Horseshoe-shaped marlex mesh for the treatment of pelvic floor prolapse.
OBJECTIVE
Pelvic prolapse results from weakness or damage to the normal pelvic-support systems. The main support for the pelvic viscera is provided by the pelvic fascia, which is naturally reinforced by urethra-pelvic ligaments, cardinal ligaments and uterosacral ligaments. A polypropylene mesh (Marlex-Bard) was used as a genitourinary and rectal support in order to substitute the damaged pelvic fascia.


METHODS
Sixteen consecutive females suffering from severe genitourinary prolapse entered the study. Using the HWS (Baden-Walker) classification 10 patients presented a grade-IV and 6 patients a grade-III cystocele, 7 patients a grade-III and 1 a grade-IV rectocele. Hysterocele of grade IV was present in 2 patients and in 5 patients grade III. No enterocele was present at the pre-operative visit. Twelve patients suffered from stress incontinence; one had obstructive urinary symptoms with postvoiding residual urine of >200 ml. All patients underwent urodynamic tests and pre-operative cystography. The primary aim was prolapse reduction and continence. The operation, under general anesthesia, consisted of insertion and fixation of a horseshoe-shaped Marlex mesh between pubis and sacrum to close the area between the pelvic viscera and inferior pelvic hiatus. Three patients underwent hysterectomy.


CONCLUSIONS
The follow-up ranged between 12 and 29 months. In 15 patients the prolapse was completely resolved and 13 were dry at follow-up. One patient presented a complete recurrence at the 3-month follow-up. Nine cases of pre-operative constipation were recovered after surgery. This technique seems to give promising results in the repair of genitourinary prolapse and stress incontinence.
Canepa
G
G
Department of Surgical Urology, E.O. Galliera Hospital, Genoa, Italy. g.canepa@galliera.it
Ricciotti
G
G
Introini
C
C
Vigliercio
G
G
Puppo
P
P
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000628:therapy*