Results of Cystocele Repair: A Comparison of Traditional Anterior Colporrhaphy, Polypropylene Mesh and Porcine Dermis

Handel, Liann N.; Frenkl, Tara L.; Kim, Young H.

doi:10.1016/j.juro.2007.03.041

Cited by 50 publications

(36 citation statements)

References 14 publications

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“…Unfortunately, recurrence rates after prolapse surgery have been reported as high as 29% (3). The significant failure rate of POP surgery led surgeons to augment native tissue repairs with biologic grafts or synthetic mesh; however, use of biologic grafts has not been definitively shown to improve outcomes, and the use of synthetic mesh has been reduced due to increasing awareness of mesh related complications as well as the FDA Public Health Notification regarding use of synthetic mesh for transvaginal repair of POP (4,5). Thus, it is crucial to identify surgical variables that may have an impact on outcomes of POP repair.…”

Section: Introductionmentioning

confidence: 99%

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Eilber¹,

Histed²,

Khan³

et al. 2012

Journal of Urology

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OBJECTIVE-Recurrent pelvic organ prolapse (POP) has been attributed to many factors, one of which is lack of vaginal apical support. To assess the role of vaginal apical support and POP, we analyzed a national dataset to compare long-term reoperation rates after prolapse surgery performed with and without apical support. METHODS-PublicUse File data on a 5% random national sample of female Medicare beneficiaries was obtained from the Centers for Medicare and Medicaid Services. Women with POP who underwent surgery during 1999 were identified by relevant International Classification of Diseases, 9 th revision, Clinical Modification and Current Procedural Terminology, 4 th edition codes. Individual patients were followed through 2009. Prolapse repair was categorized as anterior, posterior, or anterior-posterior with or without a concomitant apical suspension procedure. The primary outcome was the rate of retreatment for POP. 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery that year. There were 2,756 women who underwent an anterior colporrhapy, posterior colporrhaphy, or both with or without apical suspension. After 10 years, cumulative reoperation rates were highest among women who had an isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%, p < 0.01). RESULTS-InCONCLUSION-Ten years after surgery for POP, the reoperation rate was significantly reduced when a concomitant apical suspension procedure was performed.

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Section: Introductionmentioning

confidence: 99%

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Eilber¹,

Histed²,

Khan³

et al. 2012

Journal of Urology

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“…To prevent graft bacterial contamination, all patients underwent placement of a peri-anal cerclage suture, placed before initiating the procedure (22). In addition, the pores in the Perigee/Intexen® graft may minimize the risk for hematoma formation, a possible cause for the high graft-related complication rate reported in these studies (5,23). The relative safety of biological compared with synthetic grafts has been reported by others (10,24,25).…”

Section: Discussionmentioning

confidence: 93%

“…Although still commonly used by many pelvic reconstructive surgeons, traditional colporrhaphy for AVWP repair has a recurrence rate of up to 20% (3) with a more recently reported failure rate up to 70% (4). During traditional colporrhaphy, the laterally placed pubocervical fascia is medially plicated; however, this technique is thought to potentially lead to vaginal shortening and narrowing (5). Additionally, 70 to 80% of AVWP cases may have a concomitant lateral defect (6) in which case the sole plication of the pubocervical fascia is not a viable option.…”

Section: Introductionmentioning

confidence: 99%

The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

Mahdy¹,

Karp

Davila

et al. 2013

Int. braz j urol.

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Introduction and Hypothesis:We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) Materials and Methods: After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Results: Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. Conclusions: The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts.

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“…Four patients (33.3%) in the control group (who received only an anterior colporrhaphy) and no patients in the treatment group (who received a polypropylene mesh) had recurrent prolapse after 24 months [14]. According to a nonrandomized, retrospective, comparative study, 4% of patients who had a polypropylene mesh experienced a recurrence, compared with 36% of patients who had a porcine dermal graft or 6% who had a traditional anterior colporrhaphy [15].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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Purpose: To evaluate the efficacy and safety of the tension-free placement of a monofilament polypropylene mesh for the repair of an anterior vaginal wall prolapse (AVWP). Materials and Methods: Women aged ≥ 30 years with an AVWP stage of II or greater were included. Forty-nine women underwent trans-vaginal repair using a Gynemesh TM PS. Forty-six women who had symptomatic stress urinary incontinence received a midurethral sling (MUS). At the 12-month follow-up, evaluations were made for changes in the Pelvic Organ Prolapse Quantification (POP-Q) stage and Pelvic Floor Distress Inventory. Cure was defined as a POP-Q stage of 0 and improvement as a stage of I. Complications were also evaluated. Results: The cure rate was 71.4%, and the improvement rate was 18.4%. Obstructive/discomfort, irritative, and stress subscale scores of the Urinary Distress Inventory anterior and posterior subscale scores of the POP Distress Inventory and the obstructive subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. Thirty-two of the 46 women (69.6%) who received MUS procedures reported no leakage after surgery. Complications were 2 cases of increased intraoperative bleeding and 1 case of vaginal erosion. Conclusions: Trans-vaginal repair using a Gynemesh TM PS is a feasible and effective procedure for the treatment of AVWP with no significant complications.

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Results of Cystocele Repair: A Comparison of Traditional Anterior Colporrhaphy, Polypropylene Mesh and Porcine Dermis

Cited by 50 publications

References 14 publications

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

2141 Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

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

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