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Abstract
Purpose
Traditional anterior colporrhaphy repair can have a high recurrence rate. Therefore, the use of synthetic mesh to reinforce the anterior vaginal wall support has been proposed to prevent recurrence. The objective of our study was to compare the anatomic recurrence rates in patients that underwent the traditional anterior colporrhaphy with patients who add a monofilament polypropylene mesh repair (Gynemesh PSTM).
Materials and Methods
We reviewed the charts of patients who underwent transvaginal cystocele repair between January 2003 and June 2006. All patients had a physical examination and staging of the prolapse; the International Continence Society (ICS) system was used for the staging. Mid urethral sling operations were performed when stress incontinences was an associated feature. An anatomic recurrence was defined as an ICS stage 2 or greater anterior prolapse on the last recorded physical examination. The subjective patient satisfaction was also recorded.
Results
Seventy-one patients were available for study with a mean followup of 18.4 months. Thirty-eight patients underwent traditional anterior colporrhaphy, while 33 patients underwent cystocele repair using the monofilament polypropylene mesh (Gynemesh PSTM). Among the 71 patients, 9 (12.7%) had recurrence of the cystocele. Based on the type of repair, 21.1% (8/38) of the patients with traditional repair had a recurrence compared to 3.0% (1/33) of the patients with the polypropylene mesh repair (p=0.03). With regard to satisfaction, 76.3% (29/38) of the patients with anterior colporrhaphy and 97.0% (32/33) with the mesh repair were satisfied with the outcome of the surgery (p=0.02). One patient had erosion of the mesh, at the midline, in front of the vaginal scar, at 12 months after the procedure.
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Table 1.
Characteristics of the patients
| Anterior colporrhaphy (n=38) | Anterior repair with propylene mesh (n=33) | p-value | |
|---|---|---|---|
| Age (years) | 61.7±9.1 | 59.1±10.9 | 0.29* |
| Parity | 3 (1-7) | 3 (1-7) | 0.92* |
| BMI | 24.2±2.1 | 24.3±3.1 | 0.87* |
| Menopausal status (%) | 35/38 (92.1) | 28/33 (84.8) | 0.46† |
| Hormone replacement (%) | 11/38 (28.9) | 12/33 (36.4) | 0.51‡ |
| Prolapse stage§ | 0.14‡ | ||
| II (%) | 3 (7.9) | 8 (24.2) | |
| III (%) | 20 (52.6) | 16 (48.5) | |
| IV (%) | 15 (39.5) | 9 (27.3) | |
| Previous pelvic surgery (% | ) 13/38 (34.2) | 6/33 (18.2) | 0.13‡ |
| TAH | 7 | 5 | |
| Vaginal hysterectomy | 6 | 1 | |
| Concomitant surgery (%) | 28/38 (73.7) | 27/33 (81.8) | 0.41‡ |
| None | 10 | 6 | |
| TVT/TOT | 25 | 27 | |
| Vaginal hysterectomy | 3 | 1 | |
| Posterior colporrhaphy | 6 | 3 | |
| Mean follow-up (months from surgery) | 20.2±6.62 | 16.24±3.08 | 0.002* |
Table 2.
Operative and postoperative outcomes
| Anterior colporrhaphy (n=38) | Anterior repair with propylene mesh (n=33) | p-value | |
|---|---|---|---|
| Operation time (min) | 66.8±24.3 | 56.6±27.3 | 0.09* |
| Estimated blood loss (ml) | 182.9±150.8 | 118.8±127.0 | 0.06* |
| Catheter duration (days) | 4.1±1.3 | 2.7±2.7 | 0.01* |
| Hospital days (days) | 6.3±2.1 | 5.3±3.8 | 0.19* |
| Transfusion | 0 | 0 | |
| Postoperative complications (%) | 8 (21.1) | 7 (21.2) | 0.00† |
| Vaginal erosion | 0 | 1 (3.0) | |
| Wound disruption | 2 (5.3) | 1 (3.0) | |
| De novo urgency | 4 (10.5) | 3 (9.1) | |
| Urinary retention | 2 (5.3) | 2 (6.1) |
Table 3.
Objective and subjective success rates
| Anterior colporrhaphy (n=38) | Anterior repair with propylene mesh (n=33) | p-value | |
|---|---|---|---|
| Anatomical success* rates (%) | 0.031† | ||
| Cured | 24 (63.2) | 28 (84.9) | 0.039‡ |
| Improved | 6 (15.8) | 4 (12.1) | |
| Failed | 8 (21.0) | 1 (3.0) | |
| Subjective satisfaction (%) | 0.016† | ||
| Satisfied | 29 (76.3) | 32 (97.0) | |
| Unsatisfied | 9 (23.7) | 1 (3.0) | |
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