Transvaginal cystocele repair with polypropylene mesh using a tension-free technique

Abstract

This study describes an original surgical technique for the correction of medium/high-degree cystocele using a tension-free way to apply a polypropylene mesh: the "tension-free cystocele repair" (TCR). About 218 patients were available with a mean follow-up of 38 months. This technique showed an elevated rate of anatomic correction (75.7%), a statistically significant correction of storage symptoms (48.6 vs 32.5%, p < 0.05), voiding symptoms (40.3 vs 8.3%, p < 0.05), and symptoms associated with pelvic organ prolapse (POP; 55.9 vs 11.4%, p < 0.0001), with no negative impact on ano-rectal function and, in particular, on constipation. The percentage of erosions was 12.3%, but in the group where hysterectomy was not performed, we had erosions in only 2.5%. With the exception of the Personal Relationship domain, all of the categories examined by the Prolapse Quality of Life Questionnaire showed a statistically significant improvement, which confirms the positive impact of this surgery as perceived by patients.

A prospective, randomized, controlled study comparing Gynemesh®, a synthetic mesh, and Pelvicol®, a biologic graft, in the surgical treatment of recurrent cystocele

“…The technique for cystocele repair adopted in this study was TCR, described by our group in a previous report [15]. As a result, the outcome reported in the present study might not be predictive of the effect of the studied grafts when other surgical techniques, such as the popular transobturator approach, are adopted.…”

“…All patients underwent tension-free cystocele repair (TCR) [15] and levator myorrhaphy (LM). Concomitant hysterectomy was performed on 26 patients (27.6%) in the Pelvicol® group and 13 patients (13.5%) in the Gynemesh PS® group.…”

Cystocele repair by vaginal route: comparison of three different surgical techniques of mesh placement

“…Studies using vaginal polypropylene implants for cystocele repair generally report favorable mid-term (up to 37 months of mean follow-up) anatomic outcomes, i.e., anatomical correction of the cystocele (stage 0 or 1) between 64% and 100% [3][4][5][17][18][19][20][21][22][23][24][25][26][27][28][29]. Only three studies have reported anatomical success rates lower than 85%, after real free [28] or retropubic free techniques [22,23]. On the three randomized controlled trials which have shown significant better anatomical outcomes using polypropylene implant, one used a free technique [3] and two a transobturator technique [4,5].…”

Étude de suivi entre cinq et neuf ans des prothèses sous-vésicales libres dans la chirurgie de la cystocèle

“…Cervigni et al [16] ont un taux de récurrence de 24,3 % à 38 mois de suivi avec une prothèse de polypropylène et 5 % de réintervention. Trois études prospectives ont comparé la colporraphie antérieure et l'utilisation de prothèse synthétique par voie vaginale.…”