Grade 4 cystocele repair using four-defect repair and porcine xenograft acellular matrix (Pelvicol): outcome measures using SEAPI.
OBJECTIVE
To determine the efficacy of grade 4 cystocele repair using the four-defect repair (FDR) or modified FDR with porcine xenograft matrix (FDR+Pelvicol).


METHODS
During a 4-year period, 45 women underwent grade 4 cystocele repair. Of the 45 patients, 43 (95.5%) were available for follow-up. The mean age was 65 years. Patients presented with the following problems: grade 4 cystocele in 43 (100.0%), stress urinary incontinence in 24 (55.8%), urge urinary incontinence in 26 (60.4%), and obstructive voiding symptoms in 26 (60.4%). Patients were evaluated using the stress, emptying, anatomic, protection, and instability (SEAPI) test. We performed FDR in the first consecutive 24 (55.8%) and FDR+Pelvicol in the remaining 19 (44.2%) patients. Cystocele repair was accompanied by other transvaginal repair in 38 (88.3%) of the 43 patients.


RESULTS
The mean follow-up time was 15 months. A comparison of the preoperative and postoperative SEAPI scores of 0, representing the absence of complaints, revealed a statistically significant improvement in all the SEAPI domains using McNemar's test. Cystocele recurred in 3 patients (6.9%), all in the Pelvicol subgroup. Two patients (4.7%) had postoperative urinary retention. De novo urge incontinence occurred in 2 patients (11.7%). No infection, erosion, fistula, or vaginal stenosis have been reported.


CONCLUSIONS
Grade 4 cystocele repair using FDR or FDR+Pelvicol are two effective methods of cystocele repair. Although cystocele failures occurred exclusively in the Pelvicol+FDR subgroup, their small number and asymptomatic presentation did not result in statistical or clinical significance at this point. Both techniques are simple, efficacious, and well tolerated by patients. Follow-up is ongoing to evaluate the durability of the techniques.
Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA.
Line
L
Leboeuf
Ruth Ann
RA
Miles
Sandy S
SS
Kim
Angelo E
AE
Gousse
D000818:Animals; D001705:Bioprosthesis; D005109:Extracellular Matrix / Q000637:transplantation*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D012720:Severity of Illness Index; D013526:Surgical Mesh; D034421:Sus scrofa; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology