Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh

Abstract

We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The polypropylene mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a mesh shrinkage (5.5%) and five vaginal erosions of the mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a polypropylene mesh was efficient at 2 to 5 years follow-up. However, the first generation of polypropylene mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the polypropylene mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.

Efficacy and Safety of "Tension-free" Placement of Gynemesh PS for the Treatment of Anterior Vaginal Wall Prolapse

“…The procedure was found to improve the associated urinary and pelvic floor symptoms. The excellent anatomical results of our study correspond with the 89% objective cure rate reported by de Tayrac et al [10], whose study had a mean follow-up period of 37 months. Short-term and medium-term cure rates for anterior vaginal wall repair with a Gynemesh TM PS range from 90% to 100% [10][11][12][13].…”

“…The excellent anatomical results of our study correspond with the 89% objective cure rate reported by de Tayrac et al [10], whose study had a mean follow-up period of 37 months. Short-term and medium-term cure rates for anterior vaginal wall repair with a Gynemesh TM PS range from 90% to 100% [10][11][12][13]. Although there are a variety of forms and sizes, reinforcement of anterior wall defects with a polypropylene mesh provides a superior anatomical result compared with a traditional anterior colporrhaphy or a repair with absorbable mesh [4][5][6].…”

“…The results of this study also showed excellent improvements in the patients' perceptions of symptom improvement, even with a relatively short-term follow-up. According to de Tayrac et al [10], more than 95% of the women in that study expressed good satisfaction over the 5-year follow-up period.…”

“…We had one patient who had mesh erosion at the 1-year follow-up visit. According to previous studies, the rate of vaginal erosion after an anterior vaginal wall repair using a Gynemesh TM PS ranges from 3.8% to 20% [10][11][12][13]18], although the definition of erosion in these reports was usually absent or confusing.…”

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

“…In studies with apical fixation or concomitant apical surgery [71][72][73][74][75][76][77][78][79], anterior repair using a synthetic mesh (excluding Prolift ® and Perigee ® ) had a cumulative success rate of 93 %; the cumulative success rate of studies without apical fixation or without standard apical surgery [80][81][82][83][84][85][86][87][88][89] was 83 %. The cumulative rate of mesh erosion was 8 % (137/1740); the cumulative rate for chronic pain and de novo dyspareunia was 7% (59/846).…”