prolapse has shown long-term benefits. It provides excellent results both anatomically and functionally. However, complications are not negligible and some are specific to prosthetic surgery.

Prospective long-term results, complications and risk factors in pelvic organ prolapse treatment with vaginal mesh

“…This is very high considering the complications some of the patients reported. Good subjective results are also found in the published studies [19], Kdous reported an overall satisfaction score in VAS of 71,4% [21]. Concerning the urinary features, all of the items evaluated improved in our study.…”

“…Early complications reported in the literature include visceral injuries (bladder, rectum), bleeding, hematoma, acute urine retention, fever, mesh infection, thrombophlebitis and urinary tract infection [10,21,24]. In this study, the small rectal perforation could be repaired intraoperatively and the mesh was placed, with no further complications.…”

“…The majority of studies published are retrospective [13,14,18], and those which are prospective have a short or medium follow-up. Moreover, sometimes the evaluation is carried out through telephonic interview [10,[19][20][21]. In this study, a complete periodic evaluation is presented, including interview and physical examination of every patient.…”

“…To evaluate the functional features, some authors use personal interviews, or the VAS [21], but many employ different validated questionnaires [10,22,26]. Regarding the global subjective satisfaction of the patient, measured through the VAS, the results are outstanding, with a median of 9, and 44,9% of the patients giving the maximum score.…”

A Pilot Comparative Study between Transobturator Tape (TOT) Versus Vaginal Polypropylene Mesh in Management of Patients with Stress Urinary Incontinence in Egyptian Women

“…Mean ambulation were similar in both groups and mean hospital stay was insignificantly different between both groups the latter being relatively long as compared to most studies due to associated surgeries done in some patients, however, it was more or less similar to the mean hospital stay in the study done by [11].…”